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Background: Pictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices. Objective: Our objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones. Methods: Card sorting was used to identify existing pictographs that focus group members found “not easy” to understand. Participants then explored improvements to these pictographs while iterations were sketched in realtime by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited. Results: Among the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages. Conclusion: Low literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research. [ABSTRACT FROM AUTHOR]

Discharge medications for a patient with cancer typically are numerous and complex. During the transition between inpatient stays and ambulatory follow-up visits, patients commonly misunderstand medication instructions, placing them at risk for under- or overdosing. This column discusses the results of an evidence-based practice change project at the Seattle Cancer Care Alliance to improve adult patient knowledge and use of discharge medications. Ensuring patient receipt of written discharge medication instructions and checking in with patients after discharge may be an approach to maximize the safety of self-administered medication. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe the preferences for participation in decision making of older adult patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences.Design: Descriptive, cross-sectional design.Setting: Participants' homes and two large academic cancer centers in Seattle, WA, and Chicago, IL.Sample: A convenience sample of 20 older adults (60 years of age and older) with symptomatic myeloma diagnosed within the past six months.Methods: The Control Preferences Scale was administered followed by an in-person, one-time, semistructured interview.Main Research Variables: Role preferences for participation in treatment decision making, age, gender, race, work status, personal relationship status, education, and income.Findings: Fifty-five percent of the participants preferred a shared role with the physician and 40% preferred to make the decisions after seriously considering the opinion of their physicians. Only one participant preferred to leave the decision to the doctor, as long as the doctor considered the patient's treatment preferences.Conclusions: The study findings indicate that older adults newly diagnosed with myeloma want to participate in treatment decision making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow him or her to be autonomous in making treatment decisions.Implications for Nursing: Nurses and other oncology clinicians can elicit a patient's preferred level of participation in treatment decision making. Oncology nurses can make sure patients receive disease- and treatment-related information, encourage them to express their decisional role preference to the physician, develop a culture of mutual respect and value their desire for autonomy for treatment decision making, acknowledge that the right to make a treatment choice belongs to the patient, and provide support during treatment decision making throughout the care continuum. [ABSTRACT FROM AUTHOR]