# Treatment burden and health literacy among patients referred to a vascular access clinic: a cross-sectional study

## TL;DR

This study finds that 20% of vascular access patients face unsustainable treatment burden, with poor health literacy being a major risk factor.

## Contribution

The study identifies health literacy as the strongest predictor of treatment burden in dialysis access patients.

## Key findings

- 20% of patients reported unsustainable treatment burden levels.
- Poor health literacy was independently associated with high treatment burden (OR 3.78).
- Medication management, administrative complexity, and financial strain were key contributors to treatment burden.

## Abstract

Treatment burden, defined as ‘the work of being a patient’, can have implications on clinical outcomes and quality of life. Delivering minimally burdensome care requires recognition of the distribution of treatment burden in specific patient populations, and consideration of its key drivers whilst designing healthcare services.

A prospective, cross-sectional study was performed to assess treatment burden among patients attending a regional vascular access surgery clinic over a 2-year period. Health literacy was synchronously measured to assess patients’ ability to process written information in the clinic.

A total of 563 patients were included (median age 64 years; 57% male), of whom 263 were receiving kidney replacement therapy (KRT). One in five patients (20%; 113/563) reported treatment burden levels indicative of being at risk of becoming overwhelmed by their care. Higher treatment burden was associated with dialysis dependence and greater socioeconomic deprivation. On multivariate analysis, poor health literacy was independently associated with unsustainable treatment burden (OR 3.78, p < 0.001).

High treatment burden is prevalent among vascular access patients, particularly those with limited health literacy. Interventions that deliver patient-centred information in ways that do not depend on high literacy levels may help reduce treatment burden and support shared decision-making in this setting.

What was known

What this study adds

Potential impact

High treatment burden is associated with reduced medication adherence and poorer health-related quality of life. However, the distribution and key drivers of treatment burden have not been descriptively analysed in patients referred for dialysis access surgery.

In our centre, 20% of patients referred for dialysis access surgery reported levels of treatment burden considered unsustainable. Poor health literacy was the strongest independent predictor of high burden, with medication management, administrative complexity, and financial strain identified as key contributing factors.

Implementing patient-centred communication strategies that do not rely on high health literacy may help reduce perceived treatment burden, enhance patient understanding of the healthcare journey, and support shared decision-making in this vulnerable cohort.