# Electronic Health Literacy, Psychological Distress, and Quality of Life in Urological Cancer Patients: A Longitudinal Study During Transition from Inpatient to Outpatient Care

## TL;DR

This study explores how digital health skills affect the mental health and quality of life of urological cancer patients transitioning from hospital to home care.

## Contribution

The study reveals that electronic health literacy does not significantly impact psychological outcomes when age is considered.

## Key findings

- Higher electronic health literacy initially correlates with better mental health and quality of life.
- These differences vanish when age is accounted for, as older patients tend to have lower digital skills.
- Older patients may face barriers to digital health engagement, suggesting a need for tailored support.

## Abstract

Urological cancers, such as prostate, bladder, kidney, and testicular cancer, are common and often accompanied by a high emotional burden. Many patients do not receive enough psychological support, especially after leaving hospital care. The internet could help patients find useful information and support services, but this requires skills to search, understand, and use health information online, known as electronic health literacy. In this study, we compared patients with higher and lower levels of electronic health literacy during hospital treatment and three months after discharge. Initially, patients with higher skills reported less distress, fewer symptoms of depression, and better quality of life. However, these differences disappeared once age was taken into account, as older patients tended to have lower digital skills. These findings suggest that digital support tools may not reach those who could benefit most. Future services should be tailored to older patients’ needs to ensure equitable access.

Urological cancers are associated with reduced quality of life and high psychological burden, yet affected patients receive less psychosocial support than other cancer groups. Electronic health literacy (eHL) may facilitate independent access to resources, but its role for psychological outcomes and quality of life in this group is unclear. This study examined associations between eHL, psychological symptoms, and quality of life during transition from inpatient to outpatient care. A prospective, single-centre observational study was conducted. Eligible inpatients (urological cancer, Distress Thermometer ≥5 and/or request for psycho-oncological support) received an initial psycho-oncology consultation and completed surveys during inpatient treatment (T1) and three months later (T2). Measures included socio-demographics, PO-BADO, eHL (eHEALS), distress, depression (PHQ-2), anxiety (GAD-2), and quality of life (EORTC QLQ-C30). Of 108 patients completing T1, 71 completed T2. After controlling for age, eHL was not significantly associated with distress, depression, anxiety, or quality of life. Age did not moderate these relationships. In this sample, eHL showed no significant associations with psychological outcomes or quality of life. However, higher age was linked to lower eHL, suggesting that older patients may face barriers to digital health engagement. Age-related differences in eHL should be considered when designing digital support services for urological cancer patients.