Global disparities in patient education for radiation therapy: A cross-sectional survey of practices and gaps in low- and middle-income countries (LMICs).
Authors: Rohan K Patel, Alex Price, Maria Caicedo-Martinez, Clair Reynolds Kueny, Emily Kruse, Peter Zimmerman, Pranshu Mohindra, Benjamin Li
Journal: Journal of Clinical Oncology (2025)

e13859 Background: Effective patient education (PE) about radiation therapy (RT) is essential yet understudied in LMICs. This study evaluates practices and regional differences in PE administration amongst RT professionals from LMICs, focusing on timing, resources, content and impact. Methods: An international cross-sectional survey of RT professionals from LMICs (via World Bank) was distributed across Latin America (LATAM), Eastern Europe (EE), Africa, Middle East (ME) and Asia via email (distributed among regions) and (in LATAM) texting groups (n = 2143, 9/11/24–1/13/25). A 26-item survey, offered in English or Spanish, covered roles and institutional practices for PE on the topics of rationale, logistics, and side effects for RT, PE methods (verbal, hospital materials, YouTube, etc.), and Likert scale (1-5) ratings of perceived patient understanding. Descriptive and statistical analyses evaluated regional differences using Fisher or Chi-squared tests, pairwise comparisons, and multivariate analyses with Bonferroni correction. Results: We received 398 responses including physicians (35%), RT technicians (32%), physicists (18%), nurses (6%), advanced practitioners (5%) and dosimetrists (4%), representing LATAM (45%), Africa (17%), Asia (14%), ME (12%), and EE (12%). Across LMICs, 38% spent ≤10 min and 27% for &gt; 20 min on PE, Asia reporting highest (11-20 min, 46%) and Africa lowest (1-5 min, 30%)(p &lt; 0.0001). PE about rationale for RT was provided during consultation in 40% in LATAM and 34% in Asia, compared to 14% in Africa and 13% in ME. PE for logistics was most frequently provided during CT simulation, highest in Asia (78.6%) compared to Africa (54.3%, p = 0.04) and ME (64.6%, p = 0.02). Acute side effects were most discussed during on-treatment visits in Africa (48%) and ME (39%), versus follow-up visits in EE (30%). Long-term side effects were least addressed in ME (no education, 16%), while Asia and EE reported highest engagement during follow-up (21% and 18%). Verbal-only PE was most utilized approach, with Africa (61.5%), Asia (41.4%), and LATAM (36.1%) leading. Hospital-based materials was used most in EE (28.6%) and ME (22%), while multimedia tools like YouTube were rarely used globally ( &lt; 5%). Respondents rated patients as well-educated (score 4-5) in 24.8% for rationale, 29.7% for logistics, 22.4% for acute and 16.3% for long-term side effects. Limited educational attainment (score 1-2) was reported in Africa (46.8%), ME (42.3%) LATAM (42.2%), Asia (31.8%), and EE (26.5%) across all domains. Conclusions: Significant global disparities exist in PE practices for RT in LMICs, particularly regarding timing of PE and proportional emphasis on rationale, logistics, and side effects. Tailored, region-specific interventions to recognize barriers and enhance PE delivery are needed to bridge gaps and improve global outcomes.