When a beloved dog or cat develops cancer, the medical decisions belong to the owner. That responsibility can involve unfamiliar diagnoses, treatment schedules, risk estimates, side effects and difficult choices about quality of life. A study from researchers at Kansas State University now provides an initial look at how well pet owners understand cancer-related information, introducing a veterinary-focused measure of cancer health literacy. The cross-sectional study, published in Veterinary Oncology, found that scores were associated with education level, age, ethnicity and whether respondents had experienced a cancer diagnosis in their family. The researchers emphasize that the questionnaire is still awaiting full psychometric validation, so the results should not be treated as a definitive ranking of individuals or groups. Instead, the work offers an early framework for examining how communication affects veterinary cancer care. Its central premise is that owners function as surrogate decision-makers: although animals cannot interpret medical information or consent to treatment, their owners must absorb complex evidence and apply it to decisions made under emotional pressure.
Health literacy is broader than the ability to read. It includes obtaining, processing and understanding health information, then using it to make preventive, diagnostic and treatment decisions. Cancer health literacy is a disease-specific form of that capacity, involving concepts such as diagnosis, prognosis, treatment choices, medication management and risk interpretation. In human oncology, limited cancer health literacy has been associated with lower participation in screening and prevention programs, delays in diagnosis, difficulty making treatment decisions, poorer adherence and reduced quality of life. The Kansas State researchers propose that comparable challenges may occur in veterinary oncology, where owners must often interpret probability, balance benefits and burdens, and decide whether a treatment fits their animal’s needs and their own circumstances. Veterinary decisions also unfold within a distinct healthcare system, with its own terminology, costs, referral pathways and clinical routines. A communication strategy that assumes every client understands these systems may therefore leave important gaps between what clinicians explain and what owners are able to use.
To investigate the issue, the team adapted cancer health literacy instruments developed for human medicine and modified them for pet owners. The resulting English-language questionnaire contained 30 multiple-choice questions assessing cancer health literacy and 14 questions covering demographic characteristics and related experiences. Its content addressed several applied domains, including cancer-specific knowledge, numeracy, risk interpretation, medication and treatment management, interpretation of written and visual information, navigation of healthcare services, and the ability to distinguish cancer myths from evidence-based information. The survey also tested prose literacy, visual literacy, numerical literacy, and information and technological literacy. Before distribution, it was pretested with a subgroup of clients to identify unclear wording, problematic terminology, issues with survey flow and technical problems. The authors based the instrument on previous validated work, but they did not assume that a tool designed for human patients could be transferred unchanged to veterinary care. Changes in audience and context meant that the veterinary version would need its own validation.
The survey was sent online through Qualtrics to adult owners of dogs and cats who had used the routine healthcare service at the Kansas State University Veterinary Health Center in Manhattan, Kansas. Eligible clients lived in Kansas, had a valid email address and had brought a dog or cat to the service for any reason between January 2015 and December 2020. Veterinarians, veterinary students, and current or former hospital staff connected with oncology or small-animal internal medicine were excluded. Of 13,446 invitations, 1,773 responses were received, producing a response rate of 13 percent. A total of 1,548 respondents met the study’s inclusion threshold and were included in the statistical analysis. Nearly all respondents who progressed through the questionnaire completed it: 94.1 percent of the final study population answered every question, although completion times varied widely. The median completion time was 15 minutes, while the mean was 38.6 minutes, with reported times ranging from 5.6 minutes to more than three days.
Participants received one point for each correct answer among the 30 cancer health literacy questions, creating a score from 0 to 30; unanswered items were counted as incorrect. The mean score was 26.69, with a standard deviation of 2.4, and the median was 27. Individual scores ranged from 6 to 30. In initial, single-variable analyses, scores were associated with age, gender, marital status, ethnicity, education, employment status and field of employment. Previous cancer experience also mattered: respondents who reported a cancer diagnosis in a family member or pet showed significant associations with their scores. By contrast, owning a dog rather than a cat, owning both, or having pet insurance was not significantly associated with cancer health literacy. Because 98.3 percent of respondents identified themselves as their pet’s primary caregiver, the researchers could not meaningfully evaluate that characteristic. These findings describe patterns within this particular respondent group; they do not establish that any demographic characteristic causes higher or lower cancer health literacy.
The researchers then used a multivariable regression model to examine several factors simultaneously. The final model included education, age, ethnicity, a reported cancer diagnosis in the family, and an interaction between education and ethnicity. Higher educational attainment was generally associated with higher scores, but the size of that association differed among ethnic groups. Within each ethnic group, respondents with doctorate or professional degrees had higher scores than those with lower levels of education, while respondents with bachelor’s or master’s degrees also generally scored higher than those with an associate, trade, vocational or high-school education. The model also indicated that respondents aged 35 to 44 and 55 to 64 had higher adjusted scores than those older than 65. People reporting cancer in a family member had higher adjusted scores than those who did not report such an experience. The authors caution that ethnicity should not be interpreted as a biological or causal determinant. In this analysis, it may instead reflect intertwined structural, socioeconomic, educational, cultural and linguistic conditions that shape access to information and opportunities to use it.
The study’s implications extend beyond the questionnaire itself. Cancer consultations can involve emotionally charged news, unfamiliar terminology and decisions that depend on values as much as on medical facts. An owner may need to understand a pathology result, compare surgery with other treatments, calculate a medication dose, recognize potential side effects, interpret a graph or decide when a change in symptoms warrants a call. Information delivered in the clinic may later be reviewed at home, discussed with family members or compared with material found online. The authors therefore support communication that uses plain language, avoids unnecessary jargon and acronyms, combines verbal explanations with visual aids, and provides written summaries at an accessible reading level. They also point to teach-back, in which a client explains the information in their own words, as a way to reveal misunderstandings and allow the clinician to clarify them. Such approaches do not place responsibility solely on the owner; health literacy is also shaped by the clarity of providers and by the accessibility of the healthcare system.
Several limitations define what can be concluded from this first investigation. The questionnaire measured written, visual and basic numerical skills, but not listening, verbal communication or advocacy skills. It did not assess the veterinarian’s communication ability or the nature of the provider-client relationship. Respondents were drawn from one academic veterinary center in Kansas, and 94 percent identified as Caucasian, limiting the generalizability of the findings. The survey was offered only in English, and the primary language of participants was not recorded. The 13 percent response rate also raises the possibility of response bias because clients who answered may differ systematically from those who did not. In addition, participants were recruited from routine healthcare visits, often involving reportedly well animals, rather than from owners facing a recent cancer diagnosis; scores might differ during the stress of an oncology consultation. The authors conclude that the instrument requires further psychometric validation and that future research should test whether targeted communication and educational interventions improve owner understanding, satisfaction and clinical outcomes for veterinary cancer patients. For now, the study’s message is straightforward: effective cancer care for animals depends not only on available treatments, but also on whether owners can understand and use the information needed to choose among them.
The questionnaire’s high average score should not be read as evidence that veterinary clients generally face few communication barriers. Scores were concentrated toward the upper end of the 0–30 scale, while the response rate was 13 percent and participants came from a single academic hospital. Clients who chose to complete an online survey, had regular access to email, or felt confident answering cancer questions may have been more likely to participate than clients with different experiences. This creates the possibility that the observed distribution does not represent the broader population of pet owners, particularly people who face language, technology, educational or access barriers.
Validation is important because a reliable questionnaire must do more than produce consistent scores. Researchers must establish whether its questions measure the intended aspects of cancer health literacy, whether scores remain meaningful across demographic and language groups, and whether results correspond to relevant behaviors or outcomes. Future studies could compare questionnaire performance with owners’ understanding after a clinical consultation, their ability to explain treatment instructions, or their recognition of warning signs requiring veterinary attention. Repeated testing could also show whether scores are stable or change after education.
A further research opportunity is to examine cancer communication as an interaction rather than an attribute of the owner alone. The same client may understand information differently depending on stress, the urgency of a decision, the clinician’s explanations, the format of educational materials and the opportunity to ask questions. Studies conducted during actual oncology consultations could therefore complement survey data by analyzing explanations, questions, teach-back responses and follow-up adherence. This approach may help identify practical points at which veterinary teams can reduce misunderstanding before it affects treatment decisions.
Subject of Research: Cancer health literacy among dog and cat owners in veterinary care
Article Title: Initial implementation of a cancer health literacy questionnaire among owners of pet dogs and cats attending a primary veterinary healthcare service: Part I. Cross-sectional evaluation of the cancer health literacy of the study population
Article References: Wouda, R. M., Grimes, E., Dixon, A. L., Hocker, S. E., Higginbotham, M. L., & Cernicchiaro, N. (2026). Initial implementation of a cancer health literacy questionnaire among owners of pet dogs and cats attending a primary veterinary healthcare service: Part I. Cross-sectional evaluation of the cancer health literacy of the study population. Veterinary Oncology, 3(1), Article 22. https://doi.org/10.1186/s44356-026-00073-4
Image Credits: AI Generated
DOI: 10.1186/s44356-026-00073-4
Keywords: cancer health literacy, veterinary oncology, pet owners, veterinary communication, health literacy, dogs, cats, questionnaire, shared decision-making, Initial, implementation, cancer
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