健康素养与结直肠癌：针对脆弱人群的筛查、结局与挑战的靶向综述

Health literacy is increasingly recognized as a critical determinant of cancer prevention, treatment adherence, and survivorship outcomes. In colorectal cancer (CRC), its importance is pronounced, in part because early detection through screening can significantly reduce incidence and mortality. Persistent disparities in CRC-related health literacy may contribute to lower screening uptake, suboptimal treatment decisions, and reduced quality of life, especially among populations experiencing disproportionate health burdens. To characterize the scope and impact of health literacy in CRC, we conducted a targeted literature review examining its relationship with clinical, behavioral, and psychosocial outcomes across the CRC care continuum. Using PubMed, we identified peer-reviewed studies that evaluated associations between health literacy and outcomes such as screening participation, treatment adherence, patient-reported experiences, and quality of life. Studies were included if they addressed CRC and incorporated measurable health literacy constructs. Thirty-nine studies met inclusion criteria. We synthesized approaches and key findings, with particular attention to implications for disproportionately affected populations. Across diverse geographic and clinical settings, limited health literacy was consistently associated with lower CRC screening rates, reduced knowledge of guideline recommendations, greater perceived barriers, and more fatalistic beliefs. Among individuals diagnosed with CRC, lower health literacy was linked to poorer treatment adherence, reduced health-related quality of life, and increased mortality, with especially strong effects in early-stage disease. Challenges were amplified among individuals with both limited literacy and limited English proficiency. Interventional studies demonstrated the promise of culturally-tailored interventions, including educational materials, patient navigation, and community-based outreach, in mitigating literacy-related disparities. Recent studies identified the influence of health literacy on financial toxicity, communication preferences, and care satisfaction, particularly among rural, immigrant, and low-income populations. Overall, this review identified key ways that health literacy is a significant, modifiable determinant of CRC outcomes and a contributor to persistent disparities. Targeted interventions to address literacy gaps, especially among vulnerable populations, should be prioritized in CRC across prevention, diagnosis, and survivorship. Future research should focus on scalable, culturally and linguistically appropriate strategies, including the integration of artificial intelligence and digital health tools, to strengthen informed decision-making and improve outcomes across all populations throughout the CRC care continuum.