Perceived inequalities and cultural inclusivity in UK Breast Cancer Information and Care: a mixed method study.

Introduction: This study evaluates inequalities in National Health Service (NHS) breast cancer (BC) information, with a focus on equity and inclusivity. Drawing on the perspectives of UK medical students and resident doctors, the study explores perceived gaps in resources, supporting the development of inclusive materials that serve our diverse patient populations. Methods: A survey was distributed to gather insights into perceived gaps in education and resources. Following this, a comprehensive review of NHS BC leaflets was carried out, evaluating their inclusivity and representation. Based on these findings, an inclusive leaflet was designed; the leaflet's readability was improved through a large language model. Results: A total of 1555 survey responses were collected; 60.3% (n=938) were medical students and 39.7% (n=617) were resident doctors. 85.5% (n=1330) of respondents denied attending breast-related cultural sensitivity training, and 64.7% (n=1006) felt inadequately equipped to address breast concerns in patients from diverse backgrounds.The mean readability across NHS leaflets showed a readability age of 14-15 years. 15.9% (n=38) of resources being available in languages other than English (p=0.0012). While 27.6% (n=66) of the 239 NHS trusts had BC leaflets available, none was fully inclusiveThese insights directly informed the design of a new leaflet to address identified gaps, focusing on inclusivity and readability. The clinician developed, LLM assisted leaflet met ages 12-13, closer to national recommended levels of 9-11. (FRES +7.72; FKGL -1.96; GFI -2.24; SMOG -1.4; CLI -0.39). Conclusions: Inequalities and lack of representation are seen at a national level within BC NHS patient materials. These inequalities are similarly perceived by students and resident doctors. This can have a negative impact on patient experience and journey through a BC diagnosis. Further work is necessary to improve the quality of information given to BC patients, with gaps bridged through inclusive resources and adequate preparation in BC counselling. For this purpose, the leaflet proposed in this paper represents a prototype that may inform the design of future studies and the development of more inclusive patient information resources, in line with NHS priorities.