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Health literacy is recognized as an integral component of high-quality health care. However, health literacy has been understudied in the context of cancer care delivery and surgical decision making. The goal of this article is to outline a process for implementation of a health literacy screening assessment within the routine practices of an academic breast surgical oncology clinic. The self-reported health literacy assessment is feasible, particularly with integration of the health literacy screen in the electronic health record. The authors' estimated clinic prevalence of low health literacy was 22%, which has numerous implications for communication and shared decision-making processes.Patients with low health literacy may be at risk for impaired treatment decision making in busy clinical settings.Health literacy assessment and screening is necessary to provide patient-centered interventions.Clinical assessment of health literacy and integration within the electronic medical record is feasible in the outpatient surgical oncology setting and has numerous implications for enhanced shared decision making for limited-literacy populations.