Orthopedic oncology patient education materials written above recommended reading levels
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Published results showed current oncological musculoskeletal-related patient education materials are written significantly above the reading level recommended by the NIH and AMA.
Researchers performed a Google search with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. Researchers analyzed all patient education articles from the first 10 websites for each tumor type and evaluated the patient education materials using eight validated readability scales.
Results showed patient resources were written at an average grade level that was nearly double the NIH and AMA recommendation. Despite being written at a readability level nearly four grade levels higher than has been recommended, education materials for chordomas most closely approached national recommendations, according to results. Researchers noted patient education materials for soft tissue chondromas were written at the highest level. When analyzed using the Flesch Reading Ease assessment, researchers found the materials corresponded with a “difficult to read” result with a mean score of approximately 46.5.
“This analysis revealed that patients had to have a 12th grade education to fully comprehend the majority of materials from these websites. This is approximately double the NIH and AMA recommendations,” the authors wrote. “None of the patient education materials for any single condition were written at an average at or below the 6th-grade reading level. Given patients’ reliance on these materials within the clinical setting, further modification of these resources is warranted to ensure adequate comprehension and informed decision-making.”
Perspective
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This intriguing paper raises an issue that is probably not obvious to most physicians and not necessarily easy to fix. Although the NIH and AMA have published guidelines concerning the ideal grade reading level for patient education materials, these have obviously not been widely embraced in light of the results of the assessment scales noted. As such, perhaps the first step to correcting this problem is improved familiarity of medical professionals with the idea of reading grade levels and an appreciation for those levels as present in our patient population.
Even knowing this however, most physicians have no experience in directing written communication to a specific grade reading level and are unfamiliar with any objective measurement that would validate this attempt.
This also raises larger questions about the efficacy of physician/patient verbal communications in light of these issues. The technology underlying much of what we do has become more complicated, making explanations to patients more problematic. As such, we are increasingly challenged to ensure that patients understand their health issues whether it be in the context of educational materials or our direct discussions with them.
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