Evaluating the Readability of Online Patient Education Materials Related to Orthopedic Oncology

Abstract

The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a “difficult to read” result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [ Orthopedics . 2021;44(1):38–42.]

Validation of ChatGPT 3.5 as a Tool to Optimize Readability of Patient-facing Craniofacial Education Materials

“…Despite these recommendations, prior studies have elucidated the readability of patient education materials, with many studies describing that the average reading levels of education materials do not meet the national recommended average by several grade levels. 6,7,[9][10][11][12][13][14][15][16][17][18][19][20] In prior studies, it is clear that many patient education materials are written above the recommended levels; however, to our knowledge, this is the first study to offer a simplified solution using AI to manage and improve patient health education materials.…”

“…4,5 Although patient education materials, such as brochures and web pages, aim to provide patients with relevant information, they often require an above-average reading level to understand. 6,7 A 2020 Gallup analysis found that about 54% of Americans between the ages of 16 and 74 read below a sixth grade level. To address this, the American Medical Association recommends that readability of patient education materials should not exceed a sixth grade reading level.…”

The Readability of Patient‐Facing Social Media Posts on Common Otolaryngologic Diagnoses

“…4 However, multiple studies have shown that both printed and online material aimed at educating patients about medical diagnoses and treatment options far exceeds this level, and therefore are not comprehensible by most patients. [16][17][18][29][30][31] Furthermore, both providers and patients overestimate patients' abilities to comprehend written information presented to them, and therefore many patients are left without adequate understanding of their medical management and inadequately equipped to make medical decisions. 32 Health literacy has been shown to be an important predictor of health outcomes, including higher mortality, worse health-related quality of life, and increased medical costs for the system.…”

“…They add to an existing body of literature that suggests that online and written patient educational materials are written at a reading level that is too high for many patients to comprehend. 15,18,30,39,41 Further, they show that social media, which many presume to be easily understandable and accessible to all patients, is still incomprehensible for many. The medical community must continue efforts at ensuring that patient educational materials are comprehensible by patients and assist patients in playing an active role in their healthcare decisions.…”

“…The American Medical Association recommends that patient educational materials are written at a sixth‐grade level or lower in order to be comprehensible to the majority of Americans 4 . However, multiple studies have shown that both printed and online material aimed at educating patients about medical diagnoses and treatment options far exceeds this level, and therefore are not comprehensible by most patients 16‐18,29‐31 . Furthermore, both providers and patients overestimate patients' abilities to comprehend written information presented to them, and therefore many patients are left without adequate understanding of their medical management and inadequately equipped to make medical decisions 32 …”