Readability of the Most Commonly Accessed Online Patient Education Materials Pertaining to Surgical Treatments of the Spine

Phan, Amy; Jubril, Ayodeji; Menga, Emmanuel N.; Mesfin, Addisu

doi:10.1016/j.wneu.2021.06.010

Cited by 15 publications

(7 citation statements)

References 29 publications

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“…Health literacy and education may at least partially explain these associations. Recent literature has demonstrated that most educational materials and patient-distributed measures in spine surgery require high reading comprehension levels, [30][31][32][33][34] and most ACP documents are written far above the average reading comprehension level. 35 In our cohort, patients living in the "at-risk" communities (ie, the second most distressed quintile) interestingly demonstrated the lowest risk of ACP completion.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Socioeconomic Status on the Presence of Advance Care Planning Documents in Patients With Acute Cervical Spinal Cord Injury

Issa,

McCurdy,

Lee

et al. 2024

J Am Acad Orthop Surg

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Introduction: Patients presenting with spinal cord injury (SCI) often times have notable deficits or polytrauma and may require urgent decision making for early management. However, their presentation may affect decision-making ability. Although advance care planning (ACP) may help guide spine surgeons as to patient preferences, the rate at which they are available and disparities in ACP completion are still not understood. The objective of this study was to evaluate disparities in the completion of ACP among patients with acute SCI. Methods: All patients presenting with cervical SCI to the emergency department at an urban, tertiary level I trauma center from 2010 to 2021 were identified from a prospective database of all consults evaluated by the spine service. Each patient's medical record was reviewed to assess for the presence of ACP documents such as living will, power of attorney, or advance directive. Community-level socioeconomic status was assessed using the Distressed Communities Index. Bivariable and multivariable analyses were performed. Results: We identified 424 patients: 104 (24.5%) of whom had ACP. Patients with ACP were older (64.8 versus 56.5 years, P = 0.001), more likely White (78.8% versus 71.9%, P = 0.057), and present with ASIA Impairment Scale grade A SCI (21.2% versus 12.8%, P = 0.054), although the latter two did not reach statistical significance. On multivariable logistic regression, patients residing in at-risk communities were significantly less likely to have ACP documents compared with those in prosperous communities (odds ratio [OR]: 0.29, P = 0.03). Although patients living in distressed communities were less likely to complete ACP compared with those in prosperous communities (OR 0.50, P = 0.066), this did not meet statistical significance. Female patients were also less likely to have ACP (OR: 0.43, P = 0.005). Conclusion: Female patients and those from at-risk communities are markedly less likely to complete ACP. Attention to possible disparities during admission and ACP discussions may help ensure that patients of all backgrounds have treatment goals documented.

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Section: Discussionmentioning

confidence: 99%

The Impact of Socioeconomic Status on the Presence of Advance Care Planning Documents in Patients With Acute Cervical Spinal Cord Injury

Issa,

McCurdy,

Lee

et al. 2024

J Am Acad Orthop Surg

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“…9 Poor readability of patient education material also contributes to poor health literacy as the average readability of patient materials of 3 major spine societies exceeded recommended levels by almost 5 grade levels. 8 Multiple studies have described that this lack of literacy decreases patient satisfaction and compliance, increasing health care costs and causing adverse postdischarge events due to gaps in communication and information transfer. [32][33][34] Readability is likely also one component that predisposes to PROM noncompletion.…”

Section: Discussionmentioning

confidence: 99%

“…4 Limited ability to understand reading materials, patient education, discharge instructions, and informed consent all adversely affect the continuum of care. [5][6][7][8][9] This costs the American health system an estimated 106 to 208 billion dollars annually. 10 Despite widespread inadequate health literacy, this limitation in health care is not routinely evaluated by health care practitioners.…”

mentioning

confidence: 99%

Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy

Issa,

Lee,

Mazmudar

et al. 2023

Spine

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Observational study.Objective: To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery. Summary of Background Data: Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient. Materials and Methods: We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES > 79 or SMOG < 7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES >89) was then used to further review readability. Results: Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10-96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1-25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1). Conclusions: Most PROMs utilized in spine surgery require an average reading competency far above the average patient's comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion.

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“…Flesch–Kincaid Reading Ease (FRE) score is used in most readability studies 15 and is calculated using a formula to calculate readability based on the average sentence length and the average number of syllables per word 16 . It has a high retest and inter‐rater reliability 17 .…”

Section: Methodsmentioning

confidence: 99%

“…It is known to correlate with higher levels of accuracy and a relatively easy tool to use to assess reliability. 14 Flesch-Kincaid reading ease Flesch-Kincaid Reading Ease (FRE) score is used in most readability studies 15 and is calculated using a formula to calculate readability based on the average sentence length and the average number of syllables per word. 16 It has a high retest and inter-rater reliability.…”

Section: Journal Of the American Medical Associationmentioning

confidence: 99%

Dr Google – assessing the reliability and readability of information on general surgical procedures found via search engines

Ramli

Jambor

Kong

2023

ANZ Journal of Surgery

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Background The most common general surgical emergency operations are laparoscopic appendicectomy, laparoscopic cholecystectomy, hernia repair, hemorrhoidectomy and colectomy. Patients commonly perform an internet search for more information prior to undergoing surgery, which can lead to an inappropriate understanding of their procedure. The aim is to assess the quality of information available on three of the most used search engines. Methods A search was conducted on http://google.com, http://bing.com and http://yahoo.com using the terms related to laparoscopic appendicectomy, laparoscopic cholecystectomy, hemorrhoidectomy, hernia repair and colectomy. First 20 results from each search engine were collected for evaluation. Results were excluded if they were sponsored, duplicates, academic publications, advertisements, forums, audiovisual tools, social media or any non‐English information. Included results were assessed for reliability using DISCERN and JAMA benchmark score. Readability was assessed using Flesch Reading Ease (FRE) Score and Simple Measure of Gobbledygook (SMOG). Results Hundred and ninety‐seven websites were analysed, 44.7% were published by institutions, 34.5% by health websites and 20.8% by independent surgeons. Mean DISCERN scores for Institutions was 54.6 ± 11.3, independent surgeons 45.9 ± 11.4 and health websites 58.7 ± 10.3. Mean JAMA score for Institutions was 1.0 ± 1.0, independent surgeons 0.1 ± 0.4 and health websites 1.7 ± 1.1. FRE scores for institutions was 51.6 ± 10.3, independent surgeons 40.9 ± 10.2, and health websites 45.7 ± 12.3. SMOG scores were 9.8 ± 1.5 for institutions, 11.4 ± 1.6 for independent surgeons and 10.6 ± 1.7 for health websites. Conclusion Health information on common general surgical procedures found on search engines are generally fair to good quality but still above the suggested reading level of the population. Information on surgical procedures should be written at recommended reading level of 13–14 years old.

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Readability of the Most Commonly Accessed Online Patient Education Materials Pertaining to Surgical Treatments of the Spine

Cited by 15 publications

References 29 publications

The Impact of Socioeconomic Status on the Presence of Advance Care Planning Documents in Patients With Acute Cervical Spinal Cord Injury

The Impact of Socioeconomic Status on the Presence of Advance Care Planning Documents in Patients With Acute Cervical Spinal Cord Injury

Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy

Dr Google – assessing the reliability and readability of information on general surgical procedures found via search engines

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