Reading versus comprehension: Implications for patient education and consent in an outpatient oncology clinic

Abstract

Written educational materials and consent forms are often given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1990 census suggest that 10% of U.S. adults are functionally illiterate. In this study, 100 adult patients (64 female, 36 male) seen consecutively in an oncology clinic were tested for reading vocabulary (RD-VOCAB) and reading comprehension (RD-COMP) using the Woodcock-Johnson Psychoeducational Battery. The mean grade levels of education (last grade completed), reading vocabulary, and reading comprehension of all participants were 12.5, 11.3, and 10.5, respectively. The discrepancy between the grade level of education and RD-COMP varied by age, the largest discrepancies being found in the 30-39 (three grades) and 60-69 (2 1/2 grades) age groups. After controlling for educational level, it was found that the mean grade level of RD-COMP was statistically lower than educational level. Statistically assuming all subjects to have completed high school, the mean levels of RD-COMP ranged from ninth grade in the 30-39 age group to twelfth grade in the 40-49 age group. This study underscores the fact that the health professional cannot assume that a patient who has completed a certain grade level in school can read at the corresponding level. Consent forms and other health education materials should be written at least three grade levels lower than the average educational level of the target population.

Analysis of the readability of patient education materials from surgical subspecialties

“…Participants with higher reading levels derived greater benefit from the pamphlet than those with lower reading levels . These results prompted the recommendation that patient education materials should be written at a 5th‐grade level or at a level one to three grades below the mean reading level of the target population . Nevertheless, prior studies in surgical subfields have found the readability of patient education materials to be written way above these recommendations …”

Clinical evaluation, imaging studies, indications for cytologic study and preprocedural requirements for duct brushing studies and pancreatic fine-needle aspiration: The Papanicolaou Society of Cytopathology Guidelines

“…It is often not feasible to discuss all alternate options in the limited time available in the preprocedure setting, especially in the era of open-access radiology and open-access endoscopy. [6162636465] The use of written information supplied during the informed consent procedure may increase patient comprehension. [66676869] No matter what form informed consent takes, it must be clearly understood by the patient and adequate opportunity for patient questions must be available.…”

Indications for thyroid FNA and pre‐FNA requirements: A synopsis of the National Cancer Institute Thyroid Fine‐Needle Aspiration State of the Science Conference

“…92,93 Jubelirer et al reported that, in a study of adult cancer patients, most had a reading level between 10th and 11th grade. 84 Jubelirer et al recommended that consent forms be written at 3-grade levels below the highest level of education of the specific patient. 84 For thyroid FNA, a consent form should be patient friendly and written so that the patient fully understands the procedure.…”

“…84 Jubelirer et al recommended that consent forms be written at 3-grade levels below the highest level of education of the specific patient. 84 For thyroid FNA, a consent form should be patient friendly and written so that the patient fully understands the procedure. Patient comprehension of thyroid FNA forms has not been rigorously studied.…”

“…68,69 In addition, less than 50% of the population understands commonly used medical terms, resulting in a ''health literacy'' problem that limits patients in their attempts to understand information. [83][84][85][86][87] Several studies have focused on insufficiencies in procedures to obtain informed consent. Braddock et al created a 3-tier evaluation procedure, in which the completeness of the informed consent discussions differed depending on the complexity of the decision.…”