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Ali R, Connolly ID, Tang OY, Mirza FN, Johnston B, Abdulrazeq HF, Lim RK, Galamaga PF, Libby TJ, Sodha NR, Groff MW, Gokaslan ZL, Telfeian AE, Shin JH, Asaad WF, Zou J, Doberstein CE. Bridging the literacy gap for surgical consents: an AI-human expert collaborative approach. NPJ Digit Med 2024; 7:63. [PMID: 38459205 PMCID: PMC10923794 DOI: 10.1038/s41746-024-01039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review. Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review. This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Our framework could be extended to other patient communication materials, emphasizing clear communication and mitigating disparities related to health literacy barriers.
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Affiliation(s)
- Rohaid Ali
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Norman Prince Neurosciences Institute, Providence, RI, USA.
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Oliver Y Tang
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hael F Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Rachel K Lim
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tiffany J Libby
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel R Sodha
- Department of Surgery & Division of Cardiothoracic Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James Zou
- Departments of Electrical Engineering, Biomedical Data Science, and Computer Science, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Curtis E Doberstein
- Department of Neurosurgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Norman Prince Neurosciences Institute, Providence, RI, USA
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Massie PL, Arshad SA, Auyang ED. Readability of American Society of Metabolic Surgery's Patient Information Publications. J Surg Res 2024; 293:727-732. [PMID: 37862852 DOI: 10.1016/j.jss.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Appropriate education and information are the keystones of patient autonomy. Surgical societies support this goal through online informational publications. Despite these recommendations, many of these sources do not provide the appropriate level of reading for the average patient. Multiple national organizations, including the AMA and NIH, have recommended that such materials be written at or below a 6th-grade level. We therefore aimed to evaluate the readability of patient information publications provided by the American Society of Metabolic and Bariatric Surgery (ASMBS). METHODS Patient information publications were collected from the ASMBS webpage (https://asmbs.org/patients) and evaluated for readability. Microsoft Office was utilized to calculate Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. Flesch Reading Ease (FRE) is a 0-100 score, with higher scores equating to easier reading (≥80 = 6th-grade reading level). Flesch-Kincaid Grade Level (FKGL) rates text on a US grade school level. Qualitative and univariate analyses were performed. RESULTS Eleven patient information publications were evaluated. None of the publications achieved an FRE score of 80 or an FKGL of a 6th-grade reading level. The average FRE score was 35.8 (range 14.9-53.6). The average FKGL score was 13.1 (range 10.1-17.5). The publication with the highest FRE and lowest FKGL (best readability) was that for benefits of weight loss. The brochure with the lowest FRE and highest FKGL (worst readability) was that for Medical Tourism. CONCLUSIONS Although the ASMBS patient information publications are a trusted source of patient literature, none of the 11 publications met the recommended criteria for patient readability. Further refinement of these will be needed to provide the appropriate reading level for the average patient.
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Affiliation(s)
- Pierce L Massie
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; Department of Surgery, UNM HSC, Albuquerque, New Mexico
| | - Seyed A Arshad
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; Department of Surgery, UNM HSC, Albuquerque, New Mexico
| | - Edward D Auyang
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; Department of Surgery, UNM HSC, Albuquerque, New Mexico.
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Edwards CS, Ammanuel SG, Silva ONN, Greeneway GP, Bunch KM, Meisner LW, Page PS, Ahmed AS. Academics versus the Internet: Evaluating the readability of patient education materials for cerebrovascular conditions from major academic centers. Surg Neurol Int 2022; 13:401. [PMID: 36128118 PMCID: PMC9479524 DOI: 10.25259/sni_502_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Health literacy profoundly impacts patient outcomes as patients with decreased health literacy are less likely to understand their illness and adhere to treatment regimens. Patient education materials supplement in-person patient education, especially in cerebrovascular diseases that may require a multidisciplinary care team. This study aims to assess the readability of online patient education materials related to cerebrovascular diseases and to contrast the readability of those materials produced by academic institutions with those of non-academic sources.
Methods:
The readability of online patient education materials was analyzed using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) assessments. Readability of academic-based online patient education materials was compared to nonacademic online patient education materials. Online patient education materials from 20 academic institutions and five sources from the web were included in the analysis.
Results:
Overall median FKGL for neurovascular-related patient online education documents was 11.9 (95% CI: 10.8–13.1), reflecting that they are written at a 12th grade level, while the median FRE was 40.6 (95% CI: 34.1–47.1), indicating a rating as “difficult” to read. When comparing academic-based online patient education materials to other internet sources, there was no significant difference in FRE and FKGL scores (P = 0.63 and P = 0.26 for FKGL and FRE, respectively).
Conclusion:
This study demonstrates that online patient education materials pertaining to cerebrovascular diseases from major academic centers and other nonacademic internet sites are difficult to understand and written at levels significantly higher than that recommended by national agencies. Both academic and nonacademic sources reflect this finding equally. Further study and implementation are warranted to investigate how improvements can be made.
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Affiliation(s)
- Caleb Simpeh Edwards
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco,
| | - Simon Gashaw Ammanuel
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | | | - Garret P. Greeneway
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Katherine M. Bunch
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Lars W. Meisner
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Paul S. Page
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Azam S. Ahmed
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
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Nnamani Silva ON, Ammanuel SG, Segobiano BM, Edwards CS, Hoffman WY. Assessing the Readability of Online Patient Education Resources Related to Gynecomastia. Ann Plast Surg 2021; 87:123-125. [PMID: 33346559 DOI: 10.1097/sap.0000000000002620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages. METHODS The readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites. RESULTS Fifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages. CONCLUSIONS The readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.
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Affiliation(s)
| | - Simon G Ammanuel
- From the University of California, San Francisco School of Medicine, San Francisco, CA
| | - Brett M Segobiano
- College of Arts and Letters, University of Notre Dame, South Bend, IN
| | - Caleb S Edwards
- From the University of California, San Francisco School of Medicine, San Francisco, CA
| | - William Y Hoffman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
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Pakhchanian H, Yuan M, Raiker R, Waris S, Geist C. Readability Analysis of the American Society of Ophthalmic Plastic & Reconstructive Surgery Patient Educational Brochures. Semin Ophthalmol 2021; 37:77-82. [PMID: 33975496 DOI: 10.1080/08820538.2021.1919721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Previous studies have shown patient education material (PEM) in ophthalmology has been written at levels exceeding appropriate reading levels. However, information for readability in the field of oculoplastics remains limited. The aim of this study was to evaluate the readability of patient educational brochures from the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS). METHODS Patient educational brochures from ASOPRS were analyzed for readability. The body of text from all 18 ASOPRS patient brochures was analyzed by ten validated tests for English readability assessment: Flesch Reading Ease Test (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), New Dale-Chall Readability (NDC), FORCAST, Fry Graph Readability (FG), Raygor Readability Estimate (RRE), and New Fog Count (NFC). RESULTS The mean (± SD) readability scores from the 18 ASOPRS patient brochures were 48 (4.3), 11.0 (0.8), 13.0 (0.7), 11.7 (0.8), 13.6 (0.9), 11.3 (0.8), 11.1 (0.5), 12.1 (1.5), 12.2 (1.0), and 10.6 (1.3) for FRE, FKGL, SMOG, CLI, GFI, NDC, FORCAST, FG, RRE, and NFC, respectively. All ten of the mean readability scores were above the recommended reading levels. CONCLUSIONS These findings show that the average patient may have difficulty understanding educational information provided by ASOPRS patient brochures, thereby hindering their ability to make informed decisions on their healthcare. Revision with readability as a primary goal, with input from patients and caregivers, may be necessary to improve health literacy among patients who seek oculoplastic care.
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Affiliation(s)
- Haig Pakhchanian
- Department of Ophthalmology, George Washington University School of Medicine & Health Science, Washington DC, USA
| | - Mellissa Yuan
- Department of Ophthalmology, Weill Cornell Medicine: Medical College, New York, NY, USA
| | - Rahul Raiker
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Shanawar Waris
- Department of Ophthalmology and Visual Sciences, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Craig Geist
- Department of Ophthalmology, George Washington University School of Medicine & Health Science, Washington DC, USA
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Patel PA, Gopali R, Reddy A, Patel KK. The Readability of Ophthalmological Patient Education Materials Provided by Major Academic Hospitals. Semin Ophthalmol 2021; 37:71-76. [PMID: 33852375 DOI: 10.1080/08820538.2021.1915341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The internet is an increasingly important resource for patients seeking health-related information. Because of this trend, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend that online patient education materials (PEMs) be written between a third and seventh grade level. The present study evaluates the readability levels of ophthalmological PEMs provided by five major academic hospitals, quantifies the availability of accompanying videos and graphics, and examines the extent to which readability may be increased. METHODS In March 2021, 397 PEMs from five major academic hospitals were extracted for subsequent analysis by seven validated readability assessments. The presence of an accompanying video or graphic was noted. Statistical significance was assessed using the Kruskal-Wallis test with Dunn's multiple comparisons test and the chi-square test. RESULTS Nearly all articles were written above the recommended reading level of 7th grade. After averaging the scales for each article, the median grade level was 11.7 (interquartile range [IQR], 10.7-12.7). The PEMs with the highest median reading level were provided by the Johns Hopkins University Wilmer Institute (12.6, IQR, 11.3 - 13.6). Only 13.6% and 13.1% of articles had an accompanying video and graphic, respectively. Reduction of sentence length beneath 15 words resulted in an improvement of readability by 2.7 grade levels. CONCLUSIONS The readability of online patient resources provided by major academic hospitals were above the literacy guidelines recommended by the NIH and AMA. Furthermore, most articles did not include a video or graphic, both of which could potentially improve patient understandability of educational materials. By altering these PEMs, as demonstrated here, institutions could increase the value these articles provide for patients and therefore the quality of the patient-physician relationship.
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Affiliation(s)
- Parth A Patel
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Rhea Gopali
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Anvith Reddy
- Department of Biological Sciences, University of Georgia, Athens, GA, USA
| | - Kajol K Patel
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Patient Education in Neurosurgery: Part 1 of a Systematic Review. World Neurosurg 2020; 147:202-214.e1. [PMID: 33307255 DOI: 10.1016/j.wneu.2020.11.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patient education has become increasingly important in neurosurgery. However, little is known regarding how to comprehensively educate neurosurgical patients. In the first part of a 2-part systematic review, we identify baseline patient understanding and educational needs, examine existing patient education materials, and characterize shortcomings in neurosurgical patient education practices. Our findings may guide neurosurgeons, departments, and professional associations in improving communication with patients. METHODS A 2-part systematic review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were read and selected for full text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. RESULTS Of 1617 resultant articles, 41 were included. Patient comprehension was low. Patient informational needs differed across patients and between patients and neurosurgeons. Patient informational needs were often unmet, promoting dissatisfaction. Written educational materials from government agencies, professional associations, neurosurgery departments, neurosurgeons, or widely read Web sites were written at a reading level above the recommended reading level, with complex topics written at a higher level. Information found on hospital and university Web sites was poor quality because of self-marketing and lack of reference to peer-reviewed literature. Educational videos created by universities and hospitals were poor quality. CONCLUSIONS Current in-clinic discussions and education materials show shortcomings, promoting poor comprehension. Neurosurgeons, departments, and professional organizations can act to improve the effectiveness of patient education initiatives. This policy will better inform patients, increase rapport between neurosurgeons and patients, and improve patient decision making and satisfaction.
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Young J, Dee EC, May C. Availability and Readability of Online Patient Information on Osteosarcoma: Assessment of Pediatric Hospital and National Cancer Institute-Designated Cancer Center (NCIDCC) Osteosarcoma Web Pages. JB JS Open Access 2020; 5:JBJSOA-D-20-00054. [PMID: 32984746 PMCID: PMC7480967 DOI: 10.2106/jbjs.oa.20.00054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Online patient information (OPI) plays an important role in pediatric orthopaedic patient/caregiver education and decision-making. We assessed the availability and readability of OPI about osteosarcoma found at pediatric hospital and U.S. National Cancer Institute-designated cancer center (NCIDCC) websites.
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Affiliation(s)
- Jason Young
- Boston Children's Hospital, Boston, Massachusetts
| | | | - Collin May
- Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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The influence of race and socioeconomic status on therapeutic clinical trial screening and enrollment. J Neurooncol 2020; 148:131-139. [DOI: 10.1007/s11060-020-03503-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
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