The measurement of comprehensibility

Patient information leaflets for prostate cancer: which leaflets should healthcare professionals recommend?

This study evaluated 31 patient information leaflets (PILs) discussing treatment options for prostate cancer. In stage one, the authors evaluated the leaflets' quality, readability and suitability using objective measures: the DISCERN instrument; Flesch formula; and the Suitability Assessment of Materials (SAM) instrument, respectively. Although the leaflets varied in terms of their scores on each measure, it was possible to identify the best five leaflets across the three conditions. In stage two, eight men with prostate cancer took part in a focus group discussion or individual interview to outline their views regarding a number of leaflets, including the best five booklets or leaflets identified in stage one of the study. The interviews were audiotaped and analysed using a template analysis. Patients were able to discriminate between the best five leaflets or booklets and identify their preferred booklets. These were the booklets: "Understanding cancer of the prostate" by CancerBACUP, "Prostate cancer: everything you need to know" by the Prostate Cancer Charity and "The treatment of prostate cancer. Questions and answers" by the Covent Garden Cancer Research Trust. On the basis of their high ratings for the objective measures and patients' views, healthcare professionals are advised to recommend these three booklets to men with prostate cancer who want written information about the disease. However, randomised controlled trials are needed to examine the impact of these booklets on the psychosocial outcomes of men with prostate cancer.

The role of psychology in the teaching of medical ethics: the example of informed consent

Over the past two decades, psychology has become well established in the medical curriculum. This paper argues that it has much to say about ethical issues, particularly informed consent. Because psychology addresses such areas as providing information, ensuring understanding of this information, identifying situations in which coercion occurs and assessing competence, its inclusion in the curriculum is justified on ethical as well as scientific grounds. This has several implications, including the allocation of resources, collaboration with health and clinical psychologists and the timing of the teaching.

Assessing the written information given to families prior to their attendance at a child development centre

This paper describes an analysis of the written information given to parents of pre-school children with developmental delay prior to their attendance at a Child Development Centre. Texts were analysed for their readability and human interest, and the usefulness of the information was assessed through consultation with parent consumers. The discussion of the results includes suggestions for staff who are involved in the development of client leaflets and booklets.

Comprehensibility of patient education literature

A survey of the mental health information literature available in NSW was made using the Flesch Formula for Reading Ease. It was found that ten out of thirteen were written at a level of complexity unintelligible to up to 60% of the general public. The literature is therefore falling far short of its potential. It is recommended that a serious attempt be made to write pamphlets in Plain English style. This process should include a Reading Ease estimation.

The understanding of medical terminology used in printed health education materials

Self-administered, multiple-choice questionnaires were completed by 120 patients and students in order to assess their medical vocabulary knowledge. The fifteen test words were taken from printed health education materials. It was apparent that many respondents had problems with the words, in particular, those of low social status or low educational achievement. The scores of students, however, were not significantly higher than those of the patients. It is suggested that all health education materials be carefully screened for medical words, although they may have high readability scores. Even seemingly simple medical words should be explained in simple terms, or should be included in a glossary. This practice should increase understanding and recall.

A method for decreasing patients' medication errors

Eighty anxious and eighty depressed patients were assigned randomly to receiving one of three versions of an information leaflet about their medication, or to receiving no leaflet at all. Mean medication errors were reduced from 15 to 4% by provision of suitably constructed leaflets. The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.

Communication in the clinical setting

Recent research on the problem of communicating with the patient is reviewed. It is shown that the frequent failures of both informative and persuasive communications are due in part to patients not understanding and to their forgetting what they are told.

Factors making for difficulties in communication are outlined, and methods are described for reducing failures of understanding and for increasing memory of what is said. Evidence on the effectiveness of these remedial methods is presented.