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O'Sullivan CC, Larson NL, Vierkant RA, Smith ML, Chauhan C, Couch FJ, Olson JE, Loprinzi CL, Ruddy KJ. Advocate-BREAST: advocates and patients' advice to enhance breast cancer care delivery, patient experience and patient centered research by 2025. Arch Public Health 2024; 82:119. [PMID: 39113124 PMCID: PMC11308547 DOI: 10.1186/s13690-024-01351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE The aims of the Advocate-BREAST project are to study and improve the breast cancer (BC) patient experience through education and patient-centered research. METHODS In December 2021, an electronic REDCap survey was circulated to 6,918 BC survivors (stage 0-4) enrolled in the Mayo Clinic Breast Disease Registry. The questionnaire asked about satisfaction with BC care delivery, and education and support receive(d) regarding BC linked concerns. Patients also ranked Quality Improvement (QI) proposals. RESULTS The survey received 2,437 responses. 18% had Ductal Carcinoma in Situ, 81% had early breast cancer (EBC), i.e. stage 1-3, and 2% had metastatic breast cancer (MBC). Mean age was 64 (SD 11.8), and mean time since diagnosis was 93 months (SD 70.2). 69.3% of patients received all care at Mayo Clinic. The overall experience of care was good (> 90%). The main severe symptoms recalled in year 1 were alopecia, eyebrow/eyelash thinning, hot flashes, sexual dysfunction, and cognitive issues. The main concerns recalled were fear of BC recurrence/spread; loved ones coping; fear of dying, and emotional health. Patients were most dissatisfied with information regarding sexual dysfunction, eyebrow/eyelash thinning, peripheral neuropathy, and on side effects of immunotherapy/targeted therapies. Top ranking QI projects were: i) Lifetime access to concise educational resources; ii) Holistic support programs for MBC and iii) Wellness Programs for EBC and MBC. CONCLUSIONS Patients with early and advanced BC desire psychological support, concise educational resources, and holistic care. IMPLICATIONS Focused research and QI initiatives in these areas will improve the BC patient experience.
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Affiliation(s)
- Ciara C O'Sullivan
- Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Nicole L Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Mary Lou Smith
- Research Advocacy Network, Plano, TX, USA
- Patient Advocate, Mayo Clinic Breast Cancer Specialized Program of Research Excellence (SPORE), Mayo Clinic, Rochester, MN, USA
| | - Cynthia Chauhan
- Patient Advocate, Mayo Clinic Breast Cancer Specialized Program of Research Excellence (SPORE), Mayo Clinic, Rochester, MN, USA
| | - Fergus J Couch
- Department of Experimental Pathology & Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Charles L Loprinzi
- Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Bald A, Richardson H, Al Samaraee A, Fasih T. Quality and readability of online information and materials on post-surgery breast seroma. Br J Hosp Med (Lond) 2024; 85:1-9. [PMID: 38941972 DOI: 10.12968/hmed.2024.0058] [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] [Indexed: 06/30/2024]
Abstract
Aims/Background Seroma formation is the most common complication following breast surgery. However, there is little evidence on the readability of online patient education materials on this issue. This study aimed to assess the accessibility and readability of the relevant online information. Methods This systematic review of the literature identified 37 relevant websites for further analysis. The readability of each online article was assessed through using a range of readability formulae. Results The average Flesch-Reading Ease score for all patient education materials was 53.9 (± 21.9) and the average Flesch-Kincaid reading grade level was 7.32 (± 3.1), suggesting they were 'fairly difficult' to read and is higher than the recommended reading level. Conclusion Online patient education materials regarding post-surgery breast seroma are at a higher-than-recommended reading grade level for the public. Improvement would allow all patients, regardless of literacy level, to access such resources to aid decision-making around undergoing breast surgery.
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Affiliation(s)
- Alexander Bald
- Department of General Surgery, Queen Elizabeth Hospital, Gateshead NHS Foundation Trust, Gateshead, UK
| | - Harriet Richardson
- Department of General Surgery, Queen Elizabeth Hospital, Gateshead NHS Foundation Trust, Gateshead, UK
| | - Ahmad Al Samaraee
- Department of General Surgery, Queen Elizabeth Hospital, Gateshead NHS Foundation Trust, Gateshead, UK
| | - Tarannum Fasih
- Department of General Surgery, Queen Elizabeth Hospital, Gateshead NHS Foundation Trust, Gateshead, UK
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Gu JZ, Baird GL, Escamilla Guevara A, Sohn YJ, Lydston M, Doyle C, Tevis SEA, Miles RC. A systematic review and meta-analysis of English language online patient education materials in breast cancer: Is readability the only story? Breast 2024; 75:103722. [PMID: 38603836 PMCID: PMC11019273 DOI: 10.1016/j.breast.2024.103722] [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: 07/24/2023] [Revised: 02/09/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Online patient education materials (OPEMs) are an increasingly popular resource for women seeking information about breast cancer. The AMA recommends written patient material to be at or below a 6th grade level to meet the general public's health literacy. Metrics such as quality, understandability, and actionability also heavily influence the usability of health information, and thus should be evaluated alongside readability. PURPOSE A systematic review and meta-analysis was conducted to determine: 1) Average readability scores and reporting methodologies of breast cancer readability studies; and 2) Inclusion frequency of additional health literacy-associated metrics. MATERIALS AND METHODS A registered systematic review and meta-analysis was conducted in Ovid MEDLINE, Web of Science, Embase.com, CENTRAL via Ovid, and ClinicalTrials.gov in June 2022 in adherence with the PRISMA 2020 statement. Eligible studies performed readability analyses on English-language breast cancer-related OPEMs. Study characteristics, readability data, and reporting of non-readability health literacy metrics were extracted. Meta-analysis estimates were derived from generalized linear mixed modeling. RESULTS The meta-analysis included 30 studies yielding 4462 OPEMs. Overall, average readability was 11.81 (95% CI [11.14, 12.49]), with a significant difference (p < 0.001) when grouped by OPEM categories. Commercial organizations had the highest average readability at 12.2 [11.3,13.0]; non-profit organizations had one of the lowest at 11.3 [10.6,12.0]. Readability also varied by index, with New Fog, Lexile, and FORCAST having the lowest average scores (9.4 [8.6, 10.3], 10.4 [10.0, 10.8], and 10.7 [10.2, 11.1], respectively). Only 57% of studies calculated average readability with more than two indices. Only 60% of studies assessed other OPEM metrics associated with health literacy. CONCLUSION Average readability of breast cancer OPEMs is nearly double the AMA's recommended 6th grade level. Readability and other health literacy-associated metrics are inconsistently reported in the current literature. Standardization of future readability studies, with a focus on holistic evaluation of patient materials, may aid shared decision-making and be critical to increased screening rates and breast cancer awareness.
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Affiliation(s)
- Joey Z Gu
- Department of Medicine, Roger Williams Medical Center, Providence, RI, USA.
| | - Grayson L Baird
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Biostatistics, Epidemiology, and Research Design, Providence, RI, USA
| | | | - Young-Jin Sohn
- Harvard Medical School Center for Primary Care, Boston, MA, USA
| | - Melis Lydston
- Treadwell Virtual Library, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Doyle
- Department of Radiology and Medical Imaging, Denver Health Hospital and Authority, Denver, CO, USA
| | - Sarah E A Tevis
- Department of Surgery, School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Randy C Miles
- Department of Radiology and Medical Imaging, Denver Health Hospital and Authority, Denver, CO, USA
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Steimetz E, Minkowitz J, Gabutan EC, Ngichabe J, Attia H, Hershkop M, Ozay F, Hanna MG, Gupta R. Use of Artificial Intelligence Chatbots in Interpretation of Pathology Reports. JAMA Netw Open 2024; 7:e2412767. [PMID: 38776080 PMCID: PMC11112436 DOI: 10.1001/jamanetworkopen.2024.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Anatomic pathology reports are an essential part of health care, containing vital diagnostic and prognostic information. Currently, most patients have access to their test results online. However, the reports are complex and are generally incomprehensible to laypeople. Artificial intelligence chatbots could potentially simplify pathology reports. Objective To evaluate the ability of large language model chatbots to accurately explain pathology reports to patients. Design, Setting, and Participants This cross-sectional study used 1134 pathology reports from January 1, 2018, to May 31, 2023, from a multispecialty hospital in Brooklyn, New York. A new chat was started for each report, and both chatbots (Bard [Google Inc], hereinafter chatbot 1; GPT-4 [OpenAI], hereinafter chatbot 2) were asked in sequential prompts to explain the reports in simple terms and identify key information. Chatbot responses were generated between June 1 and August 31, 2023. The mean readability scores of the original and simplified reports were compared. Two reviewers independently screened and flagged reports with potential errors. Three pathologists reviewed the flagged reports and categorized them as medically correct, partially medically correct, or medically incorrect; they also recorded any instances of hallucinations. Main Outcomes and Measures Outcomes included improved mean readability scores and a medically accurate interpretation. Results For the 1134 reports included, the Flesch-Kincaid grade level decreased from a mean of 13.19 (95% CI, 12.98-13.41) to 8.17 (95% CI, 8.08-8.25; t = 45.29; P < .001) by chatbot 1 and 7.45 (95% CI, 7.35-7.54; t = 49.69; P < .001) by chatbot 2. The Flesch Reading Ease score was increased from a mean of 10.32 (95% CI, 8.69-11.96) to 61.32 (95% CI, 60.80-61.84; t = -63.19; P < .001) by chatbot 1 and 70.80 (95% CI, 70.32-71.28; t = -74.61; P < .001) by chatbot 2. Chatbot 1 interpreted 993 reports (87.57%) correctly, 102 (8.99%) partially correctly, and 39 (3.44%) incorrectly; chatbot 2 interpreted 1105 reports (97.44%) correctly, 24 (2.12%) partially correctly, and 5 (0.44%) incorrectly. Chatbot 1 had 32 instances of hallucinations (2.82%), while chatbot 2 had 3 (0.26%). Conclusions and Relevance The findings of this cross-sectional study suggest that artificial intelligence chatbots were able to simplify pathology reports. However, some inaccuracies and hallucinations occurred. Simplified reports should be reviewed by clinicians before distribution to patients.
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Affiliation(s)
- Eric Steimetz
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
| | - Jeremy Minkowitz
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
| | - Elmer C. Gabutan
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
| | - Joan Ngichabe
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
| | - Hagar Attia
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
| | | | - Fatih Ozay
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raavi Gupta
- Department of Pathology, SUNY (State University of New York) Downstate Medical Center, Brooklyn
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Lam MR, Manion GN, Young BK. Search engine optimization and its association with readability and accessibility of diabetic retinopathy websites. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06472-3. [PMID: 38639789 DOI: 10.1007/s00417-024-06472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE This study investigated whether websites regarding diabetic retinopathy are readable for patients, and adequately designed to be found by search engines. METHODS The term "diabetic retinopathy" was queried in the Google search engine. Patient-oriented websites from the first 10 pages were categorized by search result page number and website organization type. Metrics of search engine optimization (SEO) and readability were then calculated. RESULTS Among the 71 sites meeting inclusion criteria, informational and organizational sites were best optimized for search engines, and informational sites were the most visited. Better optimization as measured by authority score was correlated with lower Flesch Kincaid Grade Level (r = 0.267, P = 0.024). There was a significant increase in Flesch Kincaid Grade Level with successive search result pages (r = 0.275, P = 0.020). Only 2 sites met the 6th grade reading level AMA recommendation by Flesch Kincaid Grade Level; the average reading level was 10.5. There was no significant difference in readability between website categories. CONCLUSION While the readability of diabetic retinopathy patient information was poor, better readability was correlated to better SEO metrics. While we cannot assess causality, we recommend websites improve their readability, which may increase uptake of their resources.
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Affiliation(s)
- Matthew R Lam
- Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ, USA.
| | | | - Benjamin K Young
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
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Wagner AS, Milzer M, Steindorf K, Kiermeier S, Schmidt ME, Maatouk I. Cancer-related fatigue: Quality, credibility, usability, and readability of information on websites of health care institutions in Germany. PATIENT EDUCATION AND COUNSELING 2024; 121:108135. [PMID: 38199176 DOI: 10.1016/j.pec.2024.108135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVES This study aimed to portray available information on cancer-related fatigue on German health care institution websites considering the idea of patient empowerment. METHODS Based on website quality criteria, we developed a website-rating tool comprising 18 items. Descriptive analyses, a KruskalWallis test, and corresponding post hoc tests comparing rating sum scores between institution groups were performed. RESULTS Websites of 283 systematically compiled health care institutions were included in the rating. Cancer-related fatigue was introduced on 21.9% and detailed information was provided on 27.9% of the websites. Information material was offered on 9.2% of the websites, while fatigue treatment offers were presented on 21.6% of the websites. The rating sum scores differed between institution groups (p < 0.001), with Comprehensive Cancer Centers scoring significantly higher than the others. CONCLUSION The rating revealed an overall sparse provision of information, with fatigue being addressed on less than half of the websites. PRACTICE IMPLICATIONS For patients who have access to at least one introduction about fatigue, institutions need to extend their websites. Patients could further be referred to external institutions or information booklets. The naming of contact persons may help linking patients to providers.
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Affiliation(s)
- Anna S Wagner
- Julius-Maximilians-University, Department of General Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, Würzburg, Germany
| | - Marlena Milzer
- German Cancer Research Center (DKFZ), Division of Physical Activity, Prevention and Cancer, Heidelberg, Germany; University of Heidelberg, Medical Faculty, Heidelberg, Germany
| | - Karen Steindorf
- German Cancer Research Center (DKFZ), Division of Physical Activity, Prevention and Cancer, Heidelberg, Germany
| | - Senta Kiermeier
- Julius-Maximilians-University, Department of General Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, Würzburg, Germany
| | - Martina E Schmidt
- German Cancer Research Center (DKFZ), Division of Physical Activity, Prevention and Cancer, Heidelberg, Germany
| | - Imad Maatouk
- Julius-Maximilians-University, Department of General Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, Würzburg, Germany.
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Haver HL, Gupta AK, Ambinder EB, Bahl M, Oluyemi ET, Jeudy J, Yi PH. Evaluating the Use of ChatGPT to Accurately Simplify Patient-centered Information about Breast Cancer Prevention and Screening. Radiol Imaging Cancer 2024; 6:e230086. [PMID: 38305716 PMCID: PMC10988327 DOI: 10.1148/rycan.230086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024]
Abstract
Purpose To evaluate the use of ChatGPT as a tool to simplify answers to common questions about breast cancer prevention and screening. Materials and Methods In this retrospective, exploratory study, ChatGPT was requested to simplify responses to 25 questions about breast cancer to a sixth-grade reading level in March and August 2023. Simplified responses were evaluated for clinical appropriateness. All original and simplified responses were assessed for reading ease on the Flesch Reading Ease Index and for readability on five scales: Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Automated Readability Index, and the Simple Measure of Gobbledygook (ie, SMOG) Index. Mean reading ease, readability, and word count were compared between original and simplified responses using paired t tests. McNemar test was used to compare the proportion of responses with adequate reading ease (score of 60 or greater) and readability (sixth-grade level). Results ChatGPT improved mean reading ease (original responses, 46 vs simplified responses, 70; P < .001) and readability (original, grade 13 vs simplified, grade 8.9; P < .001) and decreased word count (original, 193 vs simplified, 173; P < .001). Ninety-two percent (23 of 25) of simplified responses were considered clinically appropriate. All 25 (100%) simplified responses met criteria for adequate reading ease, compared with only two of 25 original responses (P < .001). Two of the 25 simplified responses (8%) met criteria for adequate readability. Conclusion ChatGPT simplified answers to common breast cancer screening and prevention questions by improving the readability by four grade levels, though the potential to produce incorrect information necessitates physician oversight when using this tool. Keywords: Mammography, Screening, Informatics, Breast, Education, Health Policy and Practice, Oncology, Technology Assessment Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Hana L. Haver
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
| | - Anuj K. Gupta
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
| | - Emily B. Ambinder
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
| | - Manisha Bahl
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
| | - Eniola T. Oluyemi
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
| | - Jean Jeudy
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
| | - Paul H. Yi
- From the University of Maryland Medical Intelligent Imaging (UM2ii)
Center, Department of Diagnostic Radiology and Nuclear Medicine, University of
Maryland School of Medicine, 670 W Baltimore St, First Floor, Rm 1172,
Baltimore, MD 21201 (H.L.H., A.K.G., J.J., P.H.Y.); The Russell H. Morgan
Department of Radiology and Radiological Science, Johns Hopkins University
School of Medicine, Baltimore, Md (E.B.A., E.T.O.); Department of Radiology,
Division of Breast Imaging, Massachusetts General Hospital, Boston, Mass (M.B.);
Malone Center for Engineering in Healthcare, Whiting School of Engineering,
Johns Hopkins University, Baltimore, Md (P.H.Y.); and Fischell Department of
Bioengineering, A. James Clark School of Engineering, University of
Maryland–College Park, College Park, Md (P.H.Y.)
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Chu Y, Xie Q, Meng R, Leng B, Cao Z. Evaluation of the Quality and Readability of Online Information about Alzheimer's Disease in China. J Alzheimers Dis 2024; 99:667-678. [PMID: 38701143 DOI: 10.3233/jad-231339] [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] [Indexed: 05/05/2024]
Abstract
Background With the increasing popularity of the internet, a growing number of patients and their companions are actively seeking health-related information online. Objective The aim of this study was to assess the quality and readability of online information about Alzheimer's disease (AD) in China. Methods A total of 263 qualified AD-related web pages from different businesses, governments, and hospitals were obtained. The quality of the web pages was assessed using the DISCERN tool, and the readability of the web pages was assessed using a readability measurement website suitable for the Chinese language. The differences in readability and quality between different types of web pages were investigated, and the correlation between quality and readability was analyzed. Results The mean overall DISCERN score was 40.93±7.5. The government group scored significantly higher than the commercial and hospital groups. The mean readability score was 12.74±1.27, and the commercial group had the lowest readability score. There was a positive correlation between DISCERN scores and readability scores. Conclusions This study presents an evaluation of the quality and readability of health information pertaining to AD in China. The findings indicate that there is a need to enhance the quality and readability of web pages about AD in China. Recommendations for improvement are proposed in light of these findings.
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Affiliation(s)
- Yili Chu
- School of Humanistic Medicine, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Public Health Social Governance, Philosophy and Social Sciences of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Qihui Xie
- Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Rongrong Meng
- Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Bing Leng
- School of Humanistic Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Zhenxiang Cao
- Hefei Advanced Research Institute, Anhui University of Finance and Economics, Hefei, Anhui, China
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Bruce JC, Batchinsky M, Van Spronsen NR, Sinha I, Bharadia D. Analysis of online materials regarding DIEP and TRAM flap autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 82:81-91. [PMID: 37149913 DOI: 10.1016/j.bjps.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
Online resources have become a mainstay for health information, and it is vital that such resources maintain accessible literacy levels to empower informed decision making. Previous studies have shown that the online resources regarding post-mastectomy breast reconstruction are of low readability; however, none have evaluated specific online resources regarding the most common procedures within autologous breast reconstruction, limiting analysis to the results of generic searches. This study sought to discover the readability of online, patient-directed resources regarding the Deep Inferior Epigastric Perforator (DIEP) and Transverse Rectus Abdominis Muscle (TRAM) flaps, the most utilized autologous flaps in breast reconstruction, using health literacy analysis. We hypothesized that the online materials regarding DIEP and TRAM flaps would yield literacy scores above the 6th-grade reading level, as recommended by the American Medical Association, despite previous literature and readability recommendations. Google searches for "DIEP breast reconstruction" and "TRAM breast reconstruction" were conducted. All patient-directed, non-sponsored websites found within the first three pages of the search underwent analysis using a variety of readability formulae. Both DIEP and TRAM resources were well above the 6th-grade reading level according to every metric used, and there was no significant difference in the reading level between the two procedures. Based on these results, significant work was needed to simplify the online resources to be more understandable for patients; these authors propose one method for such. In addition, the low readability of online resources suggests added emphasis on the need for surgeons to ensure that patients understand the medical information discussed during the presurgical consultations.
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Affiliation(s)
- J Christian Bruce
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Maria Batchinsky
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Nicole R Van Spronsen
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Indranil Sinha
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Deepak Bharadia
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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10
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Padilla G, Awshah S, Mhaskar RS, Diab ARF, Sujka JA, DuCoin C, Docimo S. Spanish-language bariatric surgery patient education materials fail to meet healthcare literacy standards of readability. Surg Endosc 2023:10.1007/s00464-023-10088-9. [PMID: 37129638 DOI: 10.1007/s00464-023-10088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The Hispanic population is the fastest growing ethnic minority in the United States, contributing to nearly half of the population growth over the last decade. Unfortunately, this population suffers from lower-than-average health literacy rates, leading to poorer health outcomes. Per the American Medical Association and National Institutes of Health, patient education materials (PEMs) should be written at no higher than a 6th grade reading level. Given that US Hispanic adults have the second-highest obesity prevalence, this study aims to analyze the readability of Spanish-language PEMs regarding bariatric surgery available in US-based academic and medical centers. METHODS A total of 50 PEMs were found via the query ""cirugía de pérdida de peso" site: (edu OR.org)" on the Google search engine. Thirty-nine sources met the inclusion criteria of belonging to a US-based academic or medical center and containing information regarding the indications for bariatric surgery, descriptions of the types of bariatric surgery, what to expect before and after surgery, or the risks and benefits of bariatric surgery. The excerpts were analyzed according to three readability formulas designed specifically for the Spanish language and evaluated for their reading grade level. RESULTS All 39 sources were at the college reading level per the Fry graph corrected for Spanish. Per the Spaulding formula, 37 sources were "Grade 12 + " and two sources were "Grade 8-10." Per the Fernandez-Huerta formula, 16 sources were at the 8th/9th grade reading level, 22 sources were at the 7th grade reading level, and one was at the 6th grade reading level. CONCLUSION The Spanish-language bariatric surgery PEMs available online from US-based academic and medical centers are generally above the recommended 6th grade reading level. Failure to meet the recommended sixth-grade reading level decreases health care literacy for Spanish-speaking patients within the United States seeking bariatric surgery.
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Affiliation(s)
| | | | | | | | - Joseph A Sujka
- University of South Florida, Tampa, USA
- Tampa General Hospital, Tampa, USA
| | - Christopher DuCoin
- University of South Florida, Tampa, USA
- Tampa General Hospital, Tampa, USA
| | - Salvatore Docimo
- University of South Florida, Tampa, USA
- Tampa General Hospital, Tampa, USA
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11
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Ownby RL, Waldrop D, Davenport R, Simonson M, Caballero J, Thomas-Purcell K, Purcell D, Ayala V, Gonzalez J, Patel N, Kondwani K. A mobile app for chronic disease self-management for individuals with low health literacy: A multisite randomized controlled clinical trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.01.23288020. [PMID: 37066256 PMCID: PMC10104214 DOI: 10.1101/2023.04.01.23288020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Objective The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in older adult patients with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. Methods A randomized controlled trial was completed at two sites. Individuals 40 years of age and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. Results All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. Conclusions The mobile app was effective in increasing participants' levels of several psychosocial variables, but reading difficulty level was not significantly related to outcomes.Registered at clinicaltrials.gov NCT02922439.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta GA
| | - Rosemary Davenport
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Michael Simonson
- Instructional Technology and Distance Education Program, Fischler College of Education, Nova Southeastern University, Fort Lauderdale FL
| | | | | | - Donrie Purcell
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Victoria Ayala
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Juan Gonzalez
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Neil Patel
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Kofi Kondwani
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Fort Lauderdale FL
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12
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Ramli R, Jambor MA, Kong CY. Dr Google - assessing the reliability and readability of information on general surgical procedures found via search engines. ANZ J Surg 2023; 93:590-596. [PMID: 36716246 DOI: 10.1111/ans.18289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/31/2023]
Abstract
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 Google.com, Bing.com and 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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Affiliation(s)
- Raziqah Ramli
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Maxwell Andrew Jambor
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chia Yew Kong
- School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- School of Medicine, University of Glasgow, Glasgow, UK
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13
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Matthews N, Folivi F. Omit needless words: Sentence length perception. PLoS One 2023; 18:e0282146. [PMID: 36827285 PMCID: PMC9955962 DOI: 10.1371/journal.pone.0282146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Short sentences improve readability. Short sentences also promote social justice through accessibility and inclusiveness. Despite this, much remains unknown about sentence length perception-an important factor in producing readable writing. Accordingly, we conducted a psychophysical study using procedures from Signal Detection Theory to examine sentence length perception in naive adults. Participants viewed real-world full-page text samples and judged whether a bolded target sentence contained more or fewer than 17 words. The experiment yielded four findings. First, naïve adults perceived sentence length in real-world text samples quickly (median = 300-400 ms) and precisely (median = ~90% correct). Second, flipping real-world text samples upside-down generated no reaction-time cost and nearly no loss in the precision of sentence length perception. This differs from the large inversion effects that characterize other highly practiced, real-world perceptual tasks involving canonically oriented stimuli, most notably face perception and reading. Third, participants significantly underestimated the length of mirror-reversed sentences-but not upside-down, nor standard sentences. This finding parallels participants' familiarity with commonly occurring left-justified right-ragged text, and suggests a novel demonstration of left-lateralized anchoring in scene syntax. Fourth, error patterns demonstrated that participants achieved their high speed, high precision sentence-length judgments by heuristically counting text lines, not by explicitly counting words. This suggests practical advice for writing instructors to offer students. When copy editing, students can quickly and precisely identify their long sentences via a line-counting heuristic, e.g., "a 17-word sentence spans about 1.5 text lines". Students can subsequently improve a long sentence's readability and inclusiveness by omitting needless words.
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Affiliation(s)
- Nestor Matthews
- Department of Psychology, Denison University, Granville, OH, United States of America
- * E-mail:
| | - Folly Folivi
- Department of Psychology, Denison University, Granville, OH, United States of America
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14
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Byrne J, Keogh S, Cullinane C, Razzaq Z, Redmond HP. Readability and Quality of Online Health Information Regarding Parathyroidectomy. OTO Open 2022; 6:2473974X221133308. [PMID: 36311181 PMCID: PMC9597036 DOI: 10.1177/2473974x221133308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/04/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Assessment of the readability and quality of online health information
regarding parathyroidectomy. Study Design Cross-sectional analysis. Setting Websites providing patient-oriented health information regarding
parathyroidectomy obtained via the Google search engine. Methods The top 75 Google search results for “parathyroidectomy,”“parathyroid
surgery,” and “parathyroid gland removal” were reviewed. Websites were
categorized by website type and country of origin. Readability was assessed
by Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook. Website
quality was assessed per JAMA benchmark criteria and the DISCERN
instrument. Results A total of 74 unique websites were evaluated. The mean readability of the
assessed websites exceeded the recommended sixth-grade reading level on the
Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook
(P < .001). Readability did not vary significantly
by website type. Websites originating from the United Kingdom were
significantly more readable than those from the United States. The majority
of assessed websites were of poor quality (n = 42, 56.8%) on assessment
based on the DISCERN instrument. Quality varied significantly by website
category on the JAMA benchmark criteria (P < .001) and
DISCERN score (P = .049) with commercial websites receiving
the highest scores. DISCERN score also varied significantly by country of
origin (P = .036) with UK sites receiving highest mean
DISCERN scores. Conclusion Online health information regarding parathyroidectomy is largely of poor
quality and is poorly readable for many patients. Institutions utilizing
well-defined guidelines for development of patient educational resources may
provide online health information of greater quality and readability.
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Affiliation(s)
- Jim Byrne
- University College Cork, Cork,
Ireland,Department of Endocrine Surgery, Cork
University Hospital, Cork, Ireland,Jim Byrne, Department of General &
Endocrine Surgery, Cork University Hospital, Wilton Rd., Cork, T12 DC4A,
Ireland.
| | - Samuel Keogh
- Department of Endocrine Surgery, Cork
University Hospital, Cork, Ireland
| | - Carolyn Cullinane
- University College Cork, Cork,
Ireland,Department of Endocrine Surgery, Cork
University Hospital, Cork, Ireland
| | - Zeeshan Razzaq
- Department of Endocrine Surgery, Cork
University Hospital, Cork, Ireland
| | - Henry Paul Redmond
- University College Cork, Cork,
Ireland,Department of Endocrine Surgery, Cork
University Hospital, Cork, Ireland
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15
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Parker PD, Prabhu AV, Su LJ, Zorn KK, Greene CJ, Hadden KB, McSweeney JC. What's in Between the Lines: Assessing the Readability, Understandability, and Actionability in Breast Cancer Survivorship Print Materials. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1532-1539. [PMID: 33822316 PMCID: PMC8492775 DOI: 10.1007/s13187-021-02003-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Educational print materials for young women breast cancer survivors (YBCS) are supplemental tools used in patient teaching. However, the readability of the text coupled with how well YBCS understand or act upon the material are rarely explored. The purpose of this study was to assess the readability, understandability, and actionability of commonly distributed breast cancer survivorship print materials. We used an environmental scan approach to obtain a sample of breast cancer survivorship print materials available in outpatient oncology clinics in the central region of a largely rural Southern state. The readability analyses were completed using the Flesch-Kincaid (F-K), Fry Graph Readability Formula (Fry), and Simple Measure of Gobbledygook (SMOG). Understandability and actionability were analyzed using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). The environmental scan resulted in a final sample of 14 materials. The mean readability of the majority of survivorship materials was "difficult," but the majority scored above the recommended 70% in both understandability and actionability. The importance of understandability and actionability may outweigh readability results in cancer education survivorship material. While reading grade level cannot be dismissed all together, we surmise that patient behavior may hinge more on other factors such as understandability and actionability. Personalized teaching accompanying print material may help YBCS comprehend key messages and promote acting upon specific tasks.
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Affiliation(s)
- Pearman D Parker
- College of Nursing, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #529, Little Rock, Arkansas, 72205, USA.
| | - Arpan V Prabhu
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - L Joseph Su
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kristin K Zorn
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carolyn J Greene
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kristie B Hadden
- University of Arkansas for Medical Sciences, UAMS Health, Little Rock, Arkansas, USA
| | - Jean C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #529, Little Rock, Arkansas, 72205, USA
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16
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Jasem Z, AlMeraj Z, Alhuwail D. Evaluating breast cancer websites targeting Arabic speakers: empirical investigation of popularity, availability, accessibility, readability, and quality. BMC Med Inform Decis Mak 2022; 22:126. [PMID: 35534816 PMCID: PMC9082957 DOI: 10.1186/s12911-022-01868-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nowadays, patients have access to all types of health information on the internet, influencing their decision-making process. The Middle East and North Africa (MENA) region consists of 22 countries with an estimated population of around 600 million. Breast cancer is the highest diagnosed cancer in this region. Websites are commonly the go-to cancer information sources. A large population of the MENA region is only fluent in the Arabic language, thus access to Arabic websites is in more demand. However, little is known about breast cancer websites that cater to an Arabic-speaking audience. This study aims at evaluating Arabic breast cancer websites and offering recommendations to improve engagement and access to health information. Methods This study employed a cross-sectional analysis approach. Google trends was used to reveal the top searched topics across the MENA region, which in turn were used as search terms to identify the websites. To be included, a website had to be active, available in Arabic, and contain breast cancer information. The evaluation was based on a combination of automated and expert-based evaluation methods through five dimensions: Availability, Accessibility, Readability, Quality, and Popularity. Results Overall most of the websites performed poorly in the five dimensions and require careful reassessment concerning design, content, and readability levels; Only one website performed well in all dimensions, except for readability. Generally, the readability scores indicated that the websites were above the recommended level of reading. None of the websites passed the automated accessibility tests. The expert evaluation using the “Health on the Net” checklist showed good results for most websites. Conclusions Breast cancer rates are rising in the MENA region, therefore having comprehensive, accurate, trustworthy, and easy-to-understand health information in their native language is a must. The results from this study show a need for improving the accessibility to breast cancer information websites available to Arabic speakers. The search was limited to three search engines yielding 10 websites and only one tool was used per dimension. Future work is needed to overcome these limitations. Collaboration between multiple stakeholders is necessary to develop websites that contain easy-to-read and understand high-quality information.
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Affiliation(s)
- Zahraa Jasem
- Information Science Department, College of Life Sciences, Kuwait University, Kuwait City, Kuwait
| | - Zainab AlMeraj
- Information Science Department, College of Life Sciences, Kuwait University, Kuwait City, Kuwait
| | - Dari Alhuwail
- Information Science Department, College of Life Sciences, Kuwait University, Kuwait City, Kuwait. .,Health Informatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait.
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17
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Gordejeva J, Zowalla R, Pobiruchin M, Wiesner M. Readability of English, German, and Russian Disease-related Wikipedia pages: Automated Computational Analysis (Preprint). J Med Internet Res 2022; 24:e36835. [PMID: 35576562 PMCID: PMC9152717 DOI: 10.2196/36835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Richard Zowalla
- Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
- Consumer Health Informatics SIG, German Association for Medical Informatics, Biometry & Epidemiology (GMDS e. V.), Cologne, Germany
- Center for Machine Learning, Heilbronn University, Heilbronn, Germany
| | - Monika Pobiruchin
- Consumer Health Informatics SIG, German Association for Medical Informatics, Biometry & Epidemiology (GMDS e. V.), Cologne, Germany
- GECKO Institute for Medicine, Informatics & Economics, Heilbronn University, Heilbronn, Germany
| | - Martin Wiesner
- Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
- Consumer Health Informatics SIG, German Association for Medical Informatics, Biometry & Epidemiology (GMDS e. V.), Cologne, Germany
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18
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Pearson K, Ngo S, Ekpo E, Sarraju A, Baird G, Knowles J, Rodriguez F. Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment. J Med Internet Res 2022; 24:e31284. [PMID: 35014955 PMCID: PMC8790699 DOI: 10.2196/31284] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public. Objective This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association. Methods Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non–patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM. Results A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association. Conclusions Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a).
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Affiliation(s)
- Keon Pearson
- Department of Medicine, Stanford University, Stanford, CA, United States
| | - Summer Ngo
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Eson Ekpo
- Department of Medicine, Stanford University, Stanford, CA, United States
| | - Ashish Sarraju
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Grayson Baird
- Rhode Island Hospital and Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Joshua Knowles
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, United States
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19
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Miles RC, Lourenco AP, Baird GL, Roy IT, Choi PHS, Lehman C, Lamb LR. A Multimetric Evaluation of Online Patient Educational Materials for Breast Implant-associated Anaplastic Large Cell Lymphoma. JOURNAL OF BREAST IMAGING 2021; 3:564-571. [PMID: 38424944 DOI: 10.1093/jbi/wbab053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess understandability, actionability, and readability of online patient educational materials (OPEM) related to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). METHODS Search volumes for query terms related to BIA-ALCL including "breast implant associated lymphoma," "breast implant associated anaplastic large cell lymphoma," and "BIA-ALCL" were analyzed in one-week increments and normalized to total Google search volume. The same terms were then queried using an online search engine to identify commonly accessed OPEM on this topic. Understandability and actionability of OPEM were evaluated using the Patient Education Materials Assessment Tool. Grade-level readability was determined using generalized estimating equations, with observations nested within readability metrics from each website. All interval estimates were calculated for 95% confidence. RESULTS Overall, 24 websites were identified based on search parameters. Of these websites, 11 (45.8%) met criteria for understandability, and 1 (4.2%) met criteria for actionability. Overall, readability ranged from 10.2 to 17.3 for all websites with an average grade level readability of 12.4; 0 websites were written at or below a sixth-grade reading level. Government websites had the highest average grade reading level at 14.0, followed by commercial websites at 13.2, nonprofit websites at 12.0, and then academic/hospital-based websites at 11.5. CONCLUSION The quality of available OPEM on BIA-ALCL is limited. Future development of OPEM should be designed with the goal of improving both comprehension and actionability to help reduce patient anxiety and unnecessary clinical appointments related to this disease.
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Affiliation(s)
- Randy C Miles
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Ana P Lourenco
- Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI, USA
| | - Grayson L Baird
- Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Department of Diagnostic Imaging, Providence, RI, USA
| | - Ishita T Roy
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | | | - Constance Lehman
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Leslie R Lamb
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
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20
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Caneiras C, Jácome C, Moreira E, Oliveira D, Dias CC, Mendonça L, Mayoralas-Alises S, Fonseca JA, Diaz-Lobato S, Escarrabill J, Winck JC. A qualitative study of patient and carer experiences with home respiratory therapies: Long-term oxygen therapy and home mechanical ventilation. Pulmonology 2021; 28:268-275. [PMID: 34246616 DOI: 10.1016/j.pulmoe.2021.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
Studies exploring the experience of patients receiving home respiratory therapies (HRT), such as long-term oxygen therapy (LTOT) and home mechanical ventilation (HMV), are still limited. This study focused on patients' and carers' experience with LTOT and HMV. An exploratory, cross-sectional qualitative study, using semi-structured focus groups, was carried out with 18 patients receiving HRT (median 71y, 78% male, 56% on both LTOT and HMV) and 6 carers (median age 67y, 67% female). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. Patients' and carers' experience was reflected in seven major topics, linked to specific time points and settings of the treatment: Initial symptoms/circumstances (n = 41), Prescription (n = 232), Implementation (n = 184), Carer involvement (n = 34), Quality of life impact (n = 301), Health care support/navigability (n = 173) and Suggestions (n = 14). Our findings demonstrate a general good perception of the HRT by patients and carers recognizing a significative quality of life impact improvement, while identifying specific points where improvements in healthcare are needed, particularly about navigability issues, articulation between the hospital, primary care and homecare teams, especially regardingprescriptionrenewal. This knowledge is crucial to promote a long-term HRT adherence and to optimize HRT delivery in line with patients' experience, needs, and values. Moreover, these key points can inform the development of a specific patient-reported experience measure (PREM) for patients on HRT, which is not currently available, and foster a more integrated respiratory care model.
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Affiliation(s)
- Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicroLab), Faculty of Medicine, Institute of Environmental Health (ISAMB), University of Lisbon, 1649-028 Lisbon, Portugal; Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal; Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal.
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Emília Moreira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Daniela Oliveira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Rheumatology Department, University Hospital Center of São João (CHUSJ), Porto, Portugal.
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Liliane Mendonça
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Allergy Unit, CUF Institute and Hospital, 4460-188 Porto, Portugal
| | - Salvador Diaz-Lobato
- Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain; Service of Pneumology, University Hospital of Moncloa, 28008 Madrid, Spain
| | - Joan Escarrabill
- Hospital Clinic of Barcelona, 08036 Barcelona, Spain; Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain; REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain.
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Duong PT, Moy MP, Simeone FJ, Chang CY, Wong TT. Assessing the readability of patient-targeted online information on musculoskeletal radiology procedures. Skeletal Radiol 2021; 50:1379-1387. [PMID: 33392624 DOI: 10.1007/s00256-020-03562-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the readability of patient-targeted online information on musculoskeletal radiology procedures. METHODS Eleven common musculoskeletal radiology procedures were queried in three online search engines (Google, Yahoo!, Bing). All unique patient-targeted websites were identified (n = 384) from the first three pages of search results. The reading grade level of each website was calculated using 6 separate validated metrics for readability assessment. Analysis of word and sentence complexity was also performed. Results were compared between academic vs. non-academic websites and between websites found on different pages of the search results. Statistics were performed using a t test. RESULTS The mean reading grade level across all procedures was 10th-14th grade. Webpages for nerve block were written at a higher reading grade level on non-academic websites (p = 0.025). There was no difference in reading grade levels between academic and non-academic sources for all other procedures. There was no difference in reading grade levels between websites found on the first page of search results compared with the second and third pages. Across all websites, 16-22% of the words used had 3+ syllables and 31-43% of the words used had 6+ characters (complex words); 13-24% of the sentences used had 22+ words (complex sentences). CONCLUSION Patient-targeted online information on musculoskeletal radiology procedures are written at the 10th-14th grade reading level, which is well beyond the AMA and NIH recommendation. Readability can be lowered by decreasing text complexity through limitation of high-syllable words and reduction in word and sentence length.
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Affiliation(s)
- Phuong T Duong
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Matthew P Moy
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - F Joseph Simeone
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Connie Y Chang
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Tony T Wong
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA.
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Li Y, Zhou X, Zhou Y, Mao F, Shen S, Lin Y, Zhang X, Chang TH, Sun Q. Evaluation of the quality and readability of online information about breast cancer in China. PATIENT EDUCATION AND COUNSELING 2021; 104:858-864. [PMID: 32988687 DOI: 10.1016/j.pec.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/10/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aimed at evaluating the quality and readability of online information about breast cancer written in Chinese. METHODS An Internet search was conducted for "breast cancer" in Chinese using the Baidu search engine. Website quality was evaluated using the DISCERN instrument, and readability was evaluated using the Chinese Readability Index Explorer (CRIE). Higher DISCERN score indicated higher quality of websites, while higher CRIE score indicated lower readability of the content of the websites. We also investigated the effects of website producer category, and the associations of search engine ranking with DISCERN and CRIE scores. RESULTS A total of 49 websites were included. The mean overall DISCERN score was 50.27 ± 4.14, and the mean CRIE score was 6.78 ± 0.16. Websites produced by non-profit organizations had the highest overall DISCERN scores, while those produced by private individuals had the lowest CRIE scores. Search engine ranking had no significant correlation with website quality or readability. CONCLUSIONS The quality and readability of breast cancer websites in Chinese were not satisfactory, and they varied among different website producer categories. PRACTICE IMPLICATIONS Website producers should seek to provide more accurate, comprehensive, and easy-to-understand information to better meet the needs of breast cancer patients. In addition, search engines should revise algorithms to promote websites with higher quality and accessibility.
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Affiliation(s)
- Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xingtong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Tao-Hsing Chang
- Department of Computer Science and Information Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China.
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Villa Camacho JC, Pena MA, Flores EJ, Little BP, Parikh Y, Narayan AK, Miles RC. Addressing Linguistic Barriers to Care: Evaluation of Breast Cancer Online Patient Educational Materials for Spanish-Speaking Patients. J Am Coll Radiol 2021; 18:919-926. [PMID: 33676914 DOI: 10.1016/j.jacr.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the readability of breast cancer online patient educational materials (OPEM) written in Spanish and to compare to equivalent English-language OPEM. METHODS The breast cancer-related terms cáncer de seno (breast cancer), detección de cáncer de seno (breast cancer screening), and biopsia de seno (breast biopsy) were queried using an online search engine. After each query, educational information related to the queried term was downloaded from each website appearing on the first five search engine result pages. Readability of Spanish-language OPEM was evaluated using the Crawford reading grade score. When available, equivalent English-language OPEM from the same website was then evaluated using the mean of five validated readability indices. Differences in readability, word count, and reading time between Spanish- and English-language OPEM were compared using an unpaired t test. The Fisher exact test was used to compare the proportion of websites meeting AMA recommendations for patient educational resources. RESULTS Queries for cáncer de seno, detección de cáncer de seno, and biopsia de seno yielded 27, 31, and 30 results of term-specific OPEM. Equivalent English-language versions were available for 19 (70.4%), 18 (58.1%), and 20 (66.7%) websites, respectively. Spanish-language OPEM were written at a lower grade reading level than equivalent English-language versions overall (5.49 ± 0.50 versus 7.77 ± 1.95, P < .01). Spanish-language OPEM were also more likely than English-language OPEM to meet AMA recommendations (82.9% versus 40.4%, P < .01). CONCLUSIONS Breast cancer-related Spanish-language OPEM were written at a significantly lower grade reading level compared with equivalent information written in English.
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Affiliation(s)
| | - Miguel A Pena
- Harvard Kennedy School of Government, Cambridge, Massachusetts
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Officer, Radiology Community Health Improvement, Massachusetts General Hospital, Boston, Massachusetts
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Assistant Director, Radiology Resident Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yasha Parikh
- Chief Resident, Diagnostic Radiology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Anand K Narayan
- Co-Chair, Radiology Diversity, Equity & Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Randy C Miles
- Education Director, Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Miles RC, Choi P, Baird GL, Dibble EH, Lamb L, Garg M, Lehman C. Will the Effect of New Federal Breast Density Legislation Be Diminished by Currently Available Online Patient Educational Materials? Acad Radiol 2020; 27:1400-1405. [PMID: 31839567 DOI: 10.1016/j.acra.2019.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate readability of commonly accessed online patient educational materials (OPEM) on breast density in setting of recently passed federal breast density legislation. MATERIALS AND METHODS The term "breast density" was queried using an online search engine to identify the top 50 commonly accessed websites based on order of search results on December 15, 2018. Location, cookies, and user account information were disabled prior to our query. Only websites with OPEM, defined as any educational material on breast density targeted towards the general public, were evaluated in our study. Sponsored hits and research journal articles were excluded. Available patient-directed information from websites meeting inclusion criteria was then downloaded. Grade-level readability was then determined from formatted content using generalized estimating equations, with observations nested within readability metrics from each website. Results were compared to American Medical Association recommended readability parameters (sixth-grade reading level). All interval estimates were calculated for 95% confidence. RESULTS Fouty-one websites met inclusion criteria representing patient-directed OPEM on breast density. Average grade-level readability of health information on breast density in our study ranged from 8.5-16.5 years with an average grade reading level of 11.1 years across all websites. Of websites fitting into a specific category, academic websites had the highest average grade reading level (12.0), while nonprofit websites had the lowest average grade reading level (10.4). Nearly half (19/41) of all websites in our study had diagrams to aid in patient comprehension, while few websites (2/41; 4.8%) displayed videos in addition to written content. The website with the lowest average grade reading level was WebMD, which had an average reading level of 8.5. No individual website in our study met American Medical Association recommended parameters of a sixth-grade reading level CONCLUSION: Readability of currently available OPEM on breast density may be written at a level too difficult for the general public to comprehend, which may represent a barrier to educational goals of newly passed federal breast density legislation.
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Affiliation(s)
- Randy C Miles
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street Boston, MA 02114-2696.
| | - Paul Choi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Grayson L Baird
- Rhode Island Hospital and Diagnostic Imaging, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Elizabeth H Dibble
- Rhode Island Hospital and Diagnostic Imaging, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Leslie Lamb
- Massachusetts General Hospital, Department of Radiology, Massachusetts
| | - Megha Garg
- University of California, San Francisco, San Francisco VA Medical Center, San Francisco, California
| | - Constance Lehman
- Massachusetts General Hospital, Department of Radiology, Massachusetts
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Readability and Quality of Online Patient Education Material on Websites of Breast Imaging Centers. J Am Coll Radiol 2020; 17:1245-1251. [DOI: 10.1016/j.jacr.2020.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 11/20/2022]
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Rodriguez F, Ngo S, Baird G, Balla S, Miles R, Garg M. Readability of Online Patient Educational Materials for Coronary Artery Calcium Scans and Implications for Health Disparities. J Am Heart Assoc 2020; 9:e017372. [PMID: 32865121 PMCID: PMC7726991 DOI: 10.1161/jaha.120.017372] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Coronary artery calcium (CAC) scans can help reclassify risk and guide patient‐clinician shared treatment decisions for cardiovascular disease prevention. Patients increasingly access online patient educational materials (OPEMs) to guide medical decision‐making. The American Medical Association (AMA) recommends that OPEMs should be written below a 6th‐grade reading level. This study estimated the readability of commonly accessed OPEMs on CAC scans. Methods and Results The terms “coronary artery calcium scan,” “heart scan,” and “CAC score” were queried using an online search engine to identify the top 50 commonly accessed websites based on order of search results on December 17, 2019. Grade‐level readability was calculated using generalized estimating equations, with observations nested within readability metrics from each website. Results were compared with AMA‐recommended readability parameters. Overall grade‐level readability among all search terms was 10.9 (95% CI, 9.3–12.5). Average grade‐level readability of OPEMs for the search terms “coronary artery calcium scan,” “heart scan,” and “CAC score,” was 10.7 (95% CI, 9.0–12.5), 10.5 (95% CI, 8.9–12.1), and 11.9 (95% CI, 10.3–13.5), respectively. Professional society and news/media/blog websites had the highest average reading grade level of 12.6, while health system websites had the lowest average reading grade level of 10.0. Less than half of the unique websites (45.3%) included explanatory images or videos. Conclusions Current OPEMs on CAC scans are written at a higher reading level than recommended for the general public. This may lead to patient misunderstanding, which could exacerbate disparities in cardiovascular health among groups with lower health literacy.
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Affiliation(s)
- Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University Stanford CA
| | - Summer Ngo
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University Stanford CA
| | - Grayson Baird
- Rhode Island Hospital and Diagnostic Imaging Alpert Medical School Brown University Providence RI
| | - Sujana Balla
- Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University Stanford CA
| | - Randy Miles
- Department of Radiology Massachusetts General Hospital Boston MA
| | - Megha Garg
- Department of Medicine University of California San Francisco & San Francisco Veterans Affairs Medical Center San Francisco CA
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Understanding shared decision-making experience among vulnerable population: Focus group with food bank clients. J Clin Transl Sci 2020; 5:e37. [PMID: 33948259 PMCID: PMC8057450 DOI: 10.1017/cts.2020.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients' expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug-drug and drug-food interactions information.
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Baird GL, Dibble EH, Mainiero MB, Miles RC, Lourenco AP. Dense Breast Notification Letters: What Do Breast Radiologists Think? JOURNAL OF BREAST IMAGING 2020; 2:225-231. [PMID: 38424979 DOI: 10.1093/jbi/wbaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The Food and Drug Administration is currently creating national standards for language used in letters sent to women after mammography concerning dense breasts. The purpose of the current study is to survey breast radiologists on their opinions about language to be included in dense breast notification (DBN) letters. METHODS An anonymous survey (17 questions and 10 open-ended response fields) was sent to Society of Breast Imaging members between May 2019 and June 2019. Analyses were conducted using a chi-square test and the generalized linear model. RESULTS A total of 262 surveys were completed (25% response rate). The majority of breast radiologists believe letters should be sent to patients (91%), with most (66%) believing that patients should receive DBN letters regardless of having dense breasts or not. The majority of breast radiologists believe DBNs should be sent to referring physicians (69%), include statements that define masking (89%), inform patients that dense breasts are associated with cancer risk (77%), inform patients about the possible benefits of supplemental screening (86%), be written at the sixth- or eighth-grade reading level (92%), and should be provided in other languages in addition to English (89%); half of the respondents (51%) believe the letters should contain BI-RADS density descriptors. CONCLUSION There is consensus that patients and referring physicians should receive DBN letters and that those letters should address masking, increased cancer risk, and supplemental screening. Respondents believe the letters should be written at a sixth- or eighth-grade reading level.
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Affiliation(s)
- Grayson L Baird
- Alpert Medical School of Brown University, Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
| | - Elizabeth H Dibble
- Alpert Medical School of Brown University, Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
| | - Martha B Mainiero
- Alpert Medical School of Brown University, Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
| | - Randy C Miles
- Massachusetts General Hospital, Breast Imaging, Boston, MA
| | - Ana P Lourenco
- Alpert Medical School of Brown University, Rhode Island Hospital, Department of Diagnostic Imaging, Providence, RI
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Li Y, Ye S, Zhou Y, Mao F, Guo H, Lin Y, Zhang X, Shen S, Shi N, Wang X, Sun Q. Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study. J Med Internet Res 2020; 22:e16768. [PMID: 32301740 PMCID: PMC7316180 DOI: 10.2196/16768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/26/2020] [Accepted: 02/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. Objective This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. Methods Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients’ medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. Results A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01–1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). Conclusions The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer.
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Affiliation(s)
- Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Ye
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hailing Guo
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Shi
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojie Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Rooney MK, Golden DW, Byun J, Lukas RV, Sonabend AM, Lesniak MS, Sachdev S. Evaluation of patient education materials for stereotactic radiosurgery from high-performing neurosurgery hospitals and professional societies. Neurooncol Pract 2020; 7:59-67. [PMID: 32257285 DOI: 10.1093/nop/npz031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about the readability and utility of patient education materials for stereotactic radiosurgery (SRS). Therefore, the goal of this investigation was to evaluate such materials from high-performing neurosurgery hospitals and professional societies through an analysis of readability and educational content. Methods In this cross-cross sectional study, 61 websites associated with the top 50 neurosurgery and neurology hospitals according to U.S. News & World Report (USNWR) and 11 predetermined professional medical societies were queried. Identified SRS education materials were analyzed by 6 readability indices. Educational content was assessed by 10 criteria based on surveys of patients' perspectives about SRS. Results Fifty-four materials were identified from the target population (45 from USNWR hospital websites and 9 from professional society websites). Mean readability of materials ranged from 11.7 to 15.3 grade level, far more difficult than national recommendations of sixth and eighth grade. Materials were found to have deficiencies in educational content. Compared with high-performing hospitals, materials from websites of professional societies were longer (P = .002), and more likely to discuss risks and benefits specific to SRS (P = .008), alternative treatment options (P = .05) and expected outcomes or postprocedure descriptions (P = .004). Hospital materials were also more likely to favor brand-specific terminology (eg, GammaKnife) over generic terminology (eg, radiosurgery; P = .019). Conclusion Publicly available online patient educational materials for SRS are written at reading levels above national recommendations. Furthermore, many lack information identified as important by patients. Reevaluation and improvement of online SRS educational materials on a national scale are warranted.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago.,Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, IL
| | - John Byun
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Rimas V Lukas
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Adam M Sonabend
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maciej S Lesniak
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern University, Chicago, IL
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Affiliation(s)
- Tamara Miner Haygood
- From the Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1475, Houston, TX 77030
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