Readability Levels of Patient Education Materials in Professional Radiation Oncology Organizations

Reporter: Jacob E. Shabason, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 1, 2013

Presenting Author: John Byun, BA
Presenting Author Affiliation: UIC College of Medicine, Chicago, IL

Written patient directed medical information is vital for patient education and understanding about a given disease process, appropriate treatment options and side effects from these treatments. In particular, radiation can be a frightening and confusing proposal to many patients. Clearly written education materials about radiation treatments are critical for optimal patient care and outcomes. Equally as important to the content of the material is the readability level of the information presented. Regardless of patient education, these materials need to be written in a manner that can be widely understood. To this end the American Medical Association and the National Library of Medicine recommend that all patient materials be written at the 6th grade reading level or lower.

Given the importance of appropriate reading level materials, the authors analyzed the reading grade level required for adequate understanding of materials released by three prominent oncology organizations, including the American Cancer Society (ACS), the American Society of Radiation Oncology (ASTRO) and the American College of Radiology / Radiological Society of North America


Utilizing the Flesch-Kincaid Grade Level method, a well established readability measurement tool, the authors found that patient reading materials from the ACS, ASTRO and the ACR regarding radiation oncology were written at too advanced a level, thereby leaving many patients uninformed. Specifically, only 28% of ACS materials were written a the 6th grade level or below, while 30% and 42% of materials were written at the Grade 7-8 or high school level, respectively. Similarly, ASTRO patient information was written at the appropriate Grade level only 8% of the time, with 6%, 63% and 23% presented at the 7th-8th grade, high school and college level, respectively. Lastly, none of the ACR materials were written at the 6th grade level or below, while 44% and 56% of materials were written at the high school and college level, respectively.

Overall, this study identifies an important deficiency in the patient directed information materials describing aspects of radiation oncology provided by three major cancer organizations. To ensure optimal patient health literacy regarding their disease and treatments, it is vital for these organizations to reconsider some of the wording and language of the provided information. Further, research should focus on methods to better optimize patient communication and health literacy. In the meantime, healthcare providers should seek readable information to provide to their patients.


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