Readability of patient information booklets for women with breast cancer

IVC filter - assessing the readability and quality of patient information on the Internet

OBJECTIVE

The internet is an increasingly favorable source of information regarding health-related issues. The aim of this study is to apply appropriate evaluation tools to assess the evidence available online about inferior vena cava (IVC) filters with a focus on quality and readability.

METHODS

A search was performed during December 2022 using three popular search engines, namely Google, Yahoo, and Bing. Websites were categorized into academic, physician, commercial, and unspecified websites according to their content. Information quality was determined using Journal of the American Medical Association (JAMA) criteria, the DISCERN scoring tool, and whether a Health On the Net Foundation certification (HONcode) seal was present. Readability was established using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Statistical significance was accepted as P < .05.

RESULTS

In total, 110 websites were included in our study. The majority of websites were categorized as commercial (25%), followed by hospital (24%), academic (21%), unspecified (16%), and physician (14%). Average scores for all websites using JAMA and DISCERN were 1.93 ± 1.19 (median, 1.5; range, 0-4) and 45.20 ± 12.58 (median, 45.5; range, 21-75), respectively. The highest JAMA mean score of 3.07 ± 1.16 was allocated to physician websites, and the highest DISCERN mean score of 52.85 ± 12.66 was allocated to hospital websites. The HONcode seal appeared on two of the selected websites. Physician, hospital, and unspecified websites had a significantly higher mean JAMA score than academic and commercial websites (all with P < .001). Hospital websites had a significantly higher mean DISCERN score than academic (P = .007), commercial (P < .001), and unspecified websites (P = .017). Readability evaluation generated a mean FRES score of 51.57 ±12.04, which represented a 10th to 12th grade reading level and a mean FKGL score of 8.20 ± 1.70, which represented an 8th to 10th grade reading level. Only 12 sources were found to meet the ≤6th grade target reading level. No significant correlation was found between overall DISCERN score and overall FRES score.

CONCLUSIONS

The study results demonstrate that the quality of online information about IVC filters is suboptimal, and academic and commercial websites, in particular, must enhance their content quality regarding the use of IVC filters. Considering the discontinuation of the HONcode as a standardized quality assessment marker, it is recommended that a similar certification tool be developed and implemented for the accreditation of patient information online.

Development of patient information leaflets for fixed, removable, and functional appliances for Arabic-speaking orthodontic patients

OBJECTIVE

To develop Orthodontic Patient Information Leaflets (PILs) in Arabic.

MATERIAL & METHOD

This study included five phases starting with Arabic translation of existing British Orthodontic Society leaflets; initial face validation with three orthodontists; content validation with ten orthodontists; final face validation with ten orthodontists, five postgraduate students, and ten patients; and re-translation to English prior to comparing the new documents with the original PILs to verify that all the necessary information were included. The content validity index (CVI) assessed item level (I-CVI) and scale level (S-CVI).

RESULTS

The three Arabic PILs were face validated with inclusion of mini-screws, rapid maxillary expansion, and interproximal reduction. Content validity was perfect with no item I-CVI < 0.80. The S-CVI/Ave for PIL Fixed Appliances = 0.98, PIL Removable Appliances = 0.98 and PIL Functional Appliances = 0.97. In the final face validation, the three leaflets received 100% agreement from all observers for consistency of leaflet format and style, clarity, readability and use of adequate phrases. Finally, the leaflets were re-translated and the information was checked by native English speakers to ensure the completeness of information. There were no discrepancies and face validity was excellent.

CONCLUSION

Valid PILs for Arabic-speaking patients undergoing orthodontic treatment with fixed, removable, and functional appliances have been developed.

An Evaluation of the Information Sources of Cancer Patients' Relatives. A Prospective Survey

Patients followed up with a cancer diagnosis must be well-informed about cancer to be able to cope with it. Besides, informing the relatives of the cancer patients who are also experiencing the same process about the diagnosis and follow-up period of cancer is highly important. In the current study, it was aimed to evaluate the information sources about cancer which are referred to by relatives of cancer patients. Three hundred ninety-one cancer patient relatives were included in medical oncology clinic between May 1 and June 30, 2015. A questionnaire was applied to the participants, comprising 12 questions to elicit demographic information and 11 questions about the information sources to which they referred. The study included 183 female and 208 male participants with a mean age of 47.9 ± 13.6 years. While the oncologists were the primary information sources referred to by 87%, the Internet was the second most preferred information source by 72%. The websites most frequently referred were the official websites (70%), the websites of oncology associations (53%), and social networks and forums (32%). The primary factors affecting the Internet preference were age, education level, income level, and place of residence. The Internet was the second most referred information source about cancer by family caregivers following oncologists. Therefore, it is of crucial importance that physicians inform patients and their relatives comprehensively as well as guiding them to correct and reliable information sources.

The Suitability of Written Education Materials for Stroke Survivors and Their Carers

This study evaluated the suitability of written materials for stroke survivors and their carers. Twenty stroke survivors and 14 carers were interviewed about the stroke information they had received and their perceptions of the content and presentation of materials of increasing reading difficulty. The mean readability level of materials (grade 9) was higher than participants' mean reading ability (grade 7-8). Satisfaction with materials decreased as the content became more difficult to read. Seventy-five percent reported that their information needs were not met in hospital. More stroke survivors with aphasia wanted support from health professionals to read and understand written information, and identified simple language, large font size, color, and diagrams to complement the text as being important features of written materials. Simple materials that meet clients' information needs and design preferences may optimally inform them about stroke.

Quality and use of consumer information provided with home test kits: room for improvement

BACKGROUND

Diagnostic self-tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self-testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity.

OBJECTIVE

To examine consumers' use of and needs for information about self-testing, and to assess the quality of consumer information provided with home test kits, as perceived by consumers and as assessed using a checklist of quality criteria.

METHODS

A cross-sectional Internet survey among 305 self-testers assessed their use of and needs for information and their perception of the quality of consumer information provided with self-test kits. A meta-search engine was used to identify Dutch and English consumer information for home diagnostic tests available online at the time of the study. The quality of this consumer information was evaluated using a checklist of quality criteria.

RESULTS

The consumers' information needs were in line with the most frequently used information, and the information was perceived as being of moderate to good quality. The information was mostly in agreement with clinical practice guidelines, although information on reliability and follow-up behaviour was limited. Approximately half of the instruction leaflets did not include information on the target group of the test.

CONCLUSIONS

Although generally of moderate to good quality, some aspects of the information provided were in many cases insufficient. European legislation concerning self-tests and accompanying information needs to be adapted and adhered to more closely.

Surgical pathology and the patient: a systematic review evaluating the primary audience of pathology reports

The pathology report is a critical document that helps guide the management of patients with cancer. More and more patients read their reports, intending to participate in decisions about their care. However, a substantial subset of patients may lack the ability to comprehend this often technical and complex document. We hypothesized that most literature on pathology reports discusses reports from the perspective of other physicians and not from the perspective of patients. An expert panel of physicians developed a list of search criteria, which we used to identify articles on PubMed, MEDLINE, Cochrane Reviews, and Google Scholar databases. Two reviewers independently evaluated all articles to identify for detailed review those that met search criteria. We identified the primary audience of the selected articles and the degree to which these articles addressed clarity of communication of pathology reports with patients. Of 801 articles identified in our search, 25 involved the formatting of pathology reports for clarity of communication. Recurrent themes in proposed improvements in reports included content standardization, variation in terminology, clarity of communication, and quality improvement. No articles discussed patients as their target audience. No study evaluated the health literacy level required of patients to comprehend pathology reports. In summary, there is a scarcity of patient-centered approaches to improve pathology reports. The literature on pathology reports does not include patients as a target audience. Limited resources are available to help patients comprehend their reports. Efforts to improve patient-centered communication are desirable to address this overlooked aspect of patient care.

ABOP, the automatic patient information leaflet optimizer: evaluation of a tool in development

OBJECTIVE

We developed a semi-automated leaflet optimizer (ABOP) to improve the readability of Dutch patient information leaflets (PILs). Our aim was to assess whether or not revisions made with ABOP have an effect on traceability and comprehension of PIL information.

METHODS

Two leaflets (one for oxazepam and one for tetracycline) were revised with the ABOP tool and both the original versions and ABOP versions were tested for readability, according to the EC guideline.

RESULTS

The ABOP version for oxazepam (p<.0001) scored significantly better than its original counterpart in readability tests. Although the results showed that the ABOP version of the tetracycline antibiotic outperformed the original version the difference in scores was not statistically significant. Terminology improvements had the greatest effect on information retrieval and comprehension. Improvements to instructions and warnings did not affect retrieval and comprehension scores. Overall improvements did not ensure full compliance with EC requirements, but results are not far off.

CONCLUSION

This study shows that even though ABOP does not solve all text quality issues, it does largely prepare a PIL for readability testing.

PRACTICE IMPLICATIONS

Using ABOP as a revision tool for PILs can optimize PIL quality and hence reduce readability testing time and costs.

Designing effective written health education materials: Considerations for health professionals

PURPOSE

Written health education materials can only be effective if they can be read, understood, and remembered by patients. The purpose of this article was to review the literature about features that should be incorporated into written health education materials to maximize their effectiveness, identify where there is consensus and debate about which features should be incorporated, and develop recommendations that health professionals can use when reviewing their existing materials and designing new materials.

METHOD

Literature review of published research and education articles.

RESULTS

There is a large number of features that need to be considered when designing written health education materials so that they are suitable for the target audience and effective. Although there is consensus about the majority of features that should be included, further research is needed to explore the contribution of certain features, such as illustrations, to the effectiveness of written materials and the effect of well-designed written materials on patient outcomes.

CONCLUSIONS

Health professionals need to provide their patients with written health education materials that are patient-orientated and designed according to the best practice principles in written health education material design.

Suitability and readability assessment of educational print resources related to physical activity: implications and recommendations for practice

OBJECTIVE

The primary objective of this study was to assess the suitability and readability level of publicly available educational print resources related to physical activity (PA).

METHODS

Educational print resources related to PA (n=66) were requested from organizations (e.g., professional, commercial, government, and educational). The suitability assessment of materials (SAM) and the simple measure of gobbledygook (SMOG) readability measure were used to evaluate the suitability and readability of the PA resources.

RESULTS

Of the 66 PA resources, suitability scores were superior in only 10 resources (15%), adequate in 36 resources (55%), and inadequate/not suitable in 20 resources (30%). The average reading grade level for the PA resources was a 10th grade level (S.D.=1.82; Rg=5th grade to 15th grade). Only 56.5% (n=35) of PA resources depicted a primary PA recommendation that was consistent with the public health recommendation for PA.

CONCLUSION

Results indicate that the majority of educational print resources related to PA have poor readability indices and inadequate to adequate suitability.

PRACTICE IMPLICATIONS

Health educators developing educational print resources related to PA must ensure these resources conform to the highest suitability standards. This includes developing resources that a) contain information consistent with current public health recommendations, and b) can be utilized by all individuals regardless of health literacy status.

Information preferences of women receiving chemotherapy for breast cancer

The aim of this cross-sectional survey was to identify a possible relationship between the information-seeking behaviour of patients receiving chemotherapy for breast cancer with source, type, amount and satisfaction of health information accessed. The sample (n = 36) were drawn from the medical oncology department of a large city centre teaching hospital. Participants were recruited through consecutive attendance to the medical oncology department. Eighty-six patients were invited to participate (response rate 42%). An anonymous self-report questionnaire and the Miller Behavioural Style Scale were used to measure attitudes towards 10 different sources of information and identify information-seeking behaviour. The study found that high information-seeking behaviour influenced the type of information sources used to find out about chemotherapy, but did not influence the level of satisfaction with the information sources used. Healthcare professionals were the most frequently used sources of information, but the majority of the sample used a variety of information sources. The Internet was the most frequently used mass media source of information (50% of the sample), especially by those under 50 years old (P = 0.033). Patients' behavioural signature needs to be considered when addressing their information needs. Oncology services need to provide patients with details of recommended high-quality websites to access for information about their chemotherapy.

[Communicating the results of the BI-RADS categories to patients in senology]

Clinical practice guidelines for psychological care and examples of announcing results are proposed for different categories of Breast Imaging Reporting and Data system (BI-RADS) of the American College of Radiology (ACR). Interpretation and recontextualization are explained for lesions category 2, management of paradox and doubt (probably benign and surveillance) for category 3, acceptance and emotions of patients for the category 4 or 5, psychological distress for the category 6. These models of exchange in doctor-patient relationship have to be modulated and adjusted to the women's profile and attitudes. A meaningful communication is necessary for the comprehension of information, for mammography adherence, for patient satisfactions and in the short and long term, it allows an adapted psychological adjustment for breast cancer.

A systematic review of readability and comprehension instruments used for print and web-based cancer information

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.

Health literacy and the World Wide Web: comparing the readability of leading incident cancers on the Internet

PRIMARY OBJECTIVE

to assess the readability level of Web-based information on leading incident cancers.

RESEARCH DESIGN

websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n=33), prostate (n=34), and colorectal (n=33) cancers were included in the final analysis.

METHODS

readability was assessed using SMOG, Flesch-Kincaid (F - K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10 - 30 lines of continuous text. Identical text was entered into Microsoft Word 2002 where F - K and FRE scores were determined automatically by the word processor.

RESULTS

the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F - K. The mean FRE score was 45.3, a score considered 'difficult'. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs.

CONCLUSIONS

findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.

Impact of providing booklets about chemotherapy to newly presenting patients with cancer: a randomized controlled trial

BACKGROUND

There has been limited research examining the efficacy of providing written information to cancer patients in southern and eastern European countries. This study investigated the impact of a booklet about chemotherapy on patient satisfaction, quality of life (QoL) and emotional distress, and assessed booklet use.

PATIENTS AND METHODS

A total of 145 Greek cancer outpatients prior to commencing chemotherapy completed a questionnaire and were randomized to receive (n = 72) or not receive (n = 73) the booklet. All patients completed the second questionnaire before the following cycle of chemotherapy.

RESULTS

Baseline characteristics were well balanced between the two groups. Experimental group patients reported being significantly more satisfied with the information received and care overall than those in the control group, felt significantly more and better informed, and perceived the information received as being clearer and detailed. The intervention produced no benefits in terms of anxiety, depression or QoL. The booklet was read by almost all patients and to a great extent by significant others. The majority considered the booklet useful to read and helpful in recalling chemotherapy-related information.

CONCLUSIONS

The current results provide further evidence on the efficacy of information-giving interventions in societies where disclosure of information to cancer patients still remains controversial.

A survey of the quality of information leaflets on hayfever available from general practices and community pharmacies

BACKGROUND

Hayfever affects at least one in 10 people. The majority of hayfever is managed in the community setting where the management options are pharmaceutical and behavioural. Hayfever medications are available over the counter and on prescription from the general practitioner. Patient information leaflets are published to augment the advice given and to promote self-management, but these leaflets have rarely been subjected to critical review.

OBJECTIVE

To assess the quality of patient information leaflets written for people with hayfever and available from general practices and from community pharmacists.

METHOD

A structured review of patient information leaflets about hayfever. During the peak grass pollen season copies of all leaflets available were collected from a random sample of community pharmacists and general practices in Wessex. The characteristics of the leaflet were recorded and the contents and presentation of each one was reviewed using the British Medical Association patient information appraisal system. Readability was assessed using the Simple Measure of Gobbledegook (SMOG). Two allergy-accredited specialists assessed each leaflet for accuracy.

RESULTS

During the peak pollen season no leaflets were available in 30% of the Community Pharmacists and 23% general practices. In total, 38 different leaflets were identified. All the leaflets reviewed were written for adults. Forty-seven percent of the leaflets had no publication date and one-third of those dated were at least 5 years old. In general the leaflets scored highly on issues of presentation, but less than half contained information on the full range of management and treatment options, many being biased towards a single or limited range of interventions. Seventy-nine percent leaflets were produced or sponsored by pharmaceutical companies and gave prominence to their own products. All the leaflets had readability scores requiring at least secondary education (SMOG score equal or greater than 9). At least one factual inaccuracy was identified in four-fifths of leaflets.

CONCLUSION

A large number of leaflets are published for people with hayfever, but they are of variable quality and not accessible to all patients because of limited distribution or high readability scores. If all patients are to benefit from written information the authors and publishers of leaflets need to follow published recommendations, especially with respect to content and readability. In the absence of a national public health information strategy or a body that systematically vets patient information materials, clinicians must pay attention to the quality of information provided for or obtained elsewhere by their patients.

The development of a psychoeducational intervention for women living with an increased risk of breast cancer

Research has shown a widespread need for written information on topics related to familial risk of breast cancer amongst women who have been living with an increased risk of the disease for several years. This article describes the development of a psychoeducational intervention designed to meet the needs of these women. Following a review of the literature and existing information resources, a multidisciplinary group developed a written information pack consisting of scientific and psychosocial (self-help) information with the aim of improving knowledge and reducing cancer worry. The information pack has been evaluated by seven independent health professionals and piloted on eight women at increased risk of breast cancer. Aspects of readability and presentation have been considered. The results of a randomised controlled trial of the intervention, which will inform the current provision of clinical services for these women, will be reported elsewhere.

Quality and efficacy of educational materials on cancer-related fatigue: views of patients from two European countries

Cancer-related fatigue is a symptom with great implications for the quality of life of those that experience it. It is regarded as one of the most distressing symptoms that people with cancer develop. Its aetiology is complex, and although the mechanisms underlying fatigue have not been fully clarified it is evident that it is exacerbated by treatments intended to cure or palliate the disease. Patients at risk of cancer-related fatigue need access to information that will enable them to manage it effectively. There are a growing number of materials available to patients in different European countries on this topic, but it is unclear how useful patients find these. This study was undertaken to explore this through conducting focus groups with patients in the United Kingdom and Switzerland. One focus group was conducted in each country. Findings from these determined that individuals voiced common concerns: fatigue had not been addressed in the clinical setting - individuals surmised why this occurred; participants had not accessed materials on cancer-related fatigue previously; they made recommendations for future resources for patients. However, what was evident was that unless patients can access materials on this topic, their quality becomes purely an academic issue.

Developing culturally sensitive cancer genetics communication aids for African Americans

The goal of this project was to develop educational materials to communicate genetic health information in a culturally sensitive manner. These materials were designed to communicate information about cancer risk, genetic testing options, and health management options in an African American kindred with a known BRCA1 mutation. Educational materials were pilot-tested in four African American focus groups varying in socioeconomic status and gender. The audiotaped focus groups consisted of presentation of the educational materials, followed by a feedback session led by an African American facilitator. Qualitative analysis of the focus group transcripts identified important themes and the educational materials were revised in response to the participants' suggestions. The products included a booklet and a flip chart for use in educational sessions. Focus group participants recommended a substantial reduction in technical detail, and recommended that information be personalized and made relevant to the lives of the target population. Other critical themes included the importance of building trust in the medical system and avoiding words and images that have strong negative associations in the African American community. Strategies that were successful included nontechnical images to explain genetic concepts, clip art images to energize and personalize word slides, vibrant color, identifiably African American figures, and the development of themes relevant to many African Americans. The use of these materials in an ongoing study offering BRCA1 counseling and testing to a large, rural Louisiana-based kindred will provide additional feedback about the effectiveness of the culturally tailored genetic education and counseling materials.

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

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

Factors influencing consumer use of written drug information

OBJECTIVE

To provide an overview of the use and impact of written drug information (WDI) on consumers, and to review the literature on the factors influencing the use of WDI by consumers.

DATA SOURCES

Relevant articles published in English since the late 1970s were identified based on searches of on-line databases, texts, and cited references in published articles.

STUDY SELECTION

Articles reporting findings on the origin, use, and impact of WDI were included. Due to limited literature, articles reporting findings on factors influencing the use of written drug as well as disease information were included.

DATA EXTRACTION

Due to the lack of design consistency between studies and the comparatively small volume of work, subjective assessment rather than a criteria-based objective review was deemed more appropriate.

DATA SYNTHESIS

To date, research on WDI has focused on its use and impact. WDI has the potential to increase patients' knowledge, compliance, and satisfaction. However, there is also the potential for anxiety or premature cessation of therapy due to fear of possible adverse effects. Multiple factors may potentially influence the use of WDI by consumers including those associated with the written information document (readability, presentation), the patient (health literacy, role of caregiver, demographic factors, health locus of control, coping style, health belief model), and the environment (timing of provision, experience).

CONCLUSIONS

WDI has the potential to impact consumers positively and negatively. Although not widely investigated, a number of factors can potentially influence the use of WDI by consumers. The findings of this review can form the basis for much needed further research.

Information within optometric practice: comprehension, preferences and implications

The partnership approach to health care, in which patients take an active role in decision making, can potentially improve patient satisfaction and adherence to clinician recommendations. However, the process can be impeded by insufficient or poor-quality information provision. This study explored participants' understanding of, and requirements for, optometric information. Information leaflets were obtained from 12 optometry practices and four internet-based resources. Sixty-four patients/ clients participated in focus groups that explored: (1) their understanding of diagrams of visual function, (2) perceptions of good information, (3) information requirements and (4) perceptions of the effects of improved information. A theory-led thematic analysis identified three major themes within each of the four categories. The use of jargon and the inappropriate layout of diagrams and text impeded comprehension of the leaflets. High-quality information was defined as being written concisely with simple explanations and clear diagrams. There was also a preference for information to be relevant and applicable to the patient's own eye care needs. In addition, participants expressed a desire for both written and verbal information regarding eye examination procedures and interpretation of prescriptions. Advice regarding eye care was also requested. To facilitate a partnership approach and improve patient satisfaction, patients should be provided with jargon-free concisely written and clearly presented information. In addition to general information, patients would also benefit from personalised information regarding test results and eyecare regimes.

Impact of risk information in a patient education leaflet

Informed consent requires the communication of information about possible adverse effects of treatment. Health professionals have expressed concern that increased provision of risk information may make patients unduly anxious and change their decisions about treatment. This study compared two patient leaflets about laparoscopy, one containing detailed information about potential side effects. Forty one consenting participants attending an outpatient gynaecology clinic and scheduled for an elective laparoscopic procedure were studied. They were randomly assigned to receive one of two leaflets after their consultation. Knowledge about laparoscopy, satisfaction with information provided, and anxiety were tested 2 days later, between the original consultation and their operation. Results showed that the leaflet containing detailed risk information was associated with greater knowledge about laparoscopy, higher satisfaction with information provision and no increase in anxiety. Provision of detailed information about possible adverse consequences of treatment can improve patients' understanding and satisfaction without inducing increased anxiety.

Patient information leaflets for medicines: using consumer testing to determine the most effective design

Comprehensive medicine information leaflets for patients are now mandatory across the European Union. In 1997, the European Commission (EC) proposed a prescriptive 'model' for the leaflets and a method for consumer testing. This exploratory study compared consumers' ability to use a leaflet based on the EC model leaflet and an alternative leaflet based on best practice in information design (Mark II). The leaflets were tested in two matched groups of 20 consumers, who were required to find, and understand, 15 pieces of information in the leaflets. The target that each question should be answered correctly by 16 out of 20 consumers, was achieved for three of the 15 points in the EC leaflet, compared with eight in the Mark II leaflet. Open questioning confirmed the problems with the EC leaflet, including a failure to understand key concepts about medicine interactions and contraindications. This research demonstrates the benefits of consumer testing, ensuring that leaflets are patient-orientated. A rigid model leaflet would prevent these benefits from being utilised.

An evidence-based patient information leaflet about otitis media with effusion

Leaflets are a useful resource for information provision. Many otolaryngology patients have poor reading skills, and may have difficulty understanding medical jargon. The aim of this project was to produce a patient information leaflet on otitis media with effusion whose content is based on the best available research evidence, and which is presented in a clear format with simple language. Patients were involved at the planning stage, and in testing the final draft. The leaflet was preferred by the majority compared to existing information material and was felt to be more informative and easier to understand. The leaflet has been given the Crystal Mark for clarity of language by the Plain English Campaign. This study shows that existing guidelines can be used to improve the quality of written information provision.

Quality of written information used in Down syndrome screening

A qualitative assessment was performed on 81 leaflets used in maternal serum Down syndrome screening from National Health Service (NHS) obstetric units and private screening services. Quality was assessed by factual content, presentation and reading ease and this was amalgamated into a single overall score expressed as a percentage of the maximum possible score. Eleven (14%) leaflets included all eight factual items recommended by the Royal College of Obstetricians and Gynaecologists (RCOG); only one included these and a further nine items recognised as important to the consumer. Three (4%) leaflets contained information that was incorrect and 17 (21%) that was misleading or inconsistent. Using published criteria six (7%) leaflets were well presented and ten (12%) were fairly easy to read. The average reading age was 13-14 years. The overall quality score showed that five leaflets had 80% or more of the total possible score. However a substantial number, 15 (19%), were totally unacceptable having scores of 40% or less. In general the quality of leaflets used in the UK is considered poor. A national peer-reviewed leaflet should be prepared which can be modified to suit local policy.

Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer

A decision aid for the surgical treatment of early breast cancer was evaluated in a randomized controlled trial. The decision aid, a tape and workbook, includes explicit presentation of probabilities, photographs and graphics, and a values clarification exercise. Community surgeons were randomized to use the decision aid or a control pamphlet. Patients completed a questionnaire prior to using the decision aid, after reviewing it but prior to surgery, and 6 months after enrollment. There was no difference in anxiety, knowledge, or decisional regret across the 2 groups. There was a nonsignificant trend toward lower decisional conflict in the decision aid group. A subgroup of women who were initially leaning toward mastectomy or were unsure had lower decisional conflict. Although the decision aid had minimal impact on the main study outcomes, a subgroup may have benefited. Such subgroups should be identified, and appropriate decision support interventions should be developed and evaluated.

The information needs and source preferences of women with breast cancer and their family members: a review of the literature published between 1988 and 1998

A comprehensive and critical literature review was conducted to examine the information needs and source preferences of women with breast cancer and their family members. Relevant papers published between 1988 and 1998 were reviewed and despite their having several methodological weaknesses, a number of conclusions can still be drawn. First, women with breast cancer have distinct needs for information throughout their breast cancer journeys, indicating that information needs change with time since diagnosis and with treatment-related events. Second, family members of women with breast cancer also have substantial needs for information. Third, women with breast cancer and their family members often prefer verbal forms of information from health care professionals (HCPs), particularly around the time of diagnosis. Women with breast cancer, however, are often dissatisfied with the information they receive from HCPs. Further, the family members of women with breast cancer often perceive their information needs to be ignored by HCPs. Finally, few studies have focused specifically on the information needs and source preferences of family members of women with breast cancer. These findings have a number of implications for nursing, both for clinical practice and nursing research, and these are discussed in the review.

Providing patients with written medication information

OBJECTIVE

To review the literature and provide recommendations for the development and dissemination of written medication information to patients and their care providers.

DATA SOURCES

A MEDLINE search (1966-1997) of the English-language literature was performed to identify articles pertaining to the development or use of written medication information. A search of the Internet was conducted by using Yahoo as the guide and "medication information" as the search term. Additional resources were obtained through texts, bibliographies, and catalogs from medical publishers.

DATA EXTRACTION

Reports documenting the creation and use of written medication information systems were reviewed, as well as studies of readability and reading skills assessment. Examples of materials available for purchase by laypeople and healthcare providers were also examined.

DATA SYNTHESIS

Current statistics support the widespread availability of written medication information for patients and care providers. The goal set forth by the Food and Drug Administration of having 75% of patients receive written information by the year 2000 appears achievable. However, there are still many issues to address. Content is not standardized, and materials are frequently written at reading levels higher than that of the average patient. The development and use of resources requiring only minimal reading skills and an increase in the availability of materials written in Spanish are needed.

CONCLUSIONS

Written medication information provides a useful addition to counseling by healthcare professionals. A wide variety of prepared materials is available, as well as resources for those interested in developing tools for a specific patient, population, or setting. Healthcare professionals should be aware of the limitations of some resources. Content and readability must be appropriate for the intended audience for these tools to serve a useful role in patient education.