Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology

Patient Education in Neurosurgery: Part 1 of a Systematic Review

BACKGROUND

Patient education has become increasingly important in neurosurgery. However, little is known regarding how to comprehensively educate neurosurgical patients. In the first part of a 2-part systematic review, we identify baseline patient understanding and educational needs, examine existing patient education materials, and characterize shortcomings in neurosurgical patient education practices. Our findings may guide neurosurgeons, departments, and professional associations in improving communication with patients.

METHODS

A 2-part systematic review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were read and selected for full text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.

RESULTS

Of 1617 resultant articles, 41 were included. Patient comprehension was low. Patient informational needs differed across patients and between patients and neurosurgeons. Patient informational needs were often unmet, promoting dissatisfaction. Written educational materials from government agencies, professional associations, neurosurgery departments, neurosurgeons, or widely read Web sites were written at a reading level above the recommended reading level, with complex topics written at a higher level. Information found on hospital and university Web sites was poor quality because of self-marketing and lack of reference to peer-reviewed literature. Educational videos created by universities and hospitals were poor quality.

CONCLUSIONS

Current in-clinic discussions and education materials show shortcomings, promoting poor comprehension. Neurosurgeons, departments, and professional organizations can act to improve the effectiveness of patient education initiatives. This policy will better inform patients, increase rapport between neurosurgeons and patients, and improve patient decision making and satisfaction.

Readability of Patient Education Materials From RadiologyInfo.org: Has There Been Progress Over the Past 5 Years?

OBJECTIVE. As patients increasingly turn to the Internet for healthcare information, it is imperative that patient educational materials be written at an appropriate readability level. Although RadiologyInfo.org, a patient education library sponsored by the American College of Radiology (ACR) and Radiological Society of North America, was shown in 2012 to be written at levels too high for the average patient to adequately comprehend, it is unclear if there has been progress made in the past 5 years. The purpose of this study was to provide a 5-year update on the readability of patient education materials from RadiologyInfo.org. MATERIALS AND METHODS. All patient education articles available in 2017 from the ACR and RSNA-sponsored RadiologyInfo.org patient education library were reviewed. We assessed each article for readability using 6 quantitative readability scales: the Flesch-Kincaid (FK) grade level, Flesch Reading Ease, Gunnin-Fog Index, Coleman-Liau Index, Automated Readability Index, and the Simple Measure of Gobbledygook (SMOG). The number of articles with readability ≤ the 8^th grade level (average reading ability of US adults) and the 6^th-grade level (NIH-recommended level for patient materials) were determined. RESULTS. 131 patient education articles were reviewed. The mean readability grade level was greater than the 11^th grade reading level for all readability scales. None of the articles were written at less than the 8^th-grade or the 6^th-grade levels. CONCLUSION. Although there has been an increasing awareness of the issue of readability of patient educational materials within the radiological community, the patient educational materials within the ACR and RSNA-sponsored RadiologyInfo.org website are still written at levels too high for the average patient. Future efforts should be made to improve the readability of those patient education materials.

A printed information leaflet about MRI and radiologists improves neuroradiology patient health literacy

PURPOSE

To determine the health literacy benefit of a printed informational leaflet for patients scheduled to undergo brain magnetic resonance imaging (MRI) scans.

METHODS AND MATERIALS

A two-page leaflet that provided an overview of MRI and the role of radiologists was prepared and given to outpatients scheduled to undergo brain MRI examinations while in the waiting room. A survey composed mainly of yes/no and Likert scale questions pertaining to the leaflet, as well as patient demographics, was administered to the patients.

RESULTS

A total of 147 patients completed the survey, of which 110 (75%) had undergone a prior MRI scan, 120 (82%) stated that their ordering provider explained the reason for the MRI scan, and less than 1% reported having referenced online resources related to MRI. The average score for how well patients understood the MRI scan procedure and how it is reviewed was 4.16/5 (standard deviation 1.18) before versus 4.39/5 (standard deviation 1.08) after reading the leaflet, which was a statistically significant improvement based on the Wilcoxon signed-rank test ( P < 0.01). The score for how helpful the reading material was for explaining what is MRI was 4.06/5 (standard deviation 1.02) and the score for how helpful the reading material was for explaining what is a radiologist was 4.18/5 (standard deviation 0.98).

CONCLUSION

A printed leaflet about MRI and radiologists can serve as an opportunity to educate patients about certain aspects of their scans during their stay in the waiting room.

Quantitative analysis of the level of readability of online emergency radiology-based patient education resources

PURPOSE

The vast amount of information found on the internet, combined with its accessibility, makes it a widely utilized resource for Americans to find information pertaining to medical information. The field of radiology is no exception. In this paper, we assess the readability level of websites pertaining specifically to emergency radiology.

METHODS

Using Google, 23 terms were searched, and the top 10 results were recorded. Each link was evaluated for its readability level using a set of ten reputable readability scales. The search terms included the following: abdominal ultrasound, abdominal aortic aneurysm, aortic dissection, appendicitis, cord compression, CT abdomen, cholecystitis, CT chest, diverticulitis, ectopic pregnancy, epidural hematoma, dural venous thrombosis, head CT, MRI brain, MR angiography, MRI spine, ovarian torsion, pancreatitis, pelvic ultrasound, pneumoperitoneum, pulmonary embolism, subarachnoid hemorrhage, and subdural hematoma. Any content that was not written for patients was excluded.

RESULTS

The 230 articles that were assessed were written, on average, at a 12.1 grade level. Only 2 of the 230 articles (1%) were written at the third to seventh grade recommended reading level set forth by the National Institutes of Health (NIH) and American Medical Association (AMA). Fifty-two percent of the 230 articles were written so as to require a minimum of a high school education (at least a 12th grade level). Additionally, 17 of the 230 articles (7.3%) were written at a level that exceeded an undergraduate education (at least a 16th grade level).

CONCLUSIONS

The majority of websites with emergency radiology-related patient education materials are not adhering to the NIH and AMA's recommended reading levels, and it is likely that the average reader is not benefiting fully from these information outlets. With the link between health literacy and poor health outcomes, it is important to address the online content in this area of radiology, allowing for patient to more fully benefit from their online searches.