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Online patient material is not easy for patients to understand

Two recently published papers in the Journal of Vascular and Interventional Radiology (JVIR) reveal that patient materials in interventional radiology available online are way above the understanding of most patients. Both studies were carried out from the perspective of American patients and the investigators are urging hospitals and interventional radiologists to pay more attention to health literacy.

Referring to these studies, Ziv Haskal, editor-in-chief of JVIR, Charlottesville, USA, wrote in his editorial, “Consider this a call to arms as over 100 million users navigate the Web for healthcare information.”

One of the studies (Sadigh et al) set out to assess the readability of online education materials offered by hospitals describing commonly performed interventional radiology procedures. The investigators assessed online patient education materials from over 400 hospitals selected from the Medicare Hospital Compare database. They found that 76% of the hospitals presumed to offer interventional radiology services offered online patient education material for one or more of the eight service lines.

They assessed patient online education materials about uterine artery embolization for fibroid tumours, liver cancer embolization, varicose vein treatment, central venous access, inferior vena cava filter placement, nephrostomy tube insertion, gastrostomy tube placement, and vertebral augmentation using six validated readability scoring systems.

The authors reported that the average readability scores corresponding to grade varied between the ninth- and 12th-grade levels. All were higher than the recommended seventh-grade level (p<0.05) except for nephrostomy and gastrostomy tube placement. Average Flesch-Kincaid Reading Ease (that are readability tests designed to indicate how difficult a reading passage in English is to understand) scores corresponded with “fairly difficult” to “difficult” readability for all service lines except inferior vena cava filter and gastrostomy tube placement, which corresponded with standard readability.

A majority of hospitals offering interventional radiology services provide at least some online patient education material. Most, however, are written significantly above the reading comprehension level of most Americans, the authors conclude.

Another study (McEnteggart et al) set out to assess the readability of online patient education materials related to common diseases treated by and procedures performed by interventional radiology.

The investigators selected online patient education materials from the following websites due to their average Google search return: Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), National Library of Medicine, RadiologyInfo, Mayo Clinic, WebMD, and Wikipedia.

The interventional radiology content was assessed for the following procedures: peripheral arterial disease, central venous catheter, varicocoele, uterine artery embolization, vertebroplasty, transjugular intrahepatic portosystemic shunt, and deep vein thrombosis. The investigators analysed data using general mixed modelling and used a variety of common algorithms to estimate and compare readability levels.

They found that on average, online sources that required beyond high school grade-level readability were Wikipedia, SIR and RadiologyInfo; sources that required high school grade-level readability were CIRSE, Mayo Clinic, WebMD, and National Library of Medicine.

“On average, online patient education materials pertaining to uterine artery embolization, vertebroplasty, varicocele, and peripheral arterial disease required the highest level of readability,” the authors reported in JVIR.

The authors concluded that the materials assessed were “written above the recommended sixth-grade reading level and the health literacy level of the average American adult” and that “many patients may not have the ability to read and understand health information related to interventional radiology procedures.”