Readability, Complexity, and Suitability of Online Resources for Mastectomy and Lumpectomy

• Published in: The Journal of surgical research 2017-05, Vol.212, p.214-221
• Main Authors: Tran, Bao Ngoc N., MD, Singh, Mansher, MD, Singhal, Dhruv, MD, Rudd, Rima, ScD, Lee, Bernard T., MD, MBA, MPH, FACS
• Format: Article
• Language: English
• Subjects: Adult; Breast Neoplasms - surgery; Complexity; Comprehension; Consumer Health Information - standards; Consumer Health Information - statistics & numerical data; Female; Health Literacy; Humans; Internet; Lumpectomy; Mastectomy; Mastectomy - methods; Readability; Suitability; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.01.012

Background Nearly half of American adults have low or marginal health literacy. This negatively affects patients’ participation, decision-making, satisfaction, and overall outcomes especially when there is a mismatch between information provided and the skills of the intended audience. Recommendations that patient information be written below the sixth grade level have been made for over three decades. This study compares online resources for mastectomy versus lumpectomy using expanded metrics including readability level, complexity and density of data, and overall suitability for public consumption. Methods The 10 highest ranked websites for mastectomy and lumpectomy were identified using the largest Internet engine (Google). Each website was assessed for readability (SMOG, Simple Measure of Gobbledygook), complexity (PMOSE/iKIRSCH), and suitability (SAM, Suitability Assessment of Materials). Scores were analyzed by each website and overall. Results Readability analysis showed a significant reading grade level difference between mastectomy and lumpectomy online information (15.4 and 13.9, p=0.04, respectively). Complexity analysis via PMOSE/iKIRSCH revealed a mean score of 6.5 for mastectomy materials corresponding to “low” complexity and 8th -12th grade education. Lumpectomy literature had a lower PMOSE/iKIRSCH score of 5.8 corresponding to a “very low” complexity and 4th -8th grade education (p=0.05). Suitability assessment showed mean values of 41% and 46% (p=0.83) labeled as the lowest level of ‘adequacy’ for mastectomy and lumpectomy materials, respectively. Inter-rater reliability was high for both complexity and suitability analysis. Conclusions Online resources for the surgical treatment of breast cancer are above the recommended reading grade level. The suitability level is barely adequate indicating a need for revision. Online resources for mastectomy have a higher reading grade level than do materials for lumpectomy and tend to be more complex.