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. 2024 Sep 12:22:530-539.
doi: 10.1016/j.xjon.2024.09.005. eCollection 2024 Dec.

Assessment of printed lung cancer surgery patient education materials in the United States

Woorin Jang  1 , Savanna Kerstiens  1 , Rachel Nordgren  2 , Anne Dijkstra  1 , Marina DePablo  3 , Lauren Gleason  4 , Darren Bryan  1 , Jessica S Donington  1 , Mark K Ferguson  1 , Jane L Holl  1 , Maria Lucia Madariaga  1
Affiliations

Assessment of printed lung cancer surgery patient education materials in the United States

Woorin Jang et al. JTCVS Open. .

Abstract

Objective: Well-designed patient education materials (PEMs) increase health literacy, which has been linked to better surgical patient outcomes. The quality of lung cancer surgery PEMs is unknown, however. Here we assessed printed lung cancer surgery PEMs for readability, understandability, actionability, and accessibility.

Methods: Various lung cancer programs throughout the United States were contacted for their lung cancer surgery PEMs. The readability of the received materials was calculated using 6 readability tests. Four thoracic surgeon-advanced practice practitioner dyads scored the PEMs for understandability, actionability, and accessibility using the Patient Education Material Assessment Tool and the Accessibility Assessment Tool, with the recommended minimum threshold of 70%. One-sample t tests were performed to compare each parameter against its recommended threshold.

Results: Out of 34 institutions contacted, 18 (52.9%) provided PEMs. The average reading level of the PEMs ranged from 7th grade to 11th grade, significantly exceeding the recommended 6th grade health literacy threshold (P < .01). Although mean understandability (73.7 ± 13.2%) and actionability (70.2 ± 17.8%) scores were not significantly different from the minimum threshold, and the mean accessibility score (81.8 ± 13.5%) was significantly higher than the threshold (P < .05), there was wide variation in the scores. Most PEMs scored well in organization and writing but lacked other features that can enhance patient understanding, such as visual aids and summaries.

Conclusions: PEMs are written at reading levels that are too advanced for patients. Although PEMs scored well in understandability, actionability, and accessibility, analysis of individual items revealed the need for improvement, including the use of shorter sentences, more visual aids and summaries, and expansion of language translations.

Keywords: accessibility; lung cancer surgery; patient education materials; readability; understandability.

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Conflict of interest statement

Dr Donington reports receiving speaking honoraria from and advising for Amgen, AstraZeneca, BMS Merck, and Roche/Genentech. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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We measure 4 parameters to evaluate the quality of existing patient education materials for lung cancer surgery.
Figure 1
Figure 1
Graphical overview of the study.
Figure 2
Figure 2
The average readability levels of patient educational materials calculated with 6 different readability analyses all exceeded the recommended maximum threshold of the 6th grade reading level. FKGL, Flesch-Kincaid Grade Level; GFI, Gunning Fog Index; SMOG, Simple Measure of Gobbledygook Index; CLI, Coleman-Liau Index; Fry, Fry Readability Graph; Raygor, Raygor Readability Graph.
Figure 3
Figure 3
The average understandability, actionability, and accessibility scores of lung cancer patient education materials met or exceeded the minimum threshold score of 70% but showed a wide range of scores.
Figure 4
Figure 4
The percentage of patient education materials that satisfied each item on the assessment tools.
Figure E1
Figure E1
Geographic distribution of institutions invited to participate in the study.
See this image and copyright information in PMC

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