Conference Coverage

Patient instructions in surgery exceed recommended reading grade level


Key clinical point: Patient education materials in surgery typically exceed the recommended guidelines of being at a sixth-grade reading level.

Major finding: Only 16% of patient education materials from surgical specialties met the recommended guideline.

Data source: Flesch-Kincaid Grade Level analysis of 112 education materials collected from 12 different surgical specialties at the University of Alabama at Birmingham.

Disclosure: Ms. Perkins reported having no financial relationships to disclose.

Source: Perkins, C et al. Abstract 67.08.



– The American Medical Association and National Institutes of Health recommend that patient instructions should be written at a sixth-grade level, and the Centers for Disease Control and Prevention recommend an eighth-grade level so patients and caregivers can easily understand them, but a study of education materials that patients get for surgery finds that they typically overshoot that mark – in some cases considerably.

Stack of papers Ingram Publishing/
Researchers evaluated 112 education materials collected from the various specialties and used the Flesch-Kincaid Grade Level (FKGL) analysis to score their readability. This reading comprehension tool identifies reading difficulty by language by measuring average length of sentences and number of syllables. Individual words can also be scored.

“Only 16% of our collected material actually met the standards for readability,” Ms. Perkins said. “As far as surgical subspecialties go, neurosurgery had the highest grade level and plastic surgery had the lowest.”

Nine of the 12 surgical disciplines had no materials at the sixth-grade level or below. Plastic surgery had the highest percentage of materials that met the recommended standard: 47%. Overall, plastic surgery education materials had the lowest FKGL score, at the equivalent of grade 6.34. Neurosurgery had the highest, at 9.83. Other disciplines with an FKGL of 9 or greater are thoracic surgery (9.61) and pancreatic surgery (9.18), while vascular surgery had a level of 8.95.

The study also looked at specific words commonly used in patient literature with FKGL scores that far exceed the recommended level, Ms. Perkins said. They include strenuous (21 FKGL), anesthesia (26.2 FKGL), narcotic (21.5 FKGL) and incision (16.8 FKGL).

The findings, Ms. Perkins said, “provide a clear opportunity for improvement of our patient materials at UAB.” She noted that Microsoft Word has a tool for evaluating the FKGL of text, although the software does not account for potentially more challenging anatomical terms.

Ms. Perkins suggested a way forward may be to hold focus groups with surgeons and nursing clinical care coordinators to educate them about more patient-friendly terminology. In the meantime, Ms. Perkins said, using the FKGL tool in Microsoft Word is the most accessible solution to gauge education materials that talk over the patient’s head.

Ms. Perkins reported having no financial relationships to disclose.

SOURCE: Perkins, C et al. Abstract 67.08

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