Danielle J. Chuang

Online patient resources for breast reconstruction: an analysis of readability.

Background: Online resources for health information are commonly used by many patients. The discrepancy between functional health literacy and available patient information is recognized as an important contributor to health disparities. To provide understandable patient information, the National Institutes of Health and the American Medical Association have advised that health literature for patients be written at a sixth-grade reading level. This study identifies the most popular, online, patient-targeted resources for breast reconstruction information, and evaluates readability of these sites in the context of literacy in the United States. Methods: A Web search for “breast reconstruction” was performed using the two largest Internet search engines, and the top 10 websites common to both were identified. Patient-targeted content was downloaded from all relevant articles immediately available from the main sites. A total of 114 articles were assessed for readability using 10 established analyses. Readability scores were also calculated for the groups of articles arranged by website for comparison. Results: The average reading level was 11.5 across all evaluated sites (Coleman-Liau, 11.8; Flesch-Kincaid, 10.9; FORCAST, 10.7; Fry, 12; Gunning Fog, 12.7; New Dale-Chall, 10.6; New Fog Count, 9.7; Raygor Estimate, 12; and Simple Measure of Gobbledygook, 13). Readability comparison by individual website demonstrated disparity in average reading level from 9.7 to 14.9. Conclusions: Online patient resources for breast reconstruction exceed recommended reading levels and are too difficult to be understood by a large portion of the population. Significant variability between sites provides an opportunity to direct patients to appropriate websites for their level of health literacy.

Readability of online patient resources for melanoma.

Medical information is often difficult for patients to understand. With specialized vocabulary and complex pathophysiology, even well-educated adults have trouble interpreting information about their healthcare. The average American adult reads at a seventh-grade level. In light of the inherent complexity of health information, the American Medical Association and National Institutes of Health have recommended that information for patients should be written at a sixth-grade level. The goal of this study was to evaluate the most commonly used online patient resources about melanoma in the context of these recommendations. A web search for ‘melanoma’ identified the 10 most-accessed websites. Location filters were disabled and sponsored results were excluded to avoid inadvertent search bias. All relevant, patient-directed articles were downloaded and formatted into plain text. Pictures, videos, links, advertisements, and references were removed. Readability analysis was carried out using 10 established tests, both overall and arranged by parent website for comparison. A total of 130 articles for melanoma information were identified. The overall mean reading grade level was 12.6. All sites exceeded the recommended sixth-grade level. Secondary analysis of articles grouped by website indicated a range of readability across sites from 9.9 (high school freshman) to 14.9 (university sophomore). Online patient resources for melanoma uniformly exceed the recommended reading level and may be too difficult for many Americans to understand. The range of readability among websites may indicate an opportunity for physicians to direct patients to more appropriate resources for their level of health literacy.

Assessment of patient health literacy: a national survey of plastic surgeons.

Background: Health literacy affects patient participation, compliance, and outcomes. Nearly half of American adults have inadequate functional health literacy. Identification and accommodation of patients with low literacy is an important goal of the American Medical Association, U.S. Department of Health and Human Services, and the Healthy People 2020 initiative. This study aims to assess plastic surgeons’ perception of patient literacy. Methods: A survey was distributed to American Society of Plastic Surgeons members about time devoted to patient counseling, use of techniques for evaluating and enhancing patient understanding, perception of level of education, and estimated literacy. Participation was voluntary and data were collected anonymously using an online survey tool. Results: There were 235 participants in the survey (9.9 percent response rate). Patient literacy was most frequently assessed using their general impression (62.2 percent) and by asking patients about their employment (37.3 percent); 26.2 percent did not assess literacy. The majority of surgeons (62 percent) reported spending at least 20 minutes counseling new patients, and 37 percent reported spending more than 30 minutes. Lay terminology (94 percent) and pictures/diagrams (84.6 percent) were common patient education aids, whereas only 8.1 percent use teach-back methods. Plastic surgeons overestimated the level of education and reading level of their patients compared with national data. Conclusions: Formal assessment of health literacy is rarely performed, as most plastic surgeons use a general impression. Although plastic surgeons devote significant time to patient counseling, evidence-based communication methods, such as the teach-back method, are underused. Simple, directed questions can identify patients with low literacy skills, to accommodate their communication needs.

Readability Assessment of Patient Information about Lymphedema and Its Treatment.

Background: Patient use of online resources for health information is increasing, and access to appropriately written information has been associated with improved patient satisfaction and overall outcomes. The American Medical Association and the National Institutes of Health recommend that patient materials be written at a sixth-grade reading level. In this study, the authors simulated a patient search of online educational content for lymphedema and evaluated readability. Methods: An online search for the term “lymphedema” was performed, and the first 12 hits were identified. User and location filters were disabled and sponsored results were excluded. Patient information from each site was downloaded and formatted into plain text. Readability was assessed using established tests: Coleman-Liau, Flesch-Kincaid, Flesch Reading Ease Index, FORCAST Readability Formula, Fry Graph, Gunning Fog Index, New Dale-Chall Formula, New Fog Count, Raygor Readability Estimate, and Simple Measure of Gobbledygook Readability Formula. Results: There were 152 patient articles downloaded; the overall mean reading level was 12.6. Individual website reading levels ranged from 9.4 (cancer.org) to 16.7 (wikipedia.org). There were 36 articles dedicated to conservative treatments for lymphedema; surgical treatment was mentioned in nine articles across four sites. The average reading level for conservative management was 12.7, compared with 15.6 for surgery (p < 0.001). Conclusions: Patient information found through an Internet search for lymphedema is too difficult for many American adults to read. Websites queried had a range of readability, and surgeons should direct patients to sites appropriate for their level. There is limited information about surgical treatment available on the most popular sites; this information is significantly harder to read than sections on conservative measures.

Readability Assessment of Online Patient Abdominoplasty Resources

BackgroundLimited functional health literacy is recognized as an important contributor to health disparities in the United States. As internet access becomes more universal, there is increasing concern about whether patients with poor or marginal literacy can access understandable healthcare information. As such, the National Institutes of Health and American Medical Association recommend that patient information be written at a sixth grade level. This study identifies the most popular online resources for patient information about abdominoplasty and evaluates their readability in the context of average American literacy.MethodsThe two largest internet search engines were queried for “tummy tuck surgery” to simulate a patient search in lay terms. The ten most popular sites common to both search engines were identified, and all relevant articles from the main sites were downloaded. Sponsored results were excluded. Readability analysis of the articles was performed using ten established tests.ResultsOnline information about abdominoplasty from the ten most popular publically available websites had an overall average readability of 12th grade. Mean reading grade level scores among tests were: Coleman–Liau 11.9, Flesch–Kincaid 11.4, FORCAST 11.1, Fry 13, Gunning Fog 13.5, New Dale–Chall 11.8, New Fog Count 9.9, Raygor Estimate 12, and SMOG 13.4; Flesch Reading Ease index score was 46.ConclusionsOnline patient resources about abdominoplasty are uniformly above the recommended target readability level and are likely too difficult for many patients to understand. A range of readability identified among websites could allow surgeons to guide patients to more appropriate resources for their literacy skills.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Readability assessment of online patient resources for breast augmentation surgery.

Background: Patients increasingly rely on Internet resources for medical information. Well-informed patients are more likely to be active participants in their health care, contributing to higher satisfaction and better overall outcomes. Access to online patient material, however, can be limited by inadequate functional health literacy. The National Institutes of Health and the American Medical Association recommend that educational content be written at a sixth-grade reading level. This study aims to assess the readability of online patient resources for breast augmentation surgery. Methods: A Web search for “breast implant surgery” was performed using the largest public search engine. After sponsored results were excluded, the 12 most accessed sites were identified. Patient-directed information from all relevant articles immediately linked from the main site was downloaded and formatted into plain text. The readability of 110 articles was evaluated using 10 established analyses, both overall and by Web site. Results: The overall average readability of the 12 most popular Internet resources for breast augmentation was at a thirteenth-grade reading level (Coleman-Liau, 13.4; Flesch-Kincaid, 12.7; FORCAST, 11.3; Fry, 13; New Dale-Chall, 12.9; New Gunning Fog, 13.8; Raygor Estimate, 15; and Simple Mesaure of Gobbledygook Formula, 14.3). The Flesch Reading Ease index was 41, which falls into a “difficult” reading category. No individual article or Web site was at the recommended sixth-grade level. Conclusions: Online resources for breast augmentation are above recommended reading levels. This may potentially serve as a barrier to patients seeking this type of surgery. Plastic surgeons should be aware of potential gaps in understanding and direct patients toward more appropriate resources.

Patient education for carpal tunnel syndrome: analysis of readability.

BackgroundThe National Institutes of Health and American Medical Association recommend a sixth grade reading level for patient-directed content. This study aims to quantitatively evaluate the readability of the most commonly used resources for surgical treatment of carpal tunnel syndrome.MethodsA web search for “carpal tunnel surgery” was performed using an Internet search engine, and the 13 most popular sites were identified. Relevant, patient-directed articles immediately accessible from the main site were downloaded and formatted into plain text. A total of 102 articles were assessed for readability using ten established analyses: first overall, then by website for comparison.ResultsPatient information about carpal tunnel surgery had an overall average reading level of 13.1. Secondary analysis by website revealed a range of mean readability from 10.8 (high school sophomore level) to 15.3 (university junior level). All sites exceeded the recommended sixth grade reading level.ConclusionsOnline patient resources for carpal tunnel surgery uniformly exceed the recommended reading level. These are too difficult to be understood by a large portion of American adults. A better understanding of readability may be useful in tailoring more appropriate resources for average patient literacy.

Online Patient Resources for Liposuction: A Comparative Analysis of Readability.

BackgroundAs patients strive to become informed about health care, inadequate functional health literacy is a significant barrier. Nearly half of American adults have poor or marginal health literacy skills and the National Institutes of Health and American Medical Association have recommended that patient information should be written at a sixth grade level. The aim of this study is to identify the most commonly used online patient information about liposuction and to evaluate its readability relative to average American literacy. MethodsAn internet search of “liposuction” was performed and the 10 most popular websites identified. User and location data were disabled and sponsored results excluded. All relevant, patient-directed articles were downloaded and formatted into plain text. Articles were then analyzed using 10 established readability tests. A comparison group was constructed to identify the most popular online consumer information about tattooing. Mean readability scores and specific article characteristics were compared. ResultsA total of 80 articles were collected from websites about liposuction. Readability analysis revealed an overall 13.6 grade reading level (range, 10–16 grade); all articles exceeded the target sixth grade level. Consumer websites about tattooing were significantly easier to read, with a mean 7.8 grade level. These sites contained significantly fewer characters per word and words per sentence, as well as a smaller proportion of complex, long, and unfamiliar words. ConclusionsOnline patient resources about liposuction are potentially too difficult for a large number of Americans to understand. Liposuction websites are significantly harder to read than consumer websites about tattooing. Aesthetic surgeons are advised to discuss with patients resources they use and guide patients to appropriate information for their skill level.

The Readability of Online Resources for Mastopexy Surgery.

BackgroundAs more patients use Internet resources for health information, there is increasing interest in evaluating the readability of available online materials. The National Institutes of Health and American Medical Association recommend that patient educational content be written at a sixth-grade reading level. This study evaluates the most popular online resources for information about mastopexy relative to average adult literacy in the United States. MethodsThe 12 most popular sites returned by the largest Internet search engine were identified using the search term “breast lift surgery.” Relevant articles from the main sites were downloaded and formatted into text documents. Pictures, captions, links, and references were excluded. The readability of these 100 articles was analyzed overall and subsequently by site using 10 established readability tests. Subgroup analysis was performed for articles discussing the benefits of surgery and those focusing on risks. ResultsThe overall average readability of online patient information was 13.3 (range, 11.1–15). There was a range of average readability scores overall across the 12 sites from 8.9 to 16.1, suggesting that some may be more appropriate than others for patient demographics with different health literacy levels. Subgroup analysis revealed that articles discussing the risks of mastopexy were significantly harder to read (mean, 14.1) than articles about benefits (11.6). ConclusionsPatient-directed articles from the most popular online resources for mastopexy information are uniformly above the recommended reading level and likely too difficult to be understood by a large number of patients in the United States.

Effects of statins on ischemia–reperfusion complications in breast free flaps

BACKGROUND Administration of statins or other cardiovascular medications (CVMs) could potentially protect against the development of ischemia-reperfusion (I/R) injury in free flap reconstruction. The aim of this study was to examine whether the use of statins and other CVMs decreased the rate of I/R injury in autologous free flap breast reconstruction. METHODS Retrospective chart review was performed on women who had undergone mastectomy and autologous free flap breast reconstruction between 2004 and 2010. Patient characteristics, use of statin and/or CVMs, and I/R-related complications were ascertained. Multivariable logistic regression was used to identify associations between independent risk factors and specific complications. RESULTS There were 702 free flap breast reconstructions included in this study; 45 performed in patients on statins, 70 in patients on CVMs, and 38 in patients on both. Overall complication rate in patients on statins and patients on CVMs was significantly higher than those not on any medication (46.7% versus 31.5%, P=0.037 and 45.7% versus 31.5%, P=0.017, respectively). When I/R complications were pooled, there were no significant differences between patients not on any medications and those on statins (P=0.26), CVMs (P=0.18), and both (P=0.83.) CONCLUSIONS Although there may be theoretical pharmacologic benefits of statins and/or CVMs to reduce the incidence of IR injury in autologous free flap breast reconstruction, the results of this study showed no clear advantages when these drugs were used.