Tran Bao Ngoc N, Singh Mansher, Singhal Dhruv, Rudd Rima, Lee Bernard T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
J Surg Res. 2017 May 15;212:214-221. doi: 10.1016/j.jss.2017.01.012. Epub 2017 Jan 28.
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.
The 10 highest ranked Web sites for mastectomy and lumpectomy were identified using the largest Internet engine (Google). Each Web site was assessed for readability (Simple Measure of Gobbledygook), complexity (PMOSE/iKIRSCH), and suitability (Suitability Assessment of Materials). Scores were analyzed by each Web site and overall.
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 eighth to 12 grade education. Lumpectomy literature had a lower PMOSE/iKIRSCH score of 5.8 corresponding to a "very low" complexity and fourth to eighth 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.
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.
近一半的美国成年人健康素养较低或处于边缘水平。这对患者的参与度、决策能力、满意度以及总体治疗效果产生负面影响，尤其是当所提供的信息与目标受众的技能不匹配时。三十多年来，一直有人建议将患者信息的编写水平控制在六年级以下。本研究使用包括可读性水平、复杂性、数据密度以及总体公众适用性等扩展指标，比较了乳房切除术和乳房肿块切除术的在线资源。
使用最大的互联网搜索引擎（谷歌）确定乳房切除术和乳房肿块切除术排名最高的10个网站。对每个网站进行可读性（简易晦涩度测量法）、复杂性（PMOSE/iKIRSCH）和适用性（材料适用性评估）评估。对每个网站以及总体得分进行分析。
可读性分析显示，乳房切除术和乳房肿块切除术在线信息的阅读年级水平存在显著差异（分别为15.4和13.9，P = 0.04）。通过PMOSE/iKIRSCH进行的复杂性分析显示，乳房切除术材料的平均得分为6.5，对应“低”复杂性和八年级至十二年级教育水平。乳房肿块切除术文献的PMOSE/iKIRSCH得分较低，为5.8，对应“非常低”的复杂性和四年级至八年级教育水平（P = 0.05）。适用性评估显示，乳房切除术和乳房肿块切除术材料分别有41%和46%的平均值被标记为最低水平的“充分性”（P = 0.83）。评分者间信度在复杂性和适用性分析中均较高。
乳腺癌手术治疗的在线资源高于推荐的阅读年级水平。适用性水平勉强足够，表明需要修订。乳房切除术的在线资源比乳房肿块切除术的材料阅读年级水平更高，且往往更复杂。
