Chen Daniel H, Johnson Anna Rose, Ayyala Haripriya, Lee Edward S, Lee Bernard T, Tran Bao Ngoc N
From the School of Medicine, Wayne State University, Detroit, MI.
Division of Plastic and Reconstructive Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S102-S108. doi: 10.1097/SAP.0000000000002348.
Over the past decade, the demand for breast reconstruction has mirrored the rising incidence of breast cancer. Common postoncologic surgical options include autologous and implant-based reconstruction. Patient-directed health information for breast reconstruction can play a critical role in the decision-making process. This study comparatively evaluates the top online resources for autologous versus implant-based reconstruction using a multimetric health literacy analysis.
The top 10 websites for autologous and implant-based reconstruction were identified using a Google search. A total of 20 unique links were appraised by 2 independent raters for understandability and actionability using the Patient Education Materials Assessment Tool and cultural sensitivity using the Cultural Sensitivity Assessment Tool. A Cohen κ for interrater reliability was calculated. Mean reading grade level and word complexity were also determined.
Websites for both autologous and implant-based modalities exceeded the recommended sixth- to eighth-grade reading level (12.4 and 12.1, respectively; P = 0.65). Mean understandability scores for each modality were low (60.5 and 62.5, P = 0.65). Autologous-based resources had a lower mean actionability score compared with implant-based materials (19.5 and 24, respectively; P = 0.04). Both reconstructive modalities met the threshold for acceptability for cultural sensitivity (2.79 and 2.58, P = 0.09).
Our study revealed a chasm between the health literacy needs of the average adult and the quality of both implant-based and autologous breast reconstruction resources. Materials for both modalities were often too complex and failed to include tools to facilitate active decision making, particularly for autologous-based reconstruction. Strategies to improve materials should be patient centered and include simplification of reading grade level, incorporation of clear visual aids, and inclusion of procedural risks to promote patient comprehension, participation, and ultimately health outcomes.
在过去十年中，乳房重建的需求反映了乳腺癌发病率的上升。常见的肿瘤切除术后手术选择包括自体组织重建和植入物重建。面向患者的乳房重建健康信息在决策过程中可发挥关键作用。本研究使用多指标健康素养分析对自体组织重建与植入物重建的顶级在线资源进行比较评估。
通过谷歌搜索确定自体组织重建和植入物重建的前10个网站。两名独立评分者使用患者教育材料评估工具对总共20个独特链接的可理解性和可操作性进行评估，并使用文化敏感性评估工具对文化敏感性进行评估。计算评分者间可靠性的Cohen κ值。还确定了平均阅读年级水平和单词复杂度。
自体组织重建和植入物重建的网站均超过了推荐的六至八年级阅读水平（分别为12.4和12.1；P = 0.65）。每种方式的平均可理解性得分较低（分别为60.5和62.5，P = 0.65）。与植入物相关材料相比，自体组织相关资源的平均可操作性得分较低（分别为19.5和24；P = 0.04）。两种重建方式均达到了文化敏感性可接受阈值（分别为2.79和2.58，P = 0.09）。
我们的研究揭示了普通成年人的健康素养需求与植入物乳房重建和自体组织乳房重建资源质量之间的差距。两种方式的材料通常过于复杂，且未包括有助于积极决策的工具，尤其是自体组织重建。改善材料的策略应以患者为中心，包括简化阅读年级水平、纳入清晰的视觉辅助工具以及纳入手术风险以促进患者理解、参与并最终改善健康结果。
