(26) The Readability, Understandability and Actionability of Oral and Maxillofacial Surgery Patient Information Materials

Abstract:

Introduction:
A challenging aspect of providing care for patients is ensuring a full understanding of pre-operative and post-operative patient information materials. According to a 2003 National Assessment of Adult Literacy (NAAL), 90% of U.S. adults have difficulty reading and understanding health information. Patient health literacy is an important determinant of acceptance, adherence, and satisfaction.1 The goal of this study was to measure if oral and maxillofacial surgery patients experience similar difficulties when attempting to understand and comply with written patient information. We assessed a widely used oral and maxillofacial surgery patient health information database for these parameters. Elsevier materials were used and are available on hospital systems nationwide. In 2020, Cerner Powerchart represented 26% of electronic health record market share, reaching 100 million patients through 500 million encounters.2 We hypothesized that oral and maxillofacial surgery discharge materials are not adequately readable, understandable, or actionable and have room for improvement. Our specific aim was to describe the readability, understandability, and actionability of widely used patient discharge information. Through studying the knowledge gap that exists between healthcare providers and their patients, we hope to bring awareness of the need for effective information for patients in efforts to increase overall healthcare outcomes.

Methods: Preoperative and postoperative materials for oral and maxillofacial surgery procedures were collected from Elsevier. Elsevier is a single, widely used publisher which is available through the Cerner Powerchart electronic medical record platform. These patient information materials were categorized into eight categories: trauma, temporomandibular disorders/ facial pain, cosmetic, dentoalveolar, pathology, orthognathic/cleft/OSA, reconstruction, and implant. Readability, understandability and actionability were assessed by using Flesch-Kincaid Grade Level, Flesch Reading Ease, passive sentence, words per sentence, and characters per word. Scores were averaged and compared across the various categories of preoperative and postoperative materials to identify areas for improvement.

Results: 102 available preoperative and postoperative materials were collected and analyzed: trauma (17), temporomandibular disorders/facial pain (2), cosmetic (9), dentoalveolar (26), pathology (22), orthognathic/cleft/OSA (20), reconstruction (4), and implants (2). On readability assessments preoperative and postoperative discharge materials were mostly written below a 7th grade reading level. Average reading level for trauma 5.1, temporomandibular disorders/facial pain 5.2, cosmetic 5.9, dentoalveolar 5.5, pathology 6.1, orthognathic/cleft/OSA 5.9, reconstruction 6.3, and implants 6.3. The average of all preoperative and postoperative instructions was a Flesh-Kincaid grade level of 5.8, Flesch reading ease 72.1, passive sentences 0.65, words per sentence 10.56, and characters per word 4.5.

Conclusion: Most oral and maxillofacial surgery preoperative and postoperative instructions were written below the 8th grade reading level. Opportunities exist to further improve the transfer of information between the surgical team and the patient in an effort to aid patients' understanding. Areas of improvement include simplifying content, providing examples of medical terminology, and including more visual aids. Future studies hope to look at improving oral and maxillofacial surgery patient information materials to help patients better understand and experience better care before and after oral surgery procedures.

CITATIONS:
1) Chang ME, Baker SJ, Dos Santos Marques IC, et al: Health Literacy in Surgery. Health Lit Res Pract. 4, e46–e65, 2020 https://doi.org/10.3928/24748307-20191121-01

2) Cerner - Reviews, Rating, Comments, & Trending Data. (n.d.). Retrieved March 7, 2022, https://klasresearch.com/vendor-ratings/cerner/61112?tab=arch