Bridging the Knowledge Gap: An Examination of the Ideal Postoperative Autologous Breast Reconstruction Educational Material with A/B Testing

Abstract

Background: Poor health literacy is an epidemic in the United States, associated with higher mortality rates and poor postoperative care. Autologous breast reconstruction is highly complex, and the identification of complications is difficult even for non–plastic surgeon practitioners. The authors sought to explore the problem of health literacy in this context and identify the ideal postoperative patient education materials. Methods: Available online postoperative patient education materials for autologous breast reconstruction and corresponding readability scores were assessed. To derive the ideal formula for materials, the authors crowd-sourced quizzes with A/B testing, a method to examine the outcome of two versions of a single variable. The authors implemented their findings and compared performance on postoperative quizzes with and without oral reinforcement. Results: Of the 12 postoperative flap complication patient education materials found through an Internet search, the average grade level readability level was 9.9. Only one of 12 (8.3 percent) mentioned symptoms and signs of flap compromise. The A/B tests result revealed that text approximately 400 to 800 words written on a sixth-grade level led to the highest quiz scores. Patients scored significantly higher on the postoperative day–2 quiz when patient education materials, modeled after these findings, were reinforced with oral presentation (p = 0.0059). Retention of high quiz scores remained at postoperative day 10. Conclusions: Currently available patient education materials are at a high reading level and lack specific information on the identification of flap compromise. The authors propose the most effective postoperative instructions to be approximately 400 to 800 words written on a grade-six level with images and oral reinforcement.

Crowdsourcing in Plastic & Reconstructive Surgery: A Systematic Review with Reporting Recommendations

“…Forty-five articles were ultimately included for data extraction (Table 1). 13–57 Proportionate rater agreement was 91.7% for abstract screening and 92.5% for full-text screening. The Cohen kappa coefficient for interrater reliability was 0.82 for abstract screening and 0.81 for full-text screening, demonstrating sufficient interrater reliability.…”

Addressing Current Deficits in Patient Education Materials Through Crowdsourcing

“…After incorporating participants' feedback into the finalized material, the readability of the material is at the recommended reading level. The material also had the recommended length (between 400 and 800 words) 23 …”

“…The material also had the recommended length (between 400 and 800 words). 23 After investigating the breast-related patient education materials provided by local hospitals, plastic surgery societies, and federal agencies, we found that none of the materials were considered easy to comprehend. This is similar to the findings of Powell et al, 9 which concluded that the readability of breast reconstruction patient education materials from major US academic hospitals is much higher than the recommended reading level.…”

Health Literacy in Oculofacial Plastic Surgery: A Literature Review

“…Although research on HL in oculofacial plastic surgery is sparse, multiple studies propose solutions to improve the quality of patient-surgeon communication and address HL in plastic surgery [13,45,46]. There should be an effort to incorporate tools that have proven effective in other surgical specialties into the field of oculofacial plastic surgery [45,[47][48][49].…”