Health Services: A Mixed Methods Assessment of Canadian Cancer Patient Education Materials Related to the 2019 Novel Coronavirus

Abstract

The 2019 novel coronavirus (COVID-19) pandemic has prompted the reorganization in the scheduling and method of care for many patients, including patients diagnosed with cancer. Cancer patients, who have an immunocompromised status, may be at a higher risk of severe symptoms from infection with COVID-19. While information is rapidly evolving regarding COVID-19, Canada, both nationally and provincially, has been conveying new information to patients online. We assessed the content and readability of COVID-19-related online Canadian patient education material (PEM) for cancer patients to determine if the content of the material was written at a grade reading level that the majority of Canadians can understand. PEMs were extracted from provincial cancer agencies and the national Canadian Cancer Society, evaluated using 10 readability scales, qualitatively analyzed to identify their themes and difficult word content. Thirty-eight PEMs from both national and provincial cancers associations were, on average, written above the recommended 7th grade level. Each of the associations’ average grade levels were: BC Cancer (11.00 95% confidence interval [CI] 8.27-13.38), CancerControl Alberta (10.46 95% CI 8.29-12.62), Saskatchewan Cancer Agency (11.08 95% CI 9.37-12.80), Cancer Care Manitoba (9.55 95% CI 6.02-13.01), Cancer Care Ontario (9.35 95% CI 6.80-11.90), Cancer Care Nova Scotia (10.95 95% CI 9.86-12.04), Cancer Care Eastern Health Newfoundland and Labrador (10.14 95% CI 6.87-13.41), and the Canadian Cancer Society (10.06 95% CI 8.07-12.05). Thematic analysis identified 4 themes: public health strategy, information about COVID-19, patient instructions during COVID-19, and resources. Fifty-three percent of the complex words identified were medical jargon. This represents an opportunity to improve PEM readability, to allow for greater comprehension amongst a wider target audience.

Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study

“…The difficult word analysis revealed long words were the most common type of difficult word in the PEMs. This is in line with another recent Canadian publication on cancer-related PEMs [ 34 ]. Difficult terminology should be replaced with more familiar alternatives whenever possible to improve the ease of understanding.…”

“…A difficult word analysis was performed to identify the number and percentage of complex words (composed of 3 or more syllables), long words (composed of 6 or more letters), and unfamiliar words in each PEM according to the NDC criteria [ 34 , 35 ]. Once all the words were extracted from the PEMs, they were compared to the NDC word list as well as the New General Service List (NGSL).…”

Assessment of the Readability and Quality of Online Patient Education Material for Chronic Medical Conditions

“…), in order to identify synonyms that could decrease the difficulty of the word by an individual word’s syllables and/or character length. Alternatives also provided short phrases that either avoided medical jargon or were in vernacular language for certain difficult words [ 29 ].…”

Assessment of online patient education material for eye cancers: A cross-sectional study

“…If a document was a pdf, then they were manually converted to plain text for further analysis. Text sections of nonmedical information were removed from each of the PEMs before analysis, as described previously [22][23][24][25][26].…”

“…A readability assessment was then performed as described previously [22][23][24][25][26]. The software package Readability Studio professional edition version 2019.3 (Oleander Software, Ltd) was utilized to determine the GRL of the PEMs through eight numerical scales and two graphical scales.…”