Readability of patient‐reported outcome measures for chronic rhinosinusitis and skull base diseases

Abstract

Objective Outcome measures in healthcare that presume a higher level of patient health and overall literacy may inadequately estimate the disease experiences of less‐educated patients and further disadvantage them. Patient‐Reported Outcome Measures (PROMs) are widely used communication tools for clinical practice and are often used to evaluate and guide management for chronic rhinosinusitis (CRS) and skull base diseases. However, their readability and subsequent incomprehensibility for patients have not been assessed. The aim of this study is to evaluate the readability of commonly used PROMs for these conditions and whether they meet recommended readability levels. Methods Three readability measures, Gunning Fog, Simple Measure of Gobbledygook (SMOG), and FORCAST were used in the evaluation of commonly used PROMs for CRS and skull base disease. PROMs with sixth‐grade readability level or lower were considered to meet health literacy experts' recommendations. Results A total of 11 PROMs were reviewed (8 CRS, 3 skull base). Gunning Fog consistently estimated the easiest readability, whereas FORCAST the most difficult. One hundred percent of CRS and 67% of skull base PROMs were above National Institutes of Health and health literacy experts' recommended reading levels. PROMs developed more recently had easier readability. Conclusion PROMs are important clinical tools in otolaryngology that help guide management of disease for improved patient‐centered care. Like many other fields of medicine, those used in otolaryngology are beyond recommended reading levels. Development of PROMs in the future should meet recommended readability levels to fully assess the disease experience of our patients. Level of Evidence 4 Laryngoscope, 130:2305–2310, 2020

Readability of Commonly Used Patient‐Reported Outcome Measures in Laryngology

“…Previous literature describes the readability of PROMs in otolaryngology, specifically rhinology/skull‐base surgery, head and neck oncology, and pediatric otolaryngology 5–7 . Similar to laryngology PROMs, eight out of eight chronic rhinosinusitis PROMs and two out of three skull‐base PROMs were shown to be above the recommended sixth‐grade reading level 5 . All eight head and neck PROMs analyzed by Gunning Fog, SMOG, and FORCAST were found to be above the recommended reading level as well 7 .…”

“…Each PROM was analyzed via four readability formulas from the readable software: Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. These indices were included as they are commonly used throughout the United States to analyze text and have been previously used to assess readability of otolaryngology PROMs and patient education materials 5–7,12 …”

“…The Department of Health and Human Services (DHHS) recommends patient materials be written at the sixth-grade reading level in the United States. 5 Therefore, PROMs written above the middle school level may be inaccurately interpreted or challenging to understand for many patients. In turn, this may affect how providers perceive patients' outcome after treatment and may alter future interventions.…”

“…Despite the benefits of PROMs, the level of health literacy among patients serves as a significant barrier in effectively administering these surveys. The Department of Health and Human Services (DHHS) recommends patient materials be written at the sixth‐grade reading level in the United States 5 . Therefore, PROMs written above the middle school level may be inaccurately interpreted or challenging to understand for many patients.…”

Relationship between health literacy and disease‐specific quality of life in patients with sinonasal disease

“…It has been found in previous studies that the sinonasal disease‐specific QOL surveys readability level is above the recommended sixth‐grade level, 8 and the proper use of medications is affected by the readability instructions, 9 which may affect how patients with limited health literacy perceive their disease severity and how they use their medications. For these reasons, experts suggest that when counseling our patients, we should assume that all patients and caregivers may have difficulty understanding health information regardless of their literacy or educational level, and we should simplify communication 10 .…”