Readability of urologic pathology reports: the need for patient-centered approaches

The pathology report informs a patient's prognosis and treatment options. However, pathology reports are written using complex medical vocabulary. We evaluated the readability of pathology reports for common urologic cancers (prostate, bladder kidney, and testicular) to identify sources of confusion that could be addressed through modified patient-centered pathology reports.

Pathology reports from 5 cases of each of the following procedures were analyzed: partial nephrectomy, radical nephrectomy, radical prostatectomy, ultrasound-guided prostate needle biopsy (PNBx), radical cystectomy, transurethral resection of bladder tumor, radical orchiectomy, and retroperitoneal lymph node dissection. Reports were edited for grammar and syntax, and the Flesch-Kincaid readability software calculated the reading level. Modifications were performed to identify sources of obstruction to readability. We compared modified and base reports using independent samples t tests.

Bladder cancer pathology had the highest readability index; radical prostatectomy and PNBx pathology reports had the lowest average readability indices. Modified reports that both omitted gross pathologic and immunohistochemistry content and also replaced oncologic and histology terms with lay terminology had significantly lower reading levels than base reports (P<0.05 for radical nephrectomy, partial nephrectomy, and radical orchiectomy). Modified reports did not significantly alter the reading level for radical cystectomy, transurethral resection of bladder tumor, PNBx, and retroperitoneal lymph node dissection reports.

Pathology reports are written at reading levels above the average reading capability of most Americans. Deleting descriptive pathologic terms and replacing complex medical terminology with lay terms resulted in improved readability for some urologic oncology reports but complicated readability for others. Our findings may guide the development of patient-centered pathology reports.