Reading grade level and completeness of freely available materials on thyroid nodules: there is work to be done

Patient education is one of the key components required for patients to participate in decision making for their care. Sources of information should be complete and understandable. The objective of this study was to assess the quality and reading grade level of freely available materials pertaining to the evaluation and treatment of thyroid nodules.

All available materials were gathered through a comprehensive Internet search or direct contact with each identified organization associated with thyroid care. Materials meeting inclusion criteria were assessed for completeness of content and reading grade level using the SMOG readability formula. Then, the DISCERN instrument was utilized to assess the quality of the five materials which had the best (lowest) and the five materials that had the worst (highest) SMOG reading grade levels.

A total of 63 materials on thyroid nodule evaluation and management were identified. A minority of materials presented readers with a complete picture of the topic, describing both benefits and cautions of thyroid nodule evaluation, benefits and cautions of fine-needle thyroid nodule biopsy, or risks, benefits, and long-term effects of thyroidectomy. The SMOG reading grade level assessment was well above recommended levels. The range was eighth grade to college level; the mean and median reading grade level were 13. Lastly, the DISCERN instrument revealed that most of the materials with both the best and the worst reading grade levels assessed had "extensive or serious shortcomings" that would impede their usefulness as high-quality sources of information regarding management options.

Existing thyroid nodule evaluation and management materials have serious shortcomings. Future work should focus on the development of patient materials that are both grade level appropriate and meet the DISCERN criteria for topic completeness and accuracy.