Readability Metrics of Provider Postoperative Handouts in Urology

To examine the readability of postoperative urology handouts and assess for areas of improvement. We hypothesize that the majority of provider handouts exceed the National Institutes of Health recommendation of writing at a sixth-grade reading level.

We reviewed 238 postoperative patient handouts in the public domain representing United States academic and private practices. All handouts were categorized and re-formatted into text-only using Microsoft Word. A median reading grade was calculated using the Readability.io web application using Flesch-Kincaid Grade Level, Gunning Fog index, Coleman-Liau index, Simple Measure of Gobbledygook, and Automated-Reading Index. Word count was also assessed.

Provider handouts were written at a median 9.3 grade reading level (range 5.8-14, IQR 8.45-10). A total of 15 (6.8%) handouts were written at a sixth-grade reading level, with only 1 (0.4%) handout written below the target. Six (2.7%) handouts were written at college-level. There were no significant differences between different subspecialties. Median word count was 509 (range 90-3796, IQR 361-738). Although a high word count may make it more difficult for patients to follow suggestions, the readability of each handout did not correlate with word count.

Our data show that over 93% of analyzed handouts failed to meet National Institutes of Health recommendations for grade level. Longer word counts did not correlate with higher reading levels. It will be important to assess patient satisfaction with handouts and to correlate the complexity of postoperative handouts with outcome, such as unplanned phone calls and unscheduled visits.