Quality improvement project: Patient-centered breast imaging letters

Assess patient-centered revisions to our institution's screening mammography letters for BIRADS-0 and BIRADS-0 dense breast employing existing validated readability and usability rating instruments.

Cross-sectional analysis of two different mammography recall letters used by our institution revised to be patient-centered: the mammography recall letter (BIRADS 0) and the recall letter for patients with dense breasts (BIRADS 0-DB). During the editorial stage, we used chat GPT v3.5 and the Flesch-Kincaid grade level (FKGL). After updates to the layout and addition of visuals, the letters were rated by professional subject-matter experts (SME) for understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). The letters were then evaluated by patients for comprehensibility, utility, and design using the Consumer Information Rating Form (CIRF). Descriptive statistics were calculated for each assessment.

Baseline BI-RADS 0 and BI-RADS 0-DB letter FKGL levels were 11.9 and 10.7, respectively; after iterative revision the FKGL were 6.7 and 5.8, respectively. PEMAT ratings for understandability for the BI-RADS 0 recall letter improved from 41 to 90 % after the revision, and for actionability improved from 50 to 88 %. The understandability for the revised BI-RADS 0-DB letter improved from 46 to 85 % and actionability improved from 44 to 73 %. CIRF ratings indicated significant value for the added images in the BIRADS-0-DB letter.

Use of validated and established assessment tools confirmed that our new breast imaging letters were improved in terms of readability, understandability/comprehensibility, actionability, utility, and design. The process now serves as a pipeline for future revisions to documents that our department is sharing with patients.