Patient-Reported Outcome Measures in Surgical Oncology: A Cross-Sectional Study of NIH and AMA Readability Compliance

Patient-reported outcome measures (PROMs) assess function, symptoms, and quality of life in surgical oncology. However, many exceed the National Institutes of Health (NIH) and American Medical Association (AMA) readability guidelines, which recommend materials be written at or below a sixth-grade reading level. This study evaluates the readability of 24 commonly used PROMs in surgical oncology.

The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were used to assess readability. A FRES ≥ 80 or SMOG < 7.0 indicated sixth-grade-level readability, per NIH/AMA guidelines. Spearman's correlation analyzed the relationship between FRES and SMOG scores.

The mean FRES was 70 ± 14, and the mean SMOG was 8 ± 1, corresponding to an eighth- to ninth-grade reading level. Only seven PROMs met at least one readability threshold, while 75% exceeded the sixth-grade recommendation. Spearman's correlation (ρ = -0.75, p < 0.001) showed a strong inverse relationship between FRES and SMOG, though some PROMs exhibited notable discrepancies.

Most surgical oncology PROMs exceed recommended readability levels, potentially limiting patient comprehension and data accuracy. Improving readability through simplified language, multimedia adaptations, and standardized readability benchmarks may enhance accessibility and clinical utility.