Patient literacy and the readability of written cancer educational materials

The purpose of this study was to determine whether the reading level of educational materials for patients with cancer corresponds to the reading abilities of a sample of patients. A secondary aim was to describe what type of educational materials patients with cancer report as most helpful.

Descriptive, cross-sectional.

Outpatient oncology clinics at an urban Veterans Affairs Medical Center.

A convenience sample of 63 outpatients with cancer.

Investigators used the Word Recognition Achievement Test-Revised Level (WRAT-R2) to measure patients' reading levels. They used the Flesch Index to analyze the reading levels of the booklets that the patients used (14 booklets developed by the American Cancer Society and 16 developed by the National Cancer Institute). Data were analyzed through descriptive statistics and a Wilcoxon signed rank test.

Patient and booklet reading levels.

The reading level of 27% of the sample was less than that of all 30 pamphlets (less than a sixth-grade reading level). Seventeen percent of the patients had a reading level between sixth and eighth grades (representing 47% of the pamphlets). Twenty-nine percent of the sample had WRAT scores between 9th and 12th grades (representing 80% of the pamphlets). Only 27% had WRAT scores of the 13th grade and above. Twenty-six percent of the patients preferred written educational materials alone, while 57% of patients desired more than one method of instruction.

Written materials for the education of patients with cancer must be carefully matched to patient reading levels. Written materials may not be the only desirable mode of instruction.

Given the increasing complexity of cancer care, shorter hospital stays, and a shift toward busy ambulatory care centers, nurses need to develop creative, innovative, and comprehensive patient education programs that are understandable to patients and that use multiple types of instruction.