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For many prostate cancer patients, Web sites are too difficult to read

MAYWOOD, IL - Ninety million American adults read below high school levels, so the National Institutes of Health recommends that patient-education materials be written at the fourth-through-six grade level.

But a Loyola University Medical Center study has found that only 4.8 percent of web sites describing prostate cancer were written below a high school reading level. The median reading level was 12th grade.

"This is probablematic for one-third of Americans who seek to further educate themselves using online resources," senior author Gopal Gupta, MD and colleagues wrote. The study is published online ahead of print in the Journal of Urology.

Gupta and colleagues identified 62 web sites by searching for "prostate cancer" "prostate cancer treatment" and "prostatectomy" on Google, Yahoo and Bing search engines. Researchers used word processing software to test the readability of the first 300 words of each web site.

To assess readability, researchers used the Flesch-Kincaid test, which measures the reading grade level, and the Flesch reading ease test, which assigns a readability score of 0 to 100. The tests are based on formulas that incorporate total number of words, sentences and syllables.

Sixty-three percent of the sites were written above a 12th grade reading level, and the median Flesch reading ease score for all sites a relatively difficult 38.1. (The Flesch reading ease score ranges from 0 to 100. A web site with a score of 90 to 100 would be easily understood by an 11-year-old; a score of 60-to-70 would be understood by 13-to-15-year-olds; and scores lower than 30 would be suited to college grads.)

Web sites with the easiest readability scores were News-Medical Net (8th grade level), Consumer (8.9), Family (8.95), UPMC Cancer Centers (9.2) and NIH Pubmed Health (9.8).

"It was discouraging to find that only 4.8 percent of these sites had information written for those below a high school reading level," Gupta and colleagues wrote. "No sites in our study were written at the level recommended by the NIH (4-6th grade). Given that nearly one-third of the U.S. population reads below high school level, this raises the concern that many patients will have difficulty comprehending online information about prostate cancer treatment options."

Prostate cancer is among the more difficult topics for patients to comprehend. There are at least four options (surgery, radiation beam therapy, radiation seeds and active surveillance). Each option has pros and cons, which vary according to the patient's age, tumor type, overall health, etc. Doctors may find it difficult to simplify technology-based treatments, anatomical descriptions and medical terminology. And some terms doctors take for granted, such as "erection" and "impotent," might not be understood by patients with low health literacy.

Researchers concluded: "Clinicians should be aware that some of their patients may not be able to read online information and should consciously guide patients with low literacy to not only high-quality web sites, but also sites that are easy-to-read, to prevent confusion and anxiety after being diagnosed with prostate cancer."

Dr. Gupta is an instructor in the Departments of Urology and Surgery and the Oncology Institute of Loyola University Chicago Stritch School of Medicine. His special interests include urologic oncology and robotic and minimally invasive surgery.

Co-authors are of the readability study are Chandy Ellimoottil, MD, (first author); Anthony Polcari, MD; and Adam Kadlec, MD.

Contact: Jim Ritter
Loyola University Health System

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