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Readability, Complexity, and Suitability of Online Resources for Mastectomy and Lumpectomy
Bao Ngoc Tran, MD, Mansher Singh, MD, Bernard Lee, MD, MPH, MBA, FACS.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

PURPOSE: Nearly half of American adults have low or marginal health literacy. This negatively affects patients’ participation, decision-making, satisfaction, and overall outcomes. Previous studies in this area focus primarily on readability of online health information. This study compares online resources for mastectomy versus lumpectomy using expanded metrics including readability, complexity, and suitability.
METHODS: Ten most popular websites for mastectomy and lumpectomy were identified using the largest Internet engine (Google). Each website was assessed for readability (SMOG, Simple Measure of Gobbledygook), complexity (pMOSE/iKIRSCH), and suitability (SAM, Suitability Assessment of Materials). Scores were analyzed by each website and overall.
RESULTS: Readability analysis showed average reading grade level of 15.38 and 13.80 (p=0.04) for mastectomy and lumpectomy literacy respectively. Both exceeded the recommended sixth grade level. Complexity analysis via PMOSE/iKIRSCH revealed a mean score of 6.5 for mastectomy corresponding to a “low” complexity and 8th-12th grade education. Lumpectomy literature had a lower PMOSE/iKIRSCH score of 5.8 corresponding to a “very low” complexity and 4th-8th grade education (p=0.05). Suitability assessment showed mean values of 41% and 46% (p=0.83) for mastectomy and lumpectomy literacy respectively, both are interpreted as “adequate” for the intended audience. Inter-rater agreement for PMOSE/iKIRSCH are 92% (k=0.73, p<0.001), and 96% (k=0.87, p<0.001) for mastectomy and lumpectomy literature respectively. Similarly, inter-rater agreement for suitability analysis was 94% (k-0.84, p<0.001), and 90% (k=0.73, p<0.001).
CONCLUSION: Online resources for surgical treatment of breast cancer overall are above the recommended literacy level. When comparing mastectomy to lumpectomy, online resources for mastectomy have a higher reading grade level and tend to be more complex.


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