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 The American Medical Association already recommends that written
health information be targeted to a sixth grade audience because
nearly half of the U.S. population is only marginally or
functionally literate, with an elementary- or middle-school reading
level, the researchers note in the American Journal of Surgery.
But the current study of discharge instructions given to about 500
trauma patients leaving the hospital found that only one fourth had
the reading skills necessary to adequately understand their
dismissal notes.
Part of the problem is that these notes are written for two very
different audiences – patients and families who need simple
instructions and their doctors, who are accustomed to medical
jargon, said senior study author Dr. Martin Zielinski, a trauma
surgeon at the Mayo Clinic in Rochester, Minnesota.
“Even if patients believe they understand what occurred during their
hospitalization and the instructions they are to follow upon
dismissal, they can become confused after they leave the hospital
environment as their memory can be clouded by medications they were
administered, the stress of hospitalization, and, particularly
within our patient population, traumatic brain injuries such as
concussions,” Zielinski said by email.
To assess how easily the trauma patients in the study might decipher
their discharge notes, Zielinski and colleagues used two standard
formulas for determining reading levels based on the total words,
syllables and sentences in texts.
Most of the 314 patients in the study who had education data
available had a high school degree, while 22 percent had at least
some college education. About 4 percent of these patients were
functionally illiterate, with reading levels at fifth grade or
below, and another 40 percent were marginally literate with a sixth-
to eighth-grade reading level.
On average, the notes required at least a high school education to
understand, the analysis found. By one measure the instructions were
typically written at about a 10th grade reading level, while the
other assessment found the notes might be easily understood by 13 to
15 year old students.
The difficulty of deciphering these notes didn’t appear to be
different based on whether patients had surgery or how long they
stayed in the hospital.
Patient reading level didn’t appear to influence the odds of
returning to the hospital within a month of discharge or the
likelihood that they would call the hospital with questions, the
study found. But often, when these things happened, the patient had
a reading level too low to understand the discharge notes.
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Limitations of the study include the lack of education data on all
patients as well as the exclusion of non-English speakers, the
authors note. Researchers also didn’t give patients reading tests,
relying instead on the highest level of education attained to
estimate literacy skills.
Even so, the results highlight that patient discharge notes are
currently written for education levels too advanced for many
patients to understand, the authors conclude. To ensure patient
comprehension, these notes should be written for a sixth grade
audience.
“Careful design of discharge instructions, with input from patients
themselves, would help us create more comprehensible tools,” said
Dr. Kevin O’Leary, a researcher at the Northwestern University
Feinberg School of Medicine in Chicago who wasn’t involved in the
study.
It’s possible that electronic health records might be part of the
solution, O’Leary added by email. These programs might allow doctors
to assess how easily patients can read instructions in real time and
prompt physicians to adjust their wording as needed to make it
simpler to understand.
“Providing feedback for clinicians as they create the instructions
would help them revise the wording to improve readability,” O’Leary
said.
In addition, when patients or their families have trouble
understanding their care instructions after getting home, they can
still call the nurses’ station on the hospital floor where they were
treated, or call their doctor’s office to ask questions.
SOURCE: http://bit.ly/1Z8x9ug American Journal of Surgery, online
December 27, 2015.
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