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Analysis of Comprehensibility of Patient Information Regarding Complex Craniofacial Conditions

Patel, Priti P. MD; Hoppe, Ian C. BA; Ahuja, Naveen K. MD; Ciminello, Frank S. MD

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1179-1182
doi: 10.1097/SCS.0b013e31821c00e4
Special Editorials

Purpose: Health care consumers are increasingly turning to the Internet for information regarding medical and surgical procedures. When an elective procedure is under consideration, the Internet is often the first resource used by a patient. Caregivers of craniofacial patients are typically overwhelmed during the surgical planning process. A firm understanding of craniofacial condition and the associated procedures is crucial to obtain satisfactory outcomes.

Furthermore, health care providers are increasingly referring their patients to on-line sources of patient education material. Currently, the National Institutes of Health suggests the information be at the fourth- to sixth-grade reading level to maximize comprehension. Much of the information available regarding health care targeted at patients is written at a 10th-grade reading level or higher. The purpose of this study was to evaluate readily available on-line patient education information for readability; being aware of this information will aid craniofacial surgeons in appropriately educating their patients.

Methods: Texts were extracted from commonly used craniofacial educational Web sites regarding reconstructive procedures. Three objective and accepted methods (SMOG, Flesch-Kincaid, and Dale-Chall) were used to assess readability of each condition and its corresponding procedure's text.

Results: The results from all 3 of the methods used were higher than the recommended seventh-grade reading level. The mean reading level for eMedicine was 13.8, 15.2, and 15 for the Flesch-Kincaid, SMOG, and Dale-Chall methods, respectively. Likewise, the mean reading levels for FACES were 7.5, 10.7, and 8.3; and for World Craniofacial Foundation, the levels were 11.9, 13.8, and 13.

Conclusions: Patient education and understanding is a critical factor in planning for surgery; this is especially true of reconstructive craniofacial procedures. Craniofacial surgery is a diverse field, and its surgeons have correspondingly diverse practices. It is up to each individual surgeon to determine what is appropriate for his or her patients. Our results show that on-line educational material is at a level that is substantially higher than the national reading average. The ultimate impact of this fact will vary from practice to practice, but all surgeons should be aware of the possible conflicts between information distributed and the patient's ability to comprehend that information. This may assist surgeons in preoperative evaluations by discussing conditions with more level appropriate means.

From the Division of Plastic Surgery, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey.

Received November 9, 2010.

Accepted for publication December 3, 2010.

Address correspondence and reprint requests to Ian C. Hoppe, BA, Division of Plastic Surgery, University of Medicine and Dentistry of New Jersey, 140 Bergen St, E-Level, Suite 1640, Newark, NJ 07103; E-mail:

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD