title: Mammography result notification letters: are they easy to read and understand?
abstract: BACKGROUND
  Federal law mandates that mammography centers notify women of their result in writing. The purpose of this study is to assess the readability and ease of use of the sample letters provided as a template for the notification letters centers send to patients.
  
  
  METHODS
  This is a cross-sectional analysis of the 43 mammography result notification template letters available from the American College of Radiology and two leading transcription software services. To assess readability, we used the Flesch-Kincaid grade level scale and the Lexile framework. To assess document suitability, we used the Suitability Assessment of Materials (SAM). Acceptable scores were based on established standards: ≤6th grade for the Flesch-Kincaid level, ≤900 for the Lexile analysis, and ≥40% on the SAM scale. Means, standard deviations (SDs), and ranges were calculated by diagnostic category, as indicated by BI-RADS level. The Kruskal-Wallis test was used to assess differences in readability and suitability by diagnostic category.
  
  
  RESULTS
  The Flesch Kincaid score ranged from 7.7 to 13.5, with a mean of 10.2. The Lexile score ranged from 880 to 1270, with a mean of 1113. The mean SAM score ranged from 16% to 36%, with a mean of 29%. Mean grade level, Lexile score, and SAM score did not vary significantly by diagnostic category. No single document had an acceptable suitability score, and only two had acceptable Lexile scores. Common deficiencies included use of the passive voice, vague wording, and technical jargon.
  
  
  CONCLUSIONS
  The letters we analyzed were written at levels too difficult for many patients to understand. Future investigations should explore clearer ways of communicating mammography results.
authors.affiliation: Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA. emarcus@med.miami.edu
authors.forename: Erin N
authors.initials: EN
authors.lastname: Marcus
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
authors.forename: Margaret
authors.initials: M
authors.lastname: Pereyra
authors.forename: Yanisa
authors.initials: Y
authors.lastname: Del Toro
authors.forename: Ada Pat
authors.initials: AP
authors.lastname: Romilly
authors.forename: Monica
authors.initials: M
authors.lastname: Yepes
authors.forename: Monica Webb
authors.initials: MW
authors.lastname: Hooper
authors.forename: Beth A
authors.initials: BA
authors.lastname: Jones
mesh_terms: D032882:Comprehension; D015709:Correspondence as Topic; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000523:psychology*; D011871:Radiology; D011932:Reading; D012955:Societies, Medical