title: Readability of online patient resources for the operative treatment of breast cancer.
abstract: BACKGROUND
  Increasing use of Internet resources for health information is important in promoting patient involvement in medical care and decision-making. The National Institutes of Health and American Medical Association have recommended that patient health information should be written at a sixth-grade reading level. This study evaluates the readability of the most commonly used Internet resources for the operative treatment of breast cancer in the context of average American literacy.
  
  
  METHODS
  The top 10 websites for "breast cancer surgery" based on public Internet search engines were identified. Patient-directed content was downloaded from all relevant articles on these sites. A total of 104 articles were assessed with the use of 10 established readability analyses. Average readability scores were analyzed for all articles as well as by website.
  
  
  RESULTS
  The overall average reading level across all sites was 12.9; this was similar between tests (Coleman-Liau 12.6, Flesch Kincaid 12.3, FORCAST 11.2, Fry 14, Gunning Fog 14.4, New Dale-Chall 12.4, New Fog 11, Raygor 14, and Simple Measure of Gobbledygook 14.3). Comparing readability by website showed disparity in average reading level from 11.2 to 16.5.
  
  
  CONCLUSIONS
  Online patient resources for breast cancer surgery exceed recommended reading levels and are too difficult to be understood by a large portion of the United States population.
authors: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors: Christina R
authors: CR
authors: Vargas
authors: Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors: Danielle J
authors: DJ
authors: Chuang
authors: Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors: Oren
authors: O
authors: Ganor
authors: Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: btlee@bidmc.harvard.edu.
authors: Bernard T
authors: BT
authors: Lee
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D032882:Comprehension; D054626:Consumer Health Information; D005260:Female; D006295:Health Resources; D006801:Humans; D020407:Internet; D008490:Medical Informatics; D057386:Search Engine; D014481:United States