title: Readability of American online patient education materials in urologic oncology: a need for simple communication.
abstract: OBJECTIVE
  To determine the readability levels of reputable cancer and urologic Web sites addressing bladder, prostate, kidney, and testicular cancers.
  
  
  METHODS
  Online patient education materials (PEMs) for bladder, prostate, kidney, and testicular malignancies were evaluated from the American Cancer Society, American Society of Clinical Oncology, National Cancer Institute, Urology Care Foundation, Bladder Cancer Advocacy Network, Prostate Cancer Foundation, Kidney Cancer Association, and Testicular Cancer Resource Center. Grade level was determined using several readability indices, and analyses were performed on the basis of cancer type, Web site, and content area (general, causes, risk factors and prevention, diagnosis and staging, treatment, and post-treatment).
  
  
  RESULTS
  Estimated grade level of online PEMs ranged from 9.2 to 14.2 with an overall mean of 11.7. Web sites for kidney cancer had the least difficult readability (11.3) and prostate cancer had the most difficult readability (12.1). Among specific Web sites, the most difficult readability levels were noted for the Urology Care Foundation Web site for bladder and prostate cancer and the Kidney Cancer Association and Testicular Cancer Resource Center for kidney and testes cancer. Readability levels within content areas varied on the basis of the disease and Web site.
  
  
  CONCLUSIONS
  Online PEMs in urologic oncology are written at a level above the average American reader. Simplification of these resources is necessary to improve patient understanding of urologic malignancy.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Amanda
authors.initials: A
authors.lastname: Pruthi
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Raynor
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Chapel Hill, NC. Electronic address: angela_smith@med.unc.edu.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
mesh_terms: D003142:Communication; D032882:Comprehension; D006801:Humans; D020407:Internet; D008297:Male; D010353:Patient Education as Topic; D011471:Prostatic Neoplasms; D013664:Teaching Materials; D013736:Testicular Neoplasms; D014571:Urologic Neoplasms