Readability of Online Patient Educational Resources Found on NCI-Designated Cancer Center Web Sites.
The NIH and Department of Health & Human Services recommend online patient information (OPI) be written at a sixth grade level. We used a panel of readability analyses to assess OPI from NCI-Designated Cancer Center (NCIDCC) Web sites.



Cancer.gov was used to identify 68 NCIDCC Web sites from which we collected both general OPI and OPI specific to breast, prostate, lung, and colon cancers. This text was analyzed by 10 commonly used readability tests: the New Dale-Chall Readability Formula, Flesch Reading Ease scale, Flesch-Kinaid Grade Level, FORCAST scale, Fry Readability Graph, Simple Measure of Gobbledygook test, Gunning Frequency of Gobbledygook index, New Fog Count, Raygor Readability Estimate Graph, and Coleman-Liau Index. We tested the hypothesis that the readability of NCIDCC OPI was written at the sixth grade level. Secondary analyses were performed to compare readability of OPI between comprehensive and noncomprehensive centers, by region, and to OPI produced by the American Cancer Society (ACS).



A mean of 30,507 words from 40 comprehensive and 18 noncomprehensive NCIDCCs was analyzed (7 nonclinical and 3 without appropriate OPI were excluded). Using a composite grade level score, the mean readability score of 12.46 (ie, college level: 95% CI, 12.13-12.79) was significantly greater than the target grade level of 6 (middle-school: P<.001). No difference between comprehensive and noncomprehensive centers was identified. Regional differences were identified in 4 of the 10 readability metrics (P<.05). ACS OPI provides easier language, at the seventh to ninth grade level, across all tests (P<.01).



OPI from NCIDCC Web sites is more complex than recommended for the average patient.
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Stephen A
SA
Rosenberg
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
David
D
Francis
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Craig R
CR
Hullett
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Zachary S
ZS
Morris
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Michael M
MM
Fisher
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Jeffrey V
JV
Brower
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin|University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Kristin A
KA
Bradley
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin|University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Bethany M
BM
Anderson
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin|University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Michael F
MF
Bassetti
The Department of Human Oncology, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin|University of Wisconsin Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public  Health, University of Wisconsin–Madison, Madison, Wisconsin
Randall J
RJ
Kimple
D032882:Comprehension; D006801:Humans; D020407:Internet / Q000592:standards*; D054547:National Cancer Institute (U.S.); D010353:Patient Education as Topic / Q000379:methods*; D014481:United States