Readability of current patient information leaflets for informed consent in UK radiotherapy centers

Background: Guidelines on informed consent recommend the use of plain language and readability standards to enhance patient's comprehension, engagement and shared decision making. Aim: To assess the readability of current patient information leaflets (PILs) used for informed consent in radiotherapy. Methods: We evaluated PILs (n=38) from three radiation therapy centers in UK. They regard the most common radiation therapy techniques for different kinds of cancer and body disctricts, such as bladder, bowel, colo-rectum, brain, breast-chest, femal pelvis, prostate, lung, linphomas, stomach. We analyzed each text with Flesch-Kincaid (F-K) grade level, with higher numbers indicating harder-to-read text (from 0 = easy, to 25 = difficult). Then, we compared the related grade levels to the health literacy recommended standard of US grade level 5, indicating that patient education texts might be understood by a typical student in the US primary school. Results: Readibility is suboptimal for the analised PILs (red, green and blue points in the figure) and should be improved with respect to the international standard score (red dotted line in the figure). The results show a mean grade level equal to 8.1 (std = 0.8), thus suggesting the need of a 3-points decrease on average. Conclusion: Current PILs for informed consent in the three analised radiotherapy centers are hardly readable for the average patient. Although the readability scores achieved in the three centers is not very low, substantially higher readability scores should be achieved with novel PILs which explicitly discuss risks/benefits and other elements relevant for informed consent, and should be prepared by following standard recommendations of plain language.