Sa1043 THE READABILITY OF LETTERS REPORTING PATHOLOGY RESULTS AND FOLLOW-UP RECOMMENDATIONS AFTER ENDOSCOPIC PROCEDURES

Abstract

The quality of patient-physician communication is an important predictor of patient outcomes. Pathology results following endoscopic procedures are often conveyed via letter, however patient literacy varies and material written at higher than a 6th to 8th grade level may not be understood by a substantial proportion of patients in the United States. We therefore sought to measure the readability of letters to patients communicating pathology results and follow up recommendations and to identify predictors of letter readability. We reviewed consecutive colonoscopies performed at a tertiary care center over a five day period in April 2017 and identified cases in which pathology results and follow-up recommendations were communicated to patients by letter. The readability of the letters was determined using the Flesch-Kincaid grade level measure, in which more readable text is defined by a lower Flesch-Kincaid grade level. Mann-Whitney and Kruskal-Wallis tests were used to identify factors associated with letter readability. A total of 144 letters were reviewed. The mean Flesch-Kincaid grade level of the letters was 9.9 (SD 3.5). 125 letters (87%) were written over a 6th grade level, and 97 (67%) were written over an 8th grade level. 16 patients (11%) did not speak English as their primary language; all of these patients were sent letters written in English rather than their primary language, and letter readability did not differ between letters to primary English speakers and non-English speakers. Patient education level (college graduates versus non-graduates) also did not predict the Flesch-Kincaid grade level at which their letter was written. Procedures performed without a fellow and by attending endoscopists over 60 years old were associated with letters written at higher grade levels versus those performed by attending endoscopists under age 60 (mean Flesch-Kincaid grade level 11.6 vs 9.8, p=0.015). Colonoscopies performed with a fellow were followed by more readable letters than endoscopies not involving fellows (mean grade level 8.8 vs 10.5, p=0.016). There were no differences in letter readability based on patient age, patient gender, patient ethnicity, whether upper endoscopy was performed concurrently with colonoscopy, or procedural indication. Letters to patients reporting colonoscopy pathology results and follow up recommendations were usually written at a grade level that exceeded those recommended for communication with patients, and the language of the letters did not differ based on easily identifiable risk factors for lower literacy, including patients’ educational attainment and primary language. Interventions are necessary to improve the readability of written communication with patients following endoscopic procedures.