Flesch-Kincaid Research Articles

Readability of Online Patient Education Materials for the 10 Most Common Hand Conditions.

Background Millions of individuals every day turn to the internet for assistance in understanding their hand conditions and potential treatments. While online educational resources appear abundant, there are concerns about whether resources meet the readability recommendations agreed upon by the American Medical Association (AMA) and the National Institutes of Health (NIH). Identifying educational resources that are readable for the majority of patients could improve a patient's understanding of their medical condition, subsequently improving their health outcomes. Methods The readability of the top five websites for the 10 most common hand conditions was examined using the Flesch-Kincaid (FK) analysis, comprising the FK reading ease and FK grade level. The FK reading ease score is an indicator of how difficult a text is to comprehend, while the FK grade level score is the grade level an individual reading a particular text would need to fully understand the text. Results The average FK reading ease was 56.00, which correlates with "fairly difficult (high school)". The average FK corresponded to an eighth-grade reading level, far above the sixth-grade reading level recommendation set by the AMA and NIH. Conclusion Patient education, satisfaction, and the patient-physician relationship can all be improved by providing patients with more readable educational materials. Our study shows there is an opportunity for drastic improvement in the readability of online educational materials. Guiding patients with effective search techniques, advocating for the creation of more readable materials, and having a better understanding of the health literacy barriers patients face will allow hand surgeons to provide more comprehensive care to patients.

Assessing the Readability of Patient Education Materials on Cardiac Catheterization From Artificial Intelligence Chatbots: An Observational Cross-Sectional Study.

Artificial intelligence (AI) is a burgeoning new field that has increased in popularity over the past couple of years, coinciding with the public release of large language model (LLM)-driven chatbots. These chatbots, such as ChatGPT, can be engaged directly in conversation, allowing users to ask them questions or issue other commands. Since LLMs are trained on large amounts of text data, they can also answer questions reliably and factually, an ability that has allowed them to serve as a source for medical inquiries. This study seeks to assess the readability of patient education materials on cardiac catheterization across four of the most common chatbots: ChatGPT, Microsoft Copilot, Google Gemini, and Meta AI. A set of 10 questions regarding cardiac catheterization was developed using website-based patient education materials on the topic. We then asked these questions in consecutive order tofour of the most common chatbots: ChatGPT, Microsoft Copilot, Google Gemini, and Meta AI. The Flesch Reading Ease Score (FRES) was used to assess the readability score. Readability grade levels were assessed using six tools: Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index (ARI), and FORCAST Grade Level. The mean FRES across all four chatbots was 40.2, while overall mean grade levels for the four chatbots were 11.2, 13.7, 13.7, 13.3, 11.2, and 11.6 across the FKGL, GFI, CLI, SMOG, ARI, and FORCAST indices, respectively. Mean reading grade levels across the six tools were 14.8 for ChatGPT, 12.3 for Microsoft Copilot, 13.1 for Google Gemini, and 9.6 for Meta AI. Further, FRES values for the four chatbots were 31, 35.8, 36.4, and 57.7, respectively. This study shows that AI chatbots are capable of providing answers to medical questions regarding cardiac catheterization. However, the responses across the four chatbots had overall mean reading grade levels at the 11th-13th-grade level, depending on the tool used. This means that the materials were at the high school and even college reading level, which far exceeds the recommended sixth-grade level for patient education materials. Further, there is significant variability in the readability levels provided by different chatbots as, across all six grade-level assessments, Meta AI had the lowest scores andChatGPT generally had the highest.

Readability of English and Spanish online patient education materials for shoulder arthroplasty

BackgroundOnline patient educational materials (OPEMs) are a vital source of information for those undergoing shoulder arthroplasty, though their utility is limited by patient health literacy as the average American reads at an eighth-grade level. To promote optimal reading comprehension, the American Medical Association and National Institutes of Health recommend that OPEMs be written at or below a sixth-grade level. The purpose of this study is to analyze the readability of English and Spanish shoulder arthroplasty OPEMs. MethodsGoogle Search was used to identify the first 25 eligible Shoulder Arthroplasty OPEMs in both English and Spanish using the search terms “shoulder replacement” and “reemplazo de hombro.” Readability of the English OPEMs was calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Index (FRE), Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index. The readability of Spanish OPEMs was calculated using the Fernandez-Huerta Index (FHI; the Spanish version of FRE), Fernandez-Huerta Index Grade Level, Gutiérrez de Polini's Fórmula de compresibilidad, and Índice Flesch-Szigriszt. ResultsThe mean FHI of Spanish OPEMs was significantly higher than the mean FRE of English OPEMs (60.09 vs. 51.48). As such, Spanish OPEMs were written at a significantly lower grade level than English OPEMs (9.70 vs. 11.53). There was not an English or Spanish OPEM that was written at or below a sixth-grade reading level. 4% of Spanish OPEMs and 4% of English OPEMs were written below an eighth-grade reading level. 52% of Spanish OPEMs and 8% of English OPEMs were written between an eighth- and ninth-grade reading level. The designation of OPEMs as being Very Easy/Easy, Standard/Normal, Fairly/Somewhat Difficult, or Difficult/Very Difficult was significantly dependent on whether the OPEM was written in English or Spanish. Discussion and conclusionEnglish shoulder arthroplasty OPEMs were written at a higher reading difficulty than Spanish OPEMs. However, neither English nor Spanish OPEMs were written at a reading level at or below the recommended sixth-grade reading level. As older adults and those in the United States with limited English proficiency are susceptible to low health literacy, OPEMs must be written at an accessible reading level for all. Addressing these disparities in OPEM readability will improve patient care and understanding of shoulder arthroplasty and other orthopedic procedures.

Quality of Popular Online Resources About Vestibular Migraine.

To evaluate the readability, understandability, actionability, and accuracy of online resources covering vestibular migraine (VM). Cross-sectional descriptive study design. Digital collection of websites appearing on Google search. Google searches were conducted to identify common online resources for VM. We examined readability using the Flesch Reading Ease(FRE) and Flesch-Kincaid Grade Level scores, understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and accuracy by comparing the website contents to the consensus definition of "probable vestibular migraine." Eleven of the most popular websites were analyzed. Flesch-Kincaid Grade Level averaged at a 13th-gradelevel (range: 9th-18th). FRE scores averaged 35.5 (range: 9.1-54.4). No website had a readability grade level at the USAgency for Healthcare Research and Quality recommended 5th-grade level or an equivalent FRE score of 90 or greater. Understandability scores varied ranging from 49% to 88% (mean 70%). Actionability scores varied more, ranging from 12% to 87% (mean 44%). There was substantial inter-rater agreement for both PEMAT understandability scoring (mean κ = 0.76, SD = 0.08) and actionability scoring (mean κ = 0.65, SD = 0.08). Three sites included all 3 "probable vestibular migraine" diagnostic criteria as worded in the consensus statement. The quality of online resources for VM is poor overall in terms of readability, actionability, and agreement with diagnostic criteria.

Assessing readability of online patient educational material on concussion and return to play.

Concussions are self-limited forms of mild traumatic brain injury (TBI). Gradual return to play (RTP) is crucial to minimizing the risk of second impact syndrome. Online patient educational materials (OPEM) are often used to guide decision-making. Previous literature has reported that grade-level readability of OPEM is higher than recommended by the American Medical Association and the National Institutes of Health. The authors evaluated the readability of OPEM on concussion and RTP. An online search engine was used to identify websites providing OPEM on concussion and RTP. Text specific to concussion and RTP was extracted from each website and readability was assessed using the following six standardized indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. One-way ANOVA and Tukey's post hoc test were used to compare readability across sources of information. There were 59 concussion and RTP articles, and readability levels exceeded the recommended 6th grade level, irrespective of the source of information. Academic institutions published OPEM at simpler readability levels (higher FRE scores). Private organizations published OPEM at more complex (higher) grade-level readability levels in comparison with academic and nonprofit institutions (p < 0.05). The readability of OPEM on RTP after concussions exceeds the literacy of the average American. There is a critical need to modify the concussion and RTP OPEM to improve comprehension by a broad audience.

Quality and Readability of Online Health Information on Common Urologic Cancers: Assessing Barriers to Health Literacy in Urologic Oncology.

A growing number of Americans search online for health information related to urologic oncologic care each year. The American Medical Association recommends that medical information be written at a maximum sixth-grade level in order to be comprehensible by the majority of patients. As such, it is important to assess the quality and readability of online patient education material that patients are being exposed to. A Google search was performed using the terms "testicular cancer," "prostate cancer," "kidney cancer," and "bladder cancer," and the top 30 results for each were reviewed. Websites were categorized based on their source. Readability was assessed using the Flesch-Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook indices. Quality was assessed using the DISCERN Quality Index (1-5 scale). A total of 91 websites were included in our analysis. On average, online health information pertaining to urologic cancers is written at a 10th- to 11th-grade reading level, which is significantly higher than that of an average American adult and that recommended by the American Medical Association (P < .01). The overall quality of websites was 3.4 ± 0.7, representing moderate to high quality. There was no significant difference in readability based on cancer type or information source. Despite being of moderate to high quality, online patient education materials related to common urologic cancers are often written at a grade level that exceeds the reading level of an average American adult. This presents as a barrier to online health literacy and calls into question the utility of these resources.

ChatGPT Responses to Frequently Asked Questions on Ménière's Disease: A Comparison to Clinical Practice Guideline Answers.

Evaluate the quality of responses from Chat Generative Pre-Trained Transformer (ChatGPT) models compared to the answers for "Frequently Asked Questions" (FAQs) from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Clinical Practice Guidelines (CPG) for Ménière's disease (MD). Comparative analysis. The AAO-HNS CPG for MD includes FAQs that clinicians can give to patients for MD-related questions. The ability of ChatGPT to properly educate patients regarding MD is unknown. ChatGPT-3.5 and 4.0 were each prompted with 16 questions from the MD FAQs. Each response was rated in terms of (1) comprehensiveness, (2) extensiveness, (3) presence of misleading information, and (4) quality of resources. Readability was assessed using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES). ChatGPT-3.5 was comprehensive in 5 responses whereas ChatGPT-4.0 was comprehensive in 9 (31.3% vs 56.3%, P = .2852). ChatGPT-3.5 and 4.0 were extensive in all responses (P = 1.0000). ChatGPT-3.5 was misleading in 5 responses whereas ChatGPT-4.0 was misleading in 3 (31.3% vs 18.75%, P = .6851). ChatGPT-3.5 had quality resources in 10 responses whereas ChatGPT-4.0 had quality resources in 16 (62.5% vs 100%, P = .0177). AAO-HNS CPG FRES (62.4 ± 16.6) demonstrated an appropriate readability score of at least 60, while both ChatGPT-3.5 (39.1 ± 7.3) and 4.0 (42.8 ± 8.5) failed to meet this standard. All platforms had FKGL means that exceeded the recommended level of 6 or lower. While ChatGPT-4.0 had significantly better resource reporting, both models have room for improvement in being more comprehensive, more readable, and less misleading for patients.

Evaluating ChatGPT as a Patient Education Tool for COVID-19-Induced Olfactory Dysfunction.

While most patients with COVID-19-induced olfactory dysfunction (OD) recover spontaneously, those with persistent OD face significant physical and psychological sequelae. ChatGPT, an artificial intelligence chatbot, has grown as a tool for patient education. This study seeks to evaluate the quality of ChatGPT-generated responses for COVID-19 OD. Quantitative observational study. Publicly available online website. ChatGPT (GPT-4) was queried 4 times with 30 identical questions. Prior to questioning, Chat-GPT was "prompted" to respond (1) to a patient, (2) to an eighth grader, (3) with references, and (4) no prompt. Answer accuracy was independently scored by 4 rhinologists using the Global Quality Score (GCS, range: 1-5). Proportions of responses at incremental score thresholds were compared using χ 2 analysis. Flesch-Kincaid grade level was calculated for each answer. Relationship between prompt type and grade level was assessed via analysis of variance. Across all graded responses (n = 480), 364 responses (75.8%) were "at least good" (GCS ≥ 4). Proportions of responses that were "at least good" (P < .0001) or "excellent" (GCS = 5) (P < .0001) differed by prompt; "at least moderate" (GCS ≥ 3) responses did not (P = .687). Eighth-grade level (14.06 ± 2.3) and patient-friendly (14.33 ± 2.0) responses were significantly lower mean grade level than no prompting (P < .0001). ChatGPT provides appropriate answers to most questions on COVID-19 OD regardless of prompting. However, prompting influences response quality and grade level. ChatGPT responds at grade levels above accepted recommendations for presenting medical information to patients. Currently, ChatGPT offers significant potential for patient education as an adjunct to the conventional patient-physician relationship.

Evaluation of Online AI-Generated Foot and Ankle Surgery Information

As a natural progression from educational pamphlets to the worldwide web, and now artificial intelligence (AI), OpenAI chatbots provide a simple way of obtaining pathology-specific patient information, however, little is known concerning the readability and quality of foot and ankle surgery information. This investigation compares such information using the commercially available OpenAI ChatGPT Chatbot and FootCareMD®. A list of common foot and ankle pathologies from FootCareMD® were queried and compared with similar results using ChatGPT. From both resources, the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) scores were calculated for each condition. Qualitative analysis of each query was performed using the JAMA Benchmark Criteria Score and the DISCERN Score.The overall ChatGPT and FootCareMD® FRES scores were 31.12 ± 7.86 and 55.18 ± 7.27, respectively (p < .0001). The overall ChatGPT and FootCareMD® FKGL scores were 13.79 ± 1.22 and 9.60 ± 1.24 respectively (p < .0001), except for the pilon fracture FKGL scores (p = .09). The average JAMA Benchmark for all information obtained through ChatGPT and FootCareMD® were 0 ± 0 and 1.95 ± 0.15 (p < .001), respectively. The DISCERN Score for all information obtained through ChatGPT and FootCareMD® were 52.53 ± 5.39 and 66.93 ± 4.57 (p < .001), respectively. AI-assisted queries concerning common foot and ankle pathologies are written at a higher grade level and with less reliability and accuracy compared to similar information available on FootCareMD®. With the ease of use and increase in AI technology, consideration should be given to the nature and quality of information being shared with respect to the diagnosis and treatment of foot and ankle conditions.

Readability and Information Quality in Cancer Information From a Free vs Paid Chatbot

The mainstream use of chatbots requires a thorough investigation of their readability and quality of information. To identify readability and quality differences in information between a free and paywalled chatbot cancer-related responses, and to explore if more precise prompting can mitigate any observed differences. This cross-sectional study compared readability and information quality of a chatbot's free vs paywalled responses with Google Trends' top 5 search queries associated with breast, lung, prostate, colorectal, and skin cancers from January 1, 2021, to January 1, 2023. Data were extracted from the search tracker, and responses were produced by free and paywalled ChatGPT. Data were analyzed from December 20, 2023, to January 15, 2024. Free vs paywalled chatbot outputs with and without prompt: "Explain the following at a sixth grade reading level: [nonprompted input]." The primary outcome measured the readability of a chatbot's responses using Flesch Reading Ease scores (0 [graduate reading level] to 100 [easy fifth grade reading level]). Secondary outcomes included assessing consumer health information quality with the validated DISCERN instrument (overall score from 1 [low quality] to 5 [high quality]) for each response. Scores were compared between the 2 chatbot models with and without prompting. This study evaluated 100 chatbot responses. Nonprompted free chatbot responses had lower readability (median [IQR] Flesh Reading ease scores, 52.60 [44.54-61.46]) than nonprompted paywalled chatbot responses (62.48 [54.83-68.40]) (P < .05). However, prompting the free chatbot to reword responses at a sixth grade reading level was associated with increased reading ease scores than the paywalled chatbot nonprompted responses (median [IQR], 71.55 [68.20-78.99]) (P < .001). Prompting was associated with increases in reading ease in both free (median [IQR], 71.55 [68.20-78.99]; P < .001)and paywalled versions (median [IQR], 75.64 [70.53-81.12]; P < .001). There was no significant difference in overall DISCERN scores between the chatbot models, with and without prompting. In this cross-sectional study, paying for the chatbot was found to provide easier-to-read responses, but prompting the free version of the chatbot was associated with increased response readability without changing information quality. Educating the public on how to prompt chatbots may help promote equitable access to health information.

AUA Guideline Committee Members Determine Quality of Artificial Intelligence‒Generated Responses for Female Stress Urinary Incontinence.

Stress urinary incontinence (SUI) affects countless women worldwide. Given ChatGPT's rising ubiquity, patients may turn to the platform for SUI advice. Our objective was to evaluate the quality of clinical information about SUI from the ChatGPT platform. The most-asked patient questions regarding SUI were derived from patient materials from societal websites and forums, and queried using ChatGPT 3.5. The responses from ChatGPT were compiled into a survey and disseminated to 3 AUA guideline committee members who developed the Surgical Management of Female SUI guidelines. They were asked to grade responses on reliability, understandability, quality, and actionability using DISCERN and Patient Education Materials Assessment Tool standardized questionnaires. Accuracy was assessed with a 4-point Likert scale and readability using Flesch Reading Ease score. The overall material was rated as moderate to moderately high quality (DISCERN = 3.73/5) with potentially important but no serious shortcomings. Reliability and quality were reported to be 63% and 75%. Understandability was 89%, actionability 18%, and accuracy 88%. All question domains were rated at moderate or better. Actionability was poor in all domains. Every response was "hard to read" translating to a college graduate reading level. The urologic community should critically evaluate this platform's output if patients are to use it for adjunctive medical guidance. AUA committee members, who are experts in the field, rate ChatGPT-produced responses on SUI as moderate to moderately high quality, moderate reliability, excellent understandability, and poor actionability utilizing standardized questionnaires. The reading level of the material was advanced, which is an area of potential improvement to make generated responses more comprehensible.

An Evaluation of the Content Quality, Readability, and Reliability of Publicly Available Web-Based Information on Pneumothorax Surgery in Ireland.

Introduction The internet is increasingly the first port of call for patients introduced to new treatments. Unfortunately, many websites are of poor quality, thereby limiting patients' ability to make informed health decisions.Within thoracic surgery, the treatment options for pneumothoraces may be less intuitive for patients to understand compared to procedures such as lobectomies and wedge resections. Therefore, patients must receive high-quality information to make informed treatment decisions.No study to date has evaluated online information regarding pneumothorax surgery. Knowledge regarding the same may allow physicians to recommend appropriate websites to patients and supplement remaining knowledge gaps. Objective This study aims to evaluate the content, readability, and reliability of online information regarding pneumothorax surgery. Methods A total of 11 search terms including "pneumothorax surgery,""pleurectomy,"and "pleurodesis"were each entered into Google, Bing, and Yahoo. The top 20 websites found through each search were screened, yielding 660 websites. Only free websites designed for patient consumption that provided information on pneumothorax surgery were included. This criterion excluded 581 websites, leaving 79 websites to be evaluated. To evaluate website reliability, the Journal of American Medical Association (JAMA) and DISCERN benchmark criteria were applied.To evaluate the readability, 10 standardized tools were utilized including the Flesch-Kincaid Reading Ease Score. To evaluate website content, a novel,self-designed 10-part questionnaire was utilized to assess whether information deemed essential by the authors was included.It evaluated whether websites comprehensively described the surgery process for patients, including pre- and post-operative care.Website authorship and year of publication were also noted. Results The mean JAMA score was 1.69 ± 1.29out of 4, with only nine websites achieving all four reliability criteria.The median readability score was 13.42 (IQR: 11.48-16.23), which corresponded to a 13th-14thschool grade standard. Only four websites were written at a sixth-grade reading level.In the novel content questionnaire, 31.6% of websites (n = 25) did not mention any side effects of pneumothorax surgery. Similarly, 39.2% (n = 31) did not mention alternative treatment options.There was no correlation between the date of website update and JAMA (r = 0.158, p = 0.123), DISCERN (r = 0.098, p = 0.341), or readability (r = 0.053, p = 0.606) scores. Conclusion Most websites were written above the sixth-grade reading level, as recommended by the US Department of Health and Human Services. Furthermore, the exclusion of essential information regarding pneumothorax surgery from websites highlights the current gaps in online information.These findings emphasize the need to createand disseminatecomprehensive, reliable websites on pneumothorax surgery that enable patients to make informed health decisions.

Reading Difficulty of Consumer Medicine Information (CMI) Leaflets for Five Chronic Ailments in Ghana

Purpose: This study examined the reading difficulty of Consumer Medicine Information leaflets of five chronic-disease medicines. Design/ Methodology/ Approach: In this descriptive, cross-sectional study, 192 leaflets were randomly downloaded from the World Wide Web: Asthma (35), Cancer (42), Diabetes (41), HIV (29), and Hypertension (45). Text from each ‘leaflet’ was analysed using the Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease, and Gunning Fog indexes. Findings: Consistently, the difficulty of the texts exceeded the recommended difficulty levels. A comparison of mean scores showed leaflets for HIV medication were the most difficult to read because they were written at grade levels too high for the average literate adult. Research Limitations: Readability indexes are suited to only prose. They neither measure how well-organised the text is, nor indicate the suitability of typographical features, such as illustrations, typeface, appeal of presentation, and use of white space. Readability scores do not account for readers’ backgrounds, exposure, and motivation. Practical implication: Developing user-friendly consumer medicine information leaflets can reduce the need for extensive explanations, allowing healthcare providers to allocate their time more efficiently. Social Implication: Improving the readability of Consumer Medicine Information leaflets can enhance health literacy, leading to better health outcomes and reduced healthcare costs associated with medication errors. Originality/Value: While readability indices have been widely used, their application specifically to Consumer Medicine Information leaflets for chronic ailments such as diabetes, hypertension, asthma, arthritis, and heart disease in Ghana is novel. Chronic ailments require continuous and often complex medication regimens, making readability particularly crucial.

Analysis of Lexical Density and Readability of Pakistani English Newspaper Dawn

This research study aimed to analyze the lexical density and readability of Pakistani English Newspaper and so, to suggest their suitability for the level of students. Eight newspapers from four genres were selected as sample. The theory of Systemic Functional Linguistics based on the theory of lexical density by Ure (1971) was applied for finding lexical density and readability indices by using content analysis design through an online text analyzer software. Readability values were compared with the FleschmReading Ease Scale. The results of this study showed that lexical density values of all genres were greater than 40% according to the Flesch Reading Ease Scale. All the texts were lexically dense having a greater number of contents carrying lexical items as compared to grammatical items. The findings of study could also be applied to academic textbooks in order to check complexity and suitability according to the level of the students.

Quality and readability of online information and materials on post-surgery breast seroma.

Aims/Background Seroma formation is the most common complication following breast surgery. However, there is little evidence on the readability of online patient education materials on this issue. This study aimed to assess the accessibility and readability of the relevant online information. Methods This systematic review of the literature identified 37 relevant websites for further analysis. The readability of each online article was assessed through using a range of readability formulae. Results The average Flesch-Reading Ease score for all patient education materials was 53.9 (± 21.9) and the average Flesch-Kincaid reading grade level was 7.32 (± 3.1), suggesting they were 'fairly difficult' to read and is higher than the recommended reading level. Conclusion Online patient education materials regarding post-surgery breast seroma are at a higher-than-recommended reading grade level for the public. Improvement would allow all patients, regardless of literacy level, to access such resources to aid decision-making around undergoing breast surgery.

Quality Assessment of Internet Information Regarding Periodontitis in Persons Living with HIV.

The Internet is the most used source of HIV information second to information received from healthcare professionals. The aim of this study was to assess the quality of Internet information about periodontitis in people living with HIV (PLWH). An Internet search was performed on 18 April 2024 using the search terms "Periodontitis", "Periodontal disease", and "Gum disease" in combination with "HIV" in the most popular search engines (Google™, Bing™, and YAHOO!®). The first 20 results from each search term engine were pooled for analysis. Quality was assessed by JAMA benchmarks. Readability was assessed using the Flesch reading ease score (FRES). Origin of the site, type of author, and information details were also recorded. The quality of Internet information about periodontitis in PLWH varied. The mean JAMA score was 2.81 (SD = 1.0). The websites were generally fairly difficult to read (mean FRES = 57.1, SD = 15.0). Most websites provided some advice about self-treatment of oral problems, accompanied by a strong recommendation to seek professional dental care. In conclusion, advanced reading skills on periodontitis in PLWH were required and quality features were mostly not provided. Therefore, healthcare professionals should be actively involved in developing high-quality information resources and direct patients to evidence-based materials on the Internet.

AI-Generated Content in Cancer Symptom Management: A Comparative Analysis Between ChatGPT and NCCN

BackgroundArtificial intelligence-driven tools, like ChatGPT, are prevalent sources for online health information. Limited research has explored the congruity between AI-generated content and professional treatment guidelines. This study seeks to compare recommendations for cancer-related symptoms generated from ChatGPT with guidelines from the National Comprehensive Cancer Network (NCCN). InterventionWe extracted treatment recommendations for nine symptoms from NCCN, separated into four full Supportive Care sections and five subsections of the Palliative Care webpage. We entered "How can I reduce my cancer-related [symptom]" into ChatGPT- 3.5 for these same symptoms and extracted its recommendations. A comparative content analysis focused on recommendations for medications, consultations, and non-pharmacological strategies. We compared word count and Flesch-Kincaid Grade Level (FKGL) readability for each NCCN and ChatGPT section. OutcomesThe mean percent agreement between NCCN and ChatGPT recommendations was 37.3% (range 16.7%–81.8%). NCCN offered more specific medication recommendations. ChatGPT did recommend medications in the constipation and diarrhea sections that were not recommended by NCCN. Significant differences in word count (P=0.03) and FKGL (P<0.01) were found for NCCN Supportive Care webpages, with ChatGPT having lower word count and reading level. In the NCCN Palliative Care webpage subsections, there was no significant difference in word count (P=0.076), but FKGL was significantly lower with ChatGPT (P<0.01). Conclusions/Lessons LearnedWhile ChatGPT provides concise, accessible supportive care advice, discrepancies with guidelines raise concerns for patient-facing symptom management recommendations. Future research should consider how AI can be used in conjunction with evidence-based guidelines to support cancer patients’ supportive care needs.

A Content and Readability Analysis of Genitourinary and Sexual Health-Related Patient-Reported Outcome Measures in Gender-Affirming Care

ObjectivesTo the evaluate the readability and comprehensiveness of genitourinary and sexual health-related patient-reported outcomes (PROMs) used in gender-affirming care. MethodsCommon PROMs that measure genitourinary and sexual health-related outcomes in gender-affirming care literature were identified from six recent systematic reviews. Readability analysis was completed at the level of individual items and full scale using established readability assessment tool, including Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GF), Coleman Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index. The concepts measured by the PROMs were evaluated for comprehensiveness. Results25 PROMs were included, of which 12 assessed genitourinary outcomes and 13 assessed sexual health outcomes. A total of seven genitourinary domains and eight sexual health domains were identified during concept mapping. Readability analysis showed a median PROM grade level of 9.0 and 9.5 in genitourinary and sexual PROMs, respectively. The Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction v2.0 had the lowest median reading grade level of 5.7, and the Female Sexual Function Index has the highest median reading grade level of 13.9. No single PROM was found to be comprehensive. Multiple PROMs contained double-barreled items or used outdated terminology. ConclusionsMost PROMs used in the genital gender-affirming literature failed to meet the readability recommendations for patient-facing material and were culturally unfit for use in transgender and gender-diverse individuals. None of the PROMs were found to be comprehensive for evaluating outcomes of gender-affirming care. Validated gender-affirming care-specific PROMs that are comprehensible, comprehensive, and relevant are urgently needed.

Barriers to Health Care Communication: Patient Education Resource Readability and Spanish Translation for Slipped Capital Femoral Epiphysis

BackgroundThe American Medical Association (AMA) and the National Institutes of Health (NIH) recommend that patient education resources be written at 6th and 8th grade reading levels, respectively. However, many existing resources are written above this level. In addition, the majority of patient education resources are only available in English, despite the significant Spanish-speaking population in the United States. The purpose of this study was to determine the availability and readability of online patient education resources for Slipped Capital Femoral Epiphysis (SCFE) provided by the top-ranked pediatric orthopaedic hospitals and major pediatric orthopedic professional societies. MethodsWe performed a cross-sectional analysis to determine the availability of English and Spanish language resources for SCFE provided by the top pediatric orthopaedic hospitals and major professional societies. We then assessed the readability of available patient education materials via three measures of readability. Statistical analysis was performed using descriptive, univariate, and correlation analyses. ResultsIn total, 79.6% (39/49) of hospitals and 66.7% (2/3) of professional societies provided English language resources for SCFE. In contrast, Spanish language resources were provided by 34.7% (17/49) and 33% (1/3) hospitals and professional societies. English language resources scored significantly lower than Spanish language resources using the Flesch-Kincaid and Fernandez-Huerta reading ease scales, respectively (60.32 vs. 65.89, p<0.05). There was no difference in grade level calculated by Fry Graph/Gilliam-Peña-Mountain (9.5 vs. 8.5, p>0.05), but English language resources had a significantly higher grade level calculated by SMOG/SOL (11.9 vs. 10.4, p<0.01). There was greater availability of Spanish language resources in states with >20% primary Spanish- speakers (p<0.05). ConclusionThe majority of top-ranked hospitals and professional societies provide online educational materials on SCFE in English; however, only a third provide similar materials in Spanish. Additionally, the average reading level of English and Spanish language resources is above the recommendations from the AMA and NIH. Additional effort and resources should be allocated toward improving SCFE patient education materials to increase accessibility to broader patient and caregiver populations. LEVEL OF EVIDENCELevel III KEY CONCEPTS(1)Online patient education resources for Slipped Capital Femoral Epiphysis (SCFE) are written above the recommended reading grade level for both English and Spanish.(2)There is limited availability of Spanish-language patient education recourses for SCFE, despite a significant Spanish-speaking population in the United States.(3)There is greater availability of Spanish-language resources for SCFE in states with a primary Spanish-speaking population greater than 20%.

What Questions Do Patients Ask About Biologic Therapies for Chronic Sinusitis With Nasal Polyps?

Objective: The objective of this study is to explore the questions commonly asked online about biologic therapies for use in treatment of chronic sinusitis with nasal polyps (CRSwNP) and the quality of the available content. Methods: Most common search terms were identified via Google Trends. People Also Ask (PAA) questions were identified and extracted with their associated website using an online data-scraping program [Search Engine Optimization (SEO) Minion, Keywords Everywhere]. Sources were evaluated using Flesch Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE, higher number = better) score for readability; Journal of American Medical Association (JAMA) Benchmark criteria for quality assessment (0-4, 4 = all criteria met). Results: A total of 143 unique PAA questions and unique websites were identified. Questions were organized into 3 categories: questions about biologic therapies overall (38.46%), about CRSwNP (37.76%), and about treatment options for CRSwNP (23.78%). Websites answering PAA questions were from commercial (60.14%), medical practice (13.99%), academic (13.29%), and government (12.59%) sources. FKGL scores found the average reading level to be at approximately a 12th grade level (SD = 3.297) alongside a low reading ease FRE score of 37.6 (SD = 16.77). Mean JAMA criteria scores were 0.9895 (SD = 0.848), indicating largely low-quality materials. Conclusion: Biologic therapies are a novel treatment option for CRSwNP, and participants are seeking more information about these treatments and disease state. Online resources regarding biologics should be presented at a lower reading level. Sources with evidence-based information are needed. Physicians should be aware of these limitations in online material and counsel accordingly by curating and directing patients to good sources.Level of Evidence: Step 4.