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      Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis

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          Abstract

          Comprehensive patient education is necessary for shared decision-making. While patient–provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable ( P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients’ understanding of their disease processes and treatment options.

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          Low health literacy and health outcomes: an updated systematic review.

          Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes. To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages. English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011). Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels. One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence. 96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies. Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found. Low health literacy is associated with poorer health outcomes and poorer use of health care services. Agency for Healthcare Research and Quality.
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            Shared Decision Making: A Model for Clinical Practice

            The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.
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              Shared decision making--pinnacle of patient-centered care.

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                Author and article information

                Journal
                J Patient Exp
                J Patient Exp
                JPX
                spjpx
                Journal of Patient Experience
                SAGE Publications (Sage CA: Los Angeles, CA )
                2374-3735
                2374-3743
                3 March 2021
                2021
                : 8
                : 2374373521998847
                Affiliations
                [1 ]Ringgold 4002, universityThe University of Texas MD Anderson Cancer Center; , Houston, TX, USA
                [2 ]College of Medicine, Ringgold 14681, universityUniversity of Illinois at Chicago; , Chicago, IL, USA
                [3 ]Harvard Radiation Oncology Program, Boston, MA, USA
                [4 ]Department of Radiation Oncology and Herbert Irving Comprehensive Cancer Center, Ringgold 21611, universityColumbia University Irving Medical Center and New York-Presbyterian Hospital; , New York, NY, USA
                [5 ]Department of Radiation and Cellular Oncology, Ringgold 12246, universityUniversity of Chicago; , Chicago, IL, USA
                [6 ]Division of Cardiology, Department of Medicine and Radiology, Ringgold 21611, universityColumbia University Irving Medical Center and New York-Presbyterian Hospital; , New York, NY, USA
                [7 ]Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
                Author notes
                [*]Daniel W Golden, Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, 5758 South Maryland Avenue Mail Code 9006, Chicago, IL 60637, USA. Email: dgolden@ 123456radonc.uchicago.edu
                Author information
                https://orcid.org/0000-0002-2860-4653
                Article
                10.1177_2374373521998847
                10.1177/2374373521998847
                8205335
                34179407
                55242856-ea07-4378-8096-69699810df4f
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Research Article
                Custom metadata
                January-December 2021
                ts3

                patient education,patient engagement,medical decision making,health literacy

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