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Personalized Letters Improve Patient Comprehension of Foot and Ankle Pathology and Procedures

Howard N, Edwards K, Jackson G, Platt S

The purpose of this study was to enhance patient comprehension of our institution’s communication materials, specifically the standardized forms and information leaflets used in obtaining consent to elective foot and ankle surgery.
Studies have shown poor patient comprehension during the consenting process. Improved document readability has been recommended. We evaluated the readability of our existing consent forms and information leaflets using five standard indices: Flesch-Kincaid, Gunning fog, Simple Measure of Gobbledygook, Coleman-Liau, and automated readability.
We compared the results with the readability of 50 personalized letters explaining the patient’s individual pathology and surgical management plan as an adjunct to the standard consenting process. Standardized consent forms had the poorest readability, being accessible only to patients having completed higher education.
Readability of the patient information leaflets was better, requiring an average reading age of 15– 16 years, and that of the personalized letters better still (average reading age: 14–15 years), yet still markedly exceeding the recommended target age of 11–13 years.
We conclude that personalized letters offer an effective low-cost boost to patient understanding of foot and ankle pathology and treatment, but that further improvement is essential if we are to approximate to the recommended targets.