Highlight
- Most gynecologic cancer patient education materials from National Cancer Institute designated cancer centers (NCI-DCCs) and non-profit organizations (NPOs) exceed the NIH and AMA recommended 7th grade reading level.
- Only 5.4% of NCI-DCC materials and none from NPOs met the recommended reading level threshold, with the majority requiring high school or higher literacy skills.
- Improvement in the readability of these resources is essential to promote patient understanding and engagement in gynecologic cancer care.
Study Background
Patient education materials are a cornerstone of effective communication and shared decision-making in oncology. Gynecologic cancers—including ovarian, uterine, cervical, vaginal, and vulvar cancers—pose significant health burdens globally and in the United States, frequently necessitating complex treatment regimens. Adequate patient comprehension of disease specifics, treatment options, and potential outcomes is critical for adherence and informed consent. The National Institutes of Health (NIH) and the American Medical Association (AMA) have both recommended that patient-directed educational content be written at or below a 7th grade reading level to enhance accessibility to broad populations, including those with limited health literacy. Nonetheless, the actual readability of gynecologic cancer education materials from leading cancer centers and reputable nonprofits remained unclear prior to this study.
Study Design
The study conducted a cross-sectional analysis of online patient education content related to cervical, ovarian, uterine, vulvar, and vaginal cancers. Materials were retrieved from National Cancer Institute designated cancer centers (n=61) and selected patient-directed non-profit organizations (n=6). The researchers measured reading difficulty using three established readability formulas:
- Flesch-Kincaid Grade Level (FKGL)
- Simple Measure of Gobbledygook (SMOG)
- Coleman-Liau Index
Each document was analyzed using three distinct online calculators to ensure measurement robustness. Statistical comparison of reading levels between the two groups was performed using linear mixed models, accounting for variability among different cancer types and institutions.
Key Findings
A total of 202 education documents from NCI-DCCs and 29 from NPOs were included in the final analysis. The mean FKGL for NCI-DCC materials was 10.2 (±1.9), indicating a reading level appropriate for individuals with approximately a 10th-grade education. Only 5.4% of these materials were at or below the recommended 7th-grade level for any gynecologic cancer topic.
For the NPO resources, the mean FKGL was 10.0 (±1.9), with none meeting the 7th-grade threshold. Similarly, assessment with the Coleman-Liau and SMOG indices revealed reading levels consistently above 6th to 7th grade, with many materials elevated toward a high school or early college reading competency.
These findings underscore a significant and consistent mismatch between recommended readability standards and the complexity of materials currently available to gynecologic cancer patients. The high reading levels may pose barriers to comprehension, particularly for patients with lower health literacy, potentially contributing to disparities in cancer outcomes.
Expert Commentary
Effective patient education requires clear communication tailored to the audience’s literacy level. Despite institutional efforts to provide comprehensive information, overly complex language and medical jargon in educational materials can negatively affect patient understanding and engagement. The study highlights a systemic issue in oncology communication resources.
While high-level content may be comprehensive, simplification is possible without sacrificing critical information. Incorporation of plain language principles, use of visuals, and patient feedback can enhance material accessibility. Limitations of the study include its focus on online materials only, which may not represent all patient education resources, and reliance on readability formulas that assess linguistic complexity but not other comprehension factors such as cultural relevance or visual design.
Conclusion
This analysis reveals that most gynecologic cancer education materials from leading cancer centers and non-profit organizations surpass recommended reading levels, jeopardizing patient comprehension. There is a pressing need for these entities to revise and simplify content to ensure inclusivity across literacy levels. Enhancing readability could improve patient knowledge, satisfaction, and ultimately clinical outcomes by empowering patients to make informed decisions regarding their care.
Funding and Clinical Trials
The original study did not report specific funding sources or clinical trial registrations.
References
1. National Institutes of Health. Clear & Simple: Developing Effective Print Materials for Low-Literate Readers. NIH Publication.
2. American Medical Association. Health Literacy and Patient Safety: Help Patients Understand. AMA Foundation.
3. Dillon BS, Hood O, Chanda S, Madill M, Tessier KM, Erickson BK, O’Shea A. An analysis of the readability of Gynecologic Cancer patient education materials. Gynecologic Oncology. 2026 Jul 11;211:142-147. doi:10.1016/j.ygyno.2026.07.005. PMID: 42435633.
4. Weiss BD. Health Literacy and Patient Safety: Help Patients Understand. AMA Foundation; 2007.