Researchers determined that currently available templates used for treatment summaries and survivorship care plans (TS/SCPs) in the US use language that is too complex for the educational level of most adults. These results were reported in JCO Oncology Practice.

Patients who have had cancer receive TS/SCPs to aid in the survivorship process, but health literacy is often a challenge in the oncology setting, the researchers noted. They aimed to evaluate the readability of commonly used TS/SCP templates, in addition to comprehensibility for persons with differing levels of health literacy.

“Healthcare providers have an obligation to meet patients where they are at in terms of their knowledge and understanding of their disease and treatment,” the researchers reported.

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TS/SCP templates the researchers examined included the 6 disease-specific American Society of Clinical Oncology (ASCO) templates, Oncolink, Journey Forward, and a template from the researchers’ institution, The Ohio State University (OSU) in Columbus. The researchers set up a case study of a patient with colorectal cancer to serve as a scenario for evaluating some of the templates. Several measures were used for evaluating readability, which included Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid reading ease, Coleman-Liau index, and Gunning Fog index.

With blank ASCO TS/SCP templates, the researchers found the Flesch-Kincaid reading ease scores to equate to a reading level of approximately grades 10 to 12. Both the Coleman-Liau and Gunning Fog measures indicated an 11th grade reading level was needed for reading the ASCO templates, while the SMOG index suggested a college education was needed to understand the ASCO templates.

When applied to the colorectal case study, the Oncolink template, which was the longest one at 17 pages, was found to have the lowest education level needed for readability, ranging from 11th to 12th grade, depending on measure. The Journey Forward template was found to require a college graduate status across most study measures. The ASCO and OSU templates were found to be written at the college level by SMOG and Coleman-Liau measures.

“Our study showed that the existing TS/SCP templates used by many cancer centers are written at a grade level beyond the comprehension of most American adults,” the researchers concluded. They considered this study to highlight the need to improve readability of TS/SCP templates, in addition to comprehensibility in cases of low health literacy, to help patients make informed medical decisions.


Kue J, Klemanski DL, Browning KK. Evaluating readability scores of treatment summaries and cancer survivorship care plans. JCO Oncol Pract. 2021;17(10):615-621. doi:10.1200/OP.20.00789