Only 4.8% of websites describing prostate cancer are written below a high school reading level. Their median reading level was 12th grade. Notably, since 90 million American adults read below high school levels, the National Institutes of Health (NIH) recommends that patient-education materials be written at the fourth-through-sixth grade reading level.

Notably, nearly one-third of the US population reads below high school level. Prostate cancer is among the more difficult topics for patients to understand. At least four treatment options exist, which are surgery, radiation beam therapy, radiation seeds, and active surveillance. Each option has pros and cons, and these differ based on factors such as the patient’s age, tumor type, and overall health. Doctors struggle to simplify technology-based treatments, anatomical descriptions, and medical terminology. Also, some terms that doctors take for granted, such as erection and impotent, may not be understood by patients with low health literacy.

The research team identified 62 websites by searching for “prostate cancer,” “prostate cancer treatment,” and “prostatectomy” on the Google, Yahoo, and Bing search engines. The readability of the first 300 words of each website was tested with word processing software. The readability was assessed with the Flesch-Kincaid test, which measures reading level, and the Flesch reading east test, which assigns a readability score of 0-100. The tests are based on formulas that incorporate total number of words, sentences, and syllables.

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The researchers found that 63% of the websites were written above a 12th grade reading level. The median Flesch reading ease score for all sites was a relatively difficult 38.1. (The Flesch reading ease score ranges from 0-100. A score of 90-100 would be easily understood by an 11-year-old, a score of 60-70 would be understood by 13- to 15-year-olds, and scores below 30 would be suited to college graduates.)

“Clinicians should be aware that some of their patients may not be able to read online information and should consciously guide patients with low literacy to not only high-quality websites, but also sites that are easy-to-read to prevent confusion and anxiety after being diagnosed with prostate cancer,” wrote the research team, which was led by senior author Gopal Gupta, MD, of Loyola Medical Center.

The websites with the easiest readability scores were News-Medical Net (eighth grade level), Consumer (8.9, nearly ninth grade level), Family (8.95, nearly ninth grade), UPMC Cancer Centers (9.2, ninth grade), and NIH Pubmed Health (9.8, nearly 10th grade).

This research was published in Journal of Urology (2012; doi:10.1016/j.juro.2012.07.105).