Are English-language online patient education materials related to breast cancer risk assessment understandable, readable, and actionable?

PURPOSE: To evaluate the readability, understandability, and actionability of online patient education materials (OPEM) related to breast cancer risk assessment. MATERIAL AND METHODS: We queried seven English-language search terms related to breast cancer risk assessment: breast cancer high-risk, breast cancer risk factors, breast cancer family history, BRCA, breast cancer risk assessment, Tyrer-Cuzick, and Gail model. Websites were categorized as: academic/hospital-based, commercial, government, non-profit or academic based on the organization hosting the site. Grade-level readability of qualifying websites and categories was determined using readability metrics and generalized estimating equations based on written content only. Readability scores were compared to the recommended parameters set by the American Medical Association (AMA). Understandability and actionability of OPEM related to breast cancer high-risk were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and compared to criteria set at ≥70%. Descriptive statistics and inter-rater reliability analysis were utilized. RESULTS: 343 websites were identified, of which 162 met study inclusion criteria. The average grade readability score was 12.1 across all websites (range 10.8-13.4). No website met the AMA recommendation. Commercial websites demonstrated the highest overall average readability of 13.1. Of the 26 websites related to the search term breast cancer high-risk, the average understandability and actionability scores were 62% and 34% respectively, both below criteria. CONCLUSIONS: OPEM on breast cancer risk assessment available to the general public do not meet criteria for readability, understandability, or actionability. To ensure patient comprehension of medical information online, future information should be published in simpler, more appropriate terms.

A Multimetric Evaluation of Online Patient Educational Materials for Breast Implant-associated Anaplastic Large Cell Lymphoma.

OBJECTIVE: To assess understandability, actionability, and readability of online patient educational materials (OPEM) related to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). METHODS: Search volumes for query terms related to BIA-ALCL including "breast implant associated lymphoma," "breast implant associated anaplastic large cell lymphoma," and "BIA-ALCL" were analyzed in one-week increments and normalized to total Google search volume. The same terms were then queried using an online search engine to identify commonly accessed OPEM on this topic. Understandability and actionability of OPEM were evaluated using the Patient Education Materials Assessment Tool. Grade-level readability was determined using generalized estimating equations, with observations nested within readability metrics from each website. All interval estimates were calculated for 95% confidence. RESULTS: Overall, 24 websites were identified based on search parameters. Of these websites, 11 (45.8%) met criteria for understandability, and 1 (4.2%) met criteria for actionability. Overall, readability ranged from 10.2 to 17.3 for all websites with an average grade level readability of 12.4; 0 websites were written at or below a sixth-grade reading level. Government websites had the highest average grade reading level at 14.0, followed by commercial websites at 13.2, nonprofit websites at 12.0, and then academic/hospital-based websites at 11.5. CONCLUSION: The quality of available OPEM on BIA-ALCL is limited. Future development of OPEM should be designed with the goal of improving both comprehension and actionability to help reduce patient anxiety and unnecessary clinical appointments related to this disease.

Progesterone treatment shows greater protection in brain vs. retina in a rat model of middle cerebral artery occlusion: Progesterone receptor levels may play an important role.

BACKGROUND/OBJECTIVE: To determine whether inflammation increases in retina as it does in brain following middle cerebral artery occlusion (MCAO), and whether the neurosteroid progesterone, shown to have protective effects in both retina and brain after MCAO, reduces inflammation in retina as well as brain. METHODS: MCAO rats treated systemically with progesterone or vehicle were compared with shams. Protein levels of cytosolic NF-κB, nuclear NF-κB, phosphorylated NF-κB, IL-6, TNF-α, CD11b, progesterone receptor A and B, and pregnane X receptor were assessed in retinas and brains at 24 and 48 h using western blots. RESULTS: Following MCAO, significant increases were observed in the following inflammatory markers: pNF-κB and CD11b at 24 h in both brain and retina, nuclear NF-κB at 24 h in brain and 48 h in retina, and TNF-α at 24 h in brain.Progesterone treatment in MCAO animals significantly attenuated levels of the following markers in brain: pNF-κB, nuclear NF-κB, IL-6, TNF-α, and CD11b, with significantly increased levels of cytosolic NF-κB. Retinas from progesterone-treated animals showed significantly reduced levels of nuclear NF-κB and IL-6 and increased levels of cytosolic NF-κB, with a trend for reduction in other markers. Post-MCAO, progesterone receptors A and B were upregulated in brain and downregulated in retina. CONCLUSION: Inflammatory markers increased in both brain and retina after MCAO, with greater increases observed in brain. Progesterone treatment reduced inflammation, with more dramatic reductions observed in brain than retina. This differential effect may be due to differences in the response of progesterone receptors in brain and retina after injury.