Dense breast notifications still too complex for all patients to understand

The reading level of dense breast notifications (DBNs) remains too high, according to a new study published in the Journal of the American College of Radiology. The U.S. Department of Health and Human Services and American Medical Association both recommend such documents should be written at a sixth-grade reading level.

“Effective communication between patients and physicians is critical to improve health care outcomes,” wrote Ami Saraiya, MD, department of diagnostic imaging at Rhode Island Hospital in Providence, and colleagues. “DBNs may impact breast cancer screening behaviors, but it is often challenging for physicians to present written information to patients in an easily understandable format. 

Using the Flesch-Kincaid Grade Level as a readability metric, the authors found that none of the 30 states that have mandated DBNs had the notifications at or below a sixth-grade reading level. Eight of those states had DBNs “around or below” an eight-grade reading level. While Connecticut had the highest reading level (19.4), Alabama and New York tied for the lowest with a 7.2. In addition, Missouri was the only state that had updated its DBN text since 2016 and made them significantly better; the reading level dropped from 13.1 to 8.5.

Saraiya and colleagues also explored the readability of certain online resources, noting that the American Cancer Society had reading level of 6.0 and a patient pamphlet from the American College of Radiology had a reading level of 7.2.

“Given that effective communication improves health outcomes and compliance, appropriate readability level of materials directed to patients is crucial,” the authors wrote. “Efforts to notify patients of their tissue density are essentially moot if the majority of patients are unable to understand the DBNs.”

One recommendation offered by the authors was that breast radiologists should work together to create a standardized DBN letter that meets all readability requirements. States could then, if they choose, reference that letter when mandating DBNs.