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December 29, 2017

Need to explain a surgery? Just ask a 9-year-old.

Daily Briefing

    To make patient information pamphlets easier to understand, researchers in a new study featured in The BMJ's traditionally lighthearted Christmas edition called on an unusual team of editors: "a group of very bright and helpful children." 

    Study details

    For the study, Catrin Wigley of University Hospitals Coventry and Warwickshire NHS Trust in England and colleagues analyzed six National Health Service patient information pamphlets. They found that they were written, on average, at the reading level of a 17-year-old—but the average British person reads at only a fourth-grade level, roughly that of a nine-year-old child. (In comparison, acording to NPR's "Shots," the average American reads at about an eighth-grade level.)

    To help make pamphlets more comprehensible, researchers recruited 57 children ages eight to 10. The children were taught about total hip arthroplasty, including lessons on anatomy and surgical technique, as well as warning signs and risks. The children then wrote their own pamphlets under four headings:

    • Indications for surgery;
    • Complications of surgery;
    • Before the procedure; and
    • The procedure.

    The children also drew an image of their own choosing to be included in the pamphlet.

    According to the researchers, the children wrote pamphlets that were much more "honest and to the point" than the original pamphlets. For instance, one child explained the need for a hip surgery by pointing out the current hip "is old and rotten," while another wrote, "It is past its sell-by date." And to explain a possible neurovascular injury, yet another young writer succinctly stated, "The surgeons may make a mistake and cut the wrong thing."


    While researchers made clear they don't believe children should actually write patient information pamphlets, they do believe a child's straightforward approach can be instructive.

    "What better way to write a new leaflet than by engaging with nine-year-old children, so that we can begin to appreciate the disparity in the language we use to convey information through formal patient information leaflets," the researchers wrote. "Let's take our cue from the children and begin speaking honestly and to the point with our patients in a language they understand."

    Separately, Cynthia Baur—director of the Horowitz Center for Health Literacy at the University of Maryland's School of Public Health, who was not involved in the study—said the experiment is interesting, although she too noted that it wasn't a practical way to write patient pamphlets. "While children may be able to say things simply, they don't have the context and experience to recognize aspects of topics that might need more in-depth information or explanation, and they can't anticipate adult concerns," she said.

    Baur did agree, however, that patient materials "are still far from where they need to be," and she said the best approach to improving them involves the patients. "Health care organizations that truly care about excellent patient experiences and well-being will find ways to involve patients, caregivers, and others in the routine development of all types of health communication, even forms and facility signs," she said (Wigley et. al., The BMJ, 12/13; Fulton, NPR, "Shots", 12/15).

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