Improving State-Mandated Breast Density Notifications.

PURPOSE: Effective written communication directly affects health care outcomes. Since 2016, the complex language of state-mandated breast density notifications (BDNs) has been challenged, because it is perceived to be beyond the comprehension of most patients. The aim of this study was to assess whether a revised BDN written at a lower reading grade level improves understanding compared with the current state-mandated BDN. METHODS: A revised notification with similar content to the current state-mandated BDN was developed. Both notifications were presented to patients for direct comparison, using a paper survey asking questions that evaluated patients' perceptions and convictions associated with breast density. Surveys were distributed at four outpatient imaging centers to screening mammography patients. RESULTS: The current BDN's mean readability metric was 13.4, and that of the revised BDN was 6.6. Five hundred surveys were analyzed. Survey data demonstrated that 56.6% of all women perceived that dense breast tissue results indicated a "high" associated lifetime breast cancer risk from the current state-mandated BDN compared with only 2.2% with the revised notification (P < .001). Nearly all women were more likely to initiate discussions with their providers regarding their breast tissue density after reading the revised notification (96.0%) as opposed to the current state-mandated BDN (32.8%; P < .001). CONCLUSIONS: A significant portion of women misinterpret the intended messages of the current state-mandated BDN. Thus, a revised notification at a lower reading grade level may improve understanding of breast density, leading to improved individualized breast cancer screening for women with dense breasts.

Improving Patient Comprehension of Screening Mammography Recall Lay Letters.

PURPOSE: In accordance with the Mammography Quality Standards Act, recall lay letters should be written using language that is "easily understood by a lay person." The authors hypothesized that the readability of their institution's current recall lay letter may contribute to the misinterpretation of intended time for patient return. Thus, the aim of this study was to evaluate the comprehension of the current recall lay letter statement. METHODS: The Flesch-Kincaid grade level was used to assess readability of the lay letter currently used at the authors' institution. A revised statement was formulated. A single paper-based survey presented both current and revised statements and asked questions to probe patients' understanding of expected time to return. Surveys were provided to screening mammography patients at four outpatient imaging centers. RESULTS: The Flesch-Kincaid grade levels of the current and revised statements were 12th and 4th grades, respectively. Five hundred ninety-nine surveys were analyzed. Survey data demonstrated that only 49.6% of all patients understood that the current statement requests return within 1 month specifically with the breast center, compared with 95.2% of patients with the revised statement (P < .001). Of the patients who misunderstood when to follow up with the breast center, about 80% had achieved less than a college degree (P < .001). CONCLUSIONS: The grade level of the authors' institution's current lay letter statement is greater than the national recommendation for the average patient, which is between 6th and 8th grade. These data suggest that revising the language of recall statements to the recommended grade level would potentially improve patient understanding and compliance.