Patient Education Materials for Rheumatology, Internal Medicine Don’t Meet Readability Standards

Yasmin Rustomji, MD

Credit: Rush University Medical Center

Patient education materials (PEMs) available on the American College of Rheumatology (ACR) and Journal of the American Medical Association (JAMA) websites do not align with recommendations for reading comprehension (RC) levels.¹

These findings are from a recent study presented at the ACR Convergence 2024, held in November in Washington, DC, which aimed to bring attention to the discrepancy and call attention to the need to modify PEMs to promote health literacy and better patient understanding.

Investigators, including lead investigator Yasmin Rustomji, MD, a resident at Rush University Medical Center, used 6 standardized RC metrics, including Flesch Kincaid Readability Ease (FKRE) and Flesch Kincaid Grade Level (FKGL) to evaluate the RC of 175 PEMs, including 76 from the ACR and 89 from the JAMA websites.

Rustomji and colleagues found that the mean reading level of all PEMs ranged from high school to college level across RC metrics and ACR and JAMA sites. Scores on RC metrics included a mean 10.89 (standard deviation [SD], 1.88) score on Simple Measure of Gobbledygook (SMOG), which corresponds to a 10th-education, as well as a mean 14.39 (SD, 2.49) score on Gunning Fog Score (GFS), which corresponds to a 14th-grade education required to understand the text. Notably, JAMA PEMS had significantly more difficult RC levels than ACR PEMS on 5 of 6 indices measured (P <.05).¹

Other notable research for patients with rheumatic diseases to be aware of presented at the ACR meeting included an exploration of cannabis use in people with rheumatoid arthritis (RA). The study found benefits on mortality, depression, chronic pain, and anxiety, but an increased risk of opioid use, nicotine dependence, and alcohol use.²

“Cannabis is neither the evil weed from hell nor the best thing since sliced bread,” Daniel Clauw, MD, professor of anesthesiology, rheumatology and psychiatry, University of Michigan, who gave a related presentation on cannabis as a therapy for chronic pain during the meeting, said in a statement.³ “For chronic pain, it is almost certainly more effective and safer than opioids, mainly because opioids are so ineffective and dangerous when used for chronic pain.”

In terms of outcomes, the investigators found that mortality was significantly lower among cannabis users (0.98% vs. 2.71%), who also incurred lower total hospital charges ($57,773 vs. $63,681) than non-users. Shrestha and colleagues found no significant difference in the length of hospital stay.²

“More research is needed on the long-term effects of cannabis in RA patients and the population at risk of dependency should be monitored closely,” lead investigator Karun Shrestha, MD, Internal Medicine Resident at St Barnabas Hospital and Research Fellow, Acute Care Research Consortium, Mayo Clinic, and colleagues concluded.²

REFERENCES

1. Rustomji Y, Nweke UC, Hassan S, Jolly M, Ahmad U. Not So Patient-Friendly: Patient Education Materials in Rheumatology and Internal Medicine Fall Short of Nationally Recommended Readability Benchmarks in the United States. Presented at: ACR Convergence 2024; November 14-19; Washington, DC.

2. Shrestha K, Subed P, Ghimir M, et al. Inpatient Outcomes of Rheumatoid Arthritis in Hospitalized Patients Using Cannabis: Data from the National Inpatient Sample. Presented at: ACR Convergence 2024; November 15-19; Washington, DC. Abstract 0466

3. Research at ACR's Annual Meeting Explores Medicinal Marijuana Use and Rheumatic Disease-Related Pain. News release. November 14, 2024.