Assertions about patient information are not supported

EDITOR,--I am surprised at the assertion of Philip Meredith and colleagues that patients do not use information provided in printed form “nor particularly like doing so.”1 Such an assumption seems to contradict research findings over the past decade showing that patients tend to be much more satisfied with communication after they are given printed information,2 may rate leaflets more highly as a source of information than doctors,3 and want to receive printed information about surgical and medical interventions.

Meredith and colleagues' claim that leaflets may not be understood by “over a third of those reading them” seems to rest on studies using readability formulas. The validity and usefulness of these studies have been questioned.4 Hawkey and Hawkey reported that a leaflet on diverticular disease with a Flesch reading ease score of 46 was rated as easy to understand by 78% of patients.3 Ley claimed that a text with such a score would be rated as “difficult,” typically “academic,” and would be understood by only 31% of people aged 25 or older and only 17% of people aged 65 or older.5 In addition, Mayberry, whom Meredith and colleagues quote, reported that patients may be highly motivated to read difficult text.

Finally, Meredith and colleagues argue that leaflets and other educational material should be developed “independently of commercial interests.” Leaflets produced by clinicians, nurses, and other health professionals as a “do it yourself” project have been heavily criticised; many leaflets produced by medical charities could not be produced without commercial sponsorship and have been rated as very useful by patients.3 Moreover, the content of leaflets produced by pharmaceutical companies in particular is tightly regulated and forbids “covert advertising for a particular product.”