(Poster 143) Assessing Patient Understanding of Prolapse Handout at Different Reading Levels

Objectives: Patient understanding of their diseases correlates with satisfaction and symptom improvement. The American Medical Association has recommended patient handouts (PH) be written at or below a sixth-grade reading-level (BSG). Most American Urogynecologic Society (AUGS) PH are above a sixth-grade reading-level (ASG). Our objective is to determine if patient knowledge of pelvic organ prolapse (POP) is higher after reading PH written ASG compared to BSG.

Methods: We conducted a prospective randomized controlled study of patients presenting to urogynecology clinic December 2024 - March 2025. Prior to seeing a urogynecology provider, patients were randomized to read a portion of the AUGS handout on POP, reading-level 9.4 (ASG), or the same handout simplified to a 5.1 reading-level (BSG). The simplified handout was generated from the AUGS PH by giving the following prompt to an artificial intelligence large language model: “please rewrite the information below to be at a fifth grade Flesch-Kincaid grade level.“ New and returning patients were stratified and underwent block randomization. Non-English speaking patients were excluded. After reading the handout, patient knowledge was assessed using the POP portion of the Prolapse and Incontinence Knowledge Questionnaire, a validated knowledge assessment tool. A total sample of 116 was needed to detect a 2-question difference with 90% power. This study received IRB approval and was registered on clinicaltrials.gov (NCT06736808).

Results: Of 156 patients randomized, 149 completed the study: 75 in the ASG arm and 74 in the BSG arm. Median age range was 50-59 years old. Most patients reported college or higher education. Baseline characteristics including household income, education level, and rate of POP did not differ between groups (Table 1). Most patients reported the PH improved their understanding of POP (78.2%). Median knowledge scores were high for both groups and did not differ (91.7% for ASG vs 91.7% for BSG, p= 0.82) (Table 2). Scores were similarly high when analyzing only participants who had never seen a urogynecology provider (n=43, 87.5% for ASG vs 91.7% for BSG, p=0.73). After controlling for age, race, medical field employment, and urogynecologic history, there continued to be no difference in knowledge scores between groups. However, identifying as white and having an education level of college or greater are associated with an increase in knowledge score (15.9% (95%CI 0.5%, 26.5%), p=0.004 and 12.9% (95%CI 3.2%, 22.5%), p=0.01, respectively) in multivariable linear regression.

Conclusions: Most patients reported an increased understanding of POP after reading the handout. POP knowledge scores were high among both new and returning urogynecology patients and did not differ between those who received ASG and BSG PH. Many factors contribute to comprehension and lower reading level alone may not improve patient understanding of handouts.

Table legends:
n(%) or median(IQR)
†Fisher’s Exact test
‡Pearson Chi Square test
§Kruskal-Wallis tests