Patient Communication Simplifier

Patient Communication Simplifier

Overview

This skill transforms complex medical communications (clinical notes, consent forms, discharge instructions, benefit explanations, care plans) into plain-language content accessible to patients at varying health literacy levels. It applies validated readability assessment instruments (Flesch-Kincaid, SMOG, Fry Readability Graph) and suitability evaluation tools (Suitability Assessment of Materials, SAM) to ensure output meets national health literacy standards. The CDC recommends patient materials target a 6th-8th grade reading level; nearly 36% of U.S. adults have basic or below-basic health literacy (NAAL).

When to Use

• Converting clinical documentation into patient-facing after-visit summaries
• Simplifying consent forms, advance directives, or financial agreements
• Rewriting patient education materials for lower literacy audiences
• Preparing content for patient portals that must meet Meaningful Use plain-language requirements
• Adapting communications for specific populations (elderly, pediatric caregivers, LEP post-translation)
• Responding to CMS or Joint Commission findings on patient communication adequacy

Required Inputs

Methodology

Step 1: Source Content Analysis

• Compute baseline readability metrics on the source document:
  • Flesch-Kincaid Grade Level: 0.39 x (total words/total sentences) + 11.8 x (total syllables/total words) - 15.59
  • SMOG Index: 3 + sqrt(polysyllable count x 30/total sentences)
  • Flesch Reading Ease: 206.835 - 1.015 x (words/sentences) - 84.6 x (syllables/words), target 60 or above
• Identify clinical jargon, abbreviations, acronyms, and complex sentence structures
• Flag sentences exceeding 20 words (recommended maximum for patient materials)
• Catalogue multi-syllabic medical terms requiring simplification or definition

Step 2: Terminology Simplification

• Replace medical jargon with plain-language equivalents using validated substitution lists:
  • "hypertension" becomes "high blood pressure"
  • "myocardial infarction" becomes "heart attack"
  • "bilateral" becomes "on both sides"
  • "contraindicated" becomes "should not be used"
  • "prophylaxis" becomes "prevention"
  • "etiology" becomes "cause"
  • "benign" becomes "not cancer" or "not harmful"
  • "prognosis" becomes "what we expect to happen"
• When a medical term must be retained (medication names, diagnosis for insurance), introduce it with its plain-language equivalent: "metformin (your diabetes medicine)"
• Preserve clinical precision: simplification must not introduce ambiguity or inaccuracy

Step 3: Structural Simplification

• Apply plain-language writing principles (per PlainLanguage.gov and NIH Clear Communication):
  • Use active voice ("Take your medicine at 8 AM" not "Medicine should be taken at 8 AM")
  • Use second person ("you/your") to address the patient directly
  • Limit sentences to 15-20 words maximum
  • One idea per sentence, one topic per paragraph
  • Use headers and bullet points to organize information
  • Lead with the most important information (inverted pyramid)
  • Use concrete numbers instead of vague terms ("every 4 hours" not "frequently")
• Apply chunking: group related instructions under clear action-oriented headers
  • "What to Do at Home"
  • "When to Call Your Doctor"
  • "Your Medicines"
  • "Your Next Appointment"

Step 4: Visual and Layout Optimization

• Recommend design elements that improve comprehension:
  • White space: 1-inch margins minimum, 1.15 line spacing minimum
  • Font: Sans-serif, 12pt minimum (14pt for elderly audiences)
  • Contrast: Dark text on light background (WCAG AA minimum)
  • Visuals: Simple illustrations or icons to reinforce key concepts
  • Highlight critical safety information (warning signs, emergency instructions)
• Structure content for SAM evaluation targeting "superior" rating (70-100%)

Step 5: Readability Verification

• Recompute readability scores on simplified output:
  • Flesch-Kincaid Grade Level at or below target (default: 6.0)
  • SMOG Index at or below target + 1 grade level
  • Flesch Reading Ease of 60 or above (70 or above preferred)
• Apply SAM assessment across six domains:
  • Content (purpose, scope, summary)
  • Literacy demand (reading level, vocabulary, context, sentence construction)
  • Graphics (cover, type, relevance, captions)
  • Layout and Typography (subheadings, cues, whitespace)
  • Learning stimulation (interaction, modeling, motivation)
  • Cultural appropriateness (match to audience experience and imagery)
• Score: Not Suitable (0-39%), Adequate (40-69%), Superior (70-100%)

Step 6: Teach-Back Verification Framework

• Generate 3-5 teach-back questions for each content section:
  • "In your own words, what should you do if [symptom] happens?"
  • "Can you show me how you would take your medicine based on these instructions?"
  • "What is the most important thing to watch for after you go home?"
• Design questions to verify comprehension of critical safety information
• Include suggested scripts for staff administering teach-back

Output Specification

simplified_content:
  original_metrics:
    flesch_kincaid_grade: number
    smog_index: number
    flesch_reading_ease: number
    word_count: number
    avg_sentence_length: number
  simplified_metrics:
    flesch_kincaid_grade: number
    smog_index: number
    flesch_reading_ease: number
    word_count: number
    avg_sentence_length: number
    sam_score_percent: number
    sam_rating: string
  content:
    sections:
      - heading: string
        body: string
        critical_safety: boolean
  terminology_changes:
    - original_term: string
      simplified_term: string
      context: string
  teach_back_questions:
    - section: string
      question: string
      expected_response_elements: array
  design_recommendations:
    font: string
    font_size: string
    layout_notes: array
  clinical_review_status: string

Analysis Framework

Apply the CDC Clear Communication Index (CCI) as the primary evaluation framework:

1. Main message: Is the main message obvious and stated early?
2. Language: Are words common and sentences short?
3. Information design: Is the layout clean with clear visual hierarchy?
4. State of the science: Is the information accurate and evidence-based?
5. Behavioral recommendations: Are actions specific and achievable?
6. Numbers: Are numbers simple, necessary, and explained?
7. Risk: Are risks and benefits presented clearly and without bias?

Target CCI score: 90 out of 100 or higher.

Examples

Example: Discharge Instructions for Heart Failure

• Original (Grade 12.4): "Patient is advised to adhere to a sodium-restricted diet of less than 2000mg daily, monitor daily weight fluctuations, and report any acute dyspnea, peripheral edema, or weight gain exceeding 3 pounds in 24 hours to the prescribing cardiologist."
• Simplified (Grade 5.8): "Eat less salt. Try to have less than 2,000 mg of salt each day. Weigh yourself every morning before eating. Call your heart doctor right away if: you gain more than 3 pounds in one day, your feet or legs swell up, or you have trouble breathing."
• FK Grade reduction: 12.4 to 5.8; Flesch Reading Ease: 34 to 72; SAM: Superior (82%)

Guidelines

• HIPAA Compliance: Simplified content must not introduce PHI not present in the source. If source contains PHI, maintain same access controls on output. De-identify any examples used for training or quality improvement.
• Clinical Accuracy: Every simplification must be reviewed by a clinical SME before patient distribution. Simplification must never sacrifice accuracy for readability.
• Cultural Sensitivity: Avoid idioms, metaphors, and culturally specific references that may not translate across populations. Use person-first language ("person with diabetes" not "diabetic").
• Regulatory Compliance: Meet Promoting Interoperability requirements for patient-accessible clinical information. Comply with ACA Section 1557 requirements for accessible communications.
• Accessibility: Ensure output is screen-reader compatible. Provide alt-text recommendations for any visual elements. Follow WCAG 2.1 AA standards.

Validation Checklist

• Baseline readability scores computed on source content
• Target reading level achieved (Flesch-Kincaid at or below target grade)
• SMOG Index within 1 grade level of target
• Flesch Reading Ease of 60 or above
• SAM assessment completed with score of 70% or above (Superior)
• All medical jargon replaced or defined in context
• Sentence length 20 words or fewer on average
• Active voice used throughout
• Teach-back questions generated for each content section
• Clinical accuracy review assigned and tracked
• Cultural sensitivity review completed
• HIPAA compliance verified: no unintended PHI exposure
• Design recommendations included for print and digital formatting