Exploring one aspect of family-centered practice: Readability of written documents to support parental understanding and decision-making regarding cochlear implants.

PURPOSE: This exploratory study examined whether CI medical file documents met family-centered criteria for accessibility and readability, that is, could the average parent understand these documents?

METHODS: The accessibility and readability of written documents used in one cochlear implant (CI) program were studied using two approaches. First, clinicians were asked to recall and rank their most complex cases. Files were reviewed for seven of the most complex cases. All tailored written documents relating to each child's CI candidacy, expectations, meetings, and counselling that had been shared with parents were reviewed. Second, five iterations of the generic CI surgical consent and information form from the same CI program were gathered. All documents were subjected to two readability scales: Flesch-Kincaid Grade Level and Fry's Readability Graph.

RESULTS: Of the 58 tailored documents in files that considered candidacy/expectations, 27 were shared with parents (45.8%). The mean Flesch-Kincaid Grade Level for these 27 documents was 12.4 (range 11.2 - 13.0; SD 0.64) and the mean Fry Score was 13.6 (range 12.0 - 15.7; SD 1.24). The mean Flesch-Kincaid score for the generic CI surgical consent and information forms from 2000 to 2017 was 11.8 (range 10.9 - 12.9; SD 0.66) and the mean Fry Score was 14.4 (range 13 - 16; SD 1.02).

CONCLUSIONS: Readability levels for both the tailored candidacy/expectations documents and the generic CI surgical consent and information forms were higher than average adult reading levels and did not meet recommended readability targets for patient education material. CI programs should plan to share all counselling/expectation documents with parents and could apply simple readability formulae to improve family-centered engagement, empowerment and understanding.