Figure 1. Readability of Consent Forms for Cancer Radiotherapy in US Academic Medical Centers by 7 Indices.

Documents were manually edited for high and low estimation of scores dependent on sentence length (for all readability measures except FORCAST). In the high estimate (shown), forms were altered so that all lists were treated as 1 sentence with items separated by a comma. In the low estimate (eFigure 1 in the Supplement), forms were edited so that all list items were treated as independent sentences separated by a period. Boxes represent the median and interquartile range (IQR) for each distribution, with the lower and upper box limits defined by the 25th and 75th percentile, respectively. The median is represented by the line across each box. The upper and lower whiskers extend to the greatest and lowest datum within 1.5 × IQR above and below the upper and lower quartile, respectively. Any data points outside of this range are defined as outliers and are displayed as dots. Maximum reported grade levels for included readability scores were up to grade 19 (equivalent to a doctoral degree level of education) for some scores. Reported grade levels higher than grade 12 represent collegiate levels of education and higher. Current recommendations from the National Cancer Institute and National Institutes of Health state that consent forms for patients should be at the eighth-grade readability level (blue horizontal dashed line) or lower.^9,10 Current recommendations from the American Medical Association state that all written materials for patients should be at the sixth-grade readability level (red horizontal dashed line) or lower.⁸ DRP (GE) indicates Degrees of Reading Power (Grade Equivalent); FK, Flesch-Kincaid; FORCAST, Ford, Caylor, Sticht; GF, Gunning Fog; SMOG, Simple Measure of Gobbledygook.