Margaret M. Thorsen

Introduction: In obstetrics, patients with insufficient health literacy have a higher likelihood of adverse perinatal outcomes. The American Medical Association (AMA) recommends all patient‐facing health information be written at or below a sixth‐grade reading level. The reading level of standardized obstetric patient education materials embedded into Epic via “Patient Pass/Exit Care” package published by Elsevier is unknown. Since the Spanish versions of the materials have not been back‐translated, the readability of those materials also requires further assessment. In this study, our aims were to (1) characterize overall readability of Epic's obstetric patient education documents, (2) assess differences in readability between English and Spanish materials, and (3) understand differences in readability by subject material, stratified by language. Methods: Using the “Clinical References” tab in Epic, obstetric patient education materials were extracted in both English and Spanish. Materials were evaluated using metrics for assessing readability that have been validated in English and/or Spanish: Flesch–Kincaid Grade Level (FKGL), Fernandez‐Heurta (FH), and Simple Measure of Gobbledygook (SMOG). Education was coded by content category. Paired t ‐tests were conducted to evaluate differences in readability scores (FKGL vs. FH) and SMOG scores across language pairs. Mean differences (95% confidence intervals [CIs]) and one‐way ANOVA with Bonferroni‐adjusted post hoc tests assessed language readability gaps across clinical categories. Results: Of 235 total texts analyzed, grade level for English was 6.2 (SD 1.0) using the FKGL metric versus 4.2 (SD 0.5) for Spanish content that used the validated FH. Overall, the English documents were 2.0 grade levels higher than the corresponding Spanish documents (95% CI, 1.8–2.1). SMOG mean grade level for English materials was 9.7 (SD 0.9) versus 6.2 (SD 0.6) for Spanish materials ( p < 0.01). Across all perinatal topics, English texts scored significantly higher than Spanish texts on both SMOG and language‐specific readability metrics. A total of 41.2% of Spanish materials were at or below a 6th grade level using SMOG, but none of the English materials were. Conclusion: Existing obstetric patient education materials embedded in the Epic electronic medical record (EMR) do not meet AMA standards for readability and comprehension. Differences between English and Spanish materials highlight a potential for disparities in patient understanding of their plans of care.

Objective: To receive feedback on the design and content of a prenatal genetics video tool and explore pregnant patients' views on genetic information privacy.Methods: Video education covered prenatal aneuploidy screening and diagnosis and genetic privacy of cell‐free DNA (cfDNA). English or Spanish‐speaking adult patients, presenting for pregnancy dating ultrasound at a health center or clinic were eligible to answer a demographic questionnaire and view video education. Virtual, in‐depth semi‐structured interviews were then performed. Thematic analysis of transcripts was performed; all were double coded.Results: Twenty participants completed interviews, achieving data saturation. Demographics: median age 30.5 years, 50% Spanish‐speaking, 55% White, 60% Hispanic, 65% had a high‐school degree or less, 60% parous. Themes: The intervention was acceptable, accessible, and aided in decision‐making. Tangible adjunctive resources were desired. Content misunderstandings included absolute risk of diagnostic testing and perception of aneuploidy as hereditary. Genetic privacy played a minor role in decision‐making. Participants were amenable to data‐sharing with third parties, but wanted to be informed. They misunderstood that genetic data could never truly be de‐identified. No differences were found in opinions on sharing fetal versus maternal data or with academic versus private institutions.Conclusion: Video education was acceptable and comprehensible, yet participants showed limited awareness of cfDNA privacy implications.

ObjectivesComprehensive counseling on prenatal genetic screening and diagnostic testing is challenging for clinicians. We sought to identify baseline clinician knowledge of prenatal genetic screening and diagnostic testing and needs to promote counseling aligned with ACOG recommendations.MethodsWe performed an anonymous, cross-sectional survey of clinicians at two unaffiliated, tertiary academic institutions to assess the knowledge of, confidence in, and time spent counseling on prenatal genetic screening and diagnostic testing. Stata (Version 17, College Station, TX) was used to perform descriptive statistics. Deductive and inductive coding was used to analyze responses regarding ideal education resources.ResultsThe survey response rate was 78% (100/129). Only 36% of respondents correctly answered knowledge questions about prenatal genetic screening and diagnostic testing. A majority, 59% (16/39), of those confident or extremely confident in counseling were unable to answer all questions accurately. Respondents reported a median of 5.6 min (95% CI 4.9-6.4 min) spent counseling. Thematic analysis of free responses revealed desire for visual tools that discuss financial costs and patient values.ConclusionsSurveyed clinicians demonstrated deficiencies in knowledge about prenatal genetic counseling. To provide better and more comprehensive care, we noted a desire for the development of formalized resources for clinician and patient education. What is already known about this topic?Prenatal care clinicians fall short of ACOG guidelines when counseling on prenatal genetic screening and diagnostic testingWhat does this study add?Prenatal care clinicians demonstrate deficiencies in knowledge required to fulfill ACOG guidelines on prenatal genetic aneuploidy counseling. There was a notable mismatch between perceived counseling ability and correct responses to the knowledge questions. Providers desire development of educational resources that are accessible, visual, simple, and unbiased in efforts to bridge this gap.

Learning to provide care as an obstetrics and gynecology resident in 2020 has provided an opportunity for collective reflection on our role as health care professionals and the meaning of being present in a time of unpredictability.