Improving Patient Comprehension of Screening Mammography Recall Lay Letters

Derek L. Nguyen, Emily B. Ambinder, Mary Kate Jones, Ginger Hill, Susan C. Harvey

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose: In accordance with the Mammography Quality Standards Act, recall lay letters should be written using language that is “easily understood by a lay person.” The authors hypothesized that the readability of their institution's current recall lay letter may contribute to the misinterpretation of intended time for patient return. Thus, the aim of this study was to evaluate the comprehension of the current recall lay letter statement. Methods: The Flesch-Kincaid grade level was used to assess readability of the lay letter currently used at the authors’ institution. A revised statement was formulated. A single paper-based survey presented both current and revised statements and asked questions to probe patients’ understanding of expected time to return. Surveys were provided to screening mammography patients at four outpatient imaging centers. Results: The Flesch-Kincaid grade levels of the current and revised statements were 12th and 4th grades, respectively. Five hundred ninety-nine surveys were analyzed. Survey data demonstrated that only 49.6% of all patients understood that the current statement requests return within 1 month specifically with the breast center, compared with 95.2% of patients with the revised statement (P < .001). Of the patients who misunderstood when to follow up with the breast center, about 80% had achieved less than a college degree (P < .001). Conclusions: The grade level of the authors’ institution's current lay letter statement is greater than the national recommendation for the average patient, which is between 6th and 8th grade. These data suggest that revising the language of recall statements to the recommended grade level would potentially improve patient understanding and compliance.

Original languageEnglish (US)
Pages (from-to)1669-1676
Number of pages8
JournalJournal of the American College of Radiology
Issue number12
StatePublished - Dec 2019


  • Readability
  • comprehension
  • lay letter
  • quality improvement
  • recall
  • screening mammogram

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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