Multimodal evaluation of differentiated thyroid cancer patient information booklets: strengths and limitations in content quality, readability, and patient-centered communication

OBJECTIVES: Patient education can improve patients' health literacy, participation in shared decision-making, and quality of life. Contemporary guidelines, including the 2025 American Thyroid Association Guidelines for differentiated thyroid cancer (DTC), emphasize high-quality, accessible written information and survivorship-focused counseling as core components of care. This exploratory cross-sectional study performed a multimodal evaluation of DTC patient information booklets (PIBs). METHODS: Ten PIBs (five in English, five in French) were assessed by six healthcare professionals for: (i) information content across seven themes from a systematic review of unmet patient needs; (ii) quality of treatment information using DISCERN; (iii) understandability and actionability using PEMAT-P; and (iv) readability using four standard indices (Flesch-Kincaid Grade Level, Gunning Fog Index, Simple Measure of Gobbledygook and Flesch Reading Ease formulas). RESULTS: Interrater agreement was excellent. Global content scores ranged from 25-70%. General information, diagnosis, treatment, and follow-up were mostly addressed, whereas psychosocial concerns, care coordination, and complementary medicine were consistently underrepresented. Three PIBs scored "excellent", four "good", and three "fair" on DISCERN. Eight PIBs were sufficiently understandable and five sufficiently actionable on PEMAT-P. Readability levels were systemically higher than recommended. Content scores correlated positively with booklet length, DISCERN scores, and PEMAT-P actionability. CONCLUSIONS: Assessed DTC PIBs show a persistent mismatch with patient-identified needs, particularly in psychosocial, care-coordination, and complementary-medicine domains, alongside variable quality of treatment information, understandability, and actionability. Readability remains uniformly more complex than recommended. These findings are useful for the development and clinical use of patient information materials.