A four-stage service for oncology practices whose patient education materials are clinically excellent and operationally costly. Begin with the Preview at no cost. Continue through the stages as the value becomes clear.
The materials your practice produces pass every standard quality check. They've been reviewed for clinical accuracy. They've been written at appropriate reading levels. They've been formatted, reviewed, and approved. And patients still call back confused.
The reason is not in any of the checks the materials passed. It's in the one variable those checks weren't built to measure: the cognitive state of the person reading them.
Health literacy frameworks measure how a document is structured. The Diagnostic measures how it lands on a patient who is afraid. Both matter.
Fear changes the brain's ability to receive complex information. Working memory compresses under elevated cortisol. Threat content captures attention disproportionately. Action steps embedded in dense paragraphs become functionally invisible to a reader whose nervous system is scanning for danger.
The Diagnostic is the first framework built to measure what happens at the precise moment a clinically excellent document meets an anxious reader. It does not replace standard health literacy reviews. It captures the layer those reviews were never designed to reach.
Each dimension scores 0 to 20. Composite score out of 100. The five dimensions are not arbitrary — they map to five distinct ways fear interferes with a patient's ability to receive and act on clinical information.
The cumulative threat burden the document generates while the patient reads it. Threat content — side effects, complications, risk language, mortality framing — captures attention disproportionately under anxious reading. Documents that front-load threat content without managing its delivery overload the reader before the actionable information arrives.
Whether information arrives in the order a frightened brain can receive it — not the order a calm editor would organize it. Documents written for clinical completeness often present information in the order a clinician would teach it. Anxious readers need a different sequence: emotional acknowledgment, orientation, what is happening, what comes next, what to watch for.
Working memory limitations under stress. Elevated cortisol measurably reduces the capacity of working memory — meaning dense paragraphs that read clearly to a calm reviewer become functionally illegible to an anxious reader regardless of vocabulary level. Chunking is how text accommodates the compressed working memory of the patient who actually has to use it.
Psychological permission. The largely ignored requirement that a patient must feel safe enough to absorb clinical information before the clinical information can do its job. Across every institution we've stress-tested, including all 55 NCI-designated Comprehensive Cancer Centers, D4 is the dimension that most consistently fails — averaging 5 out of 20 across the field.
The last-mile execution problem. A patient who understood the instructions intellectually at the appointment and a patient who can execute them at 11 p.m. when the care team is unavailable are two different patients. Action Clarity measures whether the document supports the second one — whether it tells the patient how to triage symptoms, how to rank urgency, when to call, when to wait.
The Cognitive Assessment covers every patient-facing document in a single service line. A service line can be defined three ways. Pick the framing that matches how your practice already thinks about its materials.
A specific cancer type and the full sequence of materials a patient receives across their care.
A treatment modality and every document a patient touches as they move through it.
A cross-cutting program with its own patient-facing kit, independent of cancer type or treatment.
Each stage stands on its own. None of them require the next. Most practices begin with the Preview to see how the framework reads their materials. From there, scope grows as the value becomes obvious.
Send us one to three patient-facing documents from any service line — your breast program's chemo onboarding materials, your radiation oncology side-effect handouts, your survivorship transition packet. We score them against the framework at no cost and walk you through what we find.
The Preview is designed to answer one question: is this real? It shows you how the framework reads your materials, what an anxious patient encounters versus what a calm reader encounters, and whether the gap between those two is small or wide. If the Preview surfaces something worth investigating across a full service line, the Cognitive Assessment is the next step.
Every patient-facing document in one of your service lines, scored across five dimensions and interpreted at the level of operational consequence. The Assessment surfaces what's happening inside your materials — it does not rewrite them. That decision comes next, separately.
You receive a composite reading on each document, a finding on each of the five dimensions, and an interpretation that translates the score into the friction your practice is already absorbing: the calls, the no-shows, the patients who arrive unprepared. The deliverable closes with a one-page findings summary built for the partner or medical director who is not going to read the full report.
For the materials the Assessment flagged as highest-priority, we restructure. Not a copy edit — anxiety-informed sequencing, emotional scaffolding before clinical content, cognitive chunking matched to the working memory of a frightened reader, action clarity that survives a 2 a.m. read.
Changes are split into two layers. Layer 1 is structural — sequencing, chunking, emotional acknowledgment, action triage. It accounts for 75 to 80 percent of the comprehension improvement, alters no clinical content, and requires no physician review. Layer 2 is anxiety-informed framing that touches clinical content — two or three flagged passages requiring a 10-minute physician sign-off, bounded by a Clinical Review Sheet that names exactly what the physician is being asked to confirm.
Every restructured document is re-scored against the framework. The before-and-after delivers the evidence in the same instrument that surfaced the problem.
Materials don't stay fixed without a system to maintain them. Protocols change. New staff joins without context. New service lines get added with hastily drafted handouts that revert to the old patterns. The gains from a one-time Restructure erode over twelve to eighteen months without ongoing attention.
Maintenance is for practices that want the gains to hold over time, or that want to extend the work into additional service lines without re-engaging from scratch each time. The cadence is quarterly. The scope is what's new since the last review.
The four-stage model above describes the engagement architecture. This is the operational sequence inside any one stage — what actually happens between the first conversation and the deliverable in your hands.
A 20-minute conversation to confirm fit and define scope. We name the service line, identify the materials inside it, and confirm what you're trying to learn from the engagement.
You send the patient-facing materials in whatever format you have them — documents, web URLs, video files, screenshots. We confirm receipt and lock the scope in an engagement letter.
Every submitted material is scored across the five dimensions. Each finding is interpreted at the level of operational consequence — what this score means for the patient encounter and your practice's day-to-day burden.
You receive the report and we walk through it together — findings, dimensional scores, one-page summary for leadership. From there, you decide what's next.
The Preview is free. The discovery call is 20 minutes. Both are designed to answer one question: is The Diagnostic the right instrument for what your practice is actually trying to solve?
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