Content and Readability Analysis of Patient-Reported Outcome Measures for Gynecomastia: A Systematic Review.

Abstract

Gynecomastia, characterized by the benign enlargement of male breast tissue, has a lifetime prevalence of 65% and can significantly impact quality of life and psychosocial well-being. Although most cases resolve spontaneously within 1 to 3 years, surgical intervention is often necessary for patients experiencing persistent symptoms or distress. Understanding patient perspectives via patient-reported outcome measures (PROMs) is critical for evaluating the success of medical or surgical interventions in addressing aesthetic concerns, psychosocial functioning, and health-related quality of life (HRQOL). However, a systematic review of available PROMs specific to gynecomastia is lacking. This study aims to identify and analyze existing PROMs used for patients with gynecomastia and to assess PROM content and readability. This systematic review followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, and searches were performed across 4 databases: PubMed, EMBASE, CINAHL, and Scopus. The search strategy resulted in 22 studies and 23 unique PROMs. Following a structured domain framework with field definitions, content comparison was performed for 908 PROM items across 5 domains: objective appearance, self-perception, HRQOL, social outcomes, and intervention satisfaction. Readability was assessed using the Simple Measure of Gobbledygook and Flesch-Kincaid indices. Results indicated that although some PROMs adequately address key domains such as objective appearance and self-perception, significant gaps remain in comprehensively capturing the full spectrum of HRQOL and social outcomes among patients with gynecomastia. Additionally, readability indices for nearly all PROMs exceed the recommended grade level for the general population, thereby highlighting the need for a new gynecomastia-specific instrument that can be used for pediatric, adolescent, and adult populations.