Plain language summaries (PLSs) are essential for facilitating effective communication between clinicians and patients by making complex medical information easier for laypeople to understand and act upon. Large language models (LLMs) have recently shown promise in automating PLS generation, but their effectiveness in supporting health information comprehension remains unclear. Prior evaluations have generally relied on automated scores that do not measure understandability directly, or subjective Likert-scale ratings from convenience samples with limited generalizability. To address these gaps, we conducted a large-scale crowdsourced evaluation of LLM-generated PLSs using Amazon Mechanical Turk with 150 participants. We assessed PLS quality through subjective Likert-scale ratings focusing on simplicity, informativeness, coherence, and faithfulness; and objective multiple-choice comprehension and recall measures of reader understanding. Additionally, we examined the alignment between 10 automated evaluation metrics and human judgments. Our findings indicate that while LLMs can generate PLSs that appear indistinguishable from human-written ones in subjective evaluations, human-written PLSs lead to significantly better comprehension. Furthermore, automated evaluation metrics fail to reflect human judgment, calling into question their suitability for evaluating PLSs. This is the first study to systematically evaluate LLM-generated PLSs based on both reader preferences and comprehension outcomes. Our findings highlight the need for evaluation frameworks that move beyond surface-level quality and for generation methods that explicitly optimize for layperson comprehension.

Plain language summarization with LLMs can be useful for improving textual accessibility of technical content. But how factual are these summaries in a high-stakes domain like medicine? This paper presents FactPICO, a factuality benchmark for plain language summarization of medical texts describing randomized controlled trials (RCTs), which are the basis of evidence-based medicine and can directly inform patient treatment. FactPICO consists of 345 plain language summaries of RCT abstracts generated from three LLMs (i.e., GPT-4, Llama-2, and Alpaca), with fine-grained evaluation and natural language rationales from experts. We assess the factuality of critical elements of RCTs in those summaries: Populations, Interventions, Comparators, Outcomes (PICO), as well as the reported findings concerning these. We also evaluate the correctness of the extra information (e.g., explanations) added by LLMs. Using FactPICO, we benchmark a range of existing factuality metrics, including the newly devised ones based on LLMs. We find that plain language summarization of medical evidence is still challenging, especially when balancing between simplicity and factuality, and that existing metrics correlate poorly with expert judgments on the instance level.

While there has been significant development of models for Plain Language Summarization (PLS), evaluation remains a challenge. This is in part because PLS involves multiple, interrelated language transformations (e.g., adding background explanations, removing specialized terminology). No metrics are explicitly engineered for PLS, and the suitability of other text generation evaluation metrics remains unclear. To address these concerns, our study presents a granular meta-evaluation testbed, APPLS, designed to evaluate existing metrics for PLS. Drawing on insights from previous research, we define controlled perturbations for our testbed along four criteria that a metric of plain language should capture: informativeness, simplification, coherence, and faithfulness. Our analysis of metrics using this testbed reveals that current metrics fail to capture simplification, signaling a crucial gap. In response, we introduce POMME, a novel metric designed to assess text simplification in PLS. We demonstrate its correlation with simplification perturbations and validate across a variety of datasets. Our research contributes the first meta-evaluation testbed for PLS and a comprehensive evaluation of existing metrics, offering insights with relevance to other text generation tasks.

Different from general documents, it is recognised that the ease with which people can understand a biomedical text is eminently varied, owing to the highly technical nature of biomedical documents and the variance of readers' domain knowledge. However, existing biomedical document summarization systems have paid little attention to readability control, leaving users with summaries that are incompatible with their levels of expertise. In recognition of this urgent demand, we introduce a new task of readability controllable summarization for biomedical documents, which aims to recognise users' readability demands and generate summaries that better suit their needs: technical summaries for experts and plain language summaries (PLS) for laymen. To establish this task, we construct a corpus consisting of biomedical papers with technical summaries and PLSs written by the authors, and benchmark multiple advanced controllable abstractive and extractive summarization models based on pre-trained language models (PLMs) with prevalent controlling and generation techniques. Moreover, we propose a novel masked language model (MLM) based metric and its variant to effectively evaluate the readability discrepancy between lay and technical summaries. Experimental results from automated and human evaluations show that though current control techniques allow for a certain degree of readability adjustment during generation, the performance of existing controllable summarization methods is far from desirable in this task.