Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer.

IMPORTANCE The degree to which patients are empowered by written educational materials depends on the text's readability level and the accuracy of the information provided. The association of a website's affiliation or focus on treatment modality with its readability and accuracy has yet to be thoroughly elucidated. OBJECTIVE To compare the readability and accuracy of patient-oriented online resources for pancreatic cancer by treatment modality and website affiliation. DESIGN An online search of 50 websites discussing 5 pancreatic cancer treatment modalities (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery) was conducted. The website's affiliation was identified. Readability was measured by 9 standardized tests, and accuracy was assessed by an expert panel. MAIN OUTCOMES AND MEASURES Nine standardized tests were used to compute the median readability level of each website. The median readability scores were compared among treatment modality and affiliation categories. Accuracy was determined by an expert panel consisting of 2 medical specialists and 2 surgical specialists. The 4 raters independently evaluated all websites belonging to the 5 treatment modalities (a score of 1 indicates that <25% of the information is accurate, a score of 2 indicates that 26%-50% of the information is accurate, a score of 3 indicates that 51%-75% of the information is accurate, a score of 4 indicates that 76%-99% of the information is accurate, and a score of 5 indicates that 100% of the information is accurate). RESULTS The 50 evaluated websites differed in readability and accuracy based on the focus of the treatment modality and the website's affiliation. Websites discussing surgery (with a median readability level of 13.7 and an interquartile range [IQR] of 11.9-15.6) were easier to read than those discussing radiotherapy (median readability level, 15.2 [IQR, 13.0-17.0]) (P = .003) and clinical trials (median readability level, 15.2 [IQR, 12.8-17.0]) (P = .002). Websites of nonprofit organizations (median readability level, 12.9 [IQR, 11.2-15.0]) were easier to read than media (median readability level, 16.0 [IQR, 13.4-17.0]) (P < .001) and academic (median readability level, 14.8 [IQR, 12.9-17.0]) (P < .001) websites. Privately owned websites (median readability level, 14.0 [IQR, 12.1-16.1]) were easier to read than media websites (P = .001). Among treatment modalities, alternative therapy websites exhibited the lowest accuracy scores (median accuracy score, 2 [IQR, 1-4]) (P < .001). Nonprofit (median accuracy score, 4 [IQR, 4-5]), government (median accuracy score, 5 [IQR, 4-5]), and academic (median accuracy score, 4 [IQR, 3.5-5]) websites were more accurate than privately owned (median accuracy score, 3.5 [IQR, 1.5-4]) and media (median accuracy score, 4 [IQR, 2-4]) websites (P < .004). Websites with higher accuracy were more difficult to read than websites with lower accuracy. CONCLUSIONS AND RELEVANCE Online information on pancreatic cancer overestimates the reading ability of the overall population and lacks accurate information about alternative therapy. In the absence of quality control on the Internet, physicians should provide guidance to patients in the selection of online resources with readable and accurate information.

[1]  C. Arnold,et al.  Knowledge and attitude on screening mammography among low‐literate, low‐income women , 1996, Cancer.

[2]  M E Mumford,et al.  A descriptive study of the readability of patient information leaflets designed by nurses. , 1997, Journal of advanced nursing.

[3]  Mark A. Musen,et al.  The low availability of metadata elements for evaluating the quality of medical information on the World Wide Web , 1999, AMIA.

[4]  J. Powell,et al.  Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. , 2002, JAMA.

[5]  Falk Schubert,et al.  Quality markers of drug information on the Internet: an evaluation of sites about St. John's wort. , 2002, The American journal of medicine.

[6]  C. Daugherty,et al.  American oncologists' views of internet use by cancer patients: a mail survey of American Society of Clinical Oncology members. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  G. Eysenbach.  The Impact of the Internet on Cancer Outcomes , 2003, CA: a cancer journal for clinicians.

[8]  M. Litwin,et al.  Assessment of content completeness and accuracy of prostate cancer patient education materials. , 2004, Patient education and counseling.

[9]  M. Litwin,et al.  Suitability of prostate cancer education materials: applying a standardized assessment tool to currently available materials. , 2004, Patient education and counseling.

[10]  C. Paulino,et al.  Surfing for Scoliosis: The Quality of Information Available on the Internet , 2005, Spine.

[11]  D B Friedman,et al.  Health literacy and the World Wide Web: Comparing the readability of leading incident cancers on the Internet , 2006, Medical informatics and the Internet in medicine.

[12]  L. G. Doak,et al.  The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. , 2006, Patient education and counseling.

[13]  The Impact of Medical Terminology on Readability of Patient Education Materials , 2007, Journal of community health nursing.

[14]  J. Feinglass,et al.  Health Literacy and Mortality Among Elderly Persons , 2007 .

[15]  C. Ko,et al.  National Failure to Operate on Early Stage Pancreatic Cancer , 2007, Annals of surgery.

[16]  Consumer health care information on the internet: does the public benefit? , 2008, Respiratory care.

[17]  Unsuitable readability levels of patient information pertaining to dementia and related diseases: a comparative analysis , 2008, International Psychogeriatrics.

[18]  Namkee Choi,et al.  Relationship Between Health Service Use and Health Information Technology Use Among Older Adults: Analysis of the US National Health Interview Survey , 2011, Journal of medical Internet research.

[19]  Samuel A. Taylor,et al.  Does the quality, accuracy, and readability of information about lateral epicondylitis on the internet vary with the search term used? , 2012, Hand.

[20]  Brian E. Weeks,et al.  Behavioral Consequences of Conflict-Oriented Health News Coverage: The 2009 Mammography Guideline Controversy and Online Information Seeking , 2012, Health communication.

[21]  M. Bailey,et al.  Quality and readability of online patient information for abdominal aortic aneurysms. , 2012, Journal of vascular surgery.

[22]  Jack Tsai,et al.  Use of the internet and an online personal health record system by US veterans: comparison of Veterans Affairs mental health service users and other veterans nationally , 2012, J. Am. Medical Informatics Assoc..

[23]  Richard M McKearney,et al.  The quality and accuracy of internet information on the subject of ear tubes. , 2013, International journal of pediatric otorhinolaryngology.

[24]  Victoria A. Shaffer,et al.  The Effect of Patient Narratives on Information Search in a Web-Based Breast Cancer Decision Aid: An Eye-Tracking Study , 2013, Journal of medical Internet research.

[25]  Scarton La,et al.  Completeness, accuracy, and presentation of information on interactions between prescription drugs and alternative medicines: An Internet review , 2013 .

[26]  Michael Mackert,et al.  Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening. , 2014, Gastrointestinal endoscopy.

[27]  Race/Ethnicity, educational attainment, and foregone health care in the United States in the 2007-2009 recession. , 2014, American journal of public health.

[28]  G. Elwyn,et al.  Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. , 2014, Patient education and counseling.

[29]  Joshua T. Anderson,et al.  Can Internet Information on Vertebroplasty be a Reliable Means of Patient Self-education? , 2014, Clinical orthopaedics and related research.

[30]  M. Härter,et al.  Quality of online information on type 2 diabetes: a cross-sectional study. , 2015, Health promotion international.

[31]  Christopher F. Martin,et al.  Functional health literacy, chemotherapy decisions, and outcomes among a colorectal cancer cohort. , 2015, Cancer control : journal of the Moffitt Cancer Center.

[32]  L. Freedman,et al.  Characteristics of patients seeking health information online via social health networks versus general Internet sites: a comparative study , 2015, Informatics for health & social care.