Testicular Cancer on the Web-an Appropriate Source of Patient Information in Concordance with the European Association of Urology Guidelines?

[Digitalization in urology-challenge and opportunity]

Digitalization is changing medicine. In Germany these changes are not highly accepted yet. Medical pathways should be supported and become safer by digital transformation. Furthermore, artificial intelligence (AI) applications are increasingly used in medicine. Only time will tell whether these will decrease the workload and make patient treatment easier, while increasing precision and individualization.. Urology must accept the upcoming new challenges. This can best be done by participating in the development.

Reasons behind the Delayed Diagnosis of Testicular Cancer: A Retrospective Analysis

The aim of the present study was to identify the reasons behind the delayed diagnosis of testicular cancer in a group of Polish males diagnosed with this malignancy in 2015-2016. The study included data from 72 patients aged between 18 and 69 years. Based on the median time elapsed to the testicular cancer diagnosis, the study patients were divided into the timely diagnosis group (diagnosis within 10 weeks from initial manifestation, n = 40) and the delayed diagnosis group (diagnosis > 10 weeks from initial manifestation, n = 32). Diagnosis of testicular cancer > 10 weeks after its initial manifestation was associated with less favorable survival (5-year overall survival: 78.1% [95% CI: 59.5-88.9%] vs. 92.5% [95% CI: 78.5-97.5%], p = 0.087). Multivariate logistic regression analysis identified two independent predictors of the delayed diagnosis, age > 33 years (OR = 6.65, p = 0.020) and residence in the countryside (OR = 7.21, p = 0.012), with another two parameters, the lack of a regular intimate partner (OR = 3.32, p = 0.098) and the feeling of shame (OR = 8.13, p = 0.056), being at the verge of statistical significance. All the factors mentioned above should be considered during planning social campaigns aimed at the early detection of testicular malignancies, along with improving the quality and trustfulness of Internet-based information resources.

Caught in the net: Characterizing how testicular cancer patients use the internet as an information source

INTRODUCTION

Over 70% of Canadians who use the internet search for healthcare information online. This is especially true regarding the young adult population. Testicular cancer is the most commonly diagnosed cancer in men aged 15-29. This study characterizes how testicular cancer patients access healthcare information online, and how this influences their clinical encounters and treatment decisions.

METHODS

From June 2018 to January 2019, a survey consisting of 24 open- and close-ended questions was distributed to testicular cancer patients at a tertiary cancer center. Survey results were evaluated using mixed methods analysis.

RESULTS

Fifty-nine surveys were distributed and 44 responses were received. All respondents used the internet regularly and 82% used the internet as a source of information regarding their cancer. The majority followed top hits from Google when selecting websites to view. Frequent topics searched included treatment details and survivorship concerns. Eighty-nine percent of users found online information easy to understand and 94% found it increased their understanding. For 47% of users, the internet did not influence their clinical consultation nor their treatment decision (53%).

CONCLUSIONS

Most testicular cancer patients in this study are regular internet users and use the internet to search for testicular cancer information. Healthcare providers should recognize this, and can play important roles in discussing online findings with patients to assess their background knowledge and expectations, as well as providing guidance on selecting credible online resources. The results of this study can be used to improve patient-physician communication and education.

A fountain of knowledge? The quality of online resources for testicular cancer patients

INTRODUCTION

Testicular cancer is the most common solid malignancy diagnosed in young men aged 15-29. This population is also the age group that searches most actively for health information online. This study systematically evaluates the quality of websites available to patients with testicular cancer.

METHODS

The term "testicular cancer" was inputted into the search engines Google, Dogpile, and Yippy. The top 100 websites intended for patient education were compiled. A validated structural rating tool was used to evaluate the websites with respect to attribution, currency, disclosure, interactivity, readability, and content.

RESULTS

Less than half of the websites (44) disclosed authorship. Sixty-one websites provided a last modified date, and of those, 46 were updated in the last two years. The average readability level was 11.01 using the Flesh-Kincaid grade level system. The most accurate topic was treatment, with 82 websites being completely accurate and containing all required information. The least accurate topic was prognosis, with 27 being completely accurate.

CONCLUSIONS

These results show that authorship and currency are lacking in many online testicular resources, making it difficult for patients to validate the reliability of information. The high average readability of testicular cancer websites can affect comprehension. Topics such as prognosis were incompletely covered although represent an area for which patients often seek more information. These results can be used to counsel patients on the strength and weaknesses of online testicular cancer resources.

A reliability and content analysis of Italian language anorexia nervosa-related websites

Objective

Internet represents a major source of information related to health issues, increasingly used by providers. Indeed, there are numerous websites concerning eating and weight disorders, such as anorexia nervosa. The aim of the current investigation was to systematically perform a reliability and content analysis of Italian language anorexia nervosa-related websites.

Methods

Reliability of the anorexia nervosa website pages was assessed using the Health on the Net Foundation Code of Conduct Standards (HonCode^®) certification mark. A comprehensive content analysis (thematic cluster analysis, correspondence analysis of emerging themes and topics, density and degree-centrality analysis, and co-word analysis) was performed using the commercial software T-Lab.

Results

402 unique website pages were included and analyzed in the current study. Statistically significant differences related to the accomplishment or less to the items of the HonCode^® certificate mark were found for all items, except for confidentiality and webmaster/additional contact. From the thematic cluster analysis, four clusters were identified: namely, treatment (26.6%), vomiting (24.7%), weight (24.4%) and onset-age (24.3%). Treatment (in particular, cognitive-behavioral psychotherapy) was the most represented theme (with a frequency of 97.76%, recurring in 393 websites). Pro-ana content characterized 147 website pages (with a frequency of 36.57%).

Conclusion

The quality of Italian language anorexia nervosa-related websites was rather moderate-poor, being generally inconsistent with the principles of the HonCode^® certification mark. Therefore, physicians and health authorities should be aware of such findings to provide their patients with proper answers and education.

Websites on Bladder Cancer: an Appropriate Source of Patient Information?

A growing number of patients search for health information online. An early investigation of websites about bladder cancer (BCa) revealed mostly incomplete and particularly inaccurate information. We analyzed the quality, readability, and popularity of the most frequented websites on BCa. An Internet search on www.google.com was performed for the term "bladder cancer." After selecting the most frequented websites for patient information, HONcode quality certification, Alexa popularity rank, and readability scores (according to US grade levels) were investigated. A 36-point checklist was used to assess the content according to the EAU guidelines on BCa, which was categorized into seven topics. The popularity of the 49 websites analyzed was average, with a median Alexa popularity rank of 41,698 (interquartile range [IQR] 7-4,671,246). The readability was rated difficult with 11 years of school education needed to understand the information. Thirteen (27%) websites were HONcode certified. Out of 343 topics (seven EAU guideline topics each on 49 websites), 79% were mentioned on the websites. Of these, 10% contained incorrect information, mostly outdated or biased, and 34% contained incomplete information. Publically provided websites mentioned more topics per website (median [IQR] 7 [5.5-7] vs. 5.5 [3.3-7]; p = 0.022) and showed less incorrect information (median [IQR] 0 [0-1] vs. 1 [0-1]; p = 0.039) than physician-provided websites. Our study revealed mostly correct but partially incomplete information on BCa websites for patients. Physicians and public organizations should strive to keep their website information up-to-date and unbiased to optimize patients' health literacy.