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Goyal A, Fei-Zhang DJ, Pawlik TM, Bentrem DJ, Wayne JD. Associations of social vulnerability with truncal and extremity melanomas in the United States. J Surg Oncol 2024; 129:544-555. [PMID: 38009468 DOI: 10.1002/jso.27532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Prior studies in social determinants (SDoH) of truncal-extremity melanomas (TEM) have analyzed race, income, and environmental factors relative to their effect on health disparities. However, they are limited by the narrow scopes of SDoH and study population, while lacking analyses of interrelational contribution of SDoH on TEM disparities. METHODS This retrospective cohort study of adult TEM patients (1975-2017) assessed linear regression trends in months of survival, as well as logistic regression trends in advanced presenting stage, surgery, and chemotherapy receipt across TEM subtypes with increasing overall social vulnerability and vulnerability in 15 SDoH variables grouped into socioeconomic status (SES), minority-language status (ML), household composition (HH), and housing-transportation (HT) themes measured by the SVI. SVI measures are ranked/compared across all US counties for relative vulnerability in a specific SDH and their total composite while accounting for sociodemographic-regional differences. RESULTS Across 325 760 TEM patients, increasing overall social vulnerability demonstrated significant decreases in the survival period for 7/13 TEM histology types (p < 0.001), with relative decreases in the survival period as high as 44.0% (67.0-37.5 months) for epithelioid cell. SES and HH were the highest-magnitude contributors to these overall trends. For many patients with TEM, increased odds of advanced presenting stage (highest with acral-lentiginous: odds ratio [OR], -1.18; 95% confidence interval [CI], 1.02-1.36), decreased odds of indicated surgery receipt (lowest with amelanotic, 0.79; 0.71-0.87), and increased odds of indicated chemotherapy (highest with melanoma in giant nevi: 1.50; 1.01-2.44) were observed; SES and ML followed by HH and HT contributed to these trends. CONCLUSIONS There were detriments in TEM care & prognosis in the United States with increasing social vulnerability. Identifying which SDH quantifiably are associated more with disparities in interrelational, real-world contexts is important to provide nuance to inform future research and initiatives to address TEM disparity.
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Affiliation(s)
- Ansh Goyal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David J Fei-Zhang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - David J Bentrem
- Department of Surgery, Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey D Wayne
- Department of Surgery, Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Schreidah CM, Fahmy LM, Lapolla BA, Gordon ER, Kwinta BD, Geskin LJ. Accessibility and readability of online patient education on cutaneous lymphomas. JAAD Int 2023; 13:83-90. [PMID: 37727629 PMCID: PMC10505972 DOI: 10.1016/j.jdin.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 09/21/2023] Open
Abstract
Background Patients facing a cutaneous lymphoma diagnosis frequently turn to the internet for information but finding patient-accessible education may be a challenge. Objective To investigate accessibility and readability of patient-oriented online education on cutaneous lymphomas, including cutaneous T-cell and B-cell lymphoma subtypes. Methods This study queried a search engine for 11 cutaneous lymphoma terms, resulting in 1083 webpages. Webpages were screened using defined inclusion/exclusion criteria; literature directed to physicians and scientists was excluded. Webpages were stratified by academic/nonacademic and dermatology/nondermatology hosts and assessed by order of appearance. Readability, including text complexity, was analyzed for grade level understanding using 5 established calculators. Overall readability was assessed by Flesch-Kincaid Reading Ease. Results Academic webpages had earlier order of appearance. There was a dearth in dermatology-hosted webpages. Rarer cutaneous lymphomas yielded fewer patient-accessible results. Search term readability significantly exceeded the American Medical Association-recommended sixth grade level (P < .001∗), with higher grade levels for cutaneous T-cell lymphoma subtype webpages than cutaneous B-cell lymphoma subtypes. Limitations Webpage quality, accuracy, and language were not assessed. Conclusion Current online education for cutaneous lymphomas exceeds the American Medical Association's maximum readability recommendation. There is a need for more patient-accessible education amidst predominance of scientific literature, greater dermatology host websites, and enhanced readability of existing online education.
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Affiliation(s)
- Celine M. Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Lauren M. Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Brigit A. Lapolla
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Emily R. Gordon
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Bradley D. Kwinta
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Larisa J. Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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Özistanbullu D, Weber R, Kleemann J, Jäger M, Kippenberger S, Kaufmann R, Meissner M. Exploring the Most Visible Websites on Cutaneous T‐cell Lymphoma–Revealing Limited Quality of Patient Health Information on the Internet. J Eur Acad Dermatol Venereol 2022; 36:2008-2015. [DOI: 10.1111/jdv.18439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Deniz Özistanbullu
- Department of Dermatology, Venereology and Allergology University Hospital Frankfurt Goethe University Frankfurt Germany
| | - Ronja Weber
- Department of Dermatology, Venereology and Allergology University Hospital Frankfurt Goethe University Frankfurt Germany
| | - Johannes Kleemann
- Department of Dermatology, Venereology and Allergology University Hospital Frankfurt Goethe University Frankfurt Germany
| | - Manuel Jäger
- Department of Dermatology Städtisches Klinikum Karlsruhe Germany
| | - Stefan Kippenberger
- Department of Dermatology, Venereology and Allergology University Hospital Frankfurt Goethe University Frankfurt Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology University Hospital Frankfurt Goethe University Frankfurt Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology University Hospital Frankfurt Goethe University Frankfurt Germany
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Dowdle TS, Nguyen JM, Steadman JN, Layher H, Sturgeon ALE, Akin R. Online Readability Analysis: Mohs Micrographic Surgery Postsurgical Wound Care. Adv Skin Wound Care 2022; 35:213-218. [PMID: 35026774 DOI: 10.1097/01.asw.0000816960.79821.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although various treatment modalities exist for skin cancer care, Mohs micrographic surgery (MMS) is one of the most effective and cosmetically sensitive surgical techniques. The readability of online informational materials specifically related to MMS postsurgical wound care is extremely relevant for patients given the high rates of skin cancer in the US and the number of patients utilizing the internet for information. METHODS Investigators conducted Google searches to evaluate the current state of readability on MMS postsurgical wound care using the specific keywords "healing after Mohs surgery" and "wound care Mohs surgery." The readabilities of individual websites were analyzed using the WebFX online software. Health-specific click-through rate was used to select the number of samples assessed. RESULTS Based on the 33 unique websites evaluated, the aggregate readability of online MMS postsurgical wound care materials was 11.3, corresponding to an 11th-grade reading level by US standards. CONCLUSIONS Although this level of readability is an improvement in online MMS postsurgical wound care information relative to prior literature, there is still considerable work to be done by the dermatologic community in improving the readability of online patient materials regarding MMS.
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Affiliation(s)
- Travis S Dowdle
- Travis S. Dowdle, BS, is Medical Student, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas, United States. Jeannie M. Nguyen, MD, is Dermatology Resident, Texas Tech University Health Sciences Center. Jesse N. Steadman, BS, is Medical Student, University of Utah, School of Medicine, Salt Lake City. At the Texas Tech University Health Sciences Center, Heather Layher, DO, is Mohs Fellow; Ashley L. E. Sturgeon, MD, is Mohs Fellow and Professor; and Russell Akin, MD, is Mohs Fellow and Professor
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Marchetti MA, Sar-Graycar L, Dusza SW, Nanda JK, Kurtansky N, Rotemberg VM, Hay JL. Prevalence and Age-Related Patterns in Health Information-Seeking Behaviors and Technology Use Among Skin Cancer Survivors: Survey Study. JMIR DERMATOLOGY 2022; 5:e36256. [PMID: 36776536 PMCID: PMC9910806 DOI: 10.2196/36256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Information is an unmet need among cancer survivors. There is a paucity of population-based data examining the health information-seeking behaviors and attitudes of skin cancer survivors. Objective We aimed to identify the prevalence and patterns of health information-seeking behaviors and attitudes among skin cancer survivors across age groups. Methods We analyzed population-based data from the 2019 Health Information National Trends Survey 5 (Cycle 3). Results The 5438 respondents included 346 (6.4%) skin cancer survivors (mean age 65.8 years); of the 346 skin cancer survivors, the majority were White (96.4% [weighted percentages]), and 171 (47.8%) were men. Most reported having ever looked for health- (86.1%) or cancer-related (76.5%) information; 28.2% stated their last search took a lot of effort, and 21.6% were frustrated. The internet was most often cited as being the first source that was recently used for health or medical information (45.6%). Compared to skin cancer survivors younger than 65 years old, those 65 years of age or older were more likely to see a doctor first for important health information (≥65 years: 68.3%;<65 years: 36.2%; P<.001) and less likely to have health and wellness apps (≥65 years: 26.4%; <65 years: 54.0%, P=.10), to have watched a health-related YouTube video (≥65 years: 13.3%; <65 years: 27.4%; P=.02), and to have used electronic means to look for information (≥65 years: 61.4%;<65 years: 82.3%, P<.001). Conclusions Searches for health information are common among skin cancer survivors, but behaviors and attitudes are associated with age, which highlights the importance of access to doctors and personalized information sources.
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Affiliation(s)
| | | | - Stephen W Dusza
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Japbani K Nanda
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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6
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Quality and Readability of Online Health Information for Acral Lentiginous Melanoma. Dermatol Surg 2021; 47:697-698. [PMID: 32483094 DOI: 10.1097/dss.0000000000002457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yee D, Modiri O, Shi VY, Hsiao JL. Readability, quality, and timeliness of online health resources for rosacea. Int J Dermatol 2020; 60:e90-e92. [PMID: 32857386 DOI: 10.1111/ijd.15150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Danielle Yee
- Department of Medicine, University of California Los Angeles - Olive View, Sylmar, CA, USA
| | - Omeed Modiri
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer L Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
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Scott BB, Johnson AR, Doval AF, Tran BN, Lee BT. Readability and Understandability Analysis of Online Materials Related to Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2019; 54:111-117. [DOI: 10.1177/1538574419879855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patients commonly use online materials as a source of health information. Since poor health literacy has been shown to correlate with negative outcomes, it is recommended that patient-directed materials be written at a sixth-grade reading level. This study evaluates the readability and understandability of commonly accessed online materials pertaining to both endovascular and open repair of abdominal aortic aneurysm. Methods: Searches for “endovascular repair abdominal aortic aneurysm” and “open repair abdominal aortic aneurysm” were performed on both Google and Bing, and the top 10 websites from each search engine were identified. Relevant websites (total N = 28, endovascular n = 15, open n = 15, and 2 redundant sites) with patient-directed content were analyzed. Readability was assessed using 9 established methods, and understandability was assessed using the Patient Education Materials Assessment Tool scoring system. Results: The average reading grade level for all sites was 12.8. Endovascular sites averaged a reading grade level of 13.6 with a range from 11.5 to 15.6. Open-repair websites had a grade-level average of 12.1 with a range from 9.9 to 14.1. Readability was found to be inversely related to understandability, with a Pearson correlation coefficient of −0.551 ( P = .003). No website was written at or below the recommended sixth-grade reading level. Conclusions: Patient-directed online health information pertaining to open and endovascular repair of abdominal aortic aneurysm exceeds the recommended sixth-grade reading level. Increasing complexity of health literature correlates with poor understandability. Modifications such as shorter sentences, fewer words with more than 6 letters, and increasing usage of clear visual aids can increase readability and understandability.
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Affiliation(s)
- Benjamin B. Scott
- Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anna Rose Johnson
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andres F. Doval
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bao N. Tran
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bernard T. Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Brütting J, Bergmann M, Garzarolli M, Rauschenberg R, Weber C, Berking C, Tilgen W, Schadendorf D, Meier F. Informationssuche und Nutzung von Informationsquellen durch Melanompatienten deutscher Hautkrebszentren. J Dtsch Dermatol Ges 2019; 16:1093-1102. [PMID: 30179323 DOI: 10.1111/ddg.13630_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Brütting
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Maike Bergmann
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Marlene Garzarolli
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Ricarda Rauschenberg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Christiane Weber
- Arbeitsgemeinschaft Dermatologische Onkologie (ADO), Saarbrücken, Deutschland
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, München, Deutschland
| | - Wolfgang Tilgen
- Nationale Versorgungskonferenz Hautkrebs (NVKH), Neckargemünd, Deutschland
| | - Dirk Schadendorf
- Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Friedegund Meier
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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10
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Madrazo Azpiazu I, Pera MS. Is cross‐lingual readability assessment possible? J Assoc Inf Sci Technol 2019. [DOI: 10.1002/asi.24293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ion Madrazo Azpiazu
- People and Information Research Team (PIReT), Department of Computer ScienceBoise State University 777 W Main Street Boise ID
| | - Maria Soledad Pera
- People and Information Research Team (PIReT), Department of Computer ScienceBoise State University 777 W Main Street Boise ID
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Alshaikh EA, Almedimigh AF, Alruwaili AM, Almajnoni AH, Alhajiahmed A, Almalki TS, Alfaraj SZ, Pines JM. Patient-Focused Online Resources for Melanoma: Highly Variable Content and Quality. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:775-781. [PMID: 29732480 DOI: 10.1007/s13187-018-1372-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When patients are diagnosed or concerned with the diagnosis of melanoma, they commonly use the Internet for information. We assessed the content of patient-focused websites about melanoma. We searched for "melanoma" in four search engines then assessed the first 30 websites in each search. Among included sites, we describe potentially useful content about melanoma: website quality, readability, popularity, and social media sharing. In 31 included websites, > 80% mentioned the definition and risk factors for melanoma, when to seek medical help, how to diagnose, and treatment options, and > 70% described preventive measures. However, website quality was variable: 61% of websites had disclosures, 54% were dated, 41% had a clear author, and 41% had references. Average readability ranged from 8th to 12th grade, which is above recommended reading levels for patient websites. Despite this variation and high reading levels, we identified many high-quality melanoma websites for patients.
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Affiliation(s)
- Eman A Alshaikh
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Abdulaziz F Almedimigh
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Abdulmajeed M Alruwaili
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Abdullah H Almajnoni
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Ali Alhajiahmed
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Thamer S Almalki
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Sukayna Z Alfaraj
- Department of Emergency Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
- Center for Healthcare Innovation and Policy Research, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Jesse M Pines
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
- Center for Healthcare Innovation and Policy Research, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
- Departments of Emergency Medicine and Health Policy and Management, The George Washington University, Washington, DC, USA.
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Samuel D, Vilardo N, Isani SS, Kuo DYS, Gressel GM. Readability assessment of online gynecologic oncology patient education materials from major governmental, non-profit and pharmaceutical organizations. Gynecol Oncol 2019; 154:616-621. [PMID: 31324452 DOI: 10.1016/j.ygyno.2019.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Patients are increasingly using online materials to learn about gynecologic cancer. Providers can refer patients to online educational materials produced by a number of different major medical organizations and pharmacology companies. The National Institutes of Health (NIH) and the American Medical Association (AMA) recommend that patient educational materials (PEMs) are written between a sixth and eighth grade reading level. In this study, we assess the readability of online PEMs published by major medical organizations and industry partners. METHODS Websites from twelve websites providing educational materials for gynecologic oncology patients were surveyed. Online PEMs were identified and analyzed using seven validated readability indices. One-way ANOVA and Tukey's Honestly Significant Difference (HSD) post-hoc analysis were performed to detect differences in readability between publishers. RESULTS Two-hundred and sixty PEMs were included in this analysis. Overall, PEMs were written at a mean 11th±0.6 grade reading level. Only 6.5% of articles were written at the AMA/NIH recommended reading grade level of 6th to 8th grade or below. ANOVA demonstrated a significant difference in readability between publishing associations (p<0.01). PEMs from the Centers for Disease Control had a mean 9th±1.2 grade reading level and were significantly lower than all other organizations. PEMs from The Foundation for Women's Cancer had a mean 13th±1.8 grade reading level and were significantly higher than most other organizations. PEMs from pharmaceutical companies (mean readability=10.1±1.1, N=30) required the lowest reading grade level and were significantly more readable than those from governmental organizations (11.1±1.7, p<0.05) and nonprofit medical associations (12.4±1.7, p<0.01) in ANOVA and Tukey-Kramer post hoc analysis. CONCLUSIONS Gynecologic oncology PEMs available from twelve major organization websites are written well above the recommended sixth to eighth grade reading difficulty level.
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Affiliation(s)
- David Samuel
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States of America.
| | - Nicole Vilardo
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States of America
| | - Sara S Isani
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States of America; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - D Y S Kuo
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States of America; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Gregory M Gressel
- Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, United States of America; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
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13
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Brütting J, Steeb T, Reinhardt L, Berking C, Meier F. Exploring the Most Visible German Websites on Melanoma Immunotherapy: A Web-Based Analysis. JMIR Cancer 2018; 4:e10676. [PMID: 30545808 PMCID: PMC6315239 DOI: 10.2196/10676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 01/06/2023] Open
Abstract
Background Patients diagnosed with melanoma frequently search the internet for treatment information, including novel and complex immunotherapy. However, health literacy is limited among half of the German population, and no assessment of websites on melanoma treatment has been performed so far. Objective The aim of this study was to identify and assess the most visible websites in German language on melanoma immunotherapy. Methods In accordance with the common Web-based information-seeking behavior of patients with cancer, the first 20 hits on Google, Yahoo, and Bing were searched for combinations of German synonyms for “melanoma” and “immunotherapy” in July 2017. Websites that met our predefined eligibility criteria were considered for assessment. Three reviewers independently assessed their quality by using the established DISCERN tool and by checking the presence of quality certification. Usability and reliability were evaluated by the LIDA tool and understandability by the Patient Education Materials Assessment Tool (PEMAT). The Flesch Reading Ease Score (FRES) was calculated to estimate the readability. The ALEXA and SISTRIX tools were used to investigate the websites’ popularity and visibility. The interrater agreement was determined by calculating Cronbach alpha. Subgroup differences were identified by t test, U test, or one-way analysis of variance. Results Of 480 hits, 45 single websites from 30 domains were assessed. Only 2 website domains displayed a German quality certification. The average assessment scores, mean (SD), were as follows: DISCERN, 48 (7.6); LIDA (usability), 40 (2.0); LIDA (reliability), 10 (1.6); PEMAT, 69% (16%); and FRES, 17 (14), indicating mediocre quality, good usability, and understandability but low reliability and an even very low readability of the included individual websites. SISTRIX scores ranged from 0 to 6872 and ALEXA scores ranged from 17 to 192,675, indicating heterogeneity of the visibility and popularity of German website domains providing information on melanoma immunotherapy. Conclusions Optimization of the most accessible German websites on melanoma immunotherapy is desirable. Especially, simplification of the readability of information and further adaption to reliability criteria are required to support the education of patients with melanoma and laypersons, and to enhance transparency.
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Affiliation(s)
- Julia Brütting
- Department of Dermatology, Dresden University Hospital and Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Theresa Steeb
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Lydia Reinhardt
- Department of Dermatology, Dresden University Hospital and Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Friedegund Meier
- Department of Dermatology, Dresden University Hospital and Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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14
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Basch CH, Fera J, Ethan D, Garcia P, Perin D, Basch CE. Readability of online material related to skin cancer. Public Health 2018; 163:137-140. [PMID: 30149263 DOI: 10.1016/j.puhe.2018.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/31/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The key to reducing mortality from skin cancer depends on early detection and treatment, which, in many cases, means a patient should be informed and possess the self-efficacy necessary to seek expert opinion. The purpose of this study was to determine the readability of skin cancer materials on the Internet using the commonly used readability tests. STUDY DESIGN This is a cross-sectional study. METHODS A search was conducted using the key words 'skin cancer.' The first 15 pages of websites that contained English language articles on skin cancer comprised the sample for this study. All English language articles appearing on these websites were analyzed using the Readable.io service to automate popular readability scores. For each article, it was determined if it was generated from a .org, .com, .gov, .net, .edu or other source. Five readability tests were conducted on the materials to determine the ease with which one can read each article. RESULTS Of the 102 websites sampled, none received an acceptable score on all five assessments. In fact, more than 90% of the websites sampled received an unacceptable score on any one of the five assessments, and more than 78% of the websites sampled received an unacceptable level on all five assessments. All five readability assessments demonstrated statistically significant results; each P-value obtained from the t-tests was substantially below 0.01 and, hence, below the α = 0.05 threshold. These results indicate that it is unlikely that skin cancer websites are being written at the recommended level. Of the websites sampled, roughly 42% were .com, and slightly more than 36% were .org. Statistical evidence indicated that neither .com nor .org websites are likely to be written at the acceptable level. CONCLUSIONS Both for-profit and non-profit agencies which aim to provide health information to consumers should be mindful of the readability levels of the materials they disperse.
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Affiliation(s)
- C H Basch
- Department of Public Health, William Paterson University, Wayne, NJ 07470, USA.
| | - J Fera
- Department of Mathematics, Lehman College, The City University of New York, USA
| | - D Ethan
- Health Education and Promotion, Department of Health Sciences, Lehman College, The City University of New York, USA
| | - P Garcia
- Department of Public Health, William Paterson University, Wayne, NJ 07470, USA
| | - D Perin
- Department of Health and Behavior Studies, Teachers College, Columbia University, NY, NY 10027, USA
| | - C E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University, NY, NY 10027, USA
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Brütting J, Bergmann M, Garzarolli M, Rauschenberg R, Weber C, Berking C, Tilgen W, Schadendorf D, Meier F. Information-seeking and use of information resources among melanoma patients of German skin cancer centers. J Dtsch Dermatol Ges 2018; 16:1093-1101. [PMID: 30091517 DOI: 10.1111/ddg.13630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to explore the information-seeking behavior (ISB) of melanoma patients (MPs) and MP subgroups, in order to provide data for needs-based adaptation of information provision. METHODS In a cross-sectional survey in 27 German skin cancer centers, we explored characteristics of the ISB of MPs with the aid of a standardized questionnaire. Sub-group differences were determined with the chi-squared test and predictors of media preferences with logistic regression. RESULTS 67 % of the 529 participating MPs had clinical stage III or IV melanoma. Most of the participants (81 %) reported medical consultations as their regularly or frequently used information resource (IR). 58 % wished to have more advice about IRs from their physician. Only 8 % of MPs used the services of self-help groups and 12 % of MPs took advantage of the services of cancer counseling centers. The internet (63 %) and booklets (58 %) were reported to be the preferred media. Age, educational level, general need for information and lack of awareness of their own condition proved to be predictors for media preferences. CONCLUSIONS Most MPs expected their physician to advise them about IRs they could use in addition to medical consultations. Peer support services were quite underused by MPs. The various preferences of media by MPs should be considered when deve-loping and providing IRs.
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Affiliation(s)
- Julia Brütting
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maike Bergmann
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Marlene Garzarolli
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ricarda Rauschenberg
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christiane Weber
- Arbeitsgemeinschaft Dermatologische Onkologie (ADO), Saarbrücken, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital Munich, Munich, Germany
| | - Wolfgang Tilgen
- Nationale Versorgungskonferenz Hautkrebs (NVKH), Neckargemünd, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Friedegund Meier
- Department of Dermatology, Dresden University Hospital Carl Gustav Carus, Dresden, Germany
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Dobbs T, Neal G, Hutchings HA, Whitaker IS, Milton J. The Readability of Online Patient Resources for Skin Cancer Treatment. Oncol Ther 2017. [DOI: 10.1007/s40487-017-0051-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Rodrigue JR, Feranil M, Lang J, Fleishman A. Readability, content analysis, and racial/ethnic diversity of online living kidney donation information. Clin Transplant 2017; 31. [PMID: 28640438 PMCID: PMC5581210 DOI: 10.1111/ctr.13039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
More than three-fourths of adults in the USA use the Internet to access health-related information. Adults exploring the possibility of living donation should have access to online content that is readable and comprehensive. We simulated a search of online information about living kidney donation and evaluated readability, topics covered, and racial/ethnic diversity of 21 websites meeting inclusion criteria (eg, hosted by a nonprofit or patient advocacy organization, English content, based in USA). Using standard readability metrics, 62% of sites were classified as "Difficult to read" and none achieved the recommended reading level of sixth grade. On average, websites covered 18.5 (62%) of 30 recommended information topics (range: 7 to 28) and only 2.1 (23%) of 9 racial/ethnic diversity items (range: 0 to 6). Overall, the most common nonprofit or patient advocacy organization websites do not meet the readability standards established by the National Institutes of Health and the American Medical Association, many lack fundamental information about living kidney donation, and most are not racially/ethnically diverse. We encourage the transplant community to consider playing a more active role in improving the overall quality of online information disseminated to the general public. Further, there is a need to more critically examine the accuracy of online living donation content in future investigations.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Departments of Surgery and Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mario Feranil
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jenna Lang
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Nguyen A, Mosadeghi S, Almario CV. Persistent digital divide in access to and use of the Internet as a resource for health information: Results from a California population-based study. Int J Med Inform 2017; 103:49-54. [DOI: 10.1016/j.ijmedinf.2017.04.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/10/2017] [Accepted: 04/09/2017] [Indexed: 12/27/2022]
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Meillier A, Patel S. Readability of Healthcare Literature for Gastroparesis and Evaluation of Medical Terminology in Reading Difficulty. Gastroenterology Res 2017; 10:1-5. [PMID: 28270870 PMCID: PMC5330686 DOI: 10.14740/gr746w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Gastroparesis is a chronic condition that can be further enhanced with patient understanding. Patients’ education resources on the Internet have become increasingly important in improving healthcare literacy. We evaluated the readability of online resources for gastroparesis and the influence by medical terminology. Methods Google searches were performed for “gastroparesis”, “gastroparesis patient education material” and “gastroparesis patient information”. Following, all medical terminology was determined if included on Taber’s Medical Dictionary 22nd Edition. The medical terminology was replaced independently with “help” and “helping”. Web resources were analyzed with the Readability Studio Professional Edition (Oleander Solutions, Vandalia, OH) using 10 different readability scales. Results The average of the 26 patient education resources was 12.7 ± 1.8 grade levels. The edited “help” group had 6.6 ± 1.0 and “helping” group had 10.4 ± 2.1 reading levels. In comparing the three groups, the “help” and “helping” groups had significantly lower readability levels (P < 0.001). The “help” group was significantly less than the “helping” group (P < 0.001). Conclusions The web resources for gastroparesis were higher than the recommended reading level by the American Medical Association. Medical terminology was shown to be the cause for this elevated readability level with all, but four resources within the recommended grade levels following word replacement.
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Affiliation(s)
- Andrew Meillier
- Department of Medicine, Temple University Health System, Philadelphia, PA, USA
| | - Shyam Patel
- Department of Medicine, Temple University Health System, Philadelphia, PA, USA
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20
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Readability analysis of online resources related to lung cancer. J Surg Res 2016; 206:90-97. [PMID: 27916381 DOI: 10.1016/j.jss.2016.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/12/2016] [Accepted: 07/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients seeking health information commonly use the Internet as the first source for material. Studies show that well-informed patients have increased involvement, satisfaction, and healthcare outcomes. As one-third of Americans have only basic or below basic health literacy, the National Institutes of Health and American Medical Association recommend patient-directed health resources be written at a sixth-grade reading level. This study evaluates the readability of commonly accessed online resources on lung cancer. METHODS A search for "lung cancer" was performed using Google and Bing, and the top 10 websites were identified. Location services were disabled, and sponsored sites were excluded. Relevant articles (n = 109) with patient-directed content available directly from the main sites were downloaded. Readability was assessed using 10 established methods and analyzed with articles grouped by parent website. RESULTS The average reading grade level across all sites was 11.2, with a range from 8.8 (New Fog Count) to 12.2 (Simple Measure of Gobbledygook). The average Flesch Reading Ease score was 52, corresponding with fairly difficult to read text. The readability varied when compared by individual website, ranging in grade level from 9.2 to 15.2. Only 10 articles (9%) were written below a sixth-grade level and these tended to discuss simpler topics. CONCLUSIONS Patient-directed online information about lung cancer exceeds the recommended sixth-grade reading level. Readability varies between individual websites, allowing physicians to direct patients according to level of health literacy. Modifications to existing materials can significantly improve readability while maintaining content for patients with low health literacy.
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