Description of the Content and Quality of Publicly Available Information on the Internet About Inhaled Volatile Anesthesia and Total Intravenous Anesthesia: Descriptive Study

BACKGROUND

More than 300 million patients undergo surgical procedures requiring anesthesia worldwide annually. There are 2 standard-of-care general anesthesia administration options: inhaled volatile anesthesia (INVA) and total intravenous anesthesia (TIVA). There is limited evidence comparing these methods and their impact on patient experiences and outcomes. Patients often seek this information from sources such as the internet. However, the majority of websites on anesthesia-related topics are not comprehensive, updated, and fully accurate. The quality and availability of web-based patient information about INVA and TIVA have not been sufficiently examined.

OBJECTIVE

This study aimed to (1) assess information on the internet about INVA and TIVA for availability, readability, accuracy, and quality and (2) identify high-quality websites that can be recommended to patients to assist in their anesthesia information-seeking and decision-making.

METHODS

Web-based searches were conducted using Google from April 2022 to November 2022. Websites were coded using a coding instrument developed based on the International Patient Decision Aids Standards criteria and adapted to be appropriate for assessing websites describing INVA and TIVA. Readability was calculated with the Flesch-Kincaid (F-K) grade level and the simple measure of Gobbledygook (SMOG) readability formula.

RESULTS

A total of 67 websites containing 201 individual web pages were included for coding and analysis. Most of the websites provided a basic definition of general anesthesia (unconsciousness, n=57, 85%; analgesia, n=47, 70%). Around half of the websites described common side effects of general anesthesia, while fewer described the rare but serious adverse events, such as intraoperative awareness (n=31, 46%), allergic reactions or anaphylaxis (n=29, 43%), and malignant hyperthermia (n=18, 27%). Of the 67 websites, the median F-K grade level was 11.3 (IQR 9.5-12.8) and the median SMOG score was 13.5 (IQR 12.2-14.4), both far above the American Medical Association (AMA) recommended reading level of sixth grade. A total of 51 (76%) websites distinguished INVA versus TIVA as general anesthesia options. A total of 12 of the 51 (24%) websites explicitly stated that there is a decision to be considered about receiving INVA versus TIVA for general anesthesia. Only 10 (20%) websites made any direct comparisons between INVA and TIVA, discussing their positive and negative features. A total of 12 (24%) websites addressed the concept of shared decision-making in planning anesthesia care, but none specifically asked patients to think about which features of INVA and TIVA matter the most to them.

CONCLUSIONS

While the majority of websites described INVA and TIVA, few provided comparisons. There is a need for high-quality patient education and decision support about the choice of INVA versus TIVA to provide accurate and more comprehensive information in a format conducive to patient understanding.

Role of the internet as an information resource before anaesthesia consultation: A French prospective multicentre survey

BACKGROUND

Use of the internet as an information search tool has increased dramatically. Our study assessed preoperative use of the internet by patients to search for information regarding anaesthesia, surgery, pain or outcomes.

OBJECTIVE(S)

The aim of this study was to test whether patients used the internet prior to surgery and what kinds of information they looked for (anaesthetic technique, pain, adverse events, outcomes and surgery). Correlation between patient age and information sought about surgery from the internet was also explored.

DESIGN

A prospective multicentre observational study.

SETTING

In total, 14 French private and public institutions from May 2015 to January 2016.

PATIENTS

In total, 3161 adult patients scheduled for elective surgery under regional or general anaesthesia.

INTERVENTION(S)

An anonymous questionnaire was presented to adult patients scheduled for elective surgery under regional or general anaesthesia for completion before the first meeting with the anaesthesiologist. The investigator at each centre completed specific items that the patient could not complete.

MAIN OUTCOME MEASURES

We defined the primary endpoint as the number of patients who searched for information about their anaesthesia or surgery on the internet by the time of the their preanaesthetic consultation.

RESULTS

Of the 3234 questionnaires distributed, responses were received from 3161 patients. Within this respondent sample, 1304 (45%) were professionally active and 1664 (59%) used the internet at least once per day. Among 3098 (98%) patients who answered the question concerning the primary endpoint, 1506 (48%) had searched the internet for information about their health. In total, 784 (25%) used the internet to find information about their surgery and 113 (3.5%) looked for specific information about anaesthesia. Of the 3161, 52% reported difficulty searching for appropriate information about anaesthesia on the internet. 'Daily use of the web' [odds ratio (OR) 2.0; (95% CI: 1.65 to 2.55) P < 0.001], 'use of the web on mobile devices' [OR 1.24; (95% CI: 1.02 to 1.50) P = 0.02] and 'asking general practitioner or surgeon about information' [OR 1.35; (95% CI: 1.11 to 1.64) P = 0.002] were significantly associated with the primary endpoint.

CONCLUSION

The internet was not widely used by patients scheduled for elective surgery to search for information about anaesthesia and surgery in our French multicentre study.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT02442609.

Factors influencing the level of patients using the internet to gather information before anaesthesia: a single-centre survey of 815 patients in Switzerland : The internet for patient information before anaesthesia

Background

Aim of this study was to identify factors associated with patients using the internet to find information about their upcoming surgery in general, and more specifically about anaesthesia.

Methods

With Ethics committee approval, 1000 consecutive patients seen before elective surgery in the anaesthesia preoperative clinic of a Swiss Level 2 hospital were asked to complete a questionnaire. Primary outcome were patients using the internet to gather any medical information related to their upcoming hospital stay, secondary outcome patients using the internet to gather information regarding the upcoming anaesthesia. Multiple regression was performed to identify independent factors associated with internet use.

Results

Eighty-two percent of the patients (n = 815) participated. 97% of those were ASA physical status 1 or 2; 83% (n = 676) had experience with previous anaesthetics, 86% (n = 700) reported to use the internet in general. Overall, about one-third of the participants used the internet to learn more about their medical condition, 26% regarding their upcoming surgical procedure. Only 7% (n = 55) obtained information about the anaesthetic. In multivariate analyses, factors associated with internet use were generally doing so, and planned moderate compared to minor surgery; not using the internet was associated with previous anaesthetic experience. Of those who did not use the Internet to learn about their anaesthetic, 34% indicated that they would have visited a trusted website.

Conclusion

Only few patients used the internet to obtain information about their upcoming procedure and the anaesthetic part played an even smaller role. However, many patients would have appreciated guidance to find trustworthy internet sites.

Trial registration

German Clinical Trials Register (DRKS00005434; date of registration: 27^th December 2013); date of enrolment of first patient: 1st August 2013; study retrospectively registered.

Role of the Internet as an information resource for surgical patients: a survey of 877 patients

BACKGROUND

This study was conducted to provide preliminary data regarding current Internet use practices for information about anaesthesia in patients undergoing elective surgical procedures at a major academic institution.

METHODS

With IRB approval, 2936 patients coming for preanaesthetic evaluation at a tertiary academic hospital's preadmission testing (PAT) centre were invited to voluntarily participate in a 20-item questionnaire designed to obtain participants' characteristics and Internet use for information pertaining to their upcoming surgery. Data were analysed using statistical software SAS (Cary, NC, USA). Descriptive statistics were calculated for continuous variables using mean (sd), and for categorical data using n (%). Association analysis was performed using the Fisher's exact test.

RESULTS

Eight hundred and seventy-seven patients (30%) responded. Of these, 356 (41%) looked for information about their medical condition, 321 (37%) for their surgery, 279 (32%) for surgeon, 163 (19%) for the hospital, and only 36 (4%) for information regarding anaesthesia. Of these 36 patients, 14 (39%) said the sites they used helped answer their questions regarding anaesthesia. Of the 831 patients who did not use the Internet for anaesthesia, 503 (57%) indicated that they would be receptive to being directed to specific websites for anaesthesia.

CONCLUSIONS

Of the patients coming for elective surgery who responded (30%), the majority did not use the Internet to seek information regarding anaesthesia. Respondents indicated a high degree of interest in being directed to appropriate websites for further information. These results suggest that it may be beneficial to include information regarding reliable web-based resources to interested patients at preoperative visits.

Surfing for mouth guards: assessing quality of online information

INTRODUCTION

The Internet is an easily accessible and commonly used source of health-related information, but evaluations of the quality of this information within the dental trauma field are still lacking.

AIM

The aims of this study are (i) to present the most current scientific knowledge regarding mouth guards used in sport activities, (ii) to suggest a scoring system to evaluate the quality of information pertaining to mouth guard protection related to World Wide Web sites and (iii) to employ this scoring system when seeking reliable mouth guard-related websites.

MATERIALS AND METHODS

First, an Internet search using the keywords 'athletic injuries/prevention and control' and 'mouth protector' or 'mouth guards' in English was performed on PubMed, Cochrane, SvedMed+ and Web of Science to identify scientific knowledge about mouth guards. Second, an Internet search using the keywords 'consumer health information Internet', 'Internet information public health' and 'web usage-seeking behaviour' was performed on PubMed and Web of Science to obtain scientific articles seeking to evaluate the quality of health information on the Web. Based on the articles found in the second search, two scoring systems were selected. Then, an Internet search using the keywords 'mouth protector', 'mouth guards' and 'gum shields' in English was performed on the search engines Google, MSN and Yahoo. The websites selected were evaluated for reliability and accuracy.

RESULTS

Of the 223 websites retrieved, 39 were designated valid and evaluated. Nine sites scored 22 or higher. The mean total score of the 39 websites was 14.2. Fourteen websites scored higher than the mean total score, and 25 websites scored less. The highest total score, presented by a Public Institution Web site (Health Canada), was 31 from a maximum possible score of 34, and the lowest score was 0.

CONCLUSION

This study shows that there is a high amount of information about mouth guards on the Internet but that the quality of this information varies. It should be the responsibility of health care professionals to suggest and provide reliable Internet URL addresses to patients. In addition, an appropriate search terminology and search strategy should be made available to persons who want to search beyond the recommended sites.