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Grabbe P, Borchers MS, Gschwendtner KM, Strobel S, Wild B, Kirchner M, Kälber K, Rendon A, Steininger J, Meier F, Hassel JC, Bieber C. An Online Decision Aid for Patients With Metastatic Melanoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:385-392. [PMID: 38566437 DOI: 10.3238/arztebl.m2024.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Treatment decisions in metastatic melanoma (MM) are highly dependent on patient preferences and require the patients' involvement. The complexity of treatment options with their individual advantages and disadvantages is often overwhelming. We therefore developed an online patient decision aid (PtDA) to facilitate shared decision making (SDM). METHODS To evaluate the PtDA we conducted a two-armed, twocenter, prospective, open randomized controlled trial with MM patients who were facing a decision about first-line treatment. The patients were allotted randomly in a 1:1 ratio to an intervention group (IG) with access to the PtDA before discussion with a physician or to a control group (CG) without access to the PtDA. The primary endpoint was knowledge about the options for first-line treatment (multiple-choice test, 10 items, range 0-40 points). The secondary endpoints were the SDM (third-party ratings of audio recordings of the treatment discussions) and satisfaction with the decision at the follow-up visit. RESULTS Of the 128 randomized patients, 120 completed the baseline questionnaire and were analyzed (59% male, median age 66 years). The primary endpoint, i.e., the mean difference in knowledge after discussion with a physician, differed significantly between the IG and the CG (-3.22, 95% CI [-6.32; -0.12], p = 0.042). No differences were found for the secondary endpoints, SDM and satisfaction with the decision. The patients in the IG rated the PtDA as very useful. CONCLUSION The PtDA improved the knowledge of patients with MM about the options for treatment. Both groups were highly satisfied with their treatment decisions. However, additional physician training seems necessary to promote SDM.
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Affiliation(s)
- Pia Grabbe
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Medical Faculty, Heidelberg University, Heidelberg; Heidelberg University, Medical Faculty, Department of Dermatology and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany; Institute of Medical Biometry, Heidelberg University Hospital, Heidelberg; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany; Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
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Azer SA, Alsharafi AA. Can pharmacy students use Wikipedia as a learning resource? Critical assessment of articles on chemotherapeutic drugs. ADVANCES IN PHYSIOLOGY EDUCATION 2023; 47:333-345. [PMID: 36951631 DOI: 10.1152/advan.00212.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
Pharmacy students tend to use Wikipedia as a quick resource of knowledge. This study aimed to evaluate the accuracy of content and readability level of Wikipedia articles on chemotherapeutics, using quality and readability tools. Using the British National Formulary (BNF-2018) and ClinicalTrials.gov, we identified 188 chemotherapeutic drugs. We randomly selected 100 drugs with an Excel randomization program. The English Wikipedia was searched for the selected 100 drugs, and prints of the identified articles were obtained. Readability was calculated with an online instrument (http://www.readabilityformulas.com/). Articles were independently scored by two researchers using the modified DISCERN tool for content assessment. The modified DISCERN scores had a median value of 24 [interquartile range (IQR) = 7.5]. Two articles (2%) had good quality (DISCERN score 36-40), thirty-eight (38%) were moderate (DISCERN 26-35), and sixty (60%) were poor in score (DISCERN ≤25). The articles covered drug indications and most side effects. However, the majority lacked information on the routes of administration, contraindications, pharmacokinetics, and mechanisms of action. We found a correlation between DISCERN scores and number of edits (P value = 0.00033, R2 = 0.1238). The number of references varied from 2 to 150 (median= 17, IQR = 17). Several problems were identified in the lists of references and citations. Most articles lacked tables and figures. The readability of the articles was 14.35 ± 3.13, consistent with the readability level of university students. In conclusion, the Wikipedia articles on chemotherapeutic drugs were not written for professional pharmacy students. Although they matched the expected readability level of university students, most were incomplete and lacked essential information.NEW & NOTEWORTHY Pharmacy students use Wikipedia as a quick resource of knowledge. However, Wikipedia articles are not written for professional pharmacy students. The study shows that although Wikipedia articles on chemotherapeutic drugs matched the expected readability level of university students, most needed to be completed and lacked essential information.
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Affiliation(s)
- Samy A Azer
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aya A Alsharafi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Zowalla R, Pfeifer D, Wetter T. Readability and topics of the German Health Web: Exploratory study and text analysis. PLoS One 2023; 18:e0281582. [PMID: 36763573 PMCID: PMC9916670 DOI: 10.1371/journal.pone.0281582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The internet has become an increasingly important resource for health information, especially for lay people. However, the information found does not necessarily comply with the user's health literacy level. Therefore, it is vital to (1) identify prominent information providers, (2) quantify the readability of written health information, and (3) to analyze how different types of information sources are suited for people with differing health literacy levels. OBJECTIVE In previous work, we showed the use of a focused crawler to "capture" and describe a large sample of the "German Health Web", which we call the "Sampled German Health Web" (sGHW). It includes health-related web content of the three mostly German speaking countries Germany, Austria, and Switzerland, i.e. country-code top-level domains (ccTLDs) ".de", ".at" and ".ch". Based on the crawled data, we now provide a fully automated readability and vocabulary analysis of a subsample of the sGHW, an analysis of the sGHW's graph structure covering its size, its content providers and a ratio of public to private stakeholders. In addition, we apply Latent Dirichlet Allocation (LDA) to identify topics and themes within the sGHW. METHODS Important web sites were identified by applying PageRank on the sGHW's graph representation. LDA was used to discover topics within the top-ranked web sites. Next, a computer-based readability and vocabulary analysis was performed on each health-related web page. Flesch Reading Ease (FRE) and the 4th Vienna formula (WSTF) were used to assess the readability. Vocabulary was assessed by a specifically trained Support Vector Machine classifier. RESULTS In total, n = 14,193,743 health-related web pages were collected during the study period of 370 days. The resulting host-aggregated web graph comprises 231,733 nodes connected via 429,530 edges (network diameter = 25; average path length = 6.804; average degree = 1.854; modularity = 0.723). Among 3000 top-ranked pages (1000 per ccTLD according to PageRank), 18.50%(555/3000) belong to web sites from governmental or public institutions, 18.03% (541/3000) from nonprofit organizations, 54.03% (1621/3000) from private organizations, 4.07% (122/3000) from news agencies, 3.87% (116/3000) from pharmaceutical companies, 0.90% (27/3000) from private bloggers, and 0.60% (18/3000) are from others. LDA identified 50 topics, which we grouped into 11 themes: "Research & Science", "Illness & Injury", "The State", "Healthcare structures", "Diet & Food", "Medical Specialities", "Economy", "Food production", "Health communication", "Family" and "Other". The most prevalent themes were "Research & Science" and "Illness & Injury" accounting for 21.04% and 17.92% of all topics across all ccTLDs and provider types, respectively. Our readability analysis reveals that the majority of the collected web sites is structurally difficult or very difficult to read: 84.63% (2539/3000) scored a WSTF ≥ 12, 89.70% (2691/3000) scored a FRE ≤ 49. Moreover, our vocabulary analysis shows that 44.00% (1320/3000) web sites use vocabulary that is well suited for a lay audience. CONCLUSIONS We were able to identify major information hubs as well as topics and themes within the sGHW. Results indicate that the readability within the sGHW is low. As a consequence, patients may face barriers, even though the vocabulary used seems appropriate from a medical perspective. In future work, the authors intend to extend their analyses to identify trustworthy health information web sites.
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Affiliation(s)
- Richard Zowalla
- Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
- Center for Machine Learning, Heilbronn University, Heilbronn, Germany
- * E-mail:
| | - Daniel Pfeifer
- Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
- Center for Machine Learning, Heilbronn University, Heilbronn, Germany
| | - Thomas Wetter
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States of America
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Steeb T, Brütting J, Reinhardt L, Hoffmann J, Weiler N, Heppt MV, Erdmann M, Doppler A, Weber C, Schadendorf D, Meier F, Berking C. One Website to Gather them All: Usability Testing of the New German SKin Cancer INFOrmation (SKINFO) Website-A Mixed-methods Approach. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022:10.1007/s13187-022-02258-5. [PMID: 36585570 PMCID: PMC10366310 DOI: 10.1007/s13187-022-02258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Skin cancer patients increasingly search the internet to acquire disease-related information. However, information on the internet may be misleading. Recently, SKINFO has been launched, a website exclusively created for German-speaking skin cancer patients providing information as well as additional resources of verified quality. Here, we describe the results of the first usability test of SKINFO using a mixed-methods approach. Ten adult patients with skin cancer were recruited for usability testing in the skin cancer units of the University Hospitals of Erlangen and Dresden, Germany. Testing consisted of three different scenarios where patients were asked to find specific information on the SKINFO website guided by the think-aloud method. Descriptive analysis and content analyses were performed. All patients would recommend SKINFO and appreciated its content, design, and structure. Think-aloud analysis identified the topics layout, navigation, and content and structure which would benefit from refinement. Major criticism included the navigation through the website, and the desire for more specific information addressing patients' relatives and the latest, up-to-date information. Overall, usability testing showed that the unique web-based information platform has the potential to support patients coping with skin cancer and thus strengthen informed decision-making.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
- Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nürnberg, 91054, Erlangen, Germany.
| | - Julia Brütting
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Julia Hoffmann
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Nina Weiler
- Eurice - European Research and Project Office GmbH, Ingbert, Germany
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nürnberg, 91054, Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nürnberg, 91054, Erlangen, Germany
| | | | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen - European Metropolitan Region of Nürnberg, 91054, Erlangen, Germany
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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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Stege H, Schneider S, Forschner A, Eigentler T, Nashan D, Huening S, Meiss F, Lehr S, Kaatz M, Kuchen R, Kaehler KC, Haist M, Huebner J, Loquai C. eHealth Literacy in German Skin Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148365. [PMID: 35886215 PMCID: PMC9320579 DOI: 10.3390/ijerph19148365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022]
Abstract
The global incidence of skin cancer has steadily increased in recent years, and malignant melanoma still has one of the fastest-growing incidence rates among all malignant tumors in the western world. Thus, newly diagnosed patients have an increased need for health information concerning their disease. Using a standardized questionnaire, our study aims to investigate our patients’ primary sources of health-related information as well as their self-proclaimed eHealth literacy. We received 714 questionnaires. Regardless of age, the primary source of information was the treating dermato-oncologist, followed by the treating general practitioner and the Internet. However, with increasing age, the usage of the Internet decreased. Hence, younger participants were better equipped to find health-related information while using the Internet. Additionally, comprehending health-related information and gaining medical knowledge was significantly increased in better-educated participants. Overall, our study shows that with increased use of eHealth services, accessing web-based information increased, correlating with a better eHealth literacy of our patients. eHealth technologies are increasingly becoming more prevalent as a primary source of information in our modern health care system. Thus, it is crucial to educate cancer patients in eHealth literacy to make autonomous, informed decisions and gain more confidence in dealing with their disease.
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Affiliation(s)
- Henner Stege
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (S.S.); (M.H.); (C.L.)
- Correspondence:
| | - Sara Schneider
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (S.S.); (M.H.); (C.L.)
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany;
| | - Thomas Eigentler
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität, 10117 Berlin, Germany;
| | - Dorothée Nashan
- Department of Dermatology, Hospital Dortmund, 44137 Dortmund, Germany; (D.N.); (S.H.)
| | - Svea Huening
- Department of Dermatology, Hospital Dortmund, 44137 Dortmund, Germany; (D.N.); (S.H.)
| | - Frank Meiss
- Department of Dermatology, Medical Center—University of Freiburg, 79104 Freiburg, Germany; (F.M.); (S.L.)
| | - Saskia Lehr
- Department of Dermatology, Medical Center—University of Freiburg, 79104 Freiburg, Germany; (F.M.); (S.L.)
| | - Martin Kaatz
- Department of Dermatology, Wald-Klinikum Gera, 07546 Gera, Germany;
| | - Robert Kuchen
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, 55131 Mainz, Germany;
| | - Katharina C. Kaehler
- Department of Dermatology, Venerology and Allergology, University Hospital Schleswig Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Maximilian Haist
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (S.S.); (M.H.); (C.L.)
| | - Jutta Huebner
- Klinik für Innere Medizin II, Hämatologie und Onkologie, Universitätsklinikum Jena, 07747 Jena, Germany;
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (S.S.); (M.H.); (C.L.)
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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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Steeb T, Reinhardt L, Harlaß M, Heppt MV, Meier F, Berking C. Assessment of the Quality, Understandability, and Reliability of YouTube Videos as a Source of Information on Basal Cell Carcinoma: Web-Based Analysis. JMIR Cancer 2022; 8:e29581. [PMID: 35275067 PMCID: PMC8956995 DOI: 10.2196/29581] [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] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Patients with skin cancer increasingly watch online videos to acquire disease-related information. Until now, no scientific evaluation of the quality of videos available for German-speaking patients with basal cell carcinoma (BCC) has been performed. Objective In this study, we aimed to identify and evaluate videos about BCC provided on YouTube. Methods A video search on YouTube was conducted in July 2020, using German BCC-related keywords (eg, “Basalzellkarzinom,” “Basaliom,” “weißer hautkrebs,” and “heller hautkrebs”). The first three pages (ie, 60 videos) were searched by two independent researchers for each keyword. Two authors evaluated videos that met the predefined eligibility criteria. The quality of the information of the videos was evaluated using the DISCERN tool and the Global Quality Scale (GQS). The understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). The reliability was assessed with the JAMA (Journal of the American Medical Association) criteria score. Subgroup differences were identified using the Kruskal-Wallis test. Results A total of 41 videos were included in the evaluation. The mean assessment scores were as follows: DISCERN, 3.3 (SD 0.80); GQS, 3.8 (SD 1.1); JAMA, 27.74% (SD 22.1%); understandability, 70.8% (SD 13.3%); and actionability, 45.9% (SD 43.7%). These values indicated that the videos were of medium to good quality and had good understandability, low actionability, and poor reliability. The quality of videos provided by health professionals was significantly higher than that of videos provided by laypersons. Conclusions Optimization of health-related videos about BCC is desirable. In particular, adaptation to reliability criteria is necessary to support patient education and increase transparency.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Erlangen, Germany
| | - Lydia Reinhardt
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthias Harlaß
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Erlangen, Germany
| | - Markus Vincent Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Erlangen, Germany
| | - Friedegund Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Erlangen, Germany
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Total Knee Arthroplasty: A Quantitative Assessment of Online Patient Education Resources. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:98-106. [PMID: 36601227 PMCID: PMC9769358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Patients often turn to the online resources to learn about orthopedic procedures. As the rate of joint arthroplasty is projected to increase, the corresponding interest in relevant online education material will increase as well. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that publicly available online health information be written at the 6th grade or lower reading level to be fully understood by the average adult in the United States. Additionally, educational resources should be written such that readers can process key information (understandability) or identify available actions to take (actionability). The purpose of this study was to quantify the readability, understandability, and actionability of online patient educational materials regarding total knee arthroplasty (TKA). Methods The most common Google™ search term utilized by the American public was determined to be "knee replacement". Subsequently two independent online searches (Google.com) were performed. From the top 50 search results, websites were included if directed at educating patients regarding TKA. Non-text websites (audiovisual), articles (news/research/industry), and unrelated resources were excluded. Readability was quantified using the following valid objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). PEMAT was utilized to assess understandability and actionability (0-100%; score ≥70% indicates acceptable scoring). The relationship between search rank with FKGL and PEMAT scores was quantified. Results A total of 34 (68%) unique websites met inclusion criteria. The mean FKGL, SMOG, CLI, and GFI was 11.8±1.6, 11.1±1.2, 11.9±1.4, and 14.7±1.6, respectively. None of the websites scored within the acceptable NIH/AMA recommended reading levels. Mean understandability and actionability scores were 54.9±12.1 and 30.3±22.0. Only 5.9% (n=2) and 9.2% (n=1) of websites met the ≥70% threshold for understandability and actionability. Only 29.4% (n=10) sources used common language and only 26.9% (n=9) properly defined complicated medical terms. Based on website type, the mean understandability scores for academic institution, private practice, and health information publisher websites were 57.2±8.8%, 52.6±11.1%, and 54.3±15.3% (p=0.67). Readability (rho: -0.07; p=0.69), understandability (rho: -0.02; p=0.93), and actionability (rho: -0.22; p=0.23) scores were not associated with Google™ search rank. Conclusion TKA materials scored poorly with respect to readability, understandability, and actionability. None of the resources scored within the recommended AMA/NIH reading levels. Only 5.9% scored adequately on understandability measures. Substantial efforts are needed to improve online resources to optimize patient comprehension and facilitate informed decision-making. Level of Evidence: III.
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Grabbe P, Gschwendtner KM, Maatouk I, Strobel SB, Salzmann M, Bossert J, Eich W, Wild B, Meier F, Hassel JC, Bieber C. Development and validation of a web-based patient decision aid for immunotherapy for patients with metastatic melanoma: study protocol for a multicenter randomized trial. Trials 2021; 22:294. [PMID: 33879219 PMCID: PMC8056554 DOI: 10.1186/s13063-021-05234-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients with metastatic melanoma and their physicians are confronted with a complex decision regarding first-line therapy. Risks and benefits vary considerably between various treatment options. With this in mind, we aim to develop and evaluate a patient decision aid (PtDA) to inform patients about the risks and benefits of treatment options, namely, immunotherapy as monotherapy, immunotherapy as combination therapy, and treatment with BRAF/MEK inhibitors. We aim to test whether the use of this PtDA before medical consultation will increase patients' knowledge of treatment options and thus promote shared decision-making (SDM) and patient decision satisfaction. METHODS In total, 128 patients with metastatic melanoma from two German cancer centers will be randomized to the intervention group (IG), receiving access to the PtDA before medical consultation, or the control group (CG), receiving treatment as usual (TAU), i.e., medical consultation alone. There will be three major assessment points (before intervention, T0; after intervention, T1; and 3 months after intervention, T2). The main outcome is the patient's knowledge of their treatment options, measured by a self-developed, piloted multiple-choice test at T1. Secondary outcome measures will include the extent of SDM during medical consultation, assessed by Observer OPTION 5, and patient decision satisfaction, assessed by the Satisfaction with Decision Scale (SwD), at T1 and T2. DISCUSSION This trial will assess the effectiveness of a developed PtDA to enhance patient knowledge of treatment options for metastatic melanoma, SDM, and patient decision satisfaction. If the efficacy can be proven, the PtDA will be implemented nationwide in Germany to close a relevant gap in the education and care of patients with metastatic melanoma. TRIAL REGISTRATION ClinicalTrials.gov NCT04240717 . Registered on 27 January 2020.
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Affiliation(s)
- Pia Grabbe
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115 Heidelberg, Germany
| | - Kathrin M. Gschwendtner
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115 Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115 Heidelberg, Germany
| | - Sophia B. Strobel
- National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Martin Salzmann
- National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Julia Bossert
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Köln, Germany
- TAKEPART Media + Science, Köln, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115 Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115 Heidelberg, Germany
| | - Friedegund Meier
- National Center for Tumor Diseases, University Hospital Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Jessica C. Hassel
- National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115 Heidelberg, Germany
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Steeb T, Wessely A, Merkl H, Voskens C, Erdmann M, Heinzerling L, Berking C, Heppt MV. Experiences of In-Patients with Skin Cancer in a German University Hospital Setting: A Cross-Sectional Survey. Patient Prefer Adherence 2021; 15:41-48. [PMID: 33469273 PMCID: PMC7811463 DOI: 10.2147/ppa.s276417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE An important measure of hospital quality is the satisfaction of the patients receiving in-patient care. This cross-sectional study aimed to assess skin cancer patients' experiences in a university hospital setting as a measure of quality of cancer care. PATIENTS AND METHODS Questionnaires were mailed to patients with skin cancer after receiving in-patient overnight treatment in the dermatological unit of the university hospital Erlangen (Germany) from 1 September to 30 November 2017. Patients were asked to evaluate their overall experience of this episode of care and to complete the Picker Inpatient Survey questionnaire on specific aspects of their care, such as patient satisfaction regarding contact with staff, need for information, recommendation of the hospital as well as tumor-specific questions. The results were re-coded as problems and reported as frequencies and their percentage. RESULTS A total of 103 of 159 questionnaires were returned (64.8%). All patients rated the treatment and care they had received to be good or very good. Additionally, all patients would recommend our in-patient clinic to their families or friends. The patients most commonly criticized inconsistency of care delivered by the same physician (29.7%, 30/101) and feeling of insufficient involvement in the decision-making processes (21.1%, 20/95). Besides this, 19.0% (11/58) and 34.6% (18/52) of patients were not satisfied with physicians and nurses, respectively, appropriately addressing their fears or anxieties. In the cancer-specific questionnaire, the majority of patients were dissatisfied with further support regarding professional and social rehabilitation possibilities (85.7%, 30/35) and psycho-oncology (56.3%, 18/32). CONCLUSION Overall, the majority of patients were satisfied with the in-patient skin cancer treatment. However, physicians and nurses can enhance patient satisfaction by addressing patients' fears and anxieties regarding their disease and treatment. Besides, our results highlight the importance of psycho-oncological support.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Heike Merkl
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen91054, Germany
| | - Caroline Voskens
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
- Correspondence: Markus V Heppt Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Ulmenweg 18, Erlangen91054, GermanyTel +49-9131-85-35747 Email
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12
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Steeb T, Reinhardt L, Görgmayr C, Weingarten H, Doppler A, Brütting J, Meier F, Berking C. German YouTube™ videos as a source of information on cutaneous melanoma: a critical appraisal. J Eur Acad Dermatol Venereol 2020; 34:e642-e644. [PMID: 32307748 DOI: 10.1111/jdv.16510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- T Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - L Reinhardt
- Department of Dermatology, Dresden University Hospital, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - C Görgmayr
- Melanoma Info Deutschland - MID e.V., Essen, Germany
| | - H Weingarten
- Melanoma Info Deutschland - MID e.V., Essen, Germany
| | - A Doppler
- Melanoma Info Deutschland - MID e.V., Essen, Germany
| | - J Brütting
- Department of Dermatology, Dresden University Hospital, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - F Meier
- Department of Dermatology, Dresden University Hospital, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - C Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Rubel KE, Alwani MM, Nwosu OI, Bandali EH, Shipchandler TZ, Illing EA, Ting JY. Understandability and actionability of audiovisual patient education materials on sinusitis. Int Forum Allergy Rhinol 2020; 10:564-571. [PMID: 31930714 DOI: 10.1002/alr.22518] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute and chronic rhinosinusitis are debilitating diseases that affect from 5% to 16% of the population. YouTube is the second most commonly used search engine and is often utilized by patients to garner health information regarding various disease processes and their respective management options. An evaluation of these information resources for quality and reliability is warranted, especially in an era in which patients are increasingly turning to audiovisual (A/V) media to educate themselves regarding their ailments. METHODS The YouTube video database was searched using the term "sinusitis" from its inception through to November 2018. The first 50 videos populated under the relevance-based ranking option were collected and parsed by time and language. Of the 50 videos, 10 were eliminated either for length (≤1 minute or ≥20 minutes), language (any language other than English), and/or for later being removed by YouTube for copyright violations. The videos were then assessed using the Patient Education Materials Assessment Tool-Audio/Visual (PEMAT-A/V) by 2 independent reviewers for understandability and actionability. RESULTS A total of 40 videos were examined using the PEMAT-A/V tool. The average understandability score was 57.7%, whereas the average actionability score was 46.3%. Eleven videos (28%) had actionability scores of 0%. Videos most commonly addressed disease management options (38%). The second largest category was case presentations regarding surgical techniques (30%). There were only 6 videos focused primarily on education about the definition and common traits of sinusitis (15%). CONCLUSION Our results show a paucity of high-quality online A/V educational material pertaining to sinusitis, with a majority of videos being neither understandable nor actionable. As patients increasingly turn to internet video databases like YouTube for medical information, it is critical that physicians and institutions create A/V material that is accurate, understandable, and actionable.
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Affiliation(s)
- Kolin E Rubel
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Mohamedkazim M Alwani
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Obi I Nwosu
- Indiana University School of Medicine, Indianapolis, IN
| | - Elhaam H Bandali
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN
| | - Taha Z Shipchandler
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN.,Department of Neurological Surgery, Indiana University, Indianapolis, IN
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