Popular web information on colorectal cancer is too difficult for most lay people to read and doesn't address the appropriate risks to and concerns of patients, a study by UT Southwestern Medical Center gastroenterologists suggests.
In a review of a dozen popular websites, most of the online patient education materials for colorectal cancer screening were written beyond the recommended sixth-grade reading level, while content on the sites failed to address key risks, as well as the barriers to and benefits of screening, according to the study's authors Dr. Deepak Agrawal, Assistant Professor of Internal Medicine, and Dr. Chenlu Tian, an Internal Medicine fellow.
"Today, the Internet often is the first point of contact between the patient and health-related information, even for patients with low literacy. In, thus, is a great opportunity for us to influence the decisions people make about their health and to steer them in the right direction. Informing patients is a physician's responsibility and we take this role seriously," said Dr. Agrawal, senior author and gastroenterologist in the division of Digestive and Liver Diseases at UT Southwestern. The study, which appears in the journal Gastrointestinal Endoscopy and was conducted along with researchers from UT Arlington, is the first to analyze the appropriateness of internet-based materials in terms of health literacy.
Colorectal cancer remains the second leading cause of cancer death in the United States, despite effective screening tests, including the fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy. Developing more appropriate and targeted patient education resources on colorectal cancer may improve patient understanding and promote screening, an important goal because U.S. colorectal cancer screening rates remain below target levels, the authors said.
The "Healthy People 2010" initiative proposed a colon cancer screening rate of at least 70.5 percent. Colon cancer screening rates remain under 50 percent for those with less than high school reading levels, well below the overall average of about 65 percent, according to the study.
Previous studies have shown that six of 10 people rely on the Internet when seeking information about colonoscopy screening. Yet, readability for 10 of the 12 sites reviewed – all from reputable medical societies and considered likely referral sites for physicians – surpassed the maximum recommended sixth-grade reading level.
In addition to being too hard to read, the researchers found, the sites failed to address key concerns, such as the risk of getting colon cancer, the chances of dying from colon cancer, and how easy would it be to get screening. The review found that only half of the sites discussed colorectal cancer risk in the general population and only a quarter specifically addressed patients at high risk, such as African Americans, smokers, patients with diabetes, and obese patients.
The sites also failed to adequately address other common barriers to screening. For example, less than 10 percent of the sites addressed embarrassment, a common concern, and only a quarter addressed pain associated with colonoscopy or the costs of the procedure. None specifically mentioned the need for colonoscopy when no symptoms are present. "It is important to add that reading information on a website should not be considered a substitute for consulting a physician," Dr. Agrawal said. "Internet information is best used as a supplement. With colon cancer screening, there are many options and each has its risks and benefits. An actual discussion with a physician would help patients choose the best option."
Sites reviewed for the study included those of the American Society for Gastrointestinal Endoscopy; American Gastroenterological Association; National Cancer Institute; Centers for Disease Control and Prevention; American College of Gastroenterology; American Society of Colon and Rectal Surgeons; Colon Cancer Alliance; and the American Cancer Society.