University of Texas Southwestern Medical Center Metuchen, NJ, United States
Krishan S. Patel, MD1, Sushil Ahlawat, MD2 1University of Texas Southwestern Medical Center, Dallas, TX; 2Rutgers New Jersey Medical School, Newark, NJ
Introduction: The incidence of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EA) are rising, and management of these conditions is constantly evolving. Patients prefer using internet sources to obtain information regarding diagnostic test and treatment. Unfortunately, the level of English and health literacy in the American population is low, and online information is not always accessible due to being written above the recommended 6th-8th grade level. We sought to determine the readability and quality of internet-based patient education materials (IPEMs) regarding background and management of BE and EA.
Methods: The top ten websites with patient health information for both BE and EA were included for analysis. Quality was assessed using the Quality Evaluation Scoring Tool (QUEST) with score range 0 to 28. Average grade level was calculated using six readability metrics: Flesch Kincaid grade level, Simple Measure of Gobbledygook (SMOG), Gunning-Fog, New Dale-Chall, Raygor, and Coleman-Liau index.
Results: Mean readability was 11.2±1.5 overall, and 11.5± 1.9 for BE (range 9.2 to 14.7) and 10.9± 0.9 EA (range 10.3 to12.7) (see Figure). All websites were above the National Institutes of Health recommended eighth grade. Readability was at the highest grade level for the “treatment” (12.1 for BE and 11.7 for EA) and “testing” (11.7 for BE and 10.8 for EA) subsections. Mean QUEST scores were 16.2±4.6 for BE (range 10-20) and 15.8±5.4 for EA (range 10-28).
Discussion: The readability of IPEMs for Barrett’s esophagus and esophageal cancer is low, and important features of high quality articles are lacking in the majority of commonly accessed medical websites. The high reading level requiring to for the testing and treatment subsections are suggestive of creating a barrier to patient understanding of complex endoscopic and surgical therapies in BE and EA management. Given the relatively low health literacy of the general population, increased efforts should be made to simplify the content of online materials. Further research is warranted to understand how online materials can be improved to facilitate shared decision making and resource utilization. Strategies that target the quality and accessibility of these IPEMs have the potential to enhance patient autonomy and understanding, improve treatment adherence, and ultimately reduce the clinical and psychosocial burden of these conditions.
Figure: Mean readability scores calculated for online patient education materials pertaining to Barrett’s esophagus (BE) and esophageal adenocarcinoma (EA). Websites are listed in order of found in search results. Corresponding educational level is plotted on the right y-axis. Abbreviations: ASGE: American Society of Gastrointestinal Endoscopy, ACG: American College of Gastroenterology, NIH: National Institutes of Health, National Cancer Institute, ACS: American Cancer Society, CCA: Cancer Treatment Centers of America
Krishan Patel indicated no relevant financial relationships.
Sushil Ahlawat indicated no relevant financial relationships.
Krishan S. Patel, MD1, Sushil Ahlawat, MD2. P1369 - Quality and Readability of Online Patient Education Materials for Barrett’s Esophagus and Esophageal Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.