Evaluation of the Informational Content and Readability of US Lung Cancer Screening Program Websites

Abstract

IMPORTANCE The internet is an important source of medical information for many patients and may have a key role in the education of patients about lung cancer screening (LCS). Although most LCS programs in the United States have informational websites, the accuracy, completeness, and readability of these websites have not previously been studied.OBJECTIVE To evaluate the informational content and readability of US LCS program websites. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study assessed US LCS program websites identified on September 15, 2018. A standardized checklist was used to assess key informational content of each website, and text was analyzed for reading level, word count, and reading time. Links to US websites of national advocacy organizations with LCS program content were tabulated. All functional LCS program websites in Google internet search engine results using the search terms lung cancer screening, low-dose CT screening, and lung screening were included in the analysis. MAIN OUTCOMES AND MEASURES Radiologists used a standardized checklist to evaluate content, and readability was assessed with validated scales. Website word count, reading time, and number of links to outside LCS informational websites were assessed. RESULTS A total of 257 LCS websites were included in the analysis. The word count ranged from 73to 4410 (median, 571; interquartile range, 328-909). The reading time ranged from 0.3 to 19.6 minutes (median, 2.5; interquartile range, 1.5-4.0). The median reading level of all websites was grade 10 (interquartile range, 9-11). Only 26% (n = 66) of websites had at least 1 web link to a national website with additional information on LCS. There was wide variability regarding reported eligibility age criteria, with ages 55 to 77 years most frequently cited (42% [n = 108]). Only 56% (n = 143) of websites mentioned smoking cessation. The subject of patient cost was mentioned on 75% (n = 192) of websites. Although major LCS benefits, such as detection of lung cancer, were discussed by most (93% [n = 239]) websites, less than half of the websites (45% [n = 115]) made any mention of possible risks associated with screening.

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

“…Although SDM visits inclusive of decision aids are considered a component of highly effective LCS programs and are mandated by the U.S. Centers for Medicare and Medicaid Services (CMS) ( 60 , 61 ), currently available decision aids may not be appropriate for populations with limited health literacy. Most patient-facing websites with information about LCS are written above the recommended sixth-grade reading level advised by the American Medical Association and are largely written for English speakers ( 62 , 63 ). To ensure informed LCS decisions that are consistent with the patient’s preference, it is crucial that patients understand numeracy concepts for informed decision-making.…”

Readability Assessment of HPV Vaccination and Cervical Cancer Information: A Systematic Scoping Review

“…Studies that assessed colorectal cancer screening online information reported that most materials surpassed the sixth-grade reading level [37,38], and the average reading level was 11th grade [38]. Studies that assessed lung cancer screening online information also reported that only a few of the evaluated materials had reading levels at or below a sixth-grade reading level [39,40], and the average level was 10th grade [40]. Thus, information on the HPV vaccination and cervical cancer, as well as information on other types of vaccines and cancer screening, is often written above the recommended sixth-grade reading level and is difficult to read.…”

Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population

“…41,42 Given the findings from this study, such interventions may include written education in the form of advertisements and materials in health clinics. Because many existing websites and written materials about LCS may not be well understood by the target audience, 43-46 content should be tested with the screening-eligible population to ensure comprehension.…”