Lung Cancer Screening Guidelines: How Readable Are Internet-Based Patient Education Resources?

Hansberry, David R.; White, Michaela M.; D’Angelo, Michael; Prabhu, Arpan V.; Kamel, Sarah; Lakhani, Paras; Sundaram, Baskaran

doi:10.2214/ajr.17.19042

Cited by 16 publications

(17 citation statements)

References 28 publications

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“…The most commonly used website readability scores are the Automated Readability Index 26 (which was designed for health education materials), the Coleman-Liau Index,24 the SMOG,25 the Gunning-Fog index,23 and the Flesch-Kincaid score22 (which is found in the Microsoft Word grammar checker9 ). Similar to our findings, Hansberry et al28 found a mean (SD) grade 12.6 (2.7) reading level among 80 online LCS patient education articles. Haas et al 11 reviewed 46 LCS informational websites and calculated a mean (SD) reading level of grade 10.6 (2.…”

supporting

confidence: 92%

“…In our comprehensive analysis of the LCS program websites, we found inconsistencies, incompleteness, and a reading level Reading levels were assessed as the mean of 5 validated readability scores (Flesch-Kincaid score, 22 Gunning-Fog index, 23 Coleman-Liau formula, 24 above that of the average US adult (grade 8 level). 9 Unlike other studies 11,28 investigating the reading level of online LCS information, the present study evaluated the content of LCS program websites, which may serve as a primary source of information for many LCS-eligible persons. The LCS program websites offer an opportunity for comprehensive coverage of enrollment criteria, logistics, costs, benefits, and risks of screening.…”

Section: Discussionmentioning

confidence: 99%

“…Several prior studies 9,11,18,28 have assessed the readability of health care information for patients, a handful of which evaluated LCS patient information available on the internet. 11,28 However, these studies were limited to a smaller subset of patient educational materials rather than 2). Although readability is an important consideration for assessing accessibility of website text, word count and reading time may alter overall effectiveness by influencing reader engagement and retention.…”

Section: Readability Word Count and Reading Timementioning

confidence: 99%

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

et al. 2020

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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.

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supporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Readability Word Count and Reading Timementioning

confidence: 99%

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

et al. 2020

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“…Our study shows the internet is likely not a viable source. A recent study found similar results indicating most lung cancer screening material is written above the literacy level of the average American [ 54 ]. A simpler intervention repeated over time may yield better knowledge transfer and retention in this population.…”

Section: Discussionmentioning

confidence: 61%

Lung cancer screening: assessment of health literacy and readability of online educational resources

et al. 2018

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BackgroundLung cancer screening can reduce mortality but can be a complex, multi-step process. Poor health literacy is associated with unfavorable outcomes and decreased use of preventative services, so it is important to address barriers to care through efficient and practical education. The readability of lung cancer screening materials for patients is unknown and may not be at the recommended 6th grade reading level set by the American Medical Association. Our goals were to: (1) measure the health literacy of a lung cancer screening population from an urban academic medical center, and (2) examine the readability of online educational materials for lung cancer screening.MethodsWe performed a retrospective cross sectional study at a single urban academic center. Health literacy was assessed using three validated screening questions. To assess the readability of educational materials, we performed a Google search using the phrase, “What is lung cancer screening?” and the Flesch-Kincaid Grade Level (FKGL) formula was used to estimate the grade level required to understand the text.ResultsThere were 404 patients who underwent lung cancer screening during the study period. The prevalence of inadequate/marginal health literacy was 26.7–38.0%. Fifty websites were reviewed and four were excluded from analysis because they were intended for medical providers. The mean FKGL for the 46 websites combined was 10.6 ± 2.2.ConclusionsLow health literacy was common and is likely a barrier to appropriate education for lung cancer screening. The current online educational materials regarding lung cancer screening are written above the recommended reading level set by the American Medical Association.

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“…Poor levels of health literacy found have also been found in older UK smokers, the key target group for lung screening. In the United States, some decision aids have been developed and tested with promising results for supporting decision making; however, the readability of online aids has been challenged and further testing is needed . In the UK, there are currently no guidelines for developing quality assured lung screening patient literature or established decision‐making tools.…”

Section: Discussionmentioning

confidence: 99%

“To know or not to know…?” Push and pull in ever smokers lung screening uptake decision‐making intentions

Tonge

Atack

Barber

et al. 2018

Health Expectations

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Background In the United States, lung cancer screening aims to detect cancer early in nonsymptomatic current and former smokers. A lung screening pilot service in an area of high lung cancer incidence in the United Kingdom has been designed based on United States trial evidence. However, our understanding of acceptability and reasons for lung screening uptake or decline in a United Kingdom nontrial context are currently limited. Objective To explore with ever smokers the acceptability of targeted lung screening and uptake decision‐making intentions. Design Qualitative study using semistructured focus groups and inductive thematic analysis to explore acceptability and uptake decision‐making intentions with people of similar characteristics to lung screening eligible individuals. Setting and participants Thirty‐three participants (22 ex‐smokers; 11 smokers) men and women, smokers and ex‐smokers, aged 50‐80 were recruited purposively from community and health settings in Manchester, England. Results Lung screening was widely acceptable to participants. It was seen as offering reassurance about lung health or opportunity for early detection and treatment. Participant's desire to know about their lung health via screening was impacted by perceived benefits; emotions such as worry about a diagnosis and screening tests; practicalities such as accessibility; and smoking‐related issues including perceptions of individual risk and smoking stigma. Discussion Decision making was multifaceted with indications that current smokers faced higher participation barriers than ex‐smokers. Reducing participation barriers through careful service design and provision of decision support information will be important in lung screening programmes to support informed consent and equitable uptake.

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Lung Cancer Screening Guidelines: How Readable Are Internet-Based Patient Education Resources?

Abstract: Commonly visited online lung cancer screening-related patient education materials are written at a level beyond the general patient population's ability to comprehend and may be contributing to a knowledge gap that is inhibiting patients from improving their health literacy.

Cited by 16 publications

References 28 publications

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

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

Lung cancer screening: assessment of health literacy and readability of online educational resources

“To know or not to know…?” Push and pull in ever smokers lung screening uptake decision‐making intentions

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