A study by UT Southwestern Medical Center gastroenterologists shows that 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.
Most of the online patient education materials for colorectal cancer screening, the study shows, were written beyond the recommended sixth-grade reading level. On the other hand, as the study’s authors Dr. Deepak Agrawal and Dr. Chenlu Tian explain, content on the sites failed to address key risks, as well as the barriers to and benefits of screening.
“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, gastroenterologist in the division of Digestive and Liver Diseases at UT Southwestern and assistant professor of internal medicine.
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.
Despite effective screening tests, including the fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy, colorectal cancer is still the second leading cause of cancer death in the United States. 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, but the study shows that rates remain under 50 percent for those with less than high school reading levels, well below the overall average of about 65 percent
Six out of ten people rely on the Internet when seeking information about colonoscopy screening, previous studies have shown. Yet, readability for ten of the twelve sites reviewed in this study – all from reputable medical societies and considered likely referral sites for physicians – surpassed the maximum recommended sixth-grade reading level.
Besides 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 it would be to get screening. In addition to 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.