Tech Coloproctol DOI 10.1007/s10151-014-1222-0
CORRESPONDENCE
Quality of patient information on the internet for the treatment of anal fistula and anal fissure F. Scott • A. Seghal • H. M. Joshi • T. M. Yeung M. P. Gosselink
•
Received: 17 August 2014 / Accepted: 15 September 2014 Ó Springer-Verlag Italia Srl 2014
Dear Sir, Patient use of the internet to get answers to medical questions is increasing, and many patients discuss the results of their findings with their health care providers [1, 2]. This is helpful considering the amount of information relayed by doctors that is taken in by patients is estimated to be between 40 and 80 % [3]. However, there is no monitoring or regulation of the information available online, and patients may find it challenging to discern good-quality information from poor-quality information. The combination of these factors could lead to patients being misinformed. Therefore, this study aims to assess the quality of the patient information available on the Internet about anal fissures and fistulas, and the treatment options for both. The three most popular search engines, Google (Mountain View, CA, USA), Yahoo (Sunnyvale, CA, USA), and Wikipedia (Wikipedia Web search engines), were used to identify websites that contained patient information about either anal fissures or anal fistulas. General search engines were used instead of medical search tools (e.g., PubMed) because it better reflects the way patients use the Internet to research conditions [4]. The search terms used were simply ‘‘anal fissure’’ and ‘‘anal fistula’’ to accurately simulate typical patient
F. Scott A. Seghal Oxford University Medical School, Oxford, UK H. M. Joshi (&) T. M. Yeung M. P. Gosselink Nuffield Department of Surgery, Oxford University Hospitals Trust, Oxford, UK e-mail: [email protected] M. P. Gosselink e-mail: [email protected]
searches. Searches for both ‘‘anal fissure’’ and ‘‘anal fistula’’ were preformed in February 2014. Only the first 50 websites listed by each search engine were analyzed because the majority of Internet users do not look at websites beyond the first 50 results [5]. The inclusion criteria were websites that were free, did not require a password, were written in English, and provided patient information about either anal fissures or anal fistulas. Exclusion criteria included duplicate search results, advertisements, links, resources aimed at clinicians, clinical trials or guidelines, and discussion forums. Websites that met the inclusion criteria were assessed to determine the date of their last update (if given) and the affiliation of the group running the site. The content of each site was analyzed with focus on symptoms, investigations, treatment options and details, risks of each treatment option, and prognosis of either anal fissures or anal fistulas. The DISCERN instrument (www.discern.org.uk) was used to evaluate the quality and reliability of the information available [6]. The search results for ‘‘anal fissure’’ and ‘‘anal fistula’’ were both assessed independently by two of the authors. The kappa coefficient for this was 0.847. Any websites with discrepancies between the scores awarded by each author were re-evaluated by both authors together until a consensus on the score was reached. The search term ‘‘anal fistula’’ yielded 793,000 and 647,000 results in Google and Yahoo, while ‘‘anal fissure’’ yielded 915,000 and 1,040,000 results in the same. Of these results, the first 50 from each search engine were examined. In total, 200 websites were examined, of which 97 (48.5 %) met inclusion criteria: 45 from anal fistulas and 52 from anal fissures websites, respectively. Among the websites excluded, there were 57 duplicates, 26 clinician resources, 9 forums, 2 adverts, 2 videos, 2 websites that
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Tech Coloproctol
Fig. 1 Affiliation of websites
required a password and 5 that were not patient information. Of the 97 websites that provided patient information only, 33 (34 %) had been updated within the last 2 years and 43 (44 %) did not mention when the website was last updated. Almost half the websites were from healthcare providers (Fig. 1). This included 14 (14 %) from the National Healthcare Service (NHS) and 33 (34 %) from private healthcare providers (UK, USA and India). Most other websites aimed to provide patient information (41 %). There was an equal number of websites associated with product manufacturers, private companies, and Fig. 2 Reliability of information for a anal fissures and b anal fistula web sites
Fig. 3 Quality of treatment option information for a anal fissure and b anal fistula web sites
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alternative treatments, while the rest (‘‘others’’) was made up of charities, news articles, and insurance providers (Fig. 1). All 97 websites were assessed using the DISCERN instrument to assess the reliability (Fig. 2) and quality of information on treatment choices for anal fissures and fistulas (Fig. 3). Overall, for anal fistulas, 20 (44 %) websites were rated ‘‘High,’’ 17 (38 %) were ‘‘Moderate,’’ and 8 (18 %) were ‘‘Poor.’’ For anal fissures, 11 (21 %) were rated ‘‘High,’’ 18 (35 %) were ‘‘Moderate,’’ and 23 (44 %) were ‘‘Poor.’’ In conclusion, information addressing anal fistulas was generally judged to be of higher quality than that of concerning anal fissures. The reasons for this are unclear, although one possibility is that since the first intervention for anal fistulas is usually surgical, there are more surgical providers prepared to create good-quality websites to attract patients. The most frequent management options for anal fissures are nonsurgical, and conservative therapy is the most common approach. Moreover, the drugs used to treat anal fissures are all nonpatented. No party has a financial interest in promoting this approach, and this could explain why the information about anal fissures is of lower quality. Clinicians should be aware of the variability of the quality of information available online and should guide patients to high-quality websites that are known to contain
Tech Coloproctol
accurate and impartial information about anal fissures and fistulas. Conflict of interest
None.
References 1. Iverson SA, Howard KB, Penney BK (2008) Impact of internet use on health- related behaviors and the patient-physician relationship: a survey-based study and review. J Am Osteopath Assoc 108:699–711 2. Fashner J, Drye ST (2011) Internet availability and interest in patients at a family medicine residency clinic. Fam Med 43:117–120
3. Kessels RP (2003) Patients’ memory for medical information. J R Soc Med 96:219–222 4. Provost M, Perri M, Baujard V, Boyer C (2003) Opinions and e-health behaviours of patients and health professionals in the U.S.A. and Europe. Stud Health Technol Inform 95:695–700 5. Neuman HB, Cabral C, Charlson ME, Temple LK (2007) Is internet information adequate to facilitate surgical decisionmaking in familial adenomatous polyposis? Dis Colon Rectum 50:2135–2141 6. Charnock D, Shepperd S, Needhan G, Gann R (1999) DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 53:105–111
123
CORRESPONDENCE
Quality of patient information on the internet for the treatment of anal fistula and anal fissure F. Scott • A. Seghal • H. M. Joshi • T. M. Yeung M. P. Gosselink
•
Received: 17 August 2014 / Accepted: 15 September 2014 Ó Springer-Verlag Italia Srl 2014
Dear Sir, Patient use of the internet to get answers to medical questions is increasing, and many patients discuss the results of their findings with their health care providers [1, 2]. This is helpful considering the amount of information relayed by doctors that is taken in by patients is estimated to be between 40 and 80 % [3]. However, there is no monitoring or regulation of the information available online, and patients may find it challenging to discern good-quality information from poor-quality information. The combination of these factors could lead to patients being misinformed. Therefore, this study aims to assess the quality of the patient information available on the Internet about anal fissures and fistulas, and the treatment options for both. The three most popular search engines, Google (Mountain View, CA, USA), Yahoo (Sunnyvale, CA, USA), and Wikipedia (Wikipedia Web search engines), were used to identify websites that contained patient information about either anal fissures or anal fistulas. General search engines were used instead of medical search tools (e.g., PubMed) because it better reflects the way patients use the Internet to research conditions [4]. The search terms used were simply ‘‘anal fissure’’ and ‘‘anal fistula’’ to accurately simulate typical patient
F. Scott A. Seghal Oxford University Medical School, Oxford, UK H. M. Joshi (&) T. M. Yeung M. P. Gosselink Nuffield Department of Surgery, Oxford University Hospitals Trust, Oxford, UK e-mail: [email protected] M. P. Gosselink e-mail: [email protected]
searches. Searches for both ‘‘anal fissure’’ and ‘‘anal fistula’’ were preformed in February 2014. Only the first 50 websites listed by each search engine were analyzed because the majority of Internet users do not look at websites beyond the first 50 results [5]. The inclusion criteria were websites that were free, did not require a password, were written in English, and provided patient information about either anal fissures or anal fistulas. Exclusion criteria included duplicate search results, advertisements, links, resources aimed at clinicians, clinical trials or guidelines, and discussion forums. Websites that met the inclusion criteria were assessed to determine the date of their last update (if given) and the affiliation of the group running the site. The content of each site was analyzed with focus on symptoms, investigations, treatment options and details, risks of each treatment option, and prognosis of either anal fissures or anal fistulas. The DISCERN instrument (www.discern.org.uk) was used to evaluate the quality and reliability of the information available [6]. The search results for ‘‘anal fissure’’ and ‘‘anal fistula’’ were both assessed independently by two of the authors. The kappa coefficient for this was 0.847. Any websites with discrepancies between the scores awarded by each author were re-evaluated by both authors together until a consensus on the score was reached. The search term ‘‘anal fistula’’ yielded 793,000 and 647,000 results in Google and Yahoo, while ‘‘anal fissure’’ yielded 915,000 and 1,040,000 results in the same. Of these results, the first 50 from each search engine were examined. In total, 200 websites were examined, of which 97 (48.5 %) met inclusion criteria: 45 from anal fistulas and 52 from anal fissures websites, respectively. Among the websites excluded, there were 57 duplicates, 26 clinician resources, 9 forums, 2 adverts, 2 videos, 2 websites that
123
Tech Coloproctol
Fig. 1 Affiliation of websites
required a password and 5 that were not patient information. Of the 97 websites that provided patient information only, 33 (34 %) had been updated within the last 2 years and 43 (44 %) did not mention when the website was last updated. Almost half the websites were from healthcare providers (Fig. 1). This included 14 (14 %) from the National Healthcare Service (NHS) and 33 (34 %) from private healthcare providers (UK, USA and India). Most other websites aimed to provide patient information (41 %). There was an equal number of websites associated with product manufacturers, private companies, and Fig. 2 Reliability of information for a anal fissures and b anal fistula web sites
Fig. 3 Quality of treatment option information for a anal fissure and b anal fistula web sites
123
alternative treatments, while the rest (‘‘others’’) was made up of charities, news articles, and insurance providers (Fig. 1). All 97 websites were assessed using the DISCERN instrument to assess the reliability (Fig. 2) and quality of information on treatment choices for anal fissures and fistulas (Fig. 3). Overall, for anal fistulas, 20 (44 %) websites were rated ‘‘High,’’ 17 (38 %) were ‘‘Moderate,’’ and 8 (18 %) were ‘‘Poor.’’ For anal fissures, 11 (21 %) were rated ‘‘High,’’ 18 (35 %) were ‘‘Moderate,’’ and 23 (44 %) were ‘‘Poor.’’ In conclusion, information addressing anal fistulas was generally judged to be of higher quality than that of concerning anal fissures. The reasons for this are unclear, although one possibility is that since the first intervention for anal fistulas is usually surgical, there are more surgical providers prepared to create good-quality websites to attract patients. The most frequent management options for anal fissures are nonsurgical, and conservative therapy is the most common approach. Moreover, the drugs used to treat anal fissures are all nonpatented. No party has a financial interest in promoting this approach, and this could explain why the information about anal fissures is of lower quality. Clinicians should be aware of the variability of the quality of information available online and should guide patients to high-quality websites that are known to contain
Tech Coloproctol
accurate and impartial information about anal fissures and fistulas. Conflict of interest
None.
References 1. Iverson SA, Howard KB, Penney BK (2008) Impact of internet use on health- related behaviors and the patient-physician relationship: a survey-based study and review. J Am Osteopath Assoc 108:699–711 2. Fashner J, Drye ST (2011) Internet availability and interest in patients at a family medicine residency clinic. Fam Med 43:117–120
3. Kessels RP (2003) Patients’ memory for medical information. J R Soc Med 96:219–222 4. Provost M, Perri M, Baujard V, Boyer C (2003) Opinions and e-health behaviours of patients and health professionals in the U.S.A. and Europe. Stud Health Technol Inform 95:695–700 5. Neuman HB, Cabral C, Charlson ME, Temple LK (2007) Is internet information adequate to facilitate surgical decisionmaking in familial adenomatous polyposis? Dis Colon Rectum 50:2135–2141 6. Charnock D, Shepperd S, Needhan G, Gann R (1999) DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 53:105–111
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