Variability in Information Content on Lung Cancer Screening Websites

A study published in JAMA Network Open suggested that there appears to be marked variability in the informational content of US lung cancer screening (LCS) program websites.

Furthermore, the reading level of most of the websites observed was above that recommended by the American Medical Association and the National Institutes of Health. Researchers indicated that efforts to improve website content and readability might be warranted given these findings. 

“The LCS program websites offer an opportunity for comprehensive coverage of enrollment criteria, logistics, costs, benefits, and risks of screening,” the authors wrote. “Such information can supplement the shared decision-making process that occurs during a patient visit, which is often constrained by time and by competing health concerns.” 

Using a standardized checklist to assess key informational content of each website, as well as analyzing text for reading level, word count, and reading time, the authors included a total of 257 LCS websites in their analysis. The word count ranged from 73 to 4,410 (median, 571; interquartile range, 328-909) and 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 the websites was grade 10 (interquartile range, 9-11). 

Only 26% (n = 66) of the websites had at least 1 web link to a national website where readers could find additional information on LCS. Additionally, there was wide variability regarding reported eligibility age criteria, with ages 55 to 77 years most often cited (42% [n = 1-8]. Only 56% (n = 143) of the websites had any mention of smoking cessation, and even less (37% [n = 94] offered a phone number or link to smoking cessation resources. 

Although the subject of patient cost was mentioned on 75% (n = 192) of the websites, only 51% (n = 131) mentioned coverage by Medicare or private insurance and only 7% (n = 17) discussed out-of-pocket expenses. Moreover, though major LCS benefits, such as detection of lung cancer, were described by most (93% [n = 239]) of the websites, less than half of the websites (45% [n = 115]) made any mention of possible risks associated with screening. 

Found to be an ongoing concern for the medical community, many patient materials are written at a higher reading level than that of the average American adult. And although the American Medical Association recommends a grade 5 or 6 reading level for patient medical information, only 4 of the websites studied met this requirement; only an additional 45 met the grade 7 or 8 level recommended by the National Institutes of Health. Most US adults read at a grade 8 or 9 reading level, and 20% read at a grade 5 or lower, but of the websites observed, 54% (n = 138) were written at a grade 10 level or higher. 

Given that a good portion of adults in the US use the internet to find health information, the accuracy of these websites is of extreme importance. According to the researchers, of those who search online for information on LCS, 77% start with a search engine and likely find the websites evaluated in this study. 

“Minimizing inconsistencies, including appropriate content, and presenting information at an accessible reading level may facilitate dissemination of LCS information and potentially increase LCS participation,” the authors wrote. 

Reference:

Gagne SM, Fintelmann FJ, Flores EJ, et al. Evaluation of the Informational Content and Readability of US Lung Cancer Screening Program Websites. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.20431.