Thyroidectomy is one of the most common procedures performed in head and neck surgery. The quality of online resources for thyroidectomy is unknown. We aim to evaluate search trends and online resource quality regarding thyroidectomy.
Study Design
Cross-sectional analysis.
Setting
Websites appearing on Google search.
Methods
The first 30 Google websites for thyroidectomy were reviewed, excluding research, video, and restricted sites. Search patterns were obtained with Google Trends. Quality was measured by readability (Flesch Reading Ease and Flesch-Kinkaid Grade Level), understandability and actionability (Patient Education Materials Assessment Tool), and clinical practice guideline (CPG) compatibility. Fleiss kappa interrater reliability analysis was performed for 2 raters.
Results
Twenty-one sites were evaluated. Search popularity for thyroidectomy has increased since 2004. Median reading ease was 42.2 (range, 15.4-62.7) on a scale from 1 to 100, with 100 indicating maximum readability. Median reading grade level was 12 (range, 7-16). Thyroidectomy resources were poorly understandable (median, 66%; range, 21%-88%) and actionable (median, 10%; range, 0%-60%). Median CPG compatibility was 4 out of 5 (range, 0-5). Interrater reliability ranged from substantial to moderate for understandability (0.78), actionability (0.57), and CPG compatibility (0.58), with P < .05 for all results.
Conclusion
Online resources about thyroidectomy vary in quality and reliability and are written at grade levels above the average reading level of the public. Providers should be aware of existing resources and work to create education resources that meet universal health literacy guidelines. The framework provided in this article may also serve as a guide and provide tangible steps that providers can take to help patients access care.
EltoraiAEMGhanianSAdamsCA, et al. Readability of patient education materials on the American Association for Surgery of Trauma website. Arch Trauma Res. 2014;3(2):e18161.
2.
De MartinoID’ApolitoRMcLawhornAS, et al. Social media for patients: benefits and drawbacks. Curr Rev Musculoskelet Med. 2017;10(1):141-145.
3.
SteehlerKRSteehlerMKPierceML, et al. Social media’s role in otolaryngology–head and neck surgery: informing clinicians, empowering patients. Otolaryngol Head Neck Surg. 2013;149(4):521-524.
HarleyEH.The increasing role of social media in otolaryngology. JAMA Otolaryngol Head Neck Surg. 2019;145(3):203-204.
7.
O’MathúnaDP.How should clinicians engage with online health information?AMA Journal of Ethics. 2018;20(11):1059-1066.
8.
NijlandNGermert-PijnenJ vanBoerH, et al. Evaluation of internet-based technology for supporting self-care: problems encountered by patients and caregivers when using self-care applications. J Med Internet Res. 2008;10(2):e13.
9.
OttenhoffJSEKortleverJTPTeunisT, et al. Factors associated with quality of online information on trapeziometacarpal arthritis. J Hand Surg Am. 2018;43(10):889-896.e5.
10.
TanSS-LGoonawardeneN. Internet health information seeking and the patient-physician relationship: a systematic review. J Med Internet Res. 2017;19(1):e9.
11.
KuenzelUMonga SindeuTSchrothS, et al. Evaluation of the quality of online information for patients with rare cancers: thyroid cancer. J Cancer Educ. 2018;33(5):960-966.
12.
ChangKLGrubbsEGIngledewP-A.An analysis of the quality of thyroid cancer websites. Endocr Pract. 2019;25(10):1003-1011.
13.
MisraPKasabwalaKAgarwalN, et al. Readability analysis of internet-based patient information regarding skull base tumors. J Neurooncol. 2012;109(3):573-580.
14.
PatelCRCherlaDVSanghviS, et al. Readability assessment of online thyroid surgery patient education materials. Head Neck. 2013;35(10):1421-1425.
15.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health literacy: report of the Council on Scientific Affairs. JAMA. 1999;281(6):552-557.
16.
WangL-WMillerMJSchmittMR, et al. Assessing readability formula differences with written health information materials: application, results, and recommendations. Res Social Adm Pharm. 2013;9(5):503-516.
17.
StosselLMSegarNGliattoP, et al. Readability of patient education materials available at the point of care. J Gen Intern Med. 2012;27(9):1165-1170.
18.
BregaABarnardJMabachiNM, et al. AHRQ Health Literacy Universal Precautions Toolkit. 2nd ed.Agency for Healthcare Research and Quality; 2015.
19.
HarrisVCLinksARHongP, et al. Consulting Dr Google: quality of online resources about tympanostomy tube placement. Laryngoscope. 2018;128(2):496-501.
20.
SafeerRSKeenanJ.Health literacy: the gap between physicians and patients. AFP. 2005;72(3):463-468.
21.
JiaJLNguyenBSarinKY.Assessment of readability and content of patient-initiated google search results for epidermolysis bullosa. Pediatr Dermatol. 2019;36(6):1004-1006.
22.
RoshanAAgarwalSEnglandRJA. Role of information available over the internet: what are the parents of children undergoing tonsillectomy likely to find?Ann R Coll Surg Engl. 2008;90(7):601-605.
23.
StrychowskyJENayanSFarrokhyarF, et al. YouTube: a good source of information on pediatric tonsillectomy?Int J Pediatr Otorhinolaryngol. 2013;77(6):972-975.
24.
WozneyLChorneyJHuguetA, et al. Online tonsillectomy resources: are parents getting consistent and readable recommendations?Otolaryngol Head Neck Surg. 2017;156(5):844-852.
25.
BalakrishnanVChandyZVermaSP.Are online Zenker’s diverticulum materials readable and understandable?Otolaryngol Head Neck Surg. 2016;155(5):758-763.
26.
XieDXWangRYChinnaduraiS.Readability of online patient education materials for velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol. 2018;104:113-119.
27.
RamsdenJDJohnsonAPCocksHC, et al. Who performs thyroid surgery: a review of current otolaryngological practice. Clin Otolaryngol Allied Sci. 2002;27(5):304-309.
28.
LeeDJChinCJHongCJ, et al. Outpatient versus inpatient thyroidectomy: a systematic review and meta-analysis. Head Neck. 2018;40(1):192-202.
29.
SosaJAHannaJWRobinsonKA, et al. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surgery. 2013;154(6):1420-1426.
30.
ChangKBertheletEGrubbsE, et al. Websites, websites everywhere: how thyroid cancer patients use the internet. J Canc Educ. Published July22, 2019. doi:10.1007/s13187-019-01576-5
31.
FleschR.A new readability yardstick. J Appl Psychol. 1948;32(3):221-233.
NutiSVWaydaBRanasingheI, et al. The use of Google Trends in health care research: a systematic review. PLoS One. 2014;9(10):e109583.
34.
KaleemTMalouffTDStrossWC, et al. Google search trends in oncology and the impact of celebrity cancer awareness. Cureus. 2019;11(8):e5360.
35.
SulyokMRichterHSulyokZ, et al. Predicting tick-borne encephalitis using Google Trends. Ticks Tick Borne Dis. 2020;11(1):101306.
36.
MisitzisAWeinstockMA.Increased interest in sunless tanning versus tanning beds in the United States: a Google Trends analysis. J Am Acad Dermatol. 2019;81(6):1438-1439.
37.
MillerNLacroixE-MBackusJEB. MEDLINEplus: building and maintaining the National Library of Medicine’s consumer health web service. Bull Med Libr Assoc. 2000;88(1):11-17.
38.
LaurentMRVickersTJ.Seeking health information online: does Wikipedia matter?J Am Med Inform Assoc. 2009;16(4):471-479.
39.
KincaidJFishburneRRogersR, et al. Derivation of new readability formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula) for navy enlisted personnel. Institute for Simulation and Training. Published January1975. https://stars.library.ucf.edu/istlibrary/56
40.
ShoemakerSJWolfMSBrachC.Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96(3):395-403.
41.
ZuzeloP.Understandability and actionability: using the PEMAT to benefit health literacy. Holist Nurs Pract. 2019;33(3):191-193.
42.
ChenAYBernetVJCartySE, et al. American Thyroid Association statement on optimal surgical management of goiter. Thyroid. 2013;24(2):181-189.
43.
TerrisDJSnyderSCarneiro-PlaD, et al. American Thyroid Association statement on outpatient thyroidectomy. Thyroid. 2013;23(10):1193-1202.
44.
KundelHLPolanskyM.Measurement of observer agreement. Radiology. 2003;228(2):303-308.
WongKLeviJR.Readability trends of online information by the American Academy of Otolaryngology–Head and Neck Surgery Foundation. Otolaryngol Head Neck Surg. 2017;156(1):96-102.
PrattMSearlesGE.Using visual aids to enhance physician-patient discussions and increase health literacy. J Cutan Med Surg. 2017;21(6):497-501.
49.
BalakrishnanVChandyZHseihA, et al. Readability and understandability of online vocal cord paralysis materials. Otolaryngol Head Neck Surg. 2016;154(3):460-464.
50.
EdmundsMDennistonABoelaertK, et al. Patient information in Graves’ disease and thyroid-associated ophthalmopathy: readability assessment of online resources. Thyroid. 2014;24(1):67-72.
51.
WongKGiladACohenMB, et al. Patient education materials assessment tool for laryngectomy health information. Head Neck. 2017;39(11):2256-2263.
