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

Abstract

This cross-sectional study evaluates the informational content and readability of US lung cancer screening program websites.

Key Points

Question

Is the informational content of lung cancer screening program websites in the United States accurate, complete, and presented at an appropriate reading level for most patients?

Findings

In this cross-sectional study of 257 lung cancer screening program websites, there was large variability regarding information on enrollment criteria, benefits and risks, logistics, and costs of lung cancer screening. The reading level of the websites was consistently above that of the average adult in the United States and the level recommended by the American Medical Association and the National Institutes of Health.

Meaning

Efforts to improve the content and readability of program websites may be warranted to improve patient understanding of lung cancer screening.

Abstract

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 Participants

This 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 73 to 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.

Conclusions and Relevance

There appears to be marked variability in the informational content of US LCS program websites, and the reading level of most websites is above that recommended by the American Medical Association and the National Institutes of Health. Efforts to improve website content and readability may be warranted.