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      Internet chemotherapy information is of good quality: assessment with the DISCERN tool

      1 , * , 2

      British Journal of Cancer

      Nature Publishing Group

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          Sir, We read with interest Davies and Yeoh's (2012) paper about internet chemotherapy information (ICI). The pertinent points the authors make are the internet's potential as a source of information for patients, but also the concerns of health professionals (HP) that ICI is inaccurate and can cause harm to patients who use it. We performed a search of the term ‘chemotherapy' on, and then sought to assess the quality of the first 10 websites for this search using the DISCERN instrument. was selected as the search engine of choice because it is the most commonly used search engine (Burns, 2012). Sponsored links and news articles were excluded. The DISCERN instrument is a validated rating tool of the quality of health information (Charnock et al, 1999). It is available for use by both HPs and the general public. Websites are given a score out of 80 based on 15 questions regarding the sites' content. The questions are rated on a 5-point scale from ‘no' (1 point) to ‘yes' (5 points). The 10 websites were independently evaluated with the DISCERN instrument by two of the authors of this letter (RS and NG). Discrepancies between the scores were discussed with a view to reaching a consensus. The mean DISCERN score was 56.1 (s.d.=8.76). The DISCERN handbook would therefore categorise these websites as being of ‘good quality' (excellent=63–75; good=51–62; fair=39–50; poor=27–38; very poor=15–26). The range of scores was 41–69, so all of the top 10 sites are of ‘fair quality' at least. Four of these sites are ‘excellent'. The websites scored highest for question 15 of the criteria – ‘Does it (the publication/website) provide support for shared decision making?' – with a mean score of 4.7, and question 13 – ‘Does it describe how the treatment choices affect quality of life?', with a mean score of 4.5. The websites scored lowest for questions 5, 8 and 12: ‘Is it clear when the information used or reported in the publication was produced?' ‘Does it refer to areas of uncertainty?' ‘Does it describe what would happen if no treatment is used?' The scores for these criteria are 2.5, 2.7 and 2.7, respectively. Our evaluation shows that the overall quality of ICI is good. However, Davies and Yeoh (2012) found that the majority of HPs do not routinely recommend ICI to their patients, and fear that it could cause harm to them, partly because HPs perceive it to be of poor quality. This suggests that HPs' mistrust of the ICI is misplaced, and that the patients might benefit from HPs openly recommending ICI. However, the concerns of HPs are not completely unfounded. There are several tools and methods for evaluating website quality, such as the HONcode principles (Boyer et al, 1998) and the JAMA benchmarks (Silberg et al, 1997), as well as the DISCERN criteria. Further systematic evaluations are warranted to explore the quality of ICI.

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          The Health On the Net Code of Conduct for medical and health Websites.

          Internet has become one of the most used communication media. This and the fact that no constraining information publishing policy exists have created an urgent need to control the quality of information circulating through this media. To this purpose, the Health On the Net Foundation has initiated the Code of Conduct (HONcode) for the health/medical domain. This initiative proposes guidelines to information providers, with the aim, on the one hand, of raising the quality of data available on the Net and, on the other hand, of helping to identify Internet sites that are maintained by qualified people and contain reliable data. The HONcode mainly includes the following ethical aspects: the author's credentials, the date of the last modification with respect to clinical documents, confidentiality of data, source data reference, funding and the advertising policy. This article presents the HONcode and its evolution since it was launched in 1996.
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            Internet chemotherapy information: impact on patients and health professionals

            Background: Reliable information can improve patients' knowledge of chemotherapy. As internet chemotherapy information (ICI) is increasingly viewed as a valuable patient education tool, we investigated the impact of ICI on patient care and analysed health professionals' (HPs') attitudes towards ICI. Methods: The following questionnaires were distributed: (1) self-administered questionnaire randomly given to 261 patients receiving chemotherapy (80% returned); and (2) separate questionnaire given to 58 HPs at the same UK Oncology Centre (83% returned). Results: Just over half of the patient respondents accessed the internet regularly. They were younger, with higher incomes and qualifications. Key search topics included chemotherapy modes of action, symptom management and treatment success, and most considered ICI useful. More than half wanted to discuss ICI with HPs but most did not get the opportunity. Although the majority of HP respondents supported the need for patients to retrieve ICI, most questioned the accuracy of ICI and did not routinely recommend its use. Conclusion: This study has shown that ICI is generally perceived by patients to be a valuable information resource. Given the potential impact of ICI, the following should be addressed in future studies: (1) inequalities in accessing ICI; (2) maintaining the quality of ICI (with clear guidance on recommended websites); (3) bridging the gap between the perception of ICI by patients and HPs; (4) integration of ICI with traditional consultation models.

              Author and article information

              Br J Cancer
              Br. J. Cancer
              British Journal of Cancer
              Nature Publishing Group
              10 July 2012
              07 June 2012
              : 107
              : 2
              : 403
              [1 ]Department of General Surgery, Wycombe Hospital , Queen Alexandra Road, Wycombe HP11 2TT, UK
              [2 ]National Hospital for Neurology and Neurosurgery , Queen Square, London WC1N 3BG, UK
              Author notes
              Copyright © 2012 Cancer Research UK
              Letter to the Editor

              Oncology & Radiotherapy


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