'Prostate Cancer' Information on the Internet: Fact or Fiction? - Beyond the Abstract

Prostate cancer is the second most common cancer in men worldwide and the fourth most common cancer in both sexes combined. In today’s information era, patients often seek information regarding health using the internet. Greater access to medical information provides patients with a valuable tool for self-education and an opportunity for better-informed decision making and greater participation in overall care. However, the reliability, validity, completeness, and relevance of the information may be questionable since sources of information on the internet are varied and are largely unregulated. Suggested deficiencies in the quality of web-based health information have been reported. 

Thus, we aimed to objectively assess the quality and validity of ‘prostate cancer’ information currently available on the internet, more specifically on the ‘Google’ platform. The search term ‘Prostate Cancer’ was used on the Google search engine website (www.google.com) on June 11th,  2017. We selected three different, validated quality assessment instruments for this specific study: the Health on Net (HON) code; the JAMA benchmarks; and the DISCERN tool. Critical analysis was performed on the first 100 hits using these quality evaluation tools.

Of the searched term, 33,500,000 hits returned. The first 100 hits were critically analyzed. Ten links [duplicate links (7/10) / book reviews (1/10) / dead sites (2/10)] were excluded, therefore resulting in a total of 90 websites to be analyzed.

Subcategories assessed included: commercial (53.33%), University/Medical Centre (24.44%), Government (13.33%); NGO/NPO (8.89%). Sub-type of information content assessed included: factual (74.44%), clinical trials (18.89%); stories (5.56%); Q&A (1.11%). Validity scores were rated using HONcode scores: HONcode seal positive (14.44%), and seal negative (85.56%). Website content was based on JAMA benchmarks: zero benchmarks (4.44%), one benchmark (16.67%), two benchmarks (34.44%), three benchmarks (27.78%), four benchmarks (16.67%). DISCERN scores rated: 'low' (16–32) = 12 websites (13.33%), 'moderate' (33–64 points) = 68 websites (75.56%), ‘high’ (≥ 65 points) = 10 websites (11.11%).  

Amongst the websites with the poorest validation scores, three links have no JAMA benchmarks, no HONcode seal, and relatively low DISCERN scores (16-32), while two other links have only one JAMA benchmark, no HONcode seal and a very low DISCERN score. The four overall best-performing websites either meeting criteria or coming close to having concurrent HON positive, JAMA 4/4, and DISCERN ≥65 points included two websites particularly, with HONcode seal positive, JAMA benchmarks 4/4 and more specifically have very high DISCERN scores (≥70 out of 80). Interestingly and important to note, these top two performing websites were only found on the third and eight Google search pages respectively.

Health information is one of the most sought after topics on the internet. A recent study reported that approximately 56% of prostate cancer patients seek health information online. An evaluation of YouTube videos found that YouTube is an inadequate source of prostate cancer information for patients. However, a more recent study found an acceptable and ‘encouraging’ degree of quality and reliability of prostate cancer information on the web. When assessing for the patterns of search amongst all urological malignancies, prostate cancer has been the most common search term utilized. Figure 1 depicting the Google trends data shows that prostate cancer searches were the most common since 2004 to present. Most of the studies evaluated in the literature had found that patients who utilize the internet as a source of health information find it to be an effective tool to supplement knowledge but not as a primary source of information. One of the benefits of using multiple sources of health information is that patients are better able to equip themselves with the understanding of the nature of their illness and the various treatment modalities which may be available. By bringing this information to the consultation, it transforms the doctor-patient relationship and promotes patients to play a more active role in shared-decision making.

A critical assessment of ‘prostate cancer’ information on the internet showed that overall quality was observed to be accurate, however, a majority of individual websites are unreliable as a source of information for patients by itself. Doctors and patients need to be aware of this ‘quality vs quantity’ discrepancy when sourcing prostate cancer information on the internet. Urology societies and universities should be leading this online platform for patients with prostate cancer.

The study included several limitations, including that the search was limited to the English language only. Secondly, the internet and search engines are dynamic processes that constantly change. Therefore, the websites assessed in this investigation may not necessarily reflect the information available to patients at another point in time. Another limitation of this review would be the exclusion of all other search engines utilized in today’s era, however, for the purpose of this study, only Google was utilized since it is by far the most common search engine used with well over three billion searches daily.

The authors are grateful to Mrs. Anna Welman, Department of Surgery, Helen Joseph Hospital, University of Witwatersrand, Johannesburg, for her secretarial support.

Written by: Yusuf Moolla, Ahmed Adam, Marlon Perera, Nathan Lawrentschuk

Department of Oncology, Klerksdorp Hospital, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, North West Province., Department of Urology, Helen Joseph Hospital & Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa., Department of Surgery, Austin Health, University of Melbourne, VIC and Department of Surgery, University of Queensland, Brisbane, QLD., Department of Surgery, Austin Health, University of Melbourne, and Olivia-Newton John Cancer Centre, University of Melbourne, and Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.

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