Alberto Vargas: Thank you.
Olivia Paluszek: Thank you.
Zachary Klaassen: Alberto, to start off, when we look at the way that patients have started consuming content, there's a lot of different ways. We know that both PSMA PET for staging prostate cancer and YouTube are both pretty ubiquitous, both in prostate cancer care and just in general life. When we look at this, what was the genesis in the background for this study?
Alberto Vargas: Yeah, first of all, Zach, thank you for the invitation. We know that what's happened in the imaging world with PSMA PET is unprecedented. We went from literally doing no PSMA PET in 2020 when it was first approved by the FDA to doing it in over 70% of patients in the space of three years by 2023. And I would hazard a guess to say that today in 2026, more than 90% of patients with high-risk or advanced prostate cancer are undergoing this test. So obviously, when things move so quickly, extensive efforts are needed to educate everyone, educate the referring physicians with regards to the indications of the test and how to interpret the results. Education for the radiologist and nuke's physicians, remembering that most of us would not have ever seen one of these during our training.
Those tend to be typically covered by resources like UroToday, like medical conferences and other CME resources. However, we sometimes forget about patients. Patients need to understand the nature of the test they're being asked to undergo. And as much as we may have different opinions on where patients should get their information from, we know that YouTube is one of the most widely used online resources. Data shows that over 85% of adults in the US use YouTube regularly. So it would be natural to think that if they were to look for information on any tests, and in particular these newer tests like PSMA, PET-CT, that this would be a resource where they would go to.
Understanding that, we then thought, okay, well, as physicians, is it our role or should it be our role to see what our patients are looking at on YouTube and perhaps try to understand the nature, the quality, the information they're getting from that resource? And also knowing that Spanish is such a widely spoken language and about 13% of the US population speaks Spanish, we had an interest in seeing, well, is there information in Spanish on PSMA, PET-CT, and YouTube? And if so, how does it compare with regards to quality and some of the metrics we looked at in relation to the information that's available in English?
Zachary Klaassen: That's a fantastic background for a really important study. Olivia, you're the first author on this paper. Maybe just take some time walking through the methodology for our listeners, because you guys did a really nice job for both the English and the Spanish videos for critiquing these videos and their quality.
Olivia Paluszek: Yeah, sure. Basically, we started off by searching on YouTube using some predefined search terms. So we used the term PSMA, PET and prostate, and we did the search both in English and Spanish. And then we looked at the first 25 videos in each language, and we chose the first 25 just to reflect typical viewer patterns. Normally, when you search on YouTube, you tend to just stay, look at the top page or so of videos, so we wanted to reflect that. And then after that, after removing irrelevant videos, videos that were in other languages or just didn't pertain to the topic we were researching, we had five reviewers, including native Spanish speakers who went through and just assessed the quality of the videos. So using a validated discerned score, so a rating from one to five in terms of quality. And then they also assessed the understandability and actionability of the videos in terms of percentages. And then the last thing that they looked at was the misinformation. So were the videos, did they provide accurate information to patients?
Zachary Klaassen: That's excellent. You found some really important findings. Just take a minute to walk through the findings of your study and breaking it down by the English and the Spanish language videos.
Olivia Paluszek: Yeah, sure. Of the 25 videos in each language, we found that 17 of the English videos and only five of the Spanish videos actually met initial criteria to include in the study. And then after that, we found that the Spanish videos also had significantly lower quality and lower understandability than the English videos. And in terms of the misinformation, the Spanish videos generally provided accurate information. About 30% of the English videos provided misinformation, so there was a difference there. But overall, basically we found that there were fewer relevant Spanish videos. And then of the relevant Spanish videos, although they did give accurate information to patients, they were generally of lower quality and less understandable than the English videos.
Zachary Klaassen: I see. Alberto, I'll just maybe spin off and ask you a quick question based off of that. Why do you think the number and the quality was less for the Spanish-speaking videos?
Alberto Vargas: Yeah, the number piece was because most of the videos that popped up first in Spanish were actually directed at physicians and people in healthcare. We decided not to replace those with other videos because as Olivia said, the natural pattern when you're looking on YouTube is you just look at whatever is there. So that already, a significant number went to the side and we were left with that very small number of additional videos to look at. So that was the main rationale there.
The reason for the difference in quality, we don't know. We took things that face value for where they appeared. It could be related to the people presenting the videos. It could be related to the source of the content they were presenting. We didn't purposely dig too much into that so as to just mimic what you would do in regular life, which is you watch the video and whatever they say, that's what you take in. So that's essentially how we did it.
Zachary Klaassen: No, thanks for that. I think what's really important is patients are craving accurate, accessible online information, whether that's YouTube, whether that's ChatGPT. About 20% of our viewers on Europe today are patients, and we've got patient-specific sites on UroToday and spins off from Prostate Cancer Foundation, Prostate Cancer Patient Voices. But you have to know that that's there. YouTube's very available to everybody. And so how do we make higher quality educational videos that are out there on YouTube? Because ChatGPT is going to take everything online. They'll pull from that as well. So it's maybe an impossible question to answer, but I'll start with Olivia.
Olivia Paluszek: Yeah, it's tough. It's definitely going to be difficult to do. I think starting with videos that are very clear and concise, straight to the point is very important. You don't want to really use a lot of medical jargon. You want to use, in whatever language it is, English, Spanish, or another language, you want to try and keep the language as clean as possible, easy to understand. Visuals. So in a YouTube video can be very helpful for patients. Potentially adding in subtitles might be helpful as well. And then I think in terms of the content of the video, it's important not just to talk or describe about what you're talking about, but I think talking about what that means for the patient and things that the patient can expect, questions that the patient can bring when he or she goes to discuss whatever it is with the doctor. Those are all some things that we can try and work towards.
Zachary Klaassen: Yeah, fantastic points. Maybe, Alberto, any additional plans for future work on this topic? How do you guys expand it? What's next?
Alberto Vargas: Yeah, I think part of what we're trying to do here is get everyone thinking about this. And in addition to everything Olivia quite rightly said, perhaps some of the publishers of this content, whether it be UroToday, YouTube, or any other group that is publishing all this, to perhaps consider adopting some of the metrics we're reporting in this paper, because they really are very simple tools. You have all the references in the paper there, but if anyone would care to read through them, you would see that they're not really rocket science. And these could be metrics that can be adopted by the publishers to ensure that there's a benchmark and a minimum level of quality before deciding to publish this content online.
Zachary Klaassen: Yeah, great points. And we'll definitely tag your guys' paper to this discussion as well when we publish it.
I'll wrap up with asking you each for maybe a take-home point or two conclusions, something our UroToday listeners can take with them. I'll start with Olivia.
Olivia Paluszek: I would say just because a video or patient education tool is accurate in terms of the information doesn't necessarily mean that it is providing high quality information, high quality education. Those are two separate things. And it's important to have both, accurate information and have information that's understandable and straightforward for the patient.
Zachary Klaassen: Yeah, well said. Alberto, your thoughts?
Alberto Vargas: Yeah, I would say try to the best of people's ability to get information from sources that they trust, but always apply the thinking, trust, but verify. So whatever you read or whatever you see in the video, verify that with your physician. Talk about this openly with your physician. Ask them about the indication for the test you're going, the meaning of the findings that there are, and involve your radiologist or nuclear medicine physician. We are the experts in interpreting the images, so I encourage both referring physicians and patients to talk to us more. We are out of the era where we are based in the basements and we want to be more patient-friendly and patient-facing.
Zachary Klaassen: Yeah, fantastic conclusions. Thank you both. What a great discussion. Super helpful for our patients. As I said, I mean, they're craving accurate, good information, and your guys' studies certainly shed some light on this, particularly for our Spanish-speaking population. So really important. Congratulations. Thank you both for joining us on UroToday.
Alberto Vargas: Wonderful. Thank you, Zach.
Zachary Klaassen: Thank you.