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

Staci M Gagne,Melissa C Price,Milena Petranovic,Dexter P Mendoza,Efren J Flores,Florian J Fintelmann,Shaunagh Mcdermott,Justin T Stowell,Brent P Little

doi:10.1001/jamanetworkopen.2019.20431

Abstract

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. To evaluate the informational content and readability of US LCS program websites. 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. 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. 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. 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.

Highlights

In the United States, lung cancer has the highest cancer-specific mortality rate
There appears to be marked variability in the informational content of US lung cancer screening (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
The National Lung Screening Trial (NLST) showed a 20% reduction of lung cancer–specific mortality with low-dose computed tomography (LDCT) after 3 annual screenings compared with a chest radiography control arm.[1]

Summary

Introduction

The National Lung Screening Trial (NLST) showed a 20% reduction of lung cancer–specific mortality with low-dose computed tomography (LDCT) after 3 annual screenings compared with a chest radiography control arm.[1] After publication of the NLST results, the US Preventive Services Task Force and the Centers for Medicare & Medicaid Services (CMS) soon followed with recommendations for LDCT lung cancer screening (LCS).[2] This led health care plans offered under the Affordable Care Act’s Health Insurance Marketplace, as well as most private plans, to cover certain preventive care services, such as LDCT LCS, without patient cost sharing.[3] Despite the proven benefits of LCS among eligible patients, the insurance coverage, and the increasing number of LCS facilities across the United States, the rate of LCS participation remains low. It is estimated that only 1.9% of up to 8 million screening-eligible US adults have been screened.[4]

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Results

Discussion

Conclusion