Quality of patient information on the internet for the treatment of anal fistula and anal fissure.

Abstract

Patient use of the internet to get answers to medical questions is increasing, and many patients discuss the results of their findings with their health care providers [1, 2]. This is helpful considering the amount of information relayed by doctors that is taken in by patients is estimated to be between 40 and 80 % [3]. However, there is no monitoring or regulation of the information available online, and patients may find it challenging to discern good-quality information from poor-quality information. The combination of these factors could lead to patients being misinformed. Therefore, this study aims to assess the quality of the patient information available on the Internet about anal fissures and fistulas, and the treatment options for both. The three most popular search engines, Google (Mountain View, CA, USA), Yahoo (Sunnyvale, CA, USA), and Wikipedia (Wikipedia Web search engines), were used to identify websites that contained patient information about either anal fissures or anal fistulas. General search engines were used instead of medical search tools (e.g., PubMed) because it better reflects the way patients use the Internet to research conditions [4]. The search terms used were simply ‘‘anal fissure’’ and ‘‘anal fistula’’ to accurately simulate typical patient searches. Searches for both ‘‘anal fissure’’ and ‘‘anal fistula’’ were preformed in February 2014. Only the first 50 websites listed by each search engine were analyzed because the majority of Internet users do not look at websites beyond the first 50 results [5]. The inclusion criteria were websites that were free, did not require a password, were written in English, and provided patient information about either anal fissures or anal fistulas. Exclusion criteria included duplicate search results, advertisements, links, resources aimed at clinicians, clinical trials or guidelines, and discussion forums. Websites that met the inclusion criteria were assessed to determine the date of their last update (if given) and the affiliation of the group running the site. The content of each site was analyzed with focus on symptoms, investigations, treatment options and details, risks of each treatment option, and prognosis of either anal fissures or anal fistulas. The DISCERN instrument (www.discern.org.uk) was used to evaluate the quality and reliability of the information available [6]. The search results for ‘‘anal fissure’’ and ‘‘anal fistula’’ were both assessed independently by two of the authors. The kappa coefficient for this was 0.847. Any websites with discrepancies between the scores awarded by each author were re-evaluated by both authors together until a consensus on the score was reached. The search term ‘‘anal fistula’’ yielded 793,000 and 647,000 results in Google and Yahoo, while ‘‘anal fissure’’ yielded 915,000 and 1,040,000 results in the same. Of these results, the first 50 from each search engine were examined. In total, 200 websites were examined, of which 97 (48.5 %) met inclusion criteria: 45 from anal fistulas and 52 from anal fissures websites, respectively. Among the websites excluded, there were 57 duplicates, 26 clinician resources, 9 forums, 2 adverts, 2 videos, 2 websites that F. Scott A. Seghal Oxford University Medical School, Oxford, UK