Online palliative care and oncology patient education resources through Google: Do they meet national health literacy recommendations?
OBJECTIVE
The Google search engine is a resource commonly used by patients to access health-related patient education information. The American Medical Association and National Institutes of Health recommend that patient education resources be written at a level between the third and seventh grade reading levels. We assessed the readability levels of online palliative care patient education resources using 10 readability algorithms widely accepted in the medical literature.


METHODS
In October 2016, searches were conducted for 10 individual terms pertaining to palliative care and oncology using the Google search engine; the first 10 articles written for the public for each term were downloaded for a total of 100 articles. The terms included palliative care, hospice, advance directive, cancer pain management, treatment of metastatic disease, treatment of brain metastasis, treatment of bone metastasis, palliative radiation therapy, palliative chemotherapy, and end-of-life care. We determined the average reading level of the articles by readability scale and Web site domain.


RESULTS
Nine readability assessments with scores equivalent to academic grade level found that the 100 palliative care education articles were collectively written at a 12.1 reading level (standard deviation, 2.1; range, 7.6-17.3). Zero articles were written below a seventh grade level. Forty-nine (49%) articles were written above a high school graduate reading level. The Flesch Reading Ease scale classified the articles as "difficult" to read with a score of 45.6 of 100. The articles were collected from 62 Web site domains. Seven domains were accessed 3 or more times; among these, www.mskcc.org had the highest average reading level at a 14.5 grade level (standard deviation, 1.4; range, 13.4-16.1).


CONCLUSIONS
Most palliative care education articles readily available on Google are written above national health literacy recommendations. There is need to revise these resources to allow patients and their families to derive the most benefit from these materials.
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
Arpan V
AV
Prabhu
West Virginia University School of Medicine, Morgantown, West Virginia.
Tudor
T
Crihalmeanu
Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
David R
DR
Hansberry
Departments of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Nitin
N
Agarwal
Department of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Christine
C
Glaser
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
David A
DA
Clump
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Dwight E
DE
Heron
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. Electronic address: beriwals@upmc.edu.
Sushil
S
Beriwal
D032882:Comprehension; D019983:Guideline Adherence; D057220:Health Literacy / Q000379:methods* / Q000592:standards; D006801:Humans; D020407:Internet / Q000592:standards*; D008495:Medical Oncology / Q000193:education / Q000379:methods; D010166:Palliative Care / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D014481:United States