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An Evaluation Of The Quality Of Patient-Oriented Online Resources For Hemodialysis Access (Preprint)


 BACKGROUND
 Patients and families increasingly turn to the internet for information and resources regarding their medical conditions. These searches are conducted in an independent and unsupervised manner, often without guidance from providers. Multiple reports in the medical oncology literature have cast significant doubt on the accuracy and currency of the data found on patient-focused websites
 
 
 OBJECTIVE
 To critically appraise the quality of patient-focused online resources concerning hemodialysis access procedures.
 
 
 METHODS
 A recently validated search strategy using the meta-search engines Google, Dogpile, and Yippy with the query “hemodialysis access” was performed on a cleared-cache web browser during January 2020. Inclusion criteria for the study were websites intended for patient education in English. Exclusions criteria consisted of online monographs, academic journals, and sites requiring paid subscription. Three independent reviewers evaluated the websites using a validated, structured rating tool that scored the Affiliation, Accountability, Interactivity, Structure and Organization, Readability, and Content of the websites. Inter-rater reliability was quantified by calculated kappa coefficients for each element of the instrument.
 
 
 RESULTS
 Out of more than 27 million collective search results using the three meta-search engines, the first 269 hits were considered for analysis. Only 63 unique patient-oriented sites were acceptable for analysis. 46% were sponsored by commercial entities. Accountability and interactivity were weak across sites. Readability as determined by Flesch-Kincaid and SMOG indices ranged from 6th grade to post-graduate level. 19% were written at a college reading level or higher, however these sites had content quality comparable to those utilizing more elementary prose. 85% of non-commercial domain sites were free of inaccuracies compared to 59% of commercial sites (P=.02). Non-commercial domain sites trended toward more comprehensive content as well as superior readability (average 10th grade reading level compared to average 11th grade reading level, P=.08). The average composite score of all the websites was 2.8 out of a maximum possible weighted score of 7.8, indicating poor global quality of websites. Kappa coefficients were 0.7 or greater for a random sample of 10 websites.
 
 
 CONCLUSIONS
 This is the first report on the quality of online patient resources in vascular surgery. The study demonstrates that online patient education resources regarding hemodialysis access are poor and require input from the vascular surgery community. Providers need to be aware and understand this issue and seek to inform and mitigate misinformation and potential misguidance. The vascular surgery community should invest in more readable and comprehensive web resources.
 
 
 CLINICALTRIAL
 n.a
