Online Palliative Care and Oncology Patient Education Resources Through Google: Do They Meet National Health Literacy Recommendations?

Publication date: Available online 27 January 2017
Source:Practical Radiation Oncology
Author(s): Arpan V. Prabhu, Tudor Crihalmeanu, David R. Hansberry, Nitin Agarwal, Christine Glaser, David A. Clump, Dwight E. Heron, Sushil Beriwal
PurposeThe Google search engine is a common resource 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 between the third and seventh grade reading levels. We assessed the readability levels of online palliative care patient education resources using ten readability algorithms widely accepted in the medical literature.MethodsIn October 2016, ten terms pertaining to palliative care and oncology were individually searched for using the Google search engine, and the first ten 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 website domain.ResultsNine 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 (SD 2.1; Range 7.6–17.3). Zero articles were written below a 7th grade level. Exactly 49 (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 out of 100. The articles were collected from 62 different website domains. Seven domains were accessed 3 or more times, of which www.mskcc.org had the highest average article reading level at a 14.5 grade level (SD 1.4; Range 13.4–16.1).ConclusionMost palliative care education articles readily available on Google are written above national health literacy recommendations. There is need for revision of these resources to allow patients and their families to derive the most benefit from these materials.



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