By Chiara Ghetti, MD
Associate Professor, Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis
Dr. Ghetti reports no financial relationships relevant to this field of study.
SYNOPSIS: After review of more than 400 websites, most web-based information available to women regarding pelvic organ prolapse treatment is incomplete. The best-quality information was found on government-sponsored websites.
SOURCE: Kakos AB, et al. Quality of information on pelvic organ prolapse on the Internet. Int Urogynecol J 2015;26:551-555.
The objective of this study was to evaluate the quality of patient-centered information regarding pelvic organ prolapse treatment available on the Internet. Two independent investigators reviewed the content of websites obtained after performing Internet search for four prolapse-related terms. Google, Yahoo, and Bing search engines were used to search for the terms: bladder prolapse, dropped bladder, uterine prolapse, and dropped uterus. Websites were evaluated using a modified DISCERN instrument. The DISCERN tool, which uses a two-stage, six-point rating scale with score range per question 0–5, is reliable in estimating the quality of web-based health care information. A greater score indicated more complete information. Sixteen questions were used: 12 were based on the DISCERN instrument, rendering a maximum score of 80, and four focused on information availability and quality regarding conservative treatment (pessary, watchful waiting, and physical therapy). In addition, websites were identified as having Health On the Net (HON) certification. The HON Foundation uses health-specific criteria to estimate website health information quality. A separate Internet search was completed using the four search terms to identify the relative proportions of domain suffix for the top 100 sites identified per term.
The study reviewed a total of 218 websites. Of these, 23 (9.5%) sites were HON certified. Sites that were HON certified had higher DISCERN scores (P < 0.0001). For the three questions referencing conservative treatments (i.e., pessary, physical therapy, watchful waiting), 115 (52%) sites had a summed mean score of ≤ 3, indicating less complete information regarding these conservative treatment options. Searches performed using the medically precise term “prolapse” identified sites with better quality information using the assessment scale than searches using the term “dropped” (mean scores 32.75 and 21.3, respectively; P < 0.02). The summary of 400 sites reviewed across the four search terms identified sites with the following domains: 64% .com, 19% .org, 8% .edu, 6% other, and 3% .gov. Overall .gov sites yielded the highest quality information.
COMMENTARY
Pelvic organ prolapse is a prevalent condition that is estimated to affect as many as 38-50% of women.1,2 Despite its high prevalence, very little is known about the quality of information women are able to access online regarding this condition and its treatment options.
This study found that overall information available to women online regarding prolapse is incomplete and often biased toward surgical treatment. The authors suggest that .com and .net sites seemed to emphasize surgical treatment and were more likely to have industry bias. Searches using more medical terminology resulted in websites with higher quality information. This study also ascertained that .gov sites had the most high-quality information regarding prolapse. In addition, while some sites did better than others in describing the range of treatment options, few comprehensively described the relative benefits of each of the treatment options.
Based on this study, women may come to us with a range of information regarding their prolapse. In an era in which we often rely on information acquired online, the poor quality of online information about prolapse and its treatment options impacts not only the patient but has significant repercussions for her provider. Patients will be looking to their physicians to fill the gaps in their health information. Physician counseling is increasingly important in educating women about all available treatment options.
Informed consent is the foundation for any health care intervention, whether it is surgery or conservative treatment. While this is true in any field of medicine, the importance of impartially educating our patients with pelvic floor disorders seems to take on almost magnified importance due to the intimate nature of the disorders, perhaps because these conditions affect so many aspects of a woman’s quality of life, including social, psychological, physical, sexual, body image, and overall well-being.3,4 As physicians, we are under the moral, ethical, and legal obligation to provide patients with an unbiased and evidence-based review of all treatment alternatives, their corresponding risks and benefits, and answers to any questions they may have. We need to ensure that the poor quality of online information about prolapse does not affect the quality of information we use in physician counseling and informed consent.
REFERENCES
- Hendrix SL, et al. Pelvic organ prolapse in the women’s health initiative: Gravity and gravidity. Am J Obstet Gynecol 2002;186:1160-1166.
- Subak LL, et al. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001;98:646-651.
- Rogers GR, et al. Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2001;12:361-365.
- Lowder J, et al. Body image in women before and after reconstructive surgery for pelvic organ prolapse. Int Urogynecol J 2010;21:919-925.
After review of more than 400 websites, most web-based information available to women regarding pelvic organ prolapse treatment is incomplete. The best-quality information was found on government-sponsored websites.
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