کیفیت اطلاعات آنلاین در مورد گزینه های درمان سرطان سینه Quality of online information on breast cancer treatment options

1. Introduction The Internet is an important source of medical information for patients; 35% of the US population [1], and over 50% in the EU [2], searched for health information online. Earlier studies were concerned that patients could find low-quality information [3], and thus several assessment tools were developed to evaluate health information quality (HIQ), including the Journal of American Medical Association (JAMA) criteria [3] and the Health on the Net Foundation seal (HONcode) [4]. Ease of readability is another parameter evaluated in addition to trustworthiness [5e7]. Breast cancer is the commonest cancer among women. Treatment options include surgical, medical and complementary and alternative medicine (CAM) [8]. Mastectomy and breast conservation surgery with radiotherapy are the most common management options [9], and offering patients treatment choice has become a priority [10e12]. Sixty-three percent of cancer patients use the Internet for information, with a higher rate of use (73%) in breast cancer patients [13], mostly using search engines, primarily Google [14,15]. Cancer patients use the Internet to verify information received from their doctors and to develop questions to discuss with them, as well as to seek alternative treatments [13]. A 2014 study on breast cancer patients found that “improvement of knowledge obtained through personal research on the Internet, books and other media” is an independent predictor of an active role in the choice of therapy [16]. Early studies have warned that breast cancer patients may be basing their decisions on inaccurate or incomplete information [17e19]. As summarised in Table 1, several studies have analysed the HIQ of websites on breast cancer using different methods. A study measuring the completeness of online information on breast cancer found that for some important topics the relevant clinical information had been mentioned only briefly [17]. A more recent study found that although government, charity and formal educational websites had very high accuracy, inaccurate information on breast cancer was prevalent on the Internet [20]. The aim of this study was to assess websites on breast cancer treatment options and to ascertain the visibility given by Google to websites discussing CAM. This is particularly important to investigate as online health information can have significant implications on the patient’s decision-making regarding treatment options. The search query “breast cancer treatment options” is also very sensitive to news reports, as shown by a spike in 2013 following Angelina Jolie’s mastectomy announcement [24].