Understandability and Readability of Online Resources for Skull Base Surgery Patients

Objectives: Over the past decade, online searches have become primary resources for patients seeking medical information about skull base surgery. However, many online resources exceed the recommended reading level for patient educational materials. The quality and understandability of online resources for skull base surgery patients have not been systematically studied.

Methods: A web query was performed using the terms “endoscopic skull base surgery,” “expanded endonasal approach,” “minimally invasive skull base surgery,” and “skull base tumor.” The top 50 results were categorized by authorship and web site type (hospital, academic, industry, or popular culture). Readability was assessed using Gunning-Fog, Simple Measure of Gobbledygook (SMOG), and FORCAST scores. Understandability was assessed using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), and web site quality was assessed using the DISCERN tool and JAMA Benchmark Criteria.

Results: The majority of identified web sites was hospital web sites or academic publications. The average readability of all web sites was 12.9, indicating they required greater than a high school education to understand. Hospital web sites were significantly easier to read than academic web sites for the search terms “skull base tumor” and “minimally invasive skull base surgery” (p = 0.02 and p < 0.01, respectively). Hospital web sites also had significantly higher understandability scores than academic web sites for all search terms (p < 0.001). The average PEMAT-P score was 73.9%, indicating moderate understandability. The average DISCERN score was 42.8, suggesting fair quality of information. There was no significant difference in DISCERN scores by web site category, with the exception of “skull base tumor.” The average JAMA benchmark score was 2.7, with academic Web sites demonstrating significantly higher scores for all search terms.

Conclusion: Easily accessible online resources about skull base surgery typically exceed the National Institute of Health recommended reading level. As access to clear information is important for patient outcomes and shared decision making, otolaryngologists should take care to provide appropriate resources to patients and be aware of the complexity and quality of resources available through online searches.

Fig. 1 Average readability scores by search term for hospital and academic Web sites. A: endoscopic skull base surgery. B: expanded endonasal approach. C: minimally invasive skull base surgery. D: skull base tumor. Horizontal line denotes the recommended reading level by National Institutes of Health.

Fig. 2 Average PEMAT-P understandability scores by search term for hospital and academic web sites. A: endoscopic skull base surgery. B: expanded endonasal approach. C: minimally invasive skull base surgery. D: skull base tumor. *denotes p < 0.05.

Fig. 3 Average quality scores for DISCERN by search term for hospital and academic web sites. A: endoscopic skull base surgery. B: expanded endonasal approach. C: minimally invasive skull base surgery. D: skull base tumor. *denotes p < 0.05.

Fig. 4 Average quality scores for JAMA benchmark criteria by search term for hospital and academic web sites. A: endoscopic skull base surgery. B: expanded endonasal approach. C: minimally invasive skull base surgery. D: skull base tumor. *denotes p < 0.05.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021