★: poor; ★★: adequate; ★★★: fair; ★★★★: good; ★★★★★: excellent.
Screening for colorectal cancer (CRC) is a widely recommended preventive service that has been underused traditionally. Recent data suggest that only two-thirds of eligible individuals have been screened for CRC (www.cdc.gov/media/releases/2013/p1105-colorectal-cancer-screening.html
). Thus, continued efforts to increase screening are needed. In some health care systems, however, efforts to promote screening have resulted in overuse. This is particularly true in older and less healthy patients, for whom screening may provide limited benefit. Thus, efforts are needed to not simply increase screening use, but more specifically to increase screening use in the right patients. In this review, we examine the content and usability of 5 patient-oriented websites on CRC screening. We focused on the quality of educational information on CRC and screening, presentation of different screening options and their benefits and harms, and whether the presentation of data was tailored to individual benefit.
This website, developed by established investigators at the University of Sydney in Australia, is a true decision aid for individuals who are considering CRC screening. The site provides well-organized, educational information about CRC and screening, clearly describes the pros and cons of fecal occult blood testing (FOBT), and asks the patient to express his or her preferences for screening. It also presents personalized information on screening benefits and harms, according to age and gender. This information is presented using pictographs, which are evidence-based risk communication graphics. Although the site has many strengths, its primary shortcoming is its length and formatting. In particular, the amount of text per page may be overwhelming for some patients. It is also somewhat out of date, only considering data through 2006, and it does not present screening options other than FOBT.
This website, developed by experienced investigators at University of North Carolina, presents educational and promotional information for colonoscopy and FOBT in an interactive video-based format. It takes roughly 10–15 minutes to complete and presents information in a way that is easy to understand by patients. Information about CRC and screening tests is relatively complete, including both benefits and harms, and is reinforced through brief testimonials from patients and brief interviews with physicians. Additionally, the website is generally well-organized and easy to navigate. However, the website is not open for public use (although the investigators can be emailed for access). Furthermore, it does not present the pros and cons of the option of not screening, and the information is clearly framed to be persuasive toward undergoing a screening test. Finally, the website and information does feel slightly dated (stool testing is a guaiac-based test, and the video quality could be improved).
This website is part of a national screening promotional campaign from the US Centers for Disease Control and Prevention (CDC). The site contains a vast amount of educational information for both patients and health professionals on CRC, risk factors, the benefits of CRC screening, different screening methods, and even epidemiology. It also contains promotional material aimed at patients, such as videos, posters, and educational pamphlets. These promotional materials are well-written, professionally produced, and are at an appropriate language level. The main shortcomings of this site are its lack of information on screening-related harms and its navigational structure. In particular, the site is designed to be persuasive rather than informative. Furthermore, information that is more suited for health professionals is not well-segregated from information aimed at patients.
This website, developed by well-regarded investigators at Boston University, seeks to provide educational information about CRC, screening, and the various testing options. It provides detailed information about the attributes of various screening tests and includes video testimonials from patients. Although the site is more balanced in its presentation of screening harms than the CDC site, it still feels persuasive. It also does not provide any individualized information about benefits and harms.
This website, produced by Healthwise, is also a type of decision aid. It includes educational information about CRC screening and various screening tests, asks the user to express his or her attitudes and preferences, and summarizes the user’s responses to help them arrive at a screening decision. It allows the user to compare the pros and cons of different screening tests in a side-by-side format. It also uses brief, written testimonials from patients about why they chose a particular screening test. One notable omission from this otherwise comprehensive site is the option to not be screened; including pros and cons of this option would have made the site more comprehensive. The site also does not use any graphics or visual aids.
Bottom Line: All of these websites provide comprehensive, accurate, and readable educational information about CRC and screening. All but one also provide information about various screening options. The most notable difference between these sites has to do with whether they are seeking to promote screening or to help the patient make an informed decision about screening. In particular, the CDC site is primarily a screening promotional campaign, whereas the site from University of Sydney is a decision aid. The others fall between these 2 extremes.
Published online: January 24, 2015
Joel H. Rubenstein, Section Editor
© 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.