Total Thyroidectomy and the Readability and Reliability of Information on the World Wide Web

Introduction: Thyroidectomy is a complex procedure with significant risks and life long consequences. As a result of its complexity, many patients use the internet as a ‘quasi-second opinion’ to gain more information about the procedure. Thus, information on the internet regarding thyroidectomy should be high quality and easy to read. Our aim is to assess the quality and readability of healthcare information regarding total thyroidectomy on the internet. Methods: Thyroidectomy related websites were assessed using Google, Yahoo and Bing search engines. After removing duplicates, 34 unique websites were assessed using the DISCERN score and JAMA benchmark to assess quality of information. Readability was assessed using the Flesch Reading Ease Score, the Gunning Fog Index and the overall reading level of each website. The presence or absence of the HON code was also noted. Results: The average DISCERN score was 36.24 +/- 10.02, putting the quality of available material into the poor category. Only 4 websites had a FRES score greater than the recommended 65 points and 14 websites] (41.17%) had a reading level of grade 10 of higher, making them accessible to college level graduates only. No significant difference was found in the difference between DISCERN scores (p=0.34) or FRES scores based on whether the HON code was present or absent. The average reading level was 9.2 +/- 2.2. The reading grade level was shown to be significantly too high when compared to the sixth-grade standard (P<0.001, CI=2.4-4). Conclusion: The overall standard of information of the internet regarding thyroidectomy is of poor quality. Serious deficiencies were noted especially in terms of discussing alternative treatments, undertaking no treatment at all and encouraging shared care. Furthermore, only three websites met the criteria of a sixth grade reading level, meaning that the majority of the websites (91%) were inaccessible to patients with lower levels of education.