Background: Accessing health information online is an inevitable consequence of the ever-increasing use of the internet. New guidelines for surgeons in the UK advocate patient use of online resources to assist in decision making . Our aim was to assess the quality of online health resources to facilitate decision making for patients considering surgery or ongoing medical management for ulcerative colitis (UC).
Methods: We undertook a systematic review based on PRISMA guidelines. This was registered on the PROSPERO database. We searched Google and the Decisions Aids Library Inventory using several lay search terms for information about UC and surgery. Exclusion criteria included material not discussing UC or not aimed at patients, online fora and YouTube videos. Quality of content on websites was assessed using the validated DISCERN instrument and a modified International Patient Decision Aid Standards (IPDAS) checklist. Decision aids were assessed by the modified IPDAS checklist. Readability of written content was assessed using the Flesch-Kincaid score.
Results: Our search strategy identified 175 websites and one decision aid for assessment – 119 results were excluded at initial screen and 32 were excluded at full text assessment, leaving 24 websites for review. The decision aid scored 9/12 on the IPDAS checklist. This was created by a private company with guidance from a gastroenterologist and GP, but without a surgeons input. Most websites originated from the US (n=17) with the remainder from the UK (n=7). The mean Flesch-Kincaid score was 44.9 (±9.73, range 28.1–61.4), suggesting material was difficult to read. Nine websites (37.5%) discussed both surgical and medical options. No websites compared surgery vs medical management or traded off patient preferences. The mean IPDAS score was 4.63/12 (±1.61, range 1–7). The mean global score based on the DISCERN rating was 2/5 (±1.32, range 1–5), identifying most websites as poor quality. A summary of DISCERN domains by website can be seen in Figure 1.
Conclusions: Only a small number of websites discuss both surgical and medical therapies – with none of these websites trading off patient preferences. Health care professionals should be aware at the lack of online support resources available for those with UC considering surgery. Professional organisations should engage in the production of decision support websites. The development of a new decision aid to support patients considering surgery for UC is recommended.
 Royal College of Surgeons England, (2016), Consent: Supported Decision-Making, https://http://www.rcseng.ac.uk/library-and-publications/college-publications/docs/consent-good-practice-guide/, 2016–11–03