Newswise — October 19, 2021Online patient decision aids for common urologic conditions fall short of recommendations for readability and minimum standards for quality, reports a study in Urology Practice®, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer

"As more patients seek medical information online, patient decision aids can play an important role in involving patients in the shared decision making process about common conditions such as urinary incontinence or enlarged prostate and weighing the options for treatment," comments senior author Rena Deep Malik, MD, of University of Maryland School of Medicine. "Our study highlights the need to develop urologic decision aids that are thorough and easy to understand."

Urologic decision aids show room for improvement 

The researchers performed a Google search to identify online patient decision aids for four common conditions commonly treated by urologists: benign prostatic hyperplasia (enlarged prostate), overactive bladder, pelvic organ prolapse, and urinary incontinence.

"Decision aids are different than other online materials," Dr. Malik explains. "Their goal is specifically to facilitate shared decision-making between physicians and patients and encourage patients to participate in healthcare decisions." The study evaluated 14 decision aids in terms of:

  • Readability: A range of formulas were used to estimate the approximate US grade level required to understand the text. That’s a key consideration, since more than one-third of adults have basic or below-basic health literacy. The National Institutes of Health recommend that healthcare materials be written at or below a sixth-grade reading level.
  • Quality of health information: A validated tool (the DISCERN instrument) was used to analyze the reliability of the information presented and the quality of the information regarding treatment choices.
  • Minimum standards: An accepted set of minimum criteria (the International Patient Decision Aids Standards, or IPDASi) was used to evaluate each tool's quality in helping patients make treatment decisions.

The decision aids evaluated fell short in all three areas. Average readability score was eleventh grade – a full five grades higher than the recommended reading level. Just one decision aid had a readability score at or below the eighth-grade level, which is the average reading level of US adults.

On average, the decision aids were rated as being of "good" quality, based on DISCERN scores. Five of the decision aids were rated "excellent", while none was rated "poor."

However, none of the 14 tools met all 12 IPDASi minimum standards. Most of the decision aids met criteria related to treatment options, positive and negative features, and the decisions that need to be considered. However, none described the consequences of the treatment options or met certification criteria essential for avoiding harmful effects due to bias.

Having access to decision aids and other online educational materials can be very helpful to patients with common urologic conditions. However, some online sources can provide inaccurate or poor-quality information, potentially adding to patients' anxiety and confusion. Many previous studies have reported that online health information varies in terms of quality and reliability. "Our study demonstrates that the same problems exist for urologic patient decision aids found online," Dr. Malik and coauthors conclude.

The researchers identify some steps developers can follow to improve the readability and quality of patient decision aids. "Simple steps like using shorter sentences and fewer long words can improve readability scores by three grade levels," Dr. Malik comments. "Authors can also use available tools to ensure the quality and completeness of patient decision aids during the development process."

Click here to read “Assessing the Quality of Online Patient Decision Aids for Urological Conditions“

DOI: 10.1097/UPJ.0000000000000262


About Urology Practice

An Official Journal of the American Urological Association (AUA), Urology Practice focuses on clinical trends, challenges and practice applications in the four areas of Business, Health Policy, the Specialty and Patient Care. Information that can be used in everyday practice will be provided to the urology community via peer-reviewed clinical practice articles (including best practices, reviews, clinical guidelines, select clinical trials, editorials and white papers), "research letters" (brief original studies with an important clinical message), the business of the practice of urology, urology health policy issues, urology education and training, as well as content for urology care team members.

 About the American Urological Association

Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 23,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health care policy. To learn more about the AUA visit:

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Journal Link: Urology Practice