向谷歌医生咨询：关于鼓膜置管术的在线资源质量
Consulting Dr. Google: Quality of Online Resources About Tympanostomy Tube Placement.
作者信息
Harris Vandra C, Links Anne R, Hong Paul, Walsh Jonathan, Schoo Desi P, Tunkel David E, Stewart Charles M, Boss Emily F
机构信息
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
Laryngoscope. 2018 Feb;128(2):496-501. doi: 10.1002/lary.26824. Epub 2017 Aug 26.
OBJECTIVE
Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement.
STUDY DESIGN
Cross-sectional descriptive design.
METHODS
We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed.
RESULTS
Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6-15th). All sites were understandable (mean understandability 81.9%, range 73%-92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0-80). Shared decision-making centrality was high (mean 5, range 4-6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1-4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02).
CONCLUSION
Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.
LEVEL OF EVIDENCE
NA. Laryngoscope, 128:496-501, 2018.
目的
鼓膜置管术（TT）在儿童中很常见；然而，以家庭为中心以及用于决策和理解的在线信息的实用性尚不清楚。我们评估了描述TT置管术的主要互联网资源的质量。
研究设计
横断面描述性设计。
方法
我们在谷歌（加利福尼亚州门洛帕克）上搜索了与TT相关的术语。我们使用分级可读性指标（弗莱什易读性和弗莱什-金凯德年级水平）、易懂性和可操作性（患者教育材料评估工具）、共同决策中心性（医疗保险和医疗补助服务中心知情同意指南）以及临床实践指南（CPG）兼容性来定义质量。三位评审员对每项指标进行编码。进行了弗莱iss κ评分者间信度分析。
结果
分析了10个最常出现的网站。10个网站中有1个符合国家健康素养标准（平均十年级阅读水平，中位数九年级，范围为六年级至十五年级）。所有网站都易于理解（平均易懂性为81.9%，范围为73% - 92%）。大多数网站的可操作性得分较低（10个中有7个，中位数为47%，平均为44.6%，范围为0 - 80）。共同决策中心性较高（平均为5，范围为4 - 6），但大多数网站未列出替代治疗方案。尽管CPG兼容性较高（平均为3.4，范围为1 - 4），但许多网站关于置管持续时间、随访和防水预防措施的建议不一致。在易懂性评分方面存在评分者间一致性（κ = 0.20；P = 0.02）。
结论
关于TT置管术的互联网资源在健康素养、共同决策原则以及与实践指南的一致性方面质量参差不齐。随着越来越强调患者/家庭在医疗保健决策中的参与，对于儿童常见外科手术如鼓膜置管术的教育材料内容标准化和可用性改进应成为公共卫生的优先事项。
证据水平
无。《喉镜》，2018年，第128卷，第496 - 501页。
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