Most patients prefer to have some background knowledge about their condition to aid healthcare decision making before seeing a professional (1). Greater accessibility to the internet means most people are comfortable with using the internet to satisfy their information needs (2). In 2012, we previously evaluated quality and readability of online patient information for abdominal aortic aneurysms (AAA) and concluded that available website information was poor and required significant improvement (3). The aim of this study was to determine if the quality of information has evolved and improved a decade later.

The three most popular search engines by market shares (Google, Yahoo! and Bing) were interrogated for the term "abdominal aortic aneurysm". The first 50 results for each search engine were assessed for quality and readability. Each unique website containing AAA information was included in the analysis. Readability was calculated using the Flesch Reading Ease (FRE) score. Website quality was independently assessed by two authors using the University of Michigan Consumer Health Web Site Evaluation Checklist. The same three category scoring system with a maximum score of 6 was used to evaluate content - (1) A clear explanation of the risk-benefit assessment when determining the threshold of AAA intervention. (2) A clear explanation of the advantages and disadvantages of open repair and endovascular repair. (3) Inclusion of the volume-outcome relationship in AAA surgery. Statistics: Interobserver agreement was assessed using interclass correlation coefficient (ICC). Differences in Michigan and FRE scores according to content score and HoN certification were assessed using the Kruskal-Wallis test.

Of 150 hits, 45 websites were included in the analysis. Comparing scores from 2022 to 2012, median FRE score [IQR] has increased from 39 [29-47] to 56.4 [50.4-62.75], although both scores are in the 'difficult' readability category. Similarly, median Michigan score [IQR] has improved from 36 [25-56] to 38.5 [32-43.5], although both scores fall under the category of 'weak' site. Analysis of Michigan scores revealed good interobserver agreement (ICC 0.899, 95% CI 0.822-0.943, P<0.001). Forty percent of web sites included a detailed discussion on the individual risk-benefit balance determining the treatment threshold for AAAs. These websites had a significantly higher median [IQR] Michigan score of 40.5 [36-46] vs 36 [32-41.5]; p=0.012. Twenty-one percent of web sites included a well-reasoned explanation of the advantages and disadvantages of open AAA repair and EVAR. These websites also had a significantly higher median [IQR] Michigan score of 42 [37.5-47] vs 38 [32-42]; p=0.040. There were no significant differences in FRE score. This is in-keeping with trends noticed previously (3). Similar to the 2012 study, no website included any information on the volume-outcome relationship in aneurysm surgery, which highlights an area of improvement. The number of websites with HoN certification has increased (15% vs 29%). As demonstrated previously (3), the median Michigan score [IQR] for these sites were higher; 46 [42-48] vs 36 [30.75-40], p<0.001 but there was no significant difference in FRE scores; p=0.576.

Higher content scores and HoN certification are consistently associated with higher Michigan scores. Despite an increase in median Michigan and FRE scores in the past 10 years, the current average online website with information on AAAs continues to be of 'weak' quality and 'difficult' readability. These require significant improvement. The pandemic and growth of telemedicine means that more patients and carers are now utilizing the internet to aid their healthcare decision-making. Policy makers and healthcare providers should consider producing their own information material with significant patient co-design to improve the education of patients on evidence-based health information and to avoid misguided healthcare decisions.

1. Clarke MA, Moore JL, Steege LM et al. Health information needs, sources, and barriers of primary care patients to achieve patient-centered care: A literature review. Health Informatics Journal 2016; 22 (4): 992-1016 2. Tan SS and Goonawardene N. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review. J Med Internet Res. 2017; 19 (1): e9. 3. Bailey MA, Coughlin PA, Sohrabi S et al. Quality and readability of online patient information for abdominal aortic aneurysms. J Vasc Surg 2012; 56 (1):21-6