Post-prostatectomy incontinence treatment info on YouTube is low quality

"The team and I have discussed some further potential projects with this, especially in terms of health literacy and the understandability of these videos," says Daniel Bockelman.

Many patients turn to online searches when they want information on health-related topics, with this activity being the 3rd most popular online and YouTube becoming an increasingly common mechanism. With a portion of health queries being sought out via online videos, it begs the question: How accurate is this information? In this interview, Daniel Bockelman seeks to answer this question, discussing a recent study on the quality of information on post-prostatectomy treatments (PPI) in videos on YouTube.¹ Bockelman is a urology medical student at SUNY Downstate College of Medicine in Brooklyn, New York.

Could you describe the background for this study?

We were initially interested in looking at how social media and online interactions relate to how patients interact with urology, because online health information has become such a big part of the way the world works now. YouTube especially is big because you can put videos out in a lecture-based format. We wanted to see how accurate the information is for post-prostatectomy incontinence, because it's such a common problem that men have after having radical prostatectomy. We wanted to explore how accurate the information was and how it can help patients.

What were some of your notable findings? Were any of those surprising to you or your coauthors?

One of the main items we used as a proxy for the quality of the information is the DISCERN score, which is a validated instrument that we chose based on other research that's been done on YouTube for other topics. This questionnaire has 16 items that assess the accuracy of the information and whether it is biased. It is on a scale of 1 to 5 with the 16th item being the overall score based on all of the other items.

What we found was 71% of the DISCERN scores were 3 or lower, with 5 being the best and 1 being the worst. So, we found that a significant proportion of them were 3 or lower, so not the highest scores. That's on par with what the other studies on bladder cancer and erectile dysfunction found. They found similar results, which was the main finding that we discovered.

Some other things that we expected to happen, but didn't happen, were that the number of views, viewer engagement, and the length of the video didn't have an impact on the score at all when we did our analysis. We expected longer videos to be more accurate because they could explain things better, or that more viewed videos would have either more or less [accuracy], but neither of those affected the DISCERN scores.

Another notable finding we had [was that] we took stock of which videos discussed realistic treatment outcomes and which videos discussed risks specifically of the treatment, so the artificial urinary sphincter and the male sling. We found that only 39% of the videos discussed realistic treatment outcomes, meaning [they] actually defined incontinence or getting complete continence after surgery. 24% of the videos discussed risks such as device removal, device replacement, infection, etc. So, less than a majority of the videos mentioned these things, and I think those are important to bring up.

Is any further research on this topic planed? If so, what might that include?

The team and I have discussed some further potential projects with this, especially in terms of health literacy and the understandability of these videos. Our understandability scores were one of the other metrics, and we wanted to look into that a little further. It's called PEMAT, or the Patient Education Materials Assessment Tool [for Audiovisual Materials], which has an understandability component, or how understandable the videos are. We wanted to break down that analysis a little bit more. Also, because 54% of American adults have below a 6th grade reading level, we wanted to potentially assess the same videos but using a reading level scale of those videos to see if that has an impact on the understandability.

What is the take-home message for practicing urologists?

The take-home message would be that because social media, YouTube, Twitter, Instagram, and all these things are such a big part of the way people and their loved ones interact with health information now, and a lot of medical professionals already use these mediums, it's important to put out information that's both accurate and helps to supplement in-office decision making in an outpatient setting. A patient-centered approach is such an important hallmark for good clinical practice, so high-quality information that helps patients not only understand which treatments are effective, but what might be best for their goals of care [is important].

Incontinence is such a subjective feeling. Some people might have an issue with using any pads per day when they're incontinent and other people might not find it so bothersome. I think it should help get people back into the office more to discuss with their urologists, and providing the most accurate and the most up-to-date information is important.

Reference

1. Bockelman D, Huang A, Khosla L, et al. Quality of information for post-prostatectomy incontinence treatments on YouTube. Urology. Published online December 7, 2022. Accessed December 15, 2022. doi:10.1016/j.urology.2022.09.042