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A Systematic Review of Internet Decision-Making Resources for Patients Considering Surgery for Ulcerative Colitis

Baker, Daniel M.*,†; Marshall, Jack H.*,†; Lee, Matthew J. MBChB, BMedSci, MRCS*,†; Jones, Georgina L. BA, MA, DPhil; Brown, Steven R. MBChB, BMedSci, FRCS, MD; Lobo, Alan J. MBBS, FRCP, MD§

doi: 10.1097/MIB.0000000000001198
Clinical Review Articles

Background: Guidance from the Royal College of Surgeons advocates patient use of on-line resources to assist in decision making. Our aim was to assess the quality of on-line resources to facilitate decision making for patients considering surgery for ulcerative colitis (UC).

Methods: We undertook a systematic review based on PRISMA guidelines. This was registered on the PROSPERO database (CRD42016047177). We searched Google and repositories using several lay search terms for patient information discussing surgery for UC, published in English. Quality of content on websites was assessed using the validated DISCERN instrument and by minimum standards for decision aids (IPDASi v4.0 checklist). Decision aids were also assessed by the IPDAS checklist. Readability of written content was ascertained using the Flesch–Kincaid score.

Results: Our searches identified 175 websites and one decision aid—119 results were excluded at initial screen and 32 were excluded at full text assessment, leaving 25 sources for review. The mean Flesch-Kincaid score for websites was 44.9 (±9.73, range 28.1–61.4), suggesting material was difficult to read. No websites compared surgery to medical management or traded off patient preferences. The median IPDAS score was 5/12 (range 1–7). The median global score based on the DISCERN rating was 1/5 (range 1–5), identifying most websites as poor quality. The decision aid scored 9/12 on the IPDAS checklist, not meeting minimum standards.

Conclusions: Available information for patients considering surgery for UC is generally low quality. The development of a new decision aid to support patients considering surgery for UC is recommended.

Article first published online 13 July 2017.

*The University of Sheffield Medical School, Sheffield, United Kingdom;

Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, United Kingdom;

Department of Psychology, School of Social Sciences Leeds Beckett University, Leeds, United Kingdom; and

§Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.

Address correspondence to: Daniel M. Baker, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, United Kingdom (e-mail:

Supported by a grant through the Royal College of Surgeons of England Intercalated Bachelor of Science Degree in Surgery award for 2017. This was awarded to D. M. Baker.

A. J. Lobo is an advisory board member or received lecture fees for Takeda Pharma, Abbvie, Dr. Falk, Shield Pharmaceuticals and Vifor Pharma. The remaining authors have no conflict of interest to disclose.

Received April 19, 2017

Accepted May 18, 2017

© Crohn's & Colitis Foundation
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