Comprehensive assessment of most visible German websites on melanoma immunotherapy

Background: Patients diagnosed with melanoma frequently search the internet for treatment information including novel and complex immunotherapy. However, health literacy is limited among half of the German population and no assessment of websites on melanoma treatment has been performed so far. Objective: The aim of this study was to identify and assess the most visible websites in German language on melanoma immunotherapy. Methods: In accordance with the common online seeking behavior of cancer patients, the first 20 hits on GoogleTM, YahooTM, and BingTM were searched for combinations of German synonyms for “melanoma” and “immunotherapy” in July 2017. Websites that met our predefined eligibility criteria were considered for assessment. Three reviewers independently assessed their quality by using the established DISCERN tool and by checking the presence of a quality certification. Usability and reliability were evaluated by the LIDA tool, understandability by PEMAT. The Flesch Reading Ease Score (FRES) was calculated to estimate readability. The Alexa and SISTRIX tools were used to investigate the websites’ popularity and visibility. Inter-rater agreement was determined calculating Cronbach’s Alpha. Subgroup differences were identified by t test, U test or one-way ANOVA. Results: Out of 480 hits, 45 single websites from 30 domains were assessed. Only two website domains displayed a German quality certification. The average assessment scores (mean ± SD) were as follows: DISCERN 48 ± 7.6 , LIDA (Usability) 40 ± 2.0, LIDA (Reliability) 10 ± 1.6, PEMAT 69 ± 16%, and FRES 17 ± 14, indicating mediocre quality, good usability and understandability but low reliability and an even very low readability of the included websites. SISTRIX scores ranked from 0-6872 and Alexa scores ranked from 17192675, indicating heterogeneity of the visibility and popularity of German website domains providing information on melanoma immunotherapy Conclusion: Optimization of the most accessible German websites on melanoma immunotherapy is desirable. Especially simplification of the readability of information and further adaption to reliability criteria are required to support the education of melanoma patients and lay people, and to enhance transparency.