YouTube videos are unregulated and very unreliable and inaccurate as a source of patient information, according to a new study of prostate biopsies guided by transrectal ultrasound (TRUS). Researchers from a top London facility found most of the 41 videos did not discuss complications or side effects, even though healthcare professionals made many of them.
Dr. Neeraj Jain from the department of radiology at University College Hospital in London and colleagues searched YouTube for TRUS videos and rated them for providing information such as the procedure's mechanism. They found that 32 of the 41 videos were "very poor," and most of them failed to allow patients to make informed decisions (Clinical Radiology, 12 October 2018).
"Patients are most likely to receive poor-quality information via YouTube, which is inadequate to make an informed decision about the procedure or benefit their patient experience," noted the authors, adding that many patients search the internet for advice, and healthcare professionals have a duty to direct them toward high-quality sources of information.
"Content posted by medical professionals could be viewed as more trustworthy, which could have a negative impact on patients if it is of a low standard; however, the present study also revealed there are unexplored opportunities for medical professionals to produce high-quality, patient-focused informational videos online," they continued.
YouTube under scrutiny
YouTube offers a plethora of information on a variety of topics, including prostate cancer. The disease is the second most commonly diagnosed malignancy in men, behind lung cancer, accounting for around 15% of all cases, Jain and colleagues explained. Prostate cancer incidence increases markedly with age, more than any other cancer, and as life expectancy is increasing, prostate cancer is likely to be a significant health burden, they pointed out.
TRUS-guided biopsy often is a recommended investigation for the disease, and patients are likely to turn to YouTube for information. On 4 May 2017, the researchers searched YouTube for "TRUS," "TRUS biopsy," "transrectal ultrasound," and "prostate biopsy." They selected 41 videos from the first 10 pages of the search queries. Three researchers then reviewed and independently scored the videos based on certain criteria, such as whether they address side effects and recovery.
They based their criteria on written information from the British Association of Urological Surgeons (BAUS) for patients undergoing TRUS biopsy. Videos could reach a total score of 25, with 0 to 5 deemed very poor and 21 to 25 deemed excellent.
No video achieved a rating of "excellent", and the researchers rated 32 of the videos as "very poor." Of those very poor videos, the team excluded 12 due to the lack of sound, use of non-English language, and emphasis on the wrong procedure. Almost all (39) of the videos were from healthcare organizations or individual surgeons, with 26 of them based in the U.S.
The top-scoring video, "Prostate Biopsy" by mdconversation, was 16 minutes 12 seconds long, which may dissuade some viewers from watching it, the authors noted.
Frequently, the videos targeted healthcare professionals as opposed to patients: 14 videos focused on diagnostic techniques. The remaining patient-focused videos often only addressed one aspect of the procedure, such as the indication for a biopsy or the preparation for the procedure. General details were given, for example, in a "patient experience" video, rather than the sort of specific information deliverable in a printed leaflet.
Side effects of the procedure, given the highest weighting in the scoring system, were poorly addressed, with 28 videos failing to mention any complications at all, while six videos only focused on one or two specific complications. Also, with a mean length of 3 minutes 48 seconds, most videos were too short to comprehensively cover the procedure.
"Despite targeted searching, many of the top results were irrelevant, focused on the wrong procedure, or were not targeted at patients," they wrote. "Although patients may ignore these inappropriate videos, among the relevant videos, the quality of information was generally poor. They often lacked basic advice on preparing for the procedure, side effects, or recovery after the procedure."
A limitation of the study is that Jain and colleagues restricted their search to the first 10 pages, but it is unlikely viewers will get beyond that page count as well, they noted.
