Colon Cancer Screening and the Importance of Health Literacy

Last month a study in the journal Gastrointestinal Endoscopy reviewed the health literacy of Internet-based materials on colorectal cancer. The study looked at websites from reputable sources – the American Society for Gastrointestinal Endoscopy, the National Cancer Institute, the CDC and the American Cancer Society – websites that physicians would likely consider referring their patients to. Of the 12 sites reviewed, 10 were above a sixth-grade reading level and almost all failed in providing suitable content that patients could use to make informed decisions about the benefits of colonoscopy.

Colon cancer is the second leading cause of cancer death in the US, yet there are effective screening tests that can lead to earlier stage intervention. Research has shown that about 60 percent of people start with the Internet when seeking information on colonoscopy screening. The study authors contend that if patient information were targeted and written more effectively, screening could be more effectively promoted. Currently, the colorectal screening rate in the US for people with less than a high school education is less than 50 percent.

Beyond readability, this health literacy study looked at the suitability of content, examining how many sites addressed key concerns about colon cancer, such as chances of dying from it and how easy it would be to get screening. Those concerns were only addressed in about half of the sites and only a quarter of the sites addressed the factors that place patients at higher risk for colon cancer– being African American, a history of smoking, having diabetes, and being obese.

Screening rates remain low for a number of reasons, but frequently cited patient concerns include embarrassment (discussed on only one of the sites reviewed), pain associated with colonoscopy and the costs of the procedure (content included in only a quarter of the websites reviewed). None of the websites discussed the need to get colonoscopy when no symptoms are present.

The lead author said, “Today, the Internet often is the first point of contact between the patient and health-related information, even for patients with low literacy. In, thus, is a great opportunity for us to influence the decisions people make about their health and to steer them in the right direction. Informing patients is a physician’s responsibility and we take this role seriously.”

Health Literacy goes far beyond reading levels and making words simple. It requires understanding what patients need to understand the risks and benefits of taking an action. It requires understanding the common misconceptions that patients have and addressing them directly.  Today, the Internet is the most important source for health information, particularly as patients are making decisions about whether they should seek care, take a preventive action or follow recommended treatment. Poorly written, incomplete or confusing information leads to delays and inaction resulting in higher morbidity, mortality and added burden on the healthcare system.


Tian C, Champlin S, Mackert M, Lazard A, Agrawal D. Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening. Gastrointestinal Endoscopy 2014

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