YouTube Videos on Prostate Cancer Frequently Misleading

Pam Harrison

November 30, 2018

Over three quarters of a sample of 150 videos on prostate cancer available on YouTube contain potentially misleading and/or biased content in the video itself or in the comments section, new research indicates.

"Our study shows that people really need to be wary of many YouTube videos on prostate cancer," Stacy Loeb, MD, assistant professor of urology and population health at New York University School of Medicine in New York City, said in a statement.

The study is the largest, most comprehensive examination of YouTube prostate cancer videos to date.

Loeb added that the videos may have "valuable information," but sources need to be verified as credible and up to date.

The study was published online November 27 in European Urology.

Researchers reviewed the first 150 English-language YouTube videos that were identified on default searches for both prostate cancer screening and prostate cancer treatment. The videos analyzed for the current study had up to 1.3 million views, although the average number of views was 45,223.

The most common topics explored in the videos overall involved screening and early signs of prostate cancer.  

The investigators subjected the content or the comments to a series of validated assessment tools.

Videos were also evaluated for both their "understandability" and "actionability" — namely whether viewers could identify what they might be able to do based on the information presented — using the Agency for Healthcare Research and Quality Patient Education Materials Assessment Tool (PEMAT).

The median scores on PEMAT were 67% for understandability and 75% for actionability, according to the investigators.

"For all videos, we calculated two engagement metrics for YouTube users: the number of views per month...and the ratio of the number of users who gave a video a 'thumbs up' to the number of total views," Loeb and colleagues observe.

The team also evaluated comments made by viewers themselves that appeared underneath each video to assess response to the content.

Importantly, 75% of the reviewed videos had either a moderate to good description of the benefits of the subject being discussed compared with 53% of videos detailing its harms.

However, only half of the videos provided either moderate to good support for shared decision-making — as current prostate cancer guidelines recommend.

As Loeb, who also chairs a panel on social media for the American Urological Association (AUA) pointed out, updated AUA guidelines recommend that men between 55 and 69 years of age talk to their physicians about the risks and benefits of prostate specific–antigen screening for prostate cancer.

Many of the videos analyzed for the study were made before these recommendations were issued and thus tended to encourage more aggressive treatment than is now considered to be medically necessary for low-risk disease.

One quarter of the videos were also found to be biased in favor of new technologies and approximately one fifth recommended complementary or alternative approaches to treatment.

Analysis of the reading level for the videos indicated it ranged from grade 7 to college graduate level, with a mean reading level of grade 12.

Significant Negative Correlation

Disturbingly, researchers detected a "significant negative correlation" between the quality of the scientific information presented and viewer engagement as measured by views per month (P = .004) as well as by "thumbs up" views (P = .015).

Commercial videos, health and wellness videos, and videos posted by patients themselves had the highest number of views per month and thumbs-up per view. However, the quality of these types of videos was worse compared with the quality of videos developed by healthcare providers or professional or government groups.

"Many videos had no user-generated comments," Loeb notes.

However, of those that did, 6% of comments contained advertising, 11% contained requests for medical advice, and 5% provided medical advice from users themselves.

Researchers also note that there was "significant persuasion" for users to follow treatment options that are not concordant with current guidelines or to pursue unproven natural remedies.

For example, in one particularly noxious recommendation, men with prostate cancer were advised to have herbs injected into the gland, a treatment for which there is zero supporting evidence.

"The significant inverse relationship between expert ratings of information quality and the popularity of videos on YouTube is highly concerning because of the facilitation of wide dissemination of potentially misinformative content," investigators observe.

"A greater number of views and thumbs up on YouTube does not mean that the information is trustworthy," they conclude.

Credible sources for online information about prostate cancer include the Prostate Cancer Foundation, which helped fund the current study; the Urology Care Foundation, the AUA's website for patients; and the National Cancer Institute.

YouTube has more than 600,000 videos about prostate cancer.

Loeb reports receiving travel expenses from Sanofi and consulting fees from Lilly and has family members with equity in Gilead.

Eur Urol. Published online November 27, 2018. Full text

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