The Multilingual Divide: The Quality of Online Thyroid Cancer Information Across Languages

Thyroid cancer treatment is complex. Patients may turn to the internet to gain insights into their condition. The quality of this information, especially for non-English speakers, is unclear. This study examines the quality and accuracy of online resources for both English and non-English speaking patients with thyroid cancer.

Three search engines were queried in October 2023 using thyroid cancer care terms in English, Spanish, and Chinese. Ninety six websites per language were identified. Duplicate and non-accessible websites were excluded. Websites were categorized based by origin (U.S.-based or foreign). Quality was assessed using the JAMA criteria (0-4) and DISCERN tool (1-5) by two independent language-fluent reviewers. Scores were averaged to determine the final score. Accuracy was assessed using six management recommendations from the 2015 American Thyroid Association differentiated thyroid cancer guidelines. Categorical variables and mean scores were compared using X² analysis and one-way analysis of variance, respectively.

62 English, 37 Spanish, and 52 Chinese websites were evaluated. English and Spanish websites more commonly originated from a US source (80.6% and 53.8%, respectively) compared to Chinese websites (21.2%, P < 0.001). Mean JAMA scores for English-, Spanish-, and Chinese-language websites were 2.49 ± 1.30, 2.45 ± 1.36, and 1.33 ± 0.74, respectively (P < 0.001); mean DISCERN scores were 3.58 ± 0.57, 3.39 ± 0.58, and 2.57 ± 0.41, respectively (P < 0.001). Only six English websites and one Spanish website reported all examined ATA treatment recommendations.

The quality of online thyroid cancer treatment information is generally poor. Chinese-language websites had lower quality scores and fewer up-to-date recommendations compared to English and Spanish websites. Enhancing online information, especially in non-English languages, presents a significant opportunity.