Evaluation of the quality of internet content available to patients regarding colorectal involvement of endometriosis and associated surgical treatments

Evaluation of the quality of internet content available to patients regarding colorectal involvement of endometriosis and associated surgical treatments | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the quality of internet content available to patients regarding colorectal involvement of endometriosis and associated surgical treatments Yeong Huei Desmond Chuah, Yun Hui Liau, Paul Neary, Alison DeMaio, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3853191/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Endometriosis is a chronic inflammatory condition that can infiltrate the rectum and colon in a significant proportion of those affected. Patients commonly seek information regarding their diagnosis and treatment on the internet. Information available, however, may be incomplete or not applicable to all cases. This study aims to evaluate the quality and content of internet information on colorectal endometriosis treatment. Methods: The search term ‘colorectal endometriosis’ was used to identify websites on popular search engines including Google, Yahoo, and Bing. Websites were classified into 4 subtypes: Academic Institutions, Private Medical Centres, Non-profit Organisations, and Commercial Websites. Two independent assessors evaluated the quality of the websites using the Journal of the American Medical Association (JAMA) benchmark criteria and the DISCERN scoring system. Results: Sixteen websites were identified. 25% from Academic Institutions, 25% from Private Medical Centres, 12.5% from Non-profit Organisations, and 37.5% were Commercial Websites. Mean(±SD) JAMA criteria and DISCERN scores for all websites were noted as 1.38±1.29 and 44.75±14.53 respectively. Most websites adequately discussed treatment options, mean(±SD) DISCERN score 3.69±1.40. Risks of surgeries were infrequently discussed, mean(±SD) DISCERN score 2.56±1.50. Only 50% of the websites discussed complications of colorectal surgery including anastomotic leak and stoma requirement. Conclusion: This study demonstrated variable levels of quality and reliability of internet content regarding colorectal endometriosis treatment and associated complications. These findings can be highlighted to patients using the internet to obtain information on colorectal endometriosis. endometriosis colon rectum surgery internet Figures Figure 1 Figure 2 Figure 3 Introduction During the female reproductive period up to 15% of women will suffer with endometriosis.[1] Endometriosis frequently affects adjacent pelvic organs including the rectum and sigmoid colon.[1,2] In a significant proportion of patients, the Pouch of Douglas may be obliterated and the disease can extend beneath the peritoneum into the bowel wall with resulting significant functional issues and associated pain.[3] Symptoms described include constipation, diarrhoea, dyschezia, rectal bleeding and chronic pelvic pain which can have significant overlap with other co-existing pelvic or gastrointestinal disorders.[4] Establishing a diagnosis of endometriosis involving the colon and rectum requires several factors including exclusion of other causes of symptoms, pelvic imaging and often evaluative laparoscopy.[5] Despite extensive work-up however, it is often impossible to fully establish the extent of endometriosis in the Pouch of Douglas and at the rectovaginal septum due to inability to view this area without commencement of significant pelvic dissection.[6] The purpose of endometriosis surgery can be multifactorial and includes improvement in fertility by removing pelvic disease with restoration of pelvic anatomy and improvement of quality of life by reducing pain symptoms. Surgical intervention from a colorectal aspect can vary from low morbidity procedures with pelvic adhesiolysis and shaving of endometrial deposits to high morbidity procedures including low anterior resection and loop ileostomy formation in a difficult pelvis with significant inflammatory and fibrotic change.[7] Low anterior resection itself may lead to alternative issues including LARS (Low anterior resection syndrome), pelvic nerve damage with changes to urologic and sexual function and anastomotic issues like anastomotic leak, permanent stoma and rectovaginal fistula.[8] Leak rates of up to 4.7% have been previously described.[9] Patient counselling of associated risks prior to definitive intervention in endometriosis is critical as many young patients with benign disease may wish to avoid a stoma and severe changes in bowel, urinary and sexual function in the setting of LARS. It is increasingly frequent that patients, particularly in this young cohort, will have sought information widely on the internet regarding endometriosis and associated interventions. However, it is common to find that patients will have little or no information regarding the associated morbidity of pelvic nerve damage, bowel injury, stoma requirement and anastomotic leak. This study aims to assess the quality and content of internet-based information on the treatment and complications of colorectal endometriosis using validated and novel scoring systems. Methods Search Strategy The search term ‘colorectal endometriosis’ was entered into the top three search engines: Google (www.google.com, Mountain View, A USA), Yahoo (www.yahoo.com, Sunnyvale, CA, USA) , and Bing (www.bing.com, Belleview, WA, USA) . As Google is the most popular search engine[10], we included the top 20 websites from Google, alongside with top 10 websites identified on Yahoo and Bing. Eligibility criteria The websites were screened for duplicates and those were subsequently excluded. Websites included for analysis were assessed against the following inclusion criteria: Websites with the content about colorectal endometriosis, content in English language and content aimed at patients. Websites were excluded if they did not meet inclusion criteria or if they met the following pre-defined exclusion criteria: academic sources not aimed at patients, sources requiring subscription or log in, online videos and newspaper articles. Data Analysis Websites included in the study were analysed by two independent assessors using two scoring systems: JAMA Benchmark Criteria Evaluates websites based on four pillars – authorship, attribution, disclosure and currency. 10 Authorship examines the credentials of author and their affiliations; Attribution examines the references of web content; Disclosure reflects conflict of interests and sponsorships; and Currency examines the date of publication. Each criterion earns a score of 1 if the goals were met by the websites, leading to a maximum score of 4. 0 indicating poor accountability and 4 indicating strong accountability.[11] DISCERN Criteria Evaluates websites based on 16 criteria which looks into 3 aspects: the reliability of the website, the quality of information provided on therapeutic options, and the overall quality of the website.[12] Criteria 1 to 8 examines the reliability of the website by: identifying the aim of the website, if the aims were achieved, relevance of website to patients, sources of information, date of publication, if bias were present, if additional sources pertinent to the topic were provided, and if areas of uncertainty was addressed. Criteria 9 to 15 examines the information provided regarding treatment choices: describe how treatment works, benefits and risks of treatment, outcome without treatment, quality of life after treatment, alternative treatment options, and support for shared decision-making. The last criteria (criteria 16) assesses the overall quality of the website based on aforementioned criteria 1 to 15. A score of 1 to 5 was assigned to each criterion, with 1 being not addressed, 3 being partially addressed, to 5 being fully addressed. The maximum score awarded for each website was 80. A score of 16-30 indicates very poor quality, 30-40 indicates poor quality, 40-50 indicates fair quality, 50-60 indicates good quality and 60-80 indicates excellent quality. Complications of treatment options, if discussed, were recorded from each websites. Sub-group Analysis Websites were further classified into four main subtypes: websites produced by academic institutions, private medical centres, non-profit organisations (patient advocacy or support groups), and commercial websites. Statistical Methods Scores from two independent assessors were collected. The mean of each criterion was obtained and presented as mean ± standard deviation. Statistical analyses were performed on Microsoft Excel and GraphPad PRISM. Institutional review board approval was not required for this study. Results 40 websites were identified from search engines Google (n=20), Yahoo (n=10), and Bing (n=10) (Supplementary table 1). 15 duplicates and 9 scientific articles from academic journals were excluded from the study. 16 websites were included in analyses (Supplementary table 2). The websites can be further categorised into websites from academic institutions (n=4), private medical centres (n=4), or non-profit organisations (n=2) and commercial websites (n=6) (Figure 1). JAMA Benchmark Criteria The mean (±SD) JAMA benchmark criteria total score for all websites was 1.43±1.27; with scores for each criteria as follow: Authorship 0.50±0.50, Attribution 0.38±0.48, Disclosure 0, Currency 0.56±0.50. None of the websites achieved a maximum JAMA score of 4. 6 websites scored 0 points. 50% displayed authorship, 38% provided references for the information on the website and 56% displayed the date of upload or update. Of note, none of the websites disclosed conflict of interests or funding. On subtype analyses (Table 1, Figure 2), commercial websites scored highest on all JAMA criteria, including Authorship (1.0±0), Attribution (0.83±0.37), and Currency (1.0±0), when compared to websites from academic institutions, private medical centres, and non-profit organisations. Websites from non-profit organisations scored lowest with 0 in all four JAMA criteria.. DISCERN Scoring System The mean (±SD) DISCERN score for all websites were 44.75±14.53. (Table 2) The highest overall scoring website was published by Mayo Clinic which scored 61.5 points. The highest mean DISCERN score was found in the ‘Question 3 – Is it relevant?’ (mean score 4.31±0.92), ‘Question 9- Does it describe how each treatment works?’ (3.75±1.25) and ‘ Question 14 - Is it clear that there may be more than one possible treatment choice?’ (3.69±1.40). The lowest mean DISCERN score was in the ‘Question 8 - Does it refer to areas of uncertainty?’ category (1.47±1.12) On subtype analyses (Table 3, Figure 3), total mean DISCERN score for websites from academic institutions was 46.75±15.37, private medical centres 32.63±10.62, non-profit organisations 40.25±7.69, and commercial websites 53.0±11.62. Commercial websites scored highest in reporting sources of information (Question 4 Is it clear what sources of information were used to compile the publication: 4.08±1.9; Question 5 Is it clear when the information used or reported in the publication was produced: 3.92±1.32). Websites across all categories did not sufficiently report area of uncertainties or limitations (Question 8; Academic Institutions 1.38±0.99, Private Medical Centres 1.38±0.99, Non-profit Organisations 1.0±0, Commercial websites 1.75±1.36). Websites from Academic Institutions scored highest in the criteria discussing treatments and their associated risks and impact on quality of life (Question 9 Does it describe how each treatment work: 4.38±0.86; Question 11 Does it describe the risks of each treatment 3.0±1.12; Question 13 Does it describe how the treatment choices affect overall quality of life 3.0±1.32). Discussions Regarding Operative Outcome 50% of websites in each category provided detailed discussion in complications of operative management of colorectal endometriosis and its impact on quality of life (Academic Institutions n=2, Private Medical Centres n=2, Non-profit Organisations n=1, Commercial Websites n=3) (Table 4). Amongst websites from Academic Institutions, one website reported most extensively on the complications of surgical management of colorectal endometriosis, that includes stoma, bleeding, anastomotic leak, fistula formation, low anterior resection syndrome (LARS), urinary incontinence, pain, infection, blood clot formation (deep vein thrombosis and pulmonary embolism). (Table 4) Amongst websites that reported on operative complications, anastomotic leak (n=5) was the most reported followed by pain (n=4) , infection (n=4) and stoma formation (n=4). None of the Commercial Websites discussed stoma as a potential outcome of surgical excision of colorectal endometriosis. Discussion The top 16 websites from which patients could obtain information regarding the treatment and side effects for colorectal endometriosis on the internet have been identified via major search engines. All website categories had significant overall deficiencies in JAMA benchmark criteria with no website categories containing any disclosures and many lacking details on authorship and attributions. There is similarly significant variability in information quality throughout website categories according to the DISCERN scoring system. Only 50% of all websites in any category described associated complications of surgical intervention for colorectal endometriosis. Among those websites that described complications many omitted relevant and severe complications which may occur. We used standard non-medical search engines and limited our search to the first 10-20 websites as previous studies have shown patients do not use medical web-sites as the reference points for queries and the vast majority of patients do not view beyond the first page of websites.[10,13,14] We also excluded the use of videos and online chat groups and forums as there is very little heterogeneity in terms of their assessment and the majority of videos outside of those published by academic journals do not undergo any peer-review.[11,15] While there is increasing use of online videos by the public for medical information there are no validated tools to assess the their quality and content in a comparative fashion.[15] This study demonstrated commercial websites to have the highest level of scores in JAMA criteria and DISCERN scores. This is not necessarily a reflection of the high quality of commercial sites but the lack of certain key data factors in the other included sites. Most strikingly, the majority of websites outside of commercial websites do not include any authorship. It is possible that regulatory requirements are enforced on commercial sites so that they must provide authorship but it is unusual for academic websites, particularly from large teaching hospitals, that the authors would not be named. Similarly for disclosure there is a lack of data throughout all website types. Particularly in private websites which may promote early surgical intervention or different types of surgery the financial disclosure of the authors would be highly relevant to the information given regarding treatment. Previous survey studies have demonstrated over 50% of patients want their physician or surgeon to disclose financial conflicts of interest even though only 15% report it would change their decision regarding receiving treatment.[16] Conflict of interest statements in scientific publishing have become mandatory with several organisations for ethics producing standardised forms to provide homogenous reporting for published data.[17] Within the DISCERN scoring system there are several areas lacking in the majority of websites particularly around the sources of information, when it was produced and interestingly the option of no treatment and what it entails. There is evidence of speciality bias encouraging patients towards surgery compared to other modalities when information is given by surgeons and that is a major consideration in any online information. There are several limitations to this study. As previously discussed there is no assessment of chat forums or videos which are increasingly used by patients to gain information regarding endometriosis and its treatment. Only English language websites were used which excludes a significant number of websites. It is likely that many patients with long standing disease who have undergone multiple investigations or treatments will have significantly researched further than the websites covered in this assessment. Finally, this study does not take into account patient perceptions of website quality and qualitative assessments of patients perception of information provided with varying levels of symptoms and disease duration may demonstrate different viewpoints to clinicians objective assessments. Despite limitations, this is the first study to assess the quality of information available on the internet regarding colorectal endometriosis. Overall information has been found to lack significant details regarding authorship, sources of information, related complications and relevant disclosures. It is the authors opinion that the ethical practices and standards applied to peer reviewed journal articles could be applied in some form to published medical information on the internet to provide full clarity on authorship, financial disclosures, speciality and information source. This would likely improve the quality of information and would significantly improve transparency. Declarations Acknowledgement The authors acknowledge the support received in the realisation of these studies from all at the Colorectal Surgery and Gynaecology Department in Tallaght University Hospital. Conflict of interest No funding or financial assistance was received by the authors. The authors have no conflicts of interest to disclose. This manuscript has not been previously submitted for publication. Data Availability Statement All data including spreadsheets are available from the authors upon written request and following agreement on the intended purpose of the request. Author’s Contribution Statement Yeong Huei Desmond Chuah: conceived and designed the analyses, collected the data, performed the analysis, wrote the paper Yun Hui Liau: collected the data, performed the analysis, wrote the paper Paul Neary: contributed the data and analysis tools, supervision Alison DeMaio: contributed the data and analysis tools, supervision Aoife O’Neill: contributed the data and analysis tools, supervision Cillian Clancy: conceived and designed the analyses, wrote the paper, supervision References Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, De Buck Van Overstraeten A, D’Hoore A. Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol. 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(2015);157(4):627–633. doi: 10.1016/j.surg.2014.11.012 Tables Table 1 JAMA Benchmark Criteria by Website Subtypes JAMA Benchmark Criteria (Mean±SD) Website Subtypes Academic Institutions (n = 4) Private Medical Centres (n = 4) Non-profit Organisations (n = 2) Commercial Websites (n = 6) Authorship 0 0.50±0.50 0 1.0±0 Attribution 0.25±0.43 0 0 0.83±0.37 Disclosure 0 0 0 0 Currency 0.50±0.50 0.25±0.43 0 1.0±0 Total 0.75±0.83 0.75±0.83 0 2.83±0.37 Table 2 DISCERN scoring system for all Websites DISCERN Scoring System Mean Standard Deviation Section 1 Is the publication reliable? 1. Are the aims clear? 3.22 1.58 2. Does this achieve its aims? 3.44 1.75 3. Is it relevant? 4.31 0.92 4. Is it clear what sources of information were used to compile the publication? 2.41 1.78 5. Is it clear when the information used or reported in the publication was produced? 2.56 1.69 6. Is it balanced and unbiased? 2.66 1.71 7. Does it provide details of additional sources of support and information? 2.34 1.43 8. Does it refer to areas of uncertainty? 1.47 1.12 Section 2 How good is the quality of information on treatment choices? 9. Does it describe how each treatment work? 3.75 1.25 10. Does it describe the benefits of each treatment? 3.34 1.38 11. Does it describe the risks of each treatment? 2.56 1.50 12. Does it describe what would happen if no treatment is used? 1.63 1.39 13. Does it describe how the treatment choices affect overall quality of life? 2.47 1.25 14. Is it clear that there may be more than one possible treatment choice? 3.69 1.40 15. Does it provide support for shared decision-making? 2.25 1.56 Section 3 Overall rating of the publication 16. Rate the overall quality of the publication as a source of information about treatment choices 2.66 1.11 Total Score 44.75 14.53 Table 3 DISCERN Scoring System by Website Subtypes DISCERN Scoring System (Mean±SD) Website Subtypes Academic Institutions (n = 4) Private Medical Centres (n = 4) Non-profit Organisations (n = 2) Commercial Websites (n = 6) Section 1 Is the publication reliable? 1 Are the aims clear? 3.13±1.45 2.25±1.48 2.50±1.50 4.17±1.14 2 Does this achieve its aims? 3.38±1.58 2.25±1.48 2.25±1.64 4.67±1.11 3 Is it relevant? 4.13±0.93 3.75±1.09 4.75±0.43 4.67±0.62 4 Is it clear what sources of information were used to compile the publication? 2.0±1.73 1.0±0 1.0±0 4.08±1.19 5 Is it clear when the information used or reported in the publication was produced? 2.25±1.64 1.63±1.11 1.0±0 3.92±1.32 6 Is it balanced and unbiased? 2.5±1.73 1.13±0.33 2.25±1.09 3.92±1.44 7 Does it provide details of additional sources of support and information? 2.25±1.48 2.0±1.0 2.50±1.66 2.58±1.50 8 Does it refer to areas of uncertainty? 1.38±0.99 1.38±0.99 1.0±0 1.75±1.36 Section 2 How good is the quality of information on treatment choices? 9 Does it describe how each treatment work? 4.38±0.86 3.38±1.49 3.75±1.30 3.58±1.11 10 Does it describe the benefits of each treatment? 3.50±1.66 3.0±1.0 2.75±1.48 3.67±1.25 11 Does it describe the risks of each treatment? 3.0±1.12 2.13±1.45 2.75±1.48 2.50±1.66 12 Does it describe what would happen if no treatment is used? 2.0±1.73 1.13±0.33 3.0±2.0 1.25±0.83 13 Does it describe how the treatment choices affect overall quality of life? 3.0±1.32 2.0±1.12 2.0±1.22 2.58±1.11 14 Is it clear that there may be more than one possible treatment choice? 4.0±1.50 2.75±1.64 3.75±1.10 4.08±0.86 15 Does it provide support for shared decision-making? 3.0±1.80 1.0±0 2.75±1.10 2.42±1.55 Section 3 Overall rating of the publication 16 Rate the overall quality of the publication as a source of information about treatment choices 2.88±1.05 1.88±1.05 2.25±0.43 3.17±0.99 Total Score 46.75±15.37 32.63±10.62 40.25±7.69 53.0±11.62 Table 4 Reported Complications of Operative Management of Colorectal Endometriosis Complications Website Subtypes Total Academic Institutions (n-4) Private Medical Centres (n = 4) Non-Profit Organisations (n = 2) Commercial Websites (n = 6) Pain ✓ ✓ ✓ ✓ 4 Infection ✓ ✓ ✓ ✓ 4 Bleeding ✓ 1 VTE ✓ 1 Stoma formation ✓ ✓ ✓ ✓ 4 Fistula formation ✓ ✓ ✓ 3 Anastomotic leak ✓ ✓ ✓ ✓ ✓ 5 Urinary incontinence ✓ 1 Low anterior resection syndrome (LARS) ✓ ✓ ✓ 3 Fertility ✓ 1 Bowel Injury ✓ 1 Bowel Obstruction ✓ 1 Total 0 9 0 1 0 4 0 2 4 0 0 0 2 4 0 3 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3853191","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":270580625,"identity":"77b698cd-7d98-4ce9-8777-d9f376b84cf0","order_by":0,"name":"Yeong Huei Desmond Chuah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDCCA2CSmcGAgYGN4QMDiCRFC+MMkrUw8xDjLr7j7U83fNxhLW8ukfzsse0eO3s+BuaHj27g0SJ55ozZzZln0g13zkgzN855lpzYxsBmbJyDR4vBjRy227xthxMMbiSYSeccOJDAxsDDJo1Xy/3nz6Ba0r9JWxw4YE9Yyw0GM6iWHDNphgMHGNsIaZE8kwP0S1u64YYzb8okew4A/cJMwC98x48/u/GxzVre4Hj6NokfB+zs5dubHz7GpwULYCZN+SgYBaNgFIwCLAAAhl5NQNjliYEAAAAASUVORK5CYII=","orcid":"","institution":"Tallaght University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yeong","middleName":"Huei Desmond","lastName":"Chuah","suffix":""},{"id":270580626,"identity":"9cf11b8e-3592-448d-aa17-99ba98a78a2f","order_by":1,"name":"Yun Hui Liau","email":"","orcid":"","institution":"Tallaght University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"Hui","lastName":"Liau","suffix":""},{"id":270580627,"identity":"193f02eb-16f4-4af4-9592-4bc642e8c4ce","order_by":2,"name":"Paul Neary","email":"","orcid":"","institution":"Tallaght University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Neary","suffix":""},{"id":270580628,"identity":"0308894c-b9a8-4243-b6a4-fe3d7dc7fda6","order_by":3,"name":"Alison DeMaio","email":"","orcid":"","institution":"Tallaght University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alison","middleName":"","lastName":"DeMaio","suffix":""},{"id":270580629,"identity":"f9826f9b-7467-474d-8ef5-476eabd276a3","order_by":4,"name":"Aoife O'Neill","email":"","orcid":"","institution":"Tallaght University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aoife","middleName":"","lastName":"O'Neill","suffix":""},{"id":270580630,"identity":"2153b8c8-2468-48dd-9430-5f7aa28e3ae9","order_by":5,"name":"Cillian Clancy","email":"","orcid":"","institution":"Tallaght University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cillian","middleName":"","lastName":"Clancy","suffix":""}],"badges":[],"createdAt":"2024-01-11 11:01:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3853191/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3853191/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50672951,"identity":"3676de32-7de4-418f-a435-7a1436704899","added_by":"auto","created_at":"2024-02-05 14:55:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59694,"visible":true,"origin":"","legend":"\u003cp\u003eSubtypes of websites included in the study\u003c/p\u003e\n\u003cp\u003eWebsites included in the study was further subcategorised into websites from academic institutions (n=4), private medical centres (n=4), non-profit organisations (n=2), and commercial websites (n=6)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3853191/v1/d2987fd1480e5a2b921c5f52.png"},{"id":50673733,"identity":"16d1db55-80fc-4290-aab2-0ce97920a09a","added_by":"auto","created_at":"2024-02-05 15:03:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39612,"visible":true,"origin":"","legend":"\u003cp\u003eJAMA Benchmark Criteria by Website Subtypes\u003c/p\u003e\n\u003cp\u003eJAMA Benchmark Criteria (Authorship, Attribution, Disclosure, and Currency) were demonstrated (mean±SD) and stratified by website subtypes: websites from Academic Institutions (n=4), private medical centres (n=4), non-profit organisations (n=2), and commercial websites (n=6)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3853191/v1/e09832da2262db072d6f49b9.png"},{"id":50672950,"identity":"74b35965-6872-489f-bcfc-ea7d3f888a9d","added_by":"auto","created_at":"2024-02-05 14:55:28","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":57874,"visible":true,"origin":"","legend":"\u003cp\u003eDISCERN Scoring System by Website Subtypes\u003c/p\u003e\n\u003cp\u003e2 main sections of DISCERN Scoring System: Section 1-Is the publication reliable? (encompasses 8 questions) and Section 2-How good is the quality of information on treatment choices? (encompasses 7 questions) were demonstrated in mean±SD. This is further stratified by website subtypes: websites from Academic Institutions (n=4), private medical centres (n=4), non-profit organisations (n=2), and commercial websites (n=6)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3853191/v1/2c5edf0176883b48d47273f3.png"},{"id":52820899,"identity":"616db090-5518-4753-a9f3-3e7946b65a5a","added_by":"auto","created_at":"2024-03-16 16:13:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":503141,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3853191/v1/f3e48950-1e74-4401-92a3-16a5dde0e3ec.pdf"},{"id":50672952,"identity":"65fa0a6d-8e16-4f1c-acd4-da1c8691b7e6","added_by":"auto","created_at":"2024-02-05 14:55:28","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":41378,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-3853191/v1/9ddac0759e5f17c7e864c238.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the quality of internet content available to patients regarding colorectal involvement of endometriosis and associated surgical treatments","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDuring the female reproductive period up to 15% of women will suffer with endometriosis.[1] Endometriosis frequently affects adjacent pelvic organs including the rectum and sigmoid colon.[1,2] \u003csup\u003e\u0026nbsp;\u003c/sup\u003eIn a significant proportion of patients, the Pouch of Douglas may be obliterated and the disease can extend beneath the peritoneum into the bowel wall with resulting significant functional issues and associated pain.[3] Symptoms described include constipation, diarrhoea, dyschezia, rectal bleeding and chronic pelvic pain which can have significant overlap with other co-existing pelvic or gastrointestinal disorders.[4]\u003c/p\u003e\n\u003cp\u003eEstablishing a diagnosis of endometriosis involving the colon and rectum requires several factors including exclusion of other causes of symptoms, pelvic imaging and often evaluative laparoscopy.[5] Despite extensive work-up however, it is often impossible to fully establish the extent of endometriosis in the Pouch of Douglas and at the rectovaginal septum due to inability to view this area without commencement of significant pelvic dissection.[6] The purpose of endometriosis surgery can be multifactorial and includes improvement in fertility by removing pelvic disease with restoration of pelvic anatomy and improvement of quality of life by reducing pain symptoms. Surgical intervention from a colorectal aspect can vary from low morbidity procedures with pelvic adhesiolysis and shaving of endometrial deposits to high morbidity procedures including low anterior resection and loop ileostomy formation in a difficult pelvis with significant inflammatory and fibrotic change.[7] Low anterior resection itself may lead to alternative issues including LARS (Low anterior resection syndrome), pelvic nerve damage with changes to urologic and sexual function and anastomotic issues like anastomotic leak, permanent stoma and rectovaginal fistula.[8] Leak rates of up to 4.7% have been previously described.[9]\u003c/p\u003e\n\u003cp\u003ePatient counselling of associated risks prior to definitive intervention in endometriosis is critical as many young patients with benign disease may wish to avoid a stoma and severe changes in bowel, urinary and sexual function in the setting of LARS. It is increasingly frequent that patients, particularly in this young cohort, will have sought information widely on the internet regarding endometriosis and associated interventions. However, it is common to find that patients will have little or no information regarding the associated morbidity of pelvic nerve damage, bowel injury, stoma requirement and anastomotic leak. This study aims to assess the quality and content of internet-based information on the treatment and complications of colorectal endometriosis using validated and novel scoring systems.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eSearch Strategy\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe search term \u0026lsquo;colorectal endometriosis\u0026rsquo; was entered into the top three search engines: Google (www.google.com, Mountain View, A USA), Yahoo (www.yahoo.com, Sunnyvale, CA, USA) , and Bing (www.bing.com, Belleview, WA, USA) . As Google is the most popular search engine[10], we included the top 20 websites from Google, alongside with top 10 websites identified on Yahoo and Bing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEligibility criteria\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe websites were screened for duplicates and those were subsequently excluded. Websites included for analysis were assessed against the following inclusion criteria: Websites with the content about colorectal endometriosis, content in English language and content aimed at patients. Websites were excluded if they did not meet inclusion criteria or if they met the following pre-defined exclusion criteria: academic sources not aimed at patients, sources requiring subscription or log in, online videos and newspaper articles. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWebsites included in the study were analysed by two independent assessors using two scoring systems:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eJAMA Benchmark Criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEvaluates websites based on four pillars \u0026ndash; authorship, attribution, disclosure and currency.\u003csup\u003e10\u0026nbsp;\u003c/sup\u003eAuthorship examines the credentials of author and their affiliations; Attribution examines the references of web content; Disclosure reflects conflict of interests and sponsorships; and Currency examines the date of publication. Each criterion earns a score of 1 if the goals were met by the websites, leading to a maximum score of 4.\u0026nbsp;0 indicating poor accountability and 4 indicating strong accountability.[11]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDISCERN Criteria\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEvaluates websites based on 16 criteria which looks into 3 aspects: the reliability of the website, the quality of information provided on therapeutic options, and the overall quality of the website.[12]\u0026nbsp;Criteria 1 to 8 examines the reliability of the website by: identifying the aim of the website, if the aims were achieved, relevance of website to patients, sources of information, date of publication, if bias were present, if additional sources pertinent to the topic were provided, and if areas of uncertainty was addressed. Criteria 9 to 15 examines the information provided regarding treatment choices: describe how treatment works, benefits and risks of treatment, outcome without treatment, quality of life after treatment, alternative treatment options, and support for shared decision-making. The last criteria (criteria 16) assesses the overall quality of the website based on aforementioned criteria 1 to 15. A score of 1 to 5 was assigned to each criterion, with 1 being not addressed, 3 being partially addressed, to 5 being fully addressed. The maximum score awarded for each website was 80.\u0026nbsp;A score of 16-30 indicates very poor quality, 30-40 indicates poor quality, 40-50 indicates fair quality, 50-60 indicates good quality and 60-80 indicates excellent quality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eComplications of treatment options, if discussed, were recorded from each websites.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSub-group Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWebsites were further classified into four main subtypes: websites produced by academic institutions, private medical centres, non-profit organisations (patient advocacy or support groups), and commercial websites.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Methods\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eScores from two independent assessors were collected. The mean of each criterion was obtained and presented as mean\u0026nbsp;\u0026plusmn;\u0026nbsp;standard deviation. Statistical analyses were performed on Microsoft Excel and GraphPad PRISM. Institutional review board approval was not required for this study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e40 websites were identified from search engines Google (n=20), Yahoo (n=10), and Bing (n=10) (Supplementary table 1). 15 duplicates and 9 scientific articles from academic journals were excluded from the study. 16 websites were included in analyses (Supplementary table 2). The websites can be further categorised into websites from academic institutions (n=4), private medical centres (n=4), or non-profit organisations (n=2) and commercial websites (n=6) (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eJAMA Benchmark Criteria \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean (\u0026plusmn;SD) JAMA benchmark criteria total score for all websites was 1.43\u0026plusmn;1.27; with scores for each criteria as follow: Authorship 0.50\u0026plusmn;0.50, Attribution 0.38\u0026plusmn;0.48, Disclosure 0, Currency 0.56\u0026plusmn;0.50. None of the websites achieved a maximum JAMA score of 4. 6 websites scored 0 points. 50% displayed authorship, 38% provided references for the information on the website and 56% displayed the date of upload or update. Of note, none of the websites disclosed conflict of interests or funding.\u003c/p\u003e\n\u003cp\u003eOn subtype analyses (Table 1, Figure 2), commercial websites scored highest on all JAMA criteria, including Authorship (1.0\u0026plusmn;0), Attribution (0.83\u0026plusmn;0.37), and Currency (1.0\u0026plusmn;0), when compared to websites from academic institutions, private medical centres, and non-profit organisations. Websites from non-profit organisations scored lowest with 0 in all four JAMA criteria..\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDISCERN Scoring System \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean (\u0026plusmn;SD) DISCERN score for all websites were 44.75\u0026plusmn;14.53. (Table 2) The highest overall scoring website was published by Mayo Clinic which scored 61.5 points. The highest mean DISCERN score was found in the \u0026lsquo;Question 3 \u0026ndash; Is it relevant?\u0026rsquo; (mean score 4.31\u0026plusmn;0.92), \u0026lsquo;Question 9- Does it describe how each treatment works?\u0026rsquo; (3.75\u0026plusmn;1.25) and \u0026lsquo; Question 14 - Is it clear that there may be more than one possible treatment choice?\u0026rsquo; (3.69\u0026plusmn;1.40). The lowest mean DISCERN score was in the \u0026lsquo;Question 8 - Does it refer to areas of uncertainty?\u0026rsquo; category (1.47\u0026plusmn;1.12)\u003c/p\u003e\n\u003cp\u003eOn subtype analyses (Table 3, Figure 3), total mean DISCERN score for websites from academic institutions was 46.75\u0026plusmn;15.37, private medical centres 32.63\u0026plusmn;10.62, non-profit organisations 40.25\u0026plusmn;7.69, and commercial websites 53.0\u0026plusmn;11.62. Commercial websites scored highest in reporting sources of information (Question 4 Is it clear what sources of information were used to compile the publication: 4.08\u0026plusmn;1.9; Question 5 Is it clear when the information used or reported in the publication was produced: 3.92\u0026plusmn;1.32). Websites across all categories did not sufficiently report area of uncertainties or limitations (Question 8; Academic Institutions 1.38\u0026plusmn;0.99, Private Medical Centres 1.38\u0026plusmn;0.99, Non-profit Organisations 1.0\u0026plusmn;0, Commercial websites 1.75\u0026plusmn;1.36). Websites from Academic Institutions scored highest in the criteria discussing treatments and their associated risks and impact on quality of life (Question 9 Does it describe how each treatment work: 4.38\u0026plusmn;0.86; Question 11 Does it describe the risks of each treatment 3.0\u0026plusmn;1.12; Question 13 Does it describe how the treatment choices affect overall quality of life 3.0\u0026plusmn;1.32).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDiscussions Regarding Operative Outcome \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e50% of websites in each category provided detailed discussion in complications of operative management of colorectal endometriosis and its impact on quality of life (Academic Institutions n=2, Private Medical Centres n=2, Non-profit Organisations n=1, Commercial Websites n=3) (Table 4).\u003c/p\u003e\n\u003cp\u003eAmongst websites from Academic Institutions, one website reported most extensively on the complications of surgical management of colorectal endometriosis, that includes stoma, bleeding, anastomotic leak, fistula formation, low anterior resection syndrome (LARS), urinary incontinence, pain, infection, blood clot formation (deep vein thrombosis and pulmonary embolism). (Table 4) Amongst websites that reported on operative complications, anastomotic leak (n=5) was the most reported followed by pain (n=4) , infection (n=4) and stoma formation (n=4). None of the Commercial Websites discussed stoma as a potential outcome of surgical excision of colorectal endometriosis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe top 16 websites from which patients could obtain information regarding the treatment and side effects for colorectal endometriosis on the internet have been identified via major search engines. All website categories had significant overall deficiencies in JAMA benchmark criteria with no website categories containing any disclosures and many lacking details on authorship and attributions. There is similarly significant variability in information quality throughout website categories according to the DISCERN scoring system. Only 50% of all websites in any category described associated complications of surgical intervention for colorectal endometriosis. Among those websites that described complications many omitted relevant and severe complications which may occur.\u003c/p\u003e\n\u003cp\u003eWe used standard non-medical search engines and limited our search to the first 10-20 websites as previous studies have shown patients do not use medical web-sites as the reference points for queries and the vast majority of patients do not view beyond the first page of websites.[10,13,14] We also excluded the use of videos and online chat groups and forums as there is very little heterogeneity in terms of their assessment and the majority of videos outside of those published by academic journals do not undergo any peer-review.[11,15] While there is increasing use of online videos by the public for medical information there are no validated tools to assess the their quality and content in a comparative fashion.[15]\u003c/p\u003e\n\u003cp\u003eThis study demonstrated commercial websites to have the highest level of scores in JAMA criteria and DISCERN scores. This is not necessarily a reflection of the high quality of commercial sites but the lack of certain key data factors in the other included sites. Most strikingly, the majority of websites outside of commercial websites do not include any authorship. It is possible that regulatory requirements are enforced on commercial sites so that they must provide authorship but it is unusual for academic websites, particularly from large teaching hospitals, that the authors would not be named. Similarly for disclosure there is a lack of data throughout all website types. Particularly in private websites which may promote early surgical intervention or different types of surgery the financial disclosure of the authors would be highly relevant to the information given regarding treatment. Previous survey studies have demonstrated over 50% of patients want their physician or surgeon to disclose financial conflicts of interest even though only 15% report it would change their decision regarding receiving treatment.[16] Conflict of interest statements in scientific publishing have become mandatory with several organisations for ethics producing standardised forms to provide homogenous reporting for published data.[17] Within the DISCERN scoring system there are several areas lacking in the majority of websites particularly around the sources of information, when it was produced and interestingly the option of no treatment and what it entails. There is evidence of speciality bias encouraging patients towards surgery compared to other modalities when information is given by surgeons and that is a major consideration in any online information.\u003c/p\u003e\n\u003cp\u003eThere are several limitations to this study. As previously discussed there is no assessment of chat forums or videos which are increasingly used by patients to gain information regarding endometriosis and its treatment. Only English language websites were used which excludes a significant number of websites. It is likely that many patients with long standing disease who have undergone multiple investigations or treatments will have significantly researched further than the websites covered in this assessment. Finally, this study does not take into account patient perceptions of website quality and qualitative assessments of patients perception of information provided with varying levels of symptoms and disease duration may demonstrate different viewpoints to clinicians objective assessments.\u003c/p\u003e\n\u003cp\u003eDespite limitations, this is the first study to assess the quality of information available on the internet regarding colorectal endometriosis. Overall information has been found to lack significant details regarding authorship, sources of information, related complications and relevant disclosures. It is the authors opinion that the ethical practices and standards applied to peer reviewed journal articles could be applied in some form to published medical information on the internet to provide full clarity on authorship, financial disclosures, speciality and information source. This would likely improve the quality of information and would significantly improve transparency.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the support received in the realisation of these studies from all at the Colorectal Surgery and Gynaecology Department in Tallaght University Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or financial assistance was received by the authors. The authors have no conflicts of interest to disclose. This manuscript has not been previously submitted for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data including spreadsheets are available from the authors upon written request and following agreement on the intended purpose of the request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYeong Huei Desmond Chuah: conceived and designed the analyses, collected the data, performed the analysis, wrote the paper\u003c/p\u003e\n\u003cp\u003eYun Hui Liau: collected the data, performed the analysis, wrote the paper\u003c/p\u003e\n\u003cp\u003ePaul Neary: contributed the data and analysis tools, supervision\u003c/p\u003e\n\u003cp\u003eAlison DeMaio: contributed the data and analysis tools, supervision\u003c/p\u003e\n\u003cp\u003eAoife O\u0026rsquo;Neill: contributed the data and analysis tools, supervision\u003c/p\u003e\n\u003cp\u003eCillian Clancy: conceived and designed the analyses, wrote the paper, supervision\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWolthuis AM, Meuleman C, Tomassetti C, D\u0026rsquo;Hooghe T, De Buck Van Overstraeten A, D\u0026rsquo;Hoore A. 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DISCERN: An instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. (1999);53(2):105\u0026ndash;111. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/jech.53.2.105\u003c/span\u003e\u003cspan address=\"10.1136/jech.53.2.105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEysenbach G, Kohler C. What is the prevalence of health-related searches on the World Wide Web? Qualitative and quantitative analysis of search engine queries on the internet. \u003cem\u003eAMIA Annu Symp Proc\u003c/em\u003e. Published online 2003:225\u0026ndash;229.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEysenbach G, K\u0026ouml;hler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. Br Med J. (2002);324(7337):573\u0026ndash;577. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.324.7337.573\u003c/span\u003e\u003cspan address=\"10.1136/bmj.324.7337.573\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRemer SL, Connelly TM, Clancy C, et al. The quality and content of hyperthermic intraperitoneal chemotherapy information available to patients: An evaluation of North American hyperthermic intraperitoneal chemotherapy websites. Surg (United States). (2023);174(1):30\u0026ndash;35. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.surg.2023.03.025\u003c/span\u003e\u003cspan address=\"10.1016/j.surg.2023.03.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLieberman JR, Pensak MJ, Kelleher MS, Leger RR, Polkowski GG. Disclosure of financial conflicts of interest: An evaluation of orthopaedic surgery patients\u0026rsquo; understanding hip. Clin Orthop Relat Res. (2013);471(2):472\u0026ndash;477. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11999-012-2525-y\u003c/span\u003e\u003cspan address=\"10.1007/s11999-012-2525-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProbst P, H\u0026uuml;ttner FJ, Klaiber U, Diener MK, B\u0026uuml;chler MW, Knebel P. Thirty years of disclosure of conflict of interest in surgery journals. Surg (United States). (2015);157(4):627\u0026ndash;633. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.surg.2014.11.012\u003c/span\u003e\u003cspan address=\"10.1016/j.surg.2014.11.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eJAMA Benchmark Criteria by Website Subtypes\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eJAMA Benchmark Criteria (Mean\u0026plusmn;SD)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWebsite Subtypes\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAcademic Institutions\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrivate Medical Centres\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNon-profit Organisations\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;2)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCommercial Websites\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;6)\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAuthorship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.50\u0026plusmn;0.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAttribution\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.25\u0026plusmn;0.43\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.83\u0026plusmn;0.37\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDisclosure\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCurrency\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.50\u0026plusmn;0.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.25\u0026plusmn;0.43\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTotal\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.75\u0026plusmn;0.83\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.75\u0026plusmn;0.83\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.83\u0026plusmn;0.37\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDISCERN scoring system for all Websites\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDISCERN Scoring System\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStandard Deviation\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSection 1\u003c/span\u003e \u003cspan class=\"Underline\"\u003eIs the publication reliable?\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1. Are the aims clear?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.58\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2. Does this achieve its aims?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.44\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.75\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3. Is it relevant?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.92\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4. Is it clear what sources of information were used to compile the publication?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.41\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.78\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5. Is it clear when the information used or reported in the publication was produced?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.69\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6. Is it balanced and unbiased?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.66\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.71\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7. Does it provide details of additional sources of support and information?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.43\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8. Does it refer to areas of uncertainty?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.47\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.12\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSection 2\u003c/span\u003e \u003cspan class=\"Underline\"\u003eHow good is the quality of information on treatment choices?\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9. Does it describe how each treatment work?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.75\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.25\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10. Does it describe the benefits of each treatment?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.38\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11. Does it describe the risks of each treatment?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.50\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12. Does it describe what would happen if no treatment is used?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.63\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.39\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13. Does it describe how the treatment choices affect overall quality of life?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.47\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.25\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14. Is it clear that there may be more than one possible treatment choice?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.69\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.40\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15. Does it provide support for shared decision-making?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.56\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSection 3\u003c/span\u003e \u003cspan class=\"Underline\"\u003eOverall rating of the publication\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e16. Rate the overall quality of the publication as a source of information about treatment choices\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.66\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.11\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTotal Score\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e44.75\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14.53\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDISCERN Scoring System by Website Subtypes\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDISCERN Scoring System (Mean\u0026plusmn;SD)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWebsite Subtypes\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAcademic Institutions\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrivate Medical Centres\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNon-profit Organisations\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;2)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCommercial Websites\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;6)\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSection 1\u003c/span\u003e \u003cspan class=\"Underline\"\u003eIs the publication reliable?\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 Are the aims clear?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.13\u0026plusmn;1.45\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;1.48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.50\u0026plusmn;1.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.17\u0026plusmn;1.14\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 Does this achieve its aims?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.38\u0026plusmn;1.58\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;1.48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;1.64\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.67\u0026plusmn;1.11\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 Is it relevant?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.13\u0026plusmn;0.93\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.75\u0026plusmn;1.09\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.75\u0026plusmn;0.43\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.67\u0026plusmn;0.62\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 Is it clear what sources of information were used to compile the publication?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u0026plusmn;1.73\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.08\u0026plusmn;1.19\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 Is it clear when the information used or reported in the publication was produced?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;1.64\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.63\u0026plusmn;1.11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.92\u0026plusmn;1.32\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6 Is it balanced and unbiased?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.5\u0026plusmn;1.73\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.13\u0026plusmn;0.33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;1.09\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.92\u0026plusmn;1.44\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 Does it provide details of additional sources of support and information?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;1.48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u0026plusmn;1.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.50\u0026plusmn;1.66\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.58\u0026plusmn;1.50\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 Does it refer to areas of uncertainty?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.38\u0026plusmn;0.99\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.38\u0026plusmn;0.99\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.75\u0026plusmn;1.36\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSection 2\u003c/span\u003e \u003cspan class=\"Underline\"\u003eHow good is the quality of information on treatment choices?\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9 Does it describe how each treatment work?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.38\u0026plusmn;0.86\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.38\u0026plusmn;1.49\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.75\u0026plusmn;1.30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.58\u0026plusmn;1.11\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 Does it describe the benefits of each treatment?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.50\u0026plusmn;1.66\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u0026plusmn;1.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.75\u0026plusmn;1.48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.67\u0026plusmn;1.25\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 Does it describe the risks of each treatment?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u0026plusmn;1.12\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.13\u0026plusmn;1.45\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.75\u0026plusmn;1.48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.50\u0026plusmn;1.66\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 Does it describe what would happen if no treatment is used?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u0026plusmn;1.73\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.13\u0026plusmn;0.33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u0026plusmn;2.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.25\u0026plusmn;0.83\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13 Does it describe how the treatment choices affect overall quality of life?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u0026plusmn;1.32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u0026plusmn;1.12\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u0026plusmn;1.22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.58\u0026plusmn;1.11\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14 Is it clear that there may be more than one possible treatment choice?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.0\u0026plusmn;1.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.75\u0026plusmn;1.64\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.75\u0026plusmn;1.10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.08\u0026plusmn;0.86\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15 Does it provide support for shared decision-making?\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u0026plusmn;1.80\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u0026plusmn;0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.75\u0026plusmn;1.10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.42\u0026plusmn;1.55\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSection 3\u003c/span\u003e \u003cspan class=\"Underline\"\u003eOverall rating of the publication\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e16 Rate the overall quality of the publication as a source of information about treatment choices\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.88\u0026plusmn;1.05\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.88\u0026plusmn;1.05\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.25\u0026plusmn;0.43\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.17\u0026plusmn;0.99\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTotal Score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e46.75\u0026plusmn;15.37\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32.63\u0026plusmn;10.62\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e40.25\u0026plusmn;7.69\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e53.0\u0026plusmn;11.62\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eReported Complications of Operative Management of Colorectal Endometriosis\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eComplications\u003c/div\u003e\n \u003c/th\u003e\n \u003cth colspan=\"16\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWebsite Subtypes\u003c/div\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTotal\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAcademic Institutions (n-4)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrivate Medical Centres (n\u0026thinsp;=\u0026thinsp;4)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNon-Profit Organisations (n\u0026thinsp;=\u0026thinsp;2)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCommercial Websites (n\u0026thinsp;=\u0026thinsp;6)\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePain\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInfection\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBleeding\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVTE\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStoma formation\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFistula formation\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAnastomotic leak\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUrinary incontinence\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLow anterior resection syndrome\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e(LARS)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFertility\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBowel Injury\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBowel Obstruction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e✓\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTotal\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"endometriosis, colon, rectum, surgery, internet","lastPublishedDoi":"10.21203/rs.3.rs-3853191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3853191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Endometriosis is a chronic inflammatory condition that can infiltrate the rectum and colon in a significant proportion of those affected. Patients commonly seek information regarding their diagnosis and treatment on the internet. Information available, however, may be incomplete or not applicable to all cases. This study aims to evaluate the quality and content of internet information on colorectal endometriosis treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe search term ‘colorectal endometriosis’ was used to identify websites on popular search engines including Google, Yahoo, and Bing. Websites were classified into 4 subtypes: Academic Institutions, Private Medical Centres, Non-profit Organisations, and Commercial Websites. Two independent assessors evaluated the quality of the websites using the Journal of the American Medical Association (JAMA) benchmark criteria and the DISCERN scoring system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Sixteen websites were identified. 25% from Academic Institutions, 25% from Private Medical Centres, 12.5% from Non-profit Organisations, and 37.5% were Commercial Websites. Mean(±SD) JAMA criteria and DISCERN scores for all websites were noted as 1.38±1.29 and 44.75±14.53 respectively. Most websites adequately discussed treatment options, mean(±SD) DISCERN score 3.69±1.40. Risks of surgeries were infrequently discussed, mean(±SD) DISCERN score 2.56±1.50. Only 50% of the websites discussed complications of colorectal surgery including anastomotic leak and stoma requirement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study demonstrated variable levels of quality and reliability of internet content regarding colorectal endometriosis treatment and associated complications. These findings can be highlighted to patients using the internet to obtain information on colorectal endometriosis.\u003c/p\u003e","manuscriptTitle":"Evaluation of the quality of internet content available to patients regarding colorectal involvement of endometriosis and associated surgical treatments","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-05 14:55:23","doi":"10.21203/rs.3.rs-3853191/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7bef539-7ba0-4710-bc94-25e6fc6b45c4","owner":[],"postedDate":"February 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-16T16:05:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-05 14:55:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3853191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3853191","identity":"rs-3853191","version":["v1"]},"buildId":"2u56kwukJI3zHK-uzyFNs","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}