Skin cancer prevention education for kidney transplant recipients: A systematic evaluation of Internet sites

Context: Repeated patient education about skin cancer prevention is important to self-care after transplant. Objective: Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Design: Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. Participants: An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Main Outcome Measures: Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results: Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n = 3) to reduce the risk of skin cancer (n = 4). Few sites recommended using protective clothing (n = 5), seeking shade (n = 4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination. Conclusion: Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.