










































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

YouTube, kidney neoplasm, social media, 
misinformation, dissemination

None declared. Received on May 28, 2022 
Accepted on July 15, 2022 
This article has been peer reviewed.

Soc Int Urol J. 2022;3(5):315–321

DOI: 10.48083/HMUG9514

A Quality Assessment of Information  
Available on Renal Cancer on YouTube

Jeremy Saad,1,2 Ramesh Shanmugasundaram,2 Darius Ashrafi,1,2 Daniel Gilbourd1,3

1 Canberra Urology Department, Canberra Hospital, Garran, Australian Capital Territory, Australia 2Faculty of Medicine, University of Sydney, Sydney, Australia  
3 Faculty of Medicine, Australian National University, Canberra, Australia

Abstract

Objectives Many people are turning to alternatives to the conventional doctor-patient relationship, such as web-
based search engines and video forums for their health care information. We undertook this study to investigate the 
quality of videos and information on renal cancer available on the streaming platform YouTube.

Methods We completed a search of YouTube (www.YouTube.com) in September 2021 with the term “kidney 
cancer.” The first 120 videos found which met the inclusion criteria (English speaking, duration greater than one 
minute, greater than 500 views, renal cancer addressed) were selected. We recorded information including duration, 
view count, likes, dislikes, comments, publisher, and author. The modified DISCERN tool and Global Quality Score 
(GQS) questionnaire were used to assess the quality of the included videos. The level of misinformation was assessed 
using a Likert 5-point scale. Descriptive statistics were used to analyse the collected data. A 2-sample t test was used to 
further analyse the quality assessment tool results before, during, and after 2016.

Results Most videos were published during or after 2016 (63.3%), were predominantly created in North America 
(77.5%), and were presented by health care professionals (60%). The median length of the videos was 4.23 (1.01 to 
65.55) minutes, and the median number of views was 3087 (514 to 228 152). The median number of likes and dislikes 
was 24 and 5, respectively. The median modified DISCERN score was 3, the median GQS score was 3, and the grading 
for overall level of misinformation was moderate.

Conclusion The quality of information accessed from YouTube on kidney cancer is of a low to moderate overall 
standard with significant levels of misinformation. YouTube should not be used alone for educational purposes on 
renal cancer by patients or the public. It is best used in conjunction with information and advice from a medical 
practitioner and the health care system.

Introduction

Kidney cancer is the second most common urological cancer worldwide, with 430 000 new cases recorded per 
year[1,2]. Studies have found that 9.8% to 15.1% of patients with renal cancers report a lack of appropriate information 
as a major source of frustration in their care[3]. Increasingly, the internet has become a primary information source 
used by patients. A review of Google Trends shows there has been a 400% increase in the number of searches on 
kidney cancer-related terms over the last 12 months[4]. Surveys have shown that approximately 8 out of 10 internet 
users have searched online about health topics, and 25% have watched an online video about health or medical 

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https://orcid.org/0000-0003-0293-2226
mailto:JeremyJSaad%40gmail.com?subject=SIUJ
https://orcid.org/0000-0003-3869-4119
https://orcid.org/0000-0001-6466-5536
https://orcid.org/0000-0002-6736-4859
http://www.YouTube.com
http://SIUJ.org


issues[5,6]. The video-sharing platform, YouTube, is the 
most accessed streaming platform in the world with over 
2 billion views per day[7]. YouTube has shown to be a 
commonly used resource for patients seeking medical 
information, including on urological diseases[8–11].

We believe video platforms such as YouTube can 
enable patients to develop an improved level of health 
literacy and a greater understanding of their health 
care needs. However, there has been no objective 
analysis of the accuracy of the information available. 
Web-based resources have been shown to have variable 
levels of quality and accuracy when compared with 
guidelines[12–14]. As distinguishing informative 
videos from those with significant inaccuracies may 
be challenging for the lay person, it is important that 
clinicians be aware of the quality of content and veracity 
of the resources patients may be using. The objective of 
our study was to use validated instruments to analyse 
the quality of renal cancer information available to 
patients on YouTube.

Methods
Search Strategy
The term “kidney cancer” was used to search YouTube 
(www.YouTube.com) in September 2021. Google Trends 
indicated this was the most frequently used search 
term relating to renal cancer during the preceding  
12 months. The default search setting on YouTube was 
used, which automatically sorts the videos by relevance.  
We included all videos that were in English, had over  
500 views, and covered information on renal cancer. 
Studies were excluded if t hey were duplicates, 
advertisements, instructional surgical videos, lacked 
audio, were not published in the English language, or 
did not contain information on renal cancer. The first  
120 videos meeting these criteria were included in the 
study and saved to a “playlist” after the initial search.

Information was collected on various characteristics, 
including year of publication, place of publication by 
continent, number of views, length (minutes), number 
of likes (thumbs up), number of dislikes (thumbs down), 
number of comments, and quality of audio and visual 
(Table 1). Content characteristics were also recorded 
including subject, type of provider, author, and intended 
audience (Table 2).

Video Analysis
Two authors (J.S. R.S.) independently reviewed the 
120 videos included for further analysis. If there was 
any discrepancy, a third author (D.A.) was consulted 
held the deciding vote. Information on the accuracy of 
information was assessed on the basis of consistency 
with either the latest European Association of Urology 
or American Urological Association guidelines[15,16].  

If a video contained information on alternative 
therapies, then a literature search was conducted to 
assess the most current information on the topic.

Quality Analysis
The quality analysis was completed using a modified 
DISCERN tool[17], Global Quality Score (GQS)[18] and 
misinformation tool which was assessed on a Likert 
5-point scale[19]. The modified DISCERN tool is scored 
based on 5 questions with 1 point for each answer, 
as shown in Table 3. With 1-2 points indicating low 
quality, 3 points indicating moderate quality and 4-5 
points indicating high overall quality. This tool has been 
validated to assess the reliability of online resources and 
has been used in similar studies[20–22]. The GQS was 
based on a 5-point scale including poor quality (not 
useful for patients), generally poor quality (very limited 
use), moderate quality (somewhat useful), good quality 
(useful for patients), and excellent quality (very useful 
for patients). The GQS is used to better assess the quality 
of online resources and indicates usefulness of the 
information to the intended audience. Misinformation 
was assessed using a 5-point Likert scale. On this scale, 
a score of 1 point indicated good quality information 
with low levels of misinformation, and a score of 5 points 
indicated high levels of misinformation. The videos were 
also assessed for inclusion of commercial bias. This was 

TABLE 1. 

Video characteristics of 120 YouTube videos on  
renal cancer 

Parameter 

Upload date, n (%)

≤ 2015 44 (36.6)

≥ 2016 76 (63.3)

Location, n (%)

North America 93 (77.5)

Europe 16 (13.3)

Asia 8 (6.7)

Other 3 (2.5)

Length, median (range) 4.23 (1.01–65.55) (SD 14.597)

Views, median (range) 3087 (514–228 152)  (SD 30474.88)

Number of likes, median (range) 24 (0–1408) (SD 167.879) 

Number of dislikes, median (range) 5 (0–93) (SD 12.131)

Number of comments, median (range)  7 (0–210) (26.091)

VPI (range) 21.78 (0–42.25)

Like ratio, % 21.78 (0–42.25)

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defined as a personal judgment in favour of a specific 
product or service of a commercial interest. The presence 
of disclosures or conflict of interest, either in the video 
or written description, was recorded. Video popularity 
was assessed using the Video Power Index (like ratio 
× view ratio [views per day ÷ 100]) and the like ratio  
(like ÷ (like + dislike) × 100).

Data Analysis
This study was completed with the use of descriptive 
statistics for analysis of outcomes and demographic 
variables. Continuous variables were expressed as a mean, 

range, and standard deviation. Categorical variables were 
expressed as a number and percentage. The 2-sample t test 
was used to assess the quality analysis and misinformation 
tools, and a P value of < 0.05 was considered statistically 
significant.

Results
The YouTube search for the term “kidney cancer” 
identified over 4000 videos. Two hundred fifty videos 
were saved into a playlist for further review, and the first 
120 that met the criteria were included in the study. 

The majority of included videos were published 
during or after 2016 (63.3%) and created in North 
America (77.5%); 13.3% were created in Europe. The 
median length of the videos was 4.23 minutes (1.01 
to 65.55), and the median number of views was 3087  
(514 to 228 152). The median number of likes and dislikes 
was 24 and 5, respectively (Table 1).

The most common content category was “treat-
ment” and an “overview of renal cancer” with 3 out of 
the 4 included criteria (anatomy, symptoms, diagno-
sis, and treatment). Approximately 39% of the videos 
were created by hospitals or health clinics, 18% by 
health channels, and 18% by foundations or advocacy 
groups. Most of the videos (60%) were presented by 
health professionals including doctors or nurses, 20% 
by patients, and 16% were animations. Most of the 
videos were intended to be accessed by patients (62.4%) 
followed by the general public (37.5%) and then health 
care providers (14.7%).

The modified DISCERN indicated a high number of 
videos scoring as moderate quality of information with 
an overall median score of 3; 74.1% of all videos in the 
study were of moderate to high (≥ 3) reliability. However, 
a significant portion of the videos (25.9%) were of low 
or very low quality. The GQS tool indicated that 83.4% 
of the videos had moderate to excellent levels of quality; 
24.2% of the videos scored as excellent for the content 
they provided. A proportion of the studies (16.6%) were 

TABLE 3. 

Modified DISCERN evaluation tool for reliability and 
quality of renal cancer information on YouTube 

Modified Discern tool (point per question if answered yes)

1. Are the aims clear?

2. Are reliable information sources used?

3. Is the information balanced and unbiased?

4. Are additional sources listed for patients?

5. Are areas of uncertainty stated?

TABLE 2. 

Content characteristics of 120 YouTube videos  
on renal cancer 

Subject, n (%)

Anatomy/disease 8 (6.7)

Symptoms 5 (4.2)

Diagnosis 12 (10)

 Treatment 47 (39.2)

Overview 41 (34.2)

Alternative/future therapy 7 (5.8)

Type of provider, n (%)

Hospital/health clinic 47 (39.2)

Foundation/advocacy 18 (15)

News outlet 5 (4.2)

University 11 (9.2)

Health channel 18 (15)

Journal 5 (4.2)

Industry 11 (9.2)

Other/unknown 5 (4.2)

Author, n (%)

Doctor 72 (60)

Patient 20 (16.7)

Animation 16 (13.3)

Public figure 3 (2.5)

Other/unknown 9 (7.5)

Intended Audience, n (%)

General public 45 (37.5)

Health care providers 17 (14.2)

Patients 52 (62.4)

Unknown 6 (7.2)

317SIUJ.ORG SIUJ  •  Volume 3, Number 5  •  September 2022

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scored either poor or very poor for levels of information. 
Misinformation was found in 49.7% of the videos anal-
ysed, and 22.5% contained moderate to high levels of 
misinformation. The other 50.3% were scored as having 
no misinformation.

A subgroup analysis was done of videos published 
within the last 5 years compared with videos published 
prior to this period (pre and post 2016). The median 
scores for all the quality assessment tools were equal 
between the 2 groups including the modified DISCERN 
(3), GQS (moderate) and misinformation scores (2). The 
GQS and misinformation tools were found to have statis-
tically difference P values between the videos published 
in 2015 or before and those published during or after 
2016. Quality analysis information is shown in Table 4 
alongside the supplementary analysis comparing videos 
submitted in 2015 or before with those submitted during 
or after 2016. Less than 6% of the videos had disclosures 
or COI documented, and 24.2% were deemed to have 
commercial bias (Figure 1).

Discussion
The aim of this present study was to analyse the quality 
of renal cancer information available to patients on 
the video-sharing platform YouTube, using validated 
instruments. We found over 7000 videos relating to 
renal cancer on YouTube. Most of the included videos 
were created by medical organisations (39%) and were 
intended primarily for patient viewing (62.4%).

To our knowledge, this is the first study to analyse 
the quality of renal cancer information available on 
YouTube. Readily available, good quality, unbiased 
medical information can be beneficial for patients 
who want to inform themselves about specific health 
conditions[23,24]. There are evidence-based videos 
on YouTube that have been found to have high-
quality information when created or reviewed by a 
legitimate source[25]. However, many available videos 
and web-based sources have been shown to be of poor 
overall quality and to offer outdated advice that may 
detrimentally affect patient care and well-being[26–28]. 
At the same time, videos from high-quality sources 
such as universities and health care organisations are 
viewed less on social media and web-based browsers[29], 
further contributing to greater levels of misinformation 
accessible to patients and the public[30].

Our analysis found that there was a significant 
proportion of videos with misinformation (49.2%). Of 
these, 22.5% scored between moderate and extreme 
levels of misinformation. The overall level of quality was 
low to moderate, highlighted by the quality assessment 
tools used. On the modified DISCERN questionnaire, 
the videos had a median score of 3 out of 5, indicating 
moderate quality of information. Approximately one 

quarter of the overall total scored as having low levels of 
reliability. On the GQS, the videos had a median score 
of 3, indicating the information was somewhat useful 
to patients. However, 16.6% of the videos were found to 
have poor or generally poor information that would have 
minimal benefit for the viewer. Quality analysis studies 
within the field of urology have found that information 
available to patients on YouTube contains moderate to 
high levels of misinformation[31]. They also found that 
the included information was of low to moderate quality 
and reliability[32,33].

A contributing factor to the high levels of misinfor-
mation is the ongoing development of the medical field 
and our understanding of the conditions within it.  
A subgroup analysis was completed to review the quality 
of the information published from 2016 to 2021. A statis-
tically significant difference was found when compar-
ing the GQS and the level of misinformation with data 

TABLE 4. 

Quality and misinformation analysis 

Tool Total ≤2015 (44) ≥ 2016 (76) P value

Modified DISCERN, n (%)

1 14 (11.7) 6 8

0.3777

2 17 (14.2) 8 9

3 42 (35) 14 28

4 28 (23.3) 10 18

5 19 (15.8) 6 13

Median 3 3 3

Global Quality Scale, n (%)

Poor 7 (5.8) 4 3

0.0426

Generally poor 13 (10.8) 7 6

Moderate 38 (31.7) 12 26

Good 33 (27.5) 12 21

Excellent 29 (24.2) 9 20

Median Moderate Moderate Moderate

Misinformation score, n (%)

1 61 (50.8) 20 41

0.0455

2 32 (26.7) 11 21

3 18 (15) 7 11

4 7 (5.8) 5 2

5 2 (1.7) 1 1

Median 2 2 2

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published before 2016. This can be attributed to the 
evolution of alternate therapies that may have been 
disproved or to changes in treatment methods, such as 
surgical intervention techniques or radiotherapy and 
chemotherapy[34,35].

The role of the doctor-patient relationship in educat-
ing patients on diagnostic and management options 
is important to the patient-centred care model. The 
concern with web-based resources is that the quality 
of information varies significantly, as does the level of 
health literary expected in the viewer. As the videos are 
not reviewed for quality, to increased levels of misinter-
pretation is both plausible and found to be common.

Only 34.2% of the included videos gave an overview 
of renal cancer, with many of the remaining studies 
missing key information such as symptoms, diagno-
sis, and treatment. The number of videos produced by 
health professionals is increasing. In our study, 60% were 
produced by health professionals, and 39.2% promoted 
the use of treatment methods. Health professionals and 
patients are increasingly being used in videos (16.7%) to 
promote newer treatment options, including immuno-
therapy and robotic surgical options. The popularity of 
robotic surgery has led to an increase of the use of intra-
operative images and videos. Intraoperative scenes were 
included in 19% of videos made during or after 2016, 
compared with 12% of those made during or before 
2015. Only 29% of the videos on treatment discussed 
side effects or postoperative complications.

The increasing use of YouTube videos that focus on 
diagnostic methods or treatment options may have been 
influenced by commercial interests and the potential 
for gain. In this study only 5.8% of the videos included 
conflict of interest disclosures. Videos on YouTube with 
greater advertising and promotion of medical treat-

ments have higher levels of popularity. We found that 
videos with commercial bias have a higher standard of 
audio-visual quality. Loeb et al.[33] found that 17% of 
the YouTube videos included in their study on bladder 
cancer showed commercial bias and reached 324 287 
viewers.

The comments sections of the videos were reviewed to 
gauge viewer response. Overall, there was a low number 
of comments per video (median 5), which may indicate 
poor patient engagement.

A significant portion (21%) of the publishers were 
found to have removed the ability of the public to 
comment. In 27% of the videos, the comments included 
patients/members of the public asking for health-related 
advice. In only one video did the publisher respond to 
the request and subsequently advised the person to 
discuss this concern further with a local health practi-
tioner. The number of commenters asking for further 
clarification suggests the need for more access to reliable 
information.

Limitations
The study is limited by multiple factors including the 
inclusion of only YouTube videos. There are many web-
based platforms for patients to use including other 
search engines such as Google, which is the largest web-
based search engine. Further analysis is required to 
better understand the effectiveness of other search 
media engines. This study is also limited by design, this 
is a cross sectional study and YouTube changes rapidly, 
which makes reproducing the information and study 
design challenging.

Conclusion
The use of YouTube as a readily available source of health 
information on renal cancer has yet to be evaluated 
thoroughly. The information on YouTube assessed 
in this study was found to be low to moderate quality. 
There were significant levels of misinformation due to 
the ongoing development of treatment methods and 
understanding of the disease. YouTube should not be the 
sole source of information on renal cancer for patients 
or the public, and is best used in conjunction with 
information and advice from a medical practitioner and 
the health care system.

FIGURE 1. 

Review of disclosures and commercial bias

No Yes

Disclosure/COI

Commercial bias

113 (94.2%) 7

91 (75.8%) 29

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321SIUJ.ORG SIUJ  •  Volume 3, Number 5  •  September 2022

A Quality Assessment of Information Available on Renal Cancer on YouTube

http://SIUJ.org

