Introduction

Chronic venous disease (CVD) remains a significant health and social issue. In recent years, endovenous laser ablation (EVLA) has emerged as a widely accepted alternative to traditional surgery (stripping). It offers faster recovery, fewer complications, and high long-term efficacy [1, 2]. Many countries now recognize this method as the first-line treatment for the truncal vein incompetence [3].

Despite its reputation as a safe and minimally invasive procedure, EVLA is not entirely risk-free. Patients may experience complications such as prolonged pain, bruising, superficial thrombosis, paresthesia, skin burns, or deep vein thrombosis (DVT) [4]. Although severe complications like pulmonary embolism (PE) occur rarely, they pose a real threat [5]. Therefore, physicians must carefully select suitable candidates and thoroughly inform them about potential risks [3].

In the digital age, medical clinic websites often serve as the first step in the informed consent process. Misleading or incomplete information at this stage can create unrealistic expectations, frequently leading to legal claims if complications arise. Today’s patients actively seek medical knowledge online, making clinic websites a primary tool for health education. However, content published by private medical centers often is inclined toward promotion rather than genuine education. From a consumer psychology perspective, the way clinics present data – such as highlighting benefits while omitting risks (the framing effect) – can significantly alter how patients perceive procedural safety and make therapeutic decisions [6, 7].

Global literature has already explored the quality of online information regarding venous treatment. Previous studies show that online materials often lack transparency and provide insufficient medical value [8]. While this topic frequently appears in English-language publications, there is a distinct lack of up-to-date research evaluating the Polish medical market, particularly concerning highly popular procedures like aesthetic phlebology.

This study aimed to evaluate the quality, completeness, and reliability of information regarding the EVLA procedure on the websites of Polish medical clinics treating CVD patients. We paid particular attention to the transparency of reporting contraindications and potential complications.

Material and methods

We conducted this study in September 2025 by systematically reviewing the websites of Polish medical centers offering EVLA procedures.

We queried the Google search engine using a keyword-based algorithm with the following Polish terms: „laserowe usuwanie żylaków” (laser varicose vein removal), „EVLA”, „EVLT”, and „leczenie żylaków laserem” (laser treatment of varicose veins). The initial selection includedthe first 50 organic search results for each query. Based on our inclusion criteria, we qualified websites of private clinics and surgical practices for the analysis. Exclusion criteria encompassed:

• paid advertisements (sponsored links),
• medical offer aggregator portals,
• blog posts unrelated to commercial offers,
• duplicate records.

Ultimately, after verification and removal of duplicates, the study group consisted of 166 unique websites. We developed the methodology for keyword selection and website screening based on a framework used in previous studies evaluating the quality of online medical information [8].

We applied a custom assessment form to analyze each website for the presence of five key qualitative variables: agglomerations/urban agglomerations/big cities > 200,000 inhabitants (n = 107):

• description of the mechanism,
• indications,
• contraindications,
• safety profile,
• post-treatment recommendations.

We established the criteria for factual accuracy, particularly regarding indications and complication classification, based on the current European Society for Vascular Surgery (ESVS) guidelines [3]. To synthetically evaluate educational value, we introduced a binary variable termed „Website Quality.” We classified websites as having high substantive quality if they contained information on at least three of four key clinical components (indications, contraindications, complications, and recommendations). We categorized the remaining websites as low/moderate quality.

To verify the hypothesis regarding the impact of center location on the quality of medical communication, we stratified the facilities into three subgroups based on official demographic data from Statistics Poland (GUS) [9]
(Figure 1):

• urban agglomerations: > 200,000 inhabitants (n = 107),
• medium-sized towns: 50,000–200,000 inhabitants (n = 36),
• small towns: < 50,000 inhabitants (n = 23).

We performed the statistical analysis of the collected data using Python software. We presented categorical variables as absolute frequencies (n) and percentages (%). To examine relationships between categorical variables (e.g., center location and website quality), we used Pearson’s χ² test of independence. Furthermore, we applied the independent samples Student’s t-test to compare the mean quality scores (on a point scale) between groups differing in technological transparency. For all tests, we set the level of statistical significance at α = 0.05.

Results

Ultimately, we included 166 unique websites of Polish medical centers offering EVLA procedures in the final analysis. Clinics located in large large cities dominated the study group (64.5%), reflecting the actual structure of the medical services market in Poland. While all qualified facilities provided at least basic information describing the procedure, the level of detail varied significantly. Since purely promotional content is subjective, our analysis focused exclusively on verifiable clinical data: patient education, procedural preparation, contraindications, complications, and pharmacological and post-treatment recommendations.

General characteristics and procedural preparation

Websites provided information regarding the etiology (causes) of varicose veins in 39.8% of cases (Figure 2).
Significantly more often, in 72.3% of cases (n = 120), the websites described the indications for the EVLA procedure, usually citing CVD and symptomatic varicose veins. However, clinics detailed the specific symptoms of CVD on only 35.5% of the websites. Information regarding procedural preparation (e.g., the necessity of blood tests or proper limb preparation) was present on 59.6% (n = 99) of the analyzed websites (Figure 3).

Contraindications

Information on contraindications, which is critical for patient safety, was present on less than half of the websites (44.6%; n = 74). The most frequently listed exclusion criteria included pregnancy and lactation, DVT, coagulation disorders and active infections. Less than 10% of the facilities reported more specific exclusion criteria, such as patient immobilization, malignancy, or severe arterial disease (peripheral arterial disease). The data suggest that, at the pre-hospital stage, patients frequently receive non-specific and incomplete information regarding factors that may disqualify them from the procedure (Figure 4).

Safety profile and complications

The detailed safety profile emerged as the least frequently reported element, with only 39.2% (n = 65) of the clinics providing information on potential complications. A deeper analysis of these specific websites revealed a clear tendency toward selective risk presentation (the framing effect). The clinics’ narrative focused predominantly on minor and transient adverse effects (Figure 5):

• ecchymosis, bruising, and hematomas: 35.5% of all analyzed websites,
• nerve injury (e.g., paresthesia): 22.9%,
• skin burns: 21.7%.

In contrast, clinics reported serious systemic complications far less frequently. Only 19.3% of the websites informed patients about DVT. Furthermore, a negligible number of facilities (approximately 2–4%) acknowledged the risks of directly life-threatening events, such as PE or severe bleeding. This underscores a widespread phenomenon of downplaying significant risks in promotional content, which heavily emphasizes the safety and minimally invasive nature of EVLA.

Post-treatment recommendations and pharmacotherapy

Post-procedural management guidance was present in 68.7% (n = 114) of the cases. The most common recommendation involved compression therapy (compression stockings), frequently combined with a recommendation to avoid prolonged standing and heat exposure (Figure 6). Only 30.1% of the websites mentioned follow-up visits (usually scheduled 1–2 weeks post-procedure), and less than 8% of the clinics encouraged long-term venous monitoring or secondary prevention. Pharmacological guidelines appeared sporadically and lacked consistency. Approximately 9% of the websites mentioned antithrombotic prophylaxis (e.g., low-molecular-weight heparin), and a similar proportion (14%) recommended analgesics such as ibuprofen or paracetamol. References to venoactive drugs, vitamin C, or topical healing creams occurred in less than 2% of cases (Figure 7).

Substantive quality and message consistency

Based on our synthetic quality criterion (the presence of at least 3 out of 4 key clinical components: indications, contraindications, complications, and recommendations), we classified 47.6% (n = 79) of the websites as high substantive quality materials. The remaining 52.4% (n = 87) of the websites were rated as low or moderate quality, indicating significant deficiencies in pre, peri as well as post procedural patient education. Additionally, we noted low internal consistency within the published content – the correlation between the presence of the indications section and the contraindications section was weak (r = 0.20). This suggests that a substantial proportion of websites focus heavily on patient recruitment (indications) while omitting disqualifying criteria.

The impact of the center location on information quality

Statistical analysis revealed a significant relationship between the city size and the quality of the shared content (p = 0.016). Notably, the distribution of quality was non-linear. The highest percentage of high-quality websites occurred in large cities with over 200,000 inhabitants (55.1%) and in small towns with fewer than 50,000 inhabitants (43.5%). Conversely, websites from facilities in medium-sized towns (50,000–200,000 inhabitants) demonstrated the lowest quality, where only 27.8% of the websites met the high-quality thresholds. A detailed analysis of the individual component variables revealed the largest discrepancies in reporting of complications (p = 0.023). While 44.9% of clinics in large cities and 43.5% in small towns informed patients about procedural risks, this proportion dropped to just 19.4% in medium-sized towns (Table 1). We observed a similar trend, though on the border of statistical significance (p = 0.098), for contraindications: 50.5% of facilities in large cities provided this information compared to 30.6% in medium-sized towns. We found no statistically significant differences between the groups regarding the frequency of reporting indications (p = 0.696), post-treatment recommendations (p = 0.151), or procedural preparation (p = 0.407).

The impact of technological transparency

Precision in describing medical equipment also emerged as a powerful predictor of quality. Clinics that specified detailed laser parameters (e.g., a 1470 nm wavelength) achieved a significantly higher mean information quality score (3.93 points on a 0–4 scale) compared to facilities that failed to provide equipment specifications (1.92 points). This difference was highly statistically significant (p < 0.001), allowing us to treat technological transparency as a strong marker of a website’s overall medical reliability.

Discussion

The study results allowed for the verification of the research hypothesis, which assumed the incompleteness and selectivity of information provided to patients, as well as its transformation into promotional content. A clear disproportion was demonstrated between the number of positive pieces of information encouraging the procedure and the amount of warning and educational data. The manner of presenting information regarding EVLA in Polish medical centers is largely marketing-oriented, which may modify the patient decision-making process. These results contribute to the ongoing discussion regarding medical communication ethics and the quality of health education in the era of medical service commercialization.

This study represents the first attempt in Poland at a structured, comparative analysis of web content presented to patients in the context of EVLA. The work expands upon previous research [10] regarding pre-consultation patient information for phlebological procedures, complemented with the analysis of information asymmetry, which shows convergence with consumer psychology mechanisms. We analyzed the websites of centers from various regions of the country using a uniform and reproducible information assessment scheme.

The obtained results indicate the existence of a gap in patient education prior to minimally invasive procedures. According to current guidelines from the Society for Vascular Surgery, the American Venous Forum [11], and the ESVS [3], the informed consent process requires a clear and balanced presentation of both benefits and potential complications. However, the data demonstrate that this recommendation is not reflected in the content published by Polish private medical centers (Table 2).

The deficit of information regarding potential complications – such as DVT, skin burns, or nerve injury – contradicts the available literature. Van den Bos et al. [4], in a literature review, demonstrated that the frequency of complications after EVLA can reach approximately 25% in certain groups, depending on the definition and method. Meanwhile, in our material, only 39.2% of websites mentioned procedural risk, highlighting the disproportion between clinical data and marketing communication. This discrepancy may lead to a distorted perception of risk by patients and influence their therapeutic decisions.

The manner of information presentation plays a crucial role in the decision-making process. The analysis of the results reveals similarities to mechanisms known from consumer psychology, which sets the direction for future research on the correlation between these fields and patient behaviors. For example, website structure may facilitate the occurrence of the primacy effect [12], in which a patient best remembers positive information encountered first. This may induce confirmation bias [7], leading to the omission of data that conflict with an already formed opinion. The observed information asymmetry also shows an analogy to the rule of commitment and consistency [13, 14] and the framing effect [15], where the method of data presentation influences the perception of procedural safety and efficacy. These mechanisms suggest a need for empirical verification of the extent to which these analogies translate into real-world therapeutic choices.

The overload of benefits alongside communication simplification may distort the informed consent process. The implementation of structured electronic informed consent (e-consent) models appears justified, as they increase communication transparency and the level of risk understanding [16, 17].

It is worth emphasizing that a significant and unique element of this study was subjecting the obtained data to advanced statistical analysis. The verification revealed a statistically significant relationship between city size and the overall quality of the content presented on the websites (p = 0.016). The recorded distribution assumed a non-linear character – the highest percentage of websites with high substantive value was identified in large cities (55.1%) and in small towns (43.5%). Particularly interesting from the perspective of medical services market dynamics is the anomaly observed in medium-sized towns (50,000–200,000 inhabitants), where this rate dropped drastically, reaching a mere 27.8%. This phenomenon may suggest that, in contrast to large urban agglomerations – where intense competition enforces academization and rigorous adherence to professional standards – in medium-sized towns, a purely commercial orientation dominates over the educational function of the facilities. Concurrently, so-called technological transparency proved to be a strong predictor of website credibility. Centers precisely defining the technical parameters of procedural equipment (e.g., laser wavelength or optical fiber type) were characterized by a higher mean quality score of information compared to facilities omitting these specifications, which was confirmed by high statistical significance (p < 0.001). This demonstrates that diligence in describing the medical equipment used constitutes a direct marker of general, institutional standards of patient education. The results remain consistent with the observations of Urbanek et al. [10], who demonstrated a dominance of positive message and a lack of warning information in the case of sclerotherapy. This similarity indicates a systemic phenomenon regarding the presentation of content to patients for commercial minimally invasive procedures. The comparative analysis of study results with consumer mechanisms leads to the postulate of conducting more in-depth research to empirically verify their significance in therapeutic decisions. In the future, it would be advisable to conduct survey-based studies assessing whether and to what extent patients actually use internet when making treatment decisions. This would verify how much content published by medical centers influences therapeutic choices and whether the dominance of positive message correlates with higher acceptance of minimally invasive procedures.

The limitations of this study must be considered. The analysis did not cover the actual perception of the analyzed content by patients or its impact on therapeutic decisions. Furthermore, communication data were not integrated with clinical outcomes, such as the number of procedures performed or the rate of post-consultation refusal. The lack of these data indicates a need for future integration of quantitative and qualitative research, accounting for patient perception and the decision-making process. The study was not based on the patient informed consent form but on the website content, which did not allow us to assess the final information provided to the patients directly before the procedure. Supplementing the analysis with qualitative patient opinion studies could enable the identification of the most significant factors shaping risk perception and the perception of medical center competence. It would also be worthwhile to expand the study to other minimally invasive procedures, such as radiofrequency ablation or sclerotherapy, to compare patient education patterns across different phlebological minimally invasive therapies. Future research should be interdisciplinary, combining the expertise of specialists in phlebology, clinical psychology, and medical communication to develop more ethical and transparent medical communication standards.

Conclusions

This study found that Polish clinic websites vary widely in how well they explain EVLA-related outcomes, contraindications and complications. Most clinics describe the procedure and its benefits clearly, but less than half mention contraindications, possible complications, or medication management. Patient education is often limited to simple or promotional statements instead of evidence-based information. Medical centers usually focus on the benefits of EVLA and often downplay the possible risks. This can lead patients to have unrealistic expectations and may affect their treatment choices. To help patients make informed choices, clinics should provide clear, accurate, and balanced information. Sharing details about contraindications, care after treatment, and possible complications would help patients better understand the procedure and build trust in their doctors. Making EVLA information more consistent across clinic websites could improve patient safety, satisfaction, and the overall quality of care for people with venous disease.

Disclosures

1. Institutional review board statement: Not applicable.
2. Assistance with the article: None.
3. Financial support and sponsorship: None.
4. Conflicts of interest: None.

References