A multi-institutional study of Internet utilization by radiation oncology patients

Patients with cancer and e-mail: implications for clinical communication

GOALS OF WORK

The aim of this study was to collect information about cancer patients' current e-mail use and willingness to communicate with healthcare providers by e-mail.

MATERIALS AND METHODS

A cohort of 208 patients, undergoing treatment at a comprehensive cancer center in an urban academic medical center in southeastern USA, participated in this descriptive study. An Internet use questionnaire was developed and then used to survey patients with cancer.

MAIN RESULTS

The majority of patients indicated that e-mail would be a desirable method of clinical communication. A subset of patients would not use e-mail for clinical purposes even if they had access.

CONCLUSIONS

E-mail communication may be an acceptable form of communication among patients, nurses, and other members of the support team. Because a subset of patients will not use this form of communication, assessment of individual patient preferences for use of e-mail is indicated prior to enrolling them in an e-mail communication program.

Quality of care experienced by Finnish cancer patients during radiotherapy

The purpose of this study is to describe patients' experiences of the quality of care received at a radiotherapy centre. The data were collected using the Good Nursing Care Scale For Patients (GNCS/P), which was modified for this study. Structured questionnaires were handed out in March-May 2004 to 150 adult curative cancer patients attending outpatient radiotherapy at a university hospital in Finland. A total of 135 completed questionnaires were returned. The patients were generally satisfied with the quality of care they received. Among the four quality categories, the highest ratings were given to staff characteristics, and the lowest to the environment. Younger patients, employed patients and those with a higher level of education gave the lowest quality ratings. Improvements are needed primarily in the counselling and education of patients and their relatives. The results of this study provide valuable clues for improving the quality of care in radiotherapy based on patients' expectations.

Internet use among adolescent and young adults (AYA) with cancer

BACKGROUND

The Internet serves as an important resource for adult cancer patients, but little is known about Internet use among adolescent and young adults (AYA) with cancer. The aims of this study were to describe (1) cancer-specific websites which AYA with cancer visit and (2) Internet features desired by AYA on cancer-specific websites and how many current AYA cancer websites contain these features.

PROCEDURE

Individual phone interviews were conducted with a convenience sample of 16 AYA with cancer from across North America in June 2005. Content analysis of these interviews were coded and validated for desired website features. Current AYA cancer websites were identified on the Internet and the features on these sites were compared to the features desired by our sample.

RESULTS

Favorite websites visited by AYA with cancer (cancer-related and unrelated) were identified along with current Internet use. Twenty-one distinct cancer website features desired by AYA with cancer were described. Twenty-seven unique AYA cancer websites were found on the Internet during May-June 2006. Each site contained 7.7 (SD = 2.7) of the 21 features identified by participants as desirable, but the highest ranked features did not occur in the majority of these websites.

CONCLUSIONS

AYA with cancer indicate that they prefer to visit cancer websites that contain cancer-related information, provide the ability to chat with AYA with cancer, and offer some type of game. Although many websites exist for AYA with cancer, few individual sites contain the web features identified as most desired by AYA with cancer.

Internet-based survey evaluating use of pain medications and attitudes of radiation oncology patients toward pain intervention

PURPOSE

Pain is a common symptom among cancer patients, yet many patients do not receive adequate pain management. Few data exist quantifying analgesic use by radiation oncology patients. This study evaluated the causes of pain in cancer patients and investigated the reasons patients fail to receive optimal analgesic therapy.

METHODS AND MATERIALS

An institutional review board-approved, Internet-based questionnaire assessing analgesic use and pain control was posted on the OncoLink (available at www.oncolink.org) Website. Between November 2005 and April 2006, 243 patients responded. They were predominantly women (73%), white (71%), and educated beyond high school (67%) and had breast (38%), lung (6%), or ovarian (6%) cancer. This analysis evaluated the 106 patients (44%) who underwent radiotherapy.

RESULTS

Of the 106 patients, 58% reported pain from their cancer treatment, and 46% reported pain directly from their cancer. The pain was chronic in 51% and intermittent in 33%. Most (80%) did not use medication to manage their pain. Analgesic use was significantly less in patients with greater education levels (11% vs. 36%, p = 0.002), with a trend toward lower use by whites (16% vs. 32%, p = 0.082) and women (17% vs. 29%, p = 0.178). The reasons for not taking analgesics included healthcare provider not recommending medication (87%), fear of addiction or dependence (79%), and inability to pay (79%). Participants experiencing pain, but not taking analgesics, pursued alternative therapies for relief.

CONCLUSIONS

Many radiation oncology patients experience pain from their disease and cancer treatment. Most study participants did not use analgesics because of concerns of addiction, cost, or failure of the radiation oncologist to recommend medication. Healthcare providers should have open discussions with their patients regarding pain symptoms and treatment.

Online cancer communication: meeting the literacy, cultural and linguistic needs of diverse audiences

OBJECTIVE

This article provides an analysis of issues and empirical evidence related to literacy, cultural, and linguistic factors in online health and cancer communication, and recommendations to improve cancer communication for diverse audiences.

METHODS

We examined English-language online literature and selected books and policy documents related to literacy, cultural, and linguistic factors in health and cancer communication.

RESULTS

Studies about literacy, cultural, and linguistic factors in online cancer communication for diverse audiences are limited, but have increased during the past 15 years. Empirical evidence and theoretical guidance describe the critical importance of these factors, significant unmet needs among low-literate, multicultural and non-English-speaking populations, and strategies to improve communication.

CONCLUSION

Overall, online cancer communication has not met the literacy, cultural, and linguistic needs of diverse populations. The literature offers valuable recommendations about enhancing research, practice, and policy for better cancer communication.

PRACTICE IMPLICATIONS

Practitioners should understand the strengths and weaknesses of online cancer communication for vulnerable groups, guide patients to better Websites, and supplement that information with oral and tailored communication.

Using health communication best practices to develop a web-based provider-patient communication aid: the CONNECT study

OBJECTIVE

Although there is broad consensus that careful content vetting and user testing is important in the development of technology-based educational interventions, often these steps are overlooked. This paper highlights the development of a theory-guided, web-based communication aid (CONNECT), designed to facilitate treatment decision-making among patients with advanced cancer.

METHODS

The communication aid included an on-line survey, patient skills training module and an automated physician report. Development steps included: (1) evidence-based content development; (2) usability testing; (3) pilot testing; and (4) patient utilization and satisfaction.

RESULTS

Usability testing identified some confusing directions and navigation for the on-line survey and validated the relevance of the "patient testimonials" in the skills module. Preliminary satisfaction from the implementation of the communication aid showed that 66% found the survey length reasonable and 70% found it helpful in talking with the physician. Seventy percent reported the skills module helpful and about half found it affected the consultation.

CONCLUSION

Designing patient education interventions for translation into practice requires the integration of health communication best practice including user feedback along the developmental process.

PRACTICE IMPLICATIONS

This developmental process can be translated to a broad array of community-based patient and provider educational interventions.

The role of the Internet in cancer patients' engagement with complementary and alternative treatments

This article draws on a study of 80 National Health Service cancer patients and their experiences of using the Internet within disease and treatment processes. It focuses on the role the Internet plays in the context of potential or actual engagement with complementary and alternative medicine (CAM). The results depart from previous conceptualizations of the Internet as a major source of CAM knowledge, and second, as a major pathway to patient CAM usage. Moreover, the results highlight significant anxiety as patients attempt to process vast amounts of complex biomedical diagnostic and prognostic information online. For patients attempting to embrace alternative therapeutic models of cancer care, exposure to prognostic data may pose considerable risks to individual well-being and engagement with healing practices. On the basis of these results we problematize social theorizations of the Internet as contributing to such things as: the democratization of knowledge; the deprofessionalization of medicine; and patient empowerment. We emphasize, instead, the potential role of the Internet in reinforcing biomedicine's paradigmatic dominance in cancer care.

Internet use by cancer survivors: current use and future wishes

OBJECTIVE

The objective of this study was to evaluate the extent of internet access and use and patient characteristics associated with internet use. We also aimed to study when and at which sites cancer patients search for information, the self-reported effect on health care use, and patients' wishes with respect to future internet possibilities.

MATERIALS AND METHODS

We drew a sample of 390 patients diagnosed with breast (n = 128), prostate (n = 96), or gynecological (n = 89) cancer or lymphoma (n = 77) in four different hospitals in the period 2002-2004, who were 65 years or younger at diagnosis. These patients were sent a questionnaire that contained 45 questions about demographics and three broad applications of internet use: content, communication, community.

RESULTS

Of the 261 (75%) patients who responded, 60% used Internet by themselves, 9% via others, whereas 31% did not use the Internet. High education, young age, and high socio-economic status were all independently positively associated with internet use. Of the patients with complaints but pre-diagnosis, 41% searched the Internet for information about cancer daily to several times a week. After diagnosis, during treatment, and at follow-up, this was, respectively, 71%, 56%, and 4%. Although patients preferred to get reliable information from the Web site of their oncologist (88%), hospital (70%) or Dutch Cancer Society (76%), Web sites that are completely financed and created by pharmaceutical industries were mentioned most as source of information. Patients who used the Internet to find information about cancer felt themselves to be better informed about their disease (72%); only 3% thought that consulting the Internet increased the frequency of visiting their doctor, whereas 20% felt that information from the Internet influenced the treatment decision made by their doctor. Most patients who use the Internet would like to be able to access their own medical file (79%) or test results (81%) if possible.

CONCLUSION

Many cancer patients use the Internet to find reliable information about their disease and treatment. Patient information centers from hospitals should be strongly encouraged to improve disease and treatment information facilities on their hospital Web site, especially since most patients view their oncologist still as the most important source of information.

Internet use by end-stage renal disease patients

Information on the prevalence and predictors of use of the Internet by patients can be applied to the design and promotion of healthcare Internet technologies. To our knowledge, few studies on Internet use by end-stage renal disease (ESRD) patients have been reported. The objectives of this study are to ascertain the prevalence and predictors of Internet use by ESRD patients among different dialysis modalities. A questionnaire surveying Internet use was delivered in person to 199 conventional hemodialysis patients (57 returned), and mailed to 170 peritoneal dialysis (PD) patients (42 returned), and 65 nocturnal home hemodialysis (NHD) patients (43 returned). Of the respondents, most (58%) have used the Internet to find information on their health condition. The strong majority (76%) of these patients have easy access to the Internet. A higher proportion of NHD patients (86%) used the Internet compared with the PD patients (60%) (p=0.02). Internet use was found to be more prevalent with younger (p<0.001), more educated (p=0.001), and Canadian-born patients (p=0.005). The high prevalence of Internet use and easy access to the Internet by ESRD patients suggest that future Internet information and communication systems for healthcare management in ESRD will likely be well adopted by this patient population.

Clinical trial resources on the internet must be designed to reach underrepresented minorities

PURPOSE

Internet-based clinical trial information services are being developed to increase recruitment to studies. However, there are limited data that evaluate their ability to reach elderly and underrepresented minority populations. This study was designed to evaluate the ability of an established clinical trials registry to reach these populations based on expected Internet use.

PATIENTS AND METHODS

This study compares general Internet users to participants who enrolled in an Internet based colorectal cancer clinical trials registry established by OncoLink (www.oncolink.org) and the National Colorectal Cancer Research Alliance. Observed rates of demographic groupings were compared to those established for general Internet users.

RESULTS

Two thousand, four hundred and thirty-seven participants from the continental United States used the Internet to register for the database. New England, the Mid-Atlantic region, and the Southeast had the highest relative frequency of participation in the database, whereas the Upper Midwest, California, and the South had the lowest rates. Compared to general Internet users, there was an overrepresentation of women (73% vs. 50%) and participants over 55 years old (27% vs. 14%). However, there was an underrepresentation of minorities (10.3% vs. 22%), particularly African Americans (3.1% vs. 8%) and Hispanics (2.8% vs. 9%).

DISCUSSION

The Internet is a growing medium for registry into clinical trials databases. However, even taking into account the selection bias of Internet accessibility, there are still widely disparate demographics between general Internet users and those registering for clinical trials, particularly the underrepresentation of minorities. Internet-based educational and recruitment services for clinical trials must be designed to reach these underrepresented minorities to avoid selection biases in future clinical trials.

The Influence of Race on the Attitudes of Radiation Oncology Patients Towards Clinical Trial Enrollment

OBJECTIVES

Enrollment of adult cancer patients in clinical trials remains low, particularly in the minority population. Understanding patient attitudes towards clinical trials during the recruitment process may enhance accrual. Unfortunately, data describing patient attitudes towards clinical trials are limited, particularly in the radiation oncology clinic setting.

METHODS

A piloted questionnaire assessing basic demographics and attitudes toward clinical trials was offered in 2 radiation oncology clinics between April 2003 and October 2003. The questionnaire was completed by 166 patients. The mean age of the patients completing the questionnaire was 56 years (range, 15-84 years). Of the 166 patients included in the analysis, 108 (65%) were White. The most common cancer diagnoses included prostate (19%), head and neck (16%), and breast (14%).

RESULTS

There was no statistical difference between Whites and non-Whites regarding their interest in learning about clinical trials (84.3% versus 84.9%, P = 0.92); nor was there a significant difference in the rate of previous or current trial enrollment (21.3% versus 34.0%, P = 0.08). White patients were more likely to gather information about clinical trials from the Internet (30.6% versus 11.3%, P = 0.007), and they were more likely to use physicians as a source of this information (50.0% versus 34.0%, P = 0.05). Non-White patients were more likely to obtain information about clinical trials from other patients (24.5% versus 12.0%, P = 0.04). In addition, more non-White patients believed they had been treated on clinical trials without their knowledge (21.6% versus 9.3%, P = 0.032). Patients differed somewhat in their expectations of clinical trials. More non-Whites indicated that they would need a >50% chance of benefiting from a trial (64.4% versus 45.0%, P = 0.03) to enroll on that trial, though there were no statistical differences in outlook towards potential toxicities associated with treatment on a clinical trial.

CONCLUSIONS

Minority patients historically enroll in clinical trials at a significantly lower rate. Our study of radiation oncology patients documents significant differences in attitudes towards clinical trials between Whites and non-Whites. Understanding the differences in attitudes may allow physicians to overcome barriers that would otherwise hinder the enrollment of non-White patients into clinical trials.

Information from the Internet: attitudes of Australian oncology patients

BACKGROUND

Patients require accurate information about their illness to make informed decisions. Many sources of information exist, although reliability is variable. Our objective was to investigate information seeking behaviour and attitudes toward health-related information from the Internet in a sample of Australian oncology patients.

METHOD

During their outpatient attendance, 109 patients completed a self-administered paper-pen format questionnaire. They were required to have a recent cancer diagnosis (<6 months ago) adequate English and no cognitive impairment.

RESULTS

Seventy-four per cent of questionnaires were returned. The majority of patients (78%) wanted as much information about their cancer diagnosis as possible and 90% reported receiving adequate information from their treating team. Despite this, more than half actively searched for additional information, with 77% using the Internet. Patients were trusting of information obtained from the Internet. More than half of information searchers discussed information obtained in their search with a health professional. The majority of patients did not believe that information searching adversely affected the doctor-patient relationship.

CONCLUSION

Information searching is common in ambulatory Australian oncology patients, with the Internet being a frequently used resource. To ensure patients find reliable and relevant information and to minimize the risk of harm, health professionals involved in treating oncology patients should provide guidance in finding information sources and assistance in interpreting the information obtained.

Breast cancer patients' attitudes toward clinical trials in the radiation oncology clinic versus those searching for trial information on the Internet

Web-based clinical trials matching systems including breast cancer patients are expanding rapidly. However, limited data exist regarding the demographics and attitudes of breast cancer patients using the Internet to search for clinical trials information. Biases in patient populations could be introduced by recruiting patients to trials through the Internet. This study was designed to compare breast cancer patients in the radiation oncology clinic to those using the Internet to search for clinical trials information. A piloted questionnaire assessing demographics and attitudes regarding clinical trials was offered through the radiation oncology clinic at the University of Pennsylvania and on the OncoLink website (http://www.oncolink.org). The questionnaire consisted of 18 questions and was answered by a total of 157 patients with breast cancer. Breast cancer patients using the Web were more likely to be interested in clinical trials testing new drugs or therapies (71 [53%] versus 4 [17%], p = 0.002). More clinic patients indicated they would need a greater than 50% chance of benefiting from a trial (12 [52%] versus 33 [25%], p = 0.01) and a less than 10% potential for serious toxicity from a trial (15 [65%] versus 51 [38%], p = 0.02) for consideration of enrollment. African Americans were more likely than other races to have never used the Internet to search for cancer-related information (4 [40%] versus 18 [12%], p = 0.01), more likely to indicate that they need a greater than 50% chance of benefit to enroll in clinical trials (8 [80%] versus 37 [25%], p = 0.001), and less likely to be interested in clinical trials testing new drugs or therapies (1 [10%] versus 73 [50%], p = 0.01). Breast cancer patients have different attitudes regarding clinical trials based on race, Internet usage, and previous trial enrollment. Biases may be introduced with recruitment for clinical trials through the Internet. Radiation oncologists must consider these issues when offering clinical trials information through the Internet.

Use of the internet by colorectal cancer patients

OBJECTIVE

To identify the frequency of Internet use by colorectal cancer patients.

MATERIALS AND METHODS

Fifty patients interviews.

RESULTS

Only four patients (8%) had used the internet to access information about colorectal cancer though 36% would have used it if a site had been recommended.

CONCLUSION

The Internet is a resource rarely used by patients but there is potential for its use as an adjunct to written and verbal information.

Searching for cancer-related information online: unintended retrieval of complementary and alternative medicine information

PURPOSE

The Web is an important source of health information for consumers. Use of complementary and alternative medicine (CAM) is also increasing. Therefore, we studied the likelihood that consumers will incidentally encounter CAM information while searching the Web and the factors that influence retrieval of CAM information.

METHODS

We evaluated results retrieved by 10 cancer-related searches on six common search engines.

RESULTS

Of 1121 search results, 16.2% displayed CAM information. Sponsored (i.e., paid) results were more likely to display CAM information than non-sponsored results (38% versus 7.5%, p < 0.001). In Overture and Google, sponsored results accounted for 51% and 39% of results on the first page. These search engines also retrieved more CAM web pages. Search engines distinguished sponsored and non-sponsored results, but disclosure statements describing the differences were confusing. Cancer type used as the search keyword did not influence the number of CAM web pages retrieved. However, synonyms of cancer differed in their retrieval of CAM web pages (p < 0.001). Consistent with prior studies of Web search engine overlap, we found that 28% of CAM results were retrieved by two or more search engines.

CONCLUSIONS

Clinicians should help consumers recognize sponsored results and encourage search engines to clearly explain sponsored results.

An Internet-based cancer clinical trials matching resource

Background

Many patients are now accessing the Internet to obtain cancer clinical trials information. However, services offering clinical trials recruitment information have not been well defined.

Objectives

This study describes one of the first Web-based cancer clinical trials matching resources and the demographics of users who were successfully matched.

Methods

OncoLink is the Internet-based educational resource managed by the University of Pennsylvania Cancer Center (UPCC) and serves between 1 and 2 million pages per month to over 385000 unique IP addresses. OncoLink launched one of the first clinical trials matching resources on the Internet that allowed patients to enter demographic data through a secure connection and be matched to clinical trials. For patients with matches to potential trials, appointments were facilitated with the principal investigators.

Results

While we did not keep track of patients who could not be matched, 627 patients who submitted online applications between January 2002 and April 2003 were successfully matched for potential enrollment in clinical trials. The mean age of the patient population was 56 years (range 18–88 years). Males represented 60% of the patient population, and over 90% of users were Caucasian. Most of the applications were from patients with colorectal cancer (13%), lung cancer (14%), melanoma (10%), and non-Hodgkin's lymphoma (9%).

Conclusions

This report shows that a significant number of patients are willing to use the Internet for enrolling in clinical trials. Care must be taken to reach patients from a variety of socioeconomic and racial backgrounds. This Internet resource helps to facilitate a consultation with a cancer patient who is prescreened and motivated to enroll in clinical trials.

Living with pulmonary artery hypertension: patients' experiences

BACKGROUND

Research on the outcomes of medical therapy in persons with pulmonary artery hypertension (PAH) has increased as new therapeutic options have emerged. Little investigation has been done on the impact of living with PAH despite inferences that quality of life (QOL) improves.

PURPOSE

The purpose of this qualitative study was to describe patient experiences of living with PAH and identify factors that may have an impact on QOL.

PARTICIPANTS

Participants (n = 11; 8 women, 3 men) were selected from among 42 adult patients, 40 to 72 years of age, followed in an outpatient setting at a tertiary care hospital. Multiple types of treatment modalities were represented including calcium channel blockers, endothelin-receptor antagonists, prostacyclin analog, and lung transplantation.

METHODS

Semistructured interviews allowed participants to describe experiences living with PAH. Interviews were recorded on audiotape and transcribed verbatim. Analysis was conducted in accordance with Colaizzi's 7-step process for analysis of phenomenologic data.

RESULTS

Two overarching themes emerged indicating that participants experience uncertainty associated with a variety of aspects of this illness but also learn to cope with this uncertainty and move on with their lives.

IMPLICATIONS

Assisting patients to cope with the uncertainty associated with this chronic health problem is essential if patients are to successfully adjust to the demands of the illness and its treatment. Attention to the findings of this study should guide health care professionals in their efforts to improve QOL in this patient population.

Recruitment of patients into an internet-based clinical trials database: the experience of OncoLink and the National Colorectal Cancer Research Alliance

PURPOSE

In March 2001, the National Colorectal Cancer Research Alliance (NCCRA) and OncoLink (http://www.oncolink.org) established a database to facilitate patient enrollment onto clinical trials. This study describes the population registering with the database and identifies discrepancies between individuals registering through the Internet and those registering through a telephone call center.

METHODS

Participants registered with the NCCRA/OncoLink database through the Internet or a telephone call center. All participants entering the database completed a questionnaire regarding basic demographics, colon cancer risk factors, and indicated how they became aware of the database. Comparisons were made between individuals registering through the Internet and those registering through the telephone call center.

RESULTS

A total of 2,162 participants registered during the first 16 months of the database. Most patients registered through the Internet rather than the telephone call center (88% v 12%; P < .001). More females than males registered (73% v 27%; P < .001). The majority (89%) were white. Participants registering through the Internet were younger than those registering through the call center (mean, 48.8 v 55.0 years; P < .001). There was no difference between the two groups with regard to sex or ethnicity.

CONCLUSION

The Internet has the potential to increase the likelihood that interested individuals find appropriate clinical trials. Some of the discrepancies that are known to exist for access to the Internet were also seen for those registering with the database through the Internet. Despite these differences, the potential to increase clinical trial enrollment with this type of Internet-based database is high.

Intensity-modulated radiotherapy and the Internet

BACKGROUND

The objective of the current study was to evaluate the content and quality of patient-oriented information regarding intensity-modulated radiotherapy (IMRT) on the Internet.

METHODS

IMRT websites were identified by reviewing the first 50 uniform resource locators on 5 search engines using the search terms IMRT and intensity modulated radiation therapy. Each site was evaluated by three observers for informational content, presentation, accuracy, and balance. A score of low, moderate, or high was assigned to each category based on a predefined scoring system. An overall score was assigned to each site, ranging from -35 to 100 points.

RESULTS

Seventy-seven patient-oriented IMRT websites were identified (45% private, 21% academic, and 18% commercial). Most sites (58%) had a low level of informational content, with information on fundamental aspects of IMRT planning (target delineation and inverse planning) appearing on < 50% of sites. The most commonly discussed tumors were genitourinary (65%) and head and neck (53%) lesions. Few sites, however, described the potential benefits of IMRT (toxicity and tumor control). Most sites (82%) used patient-appropriate language. False and/or misleading information was seen on 42% of sites and was equally common on academic, private, and commercial sites. Balance statements were present on 24% of sites (most of which were commercial). The median overall score was 20 points (range, -25 to 70 points). The median overall scores for academic, private, commercial, and other sites were 10, 20, 25, and 20 points, respectively (P = 0.26).

CONCLUSIONS

In general, the content and quality of patient-oriented information regarding IMRT on the Internet were poor. Patients and their physicians need to be aware of these problems when selecting treatment courses.

Use of information resources by patients with cancer and their companions

BACKGROUND

Use of the Internet is common among patients with cancer and their companions. However, little is known about patterns of use of print or telephone-based resources amidst growing Internet utilization, nor is it known whether different types of information are sought from electronic compared with print media. It is not clear as to whether patients and their companions differ in their patterns of content seeking.

METHODS

A survey was developed to evaluate the use of electronic and nonelectronic informational resources by patients and their companions. During a 10-week period, this questionnaire was administered to 443 outpatients and 124 paired companions attending an urban academic cancer center.

RESULTS

In this cohort, 64% of patients and 76% of companions were computer owners, with home Internet access indicated by 58% and 68%, respectively. Use of the Internet to obtain cancer-related information was reported by 44% of patients and 60% of companions. Print resources were used by 79% of patients and 83% of companions, with telephone resources used by 22% and 23%, respectively. The majority of Internet users also read print content (85%), whereas one-half of print users did not access data electronically (52%). Topic areas sought via print and the Internet were similar, with the exception of nutrition-related information, which was more commonly sought in print texts. There was a high rate of concordance between patient and companion use of both electronic and nonelectronic resources.

CONCLUSIONS

Despite recent publicity and scrutiny focusing on the quality of Internet health care content, print products remain the most common source of information sought by patients with cancer. Future investigation should focus on the quality of print products used by patients.

Searching for cancer information on the internet: analyzing natural language search queries

Background

Searching for health information is one of the most-common tasks performed by Internet users. Many users begin searching on popular search engines rather than on prominent health information sites. We know that many visitors to our (National Cancer Institute) Web site, cancer.gov, arrive via links in search engine result.

Objective

To learn more about the specific needs of our general-public users, we wanted to understand what lay users really wanted to know about cancer, how they phrased their questions, and how much detail they used.

Methods

The National Cancer Institute partnered with AskJeeves, Inc to develop a methodology to capture, sample, and analyze 3 months of cancer-related queries on the Ask.com Web site, a prominent United States consumer search engine, which receives over 35 million queries per week. Using a benchmark set of 500 terms and word roots supplied by the National Cancer Institute, AskJeeves identified a test sample of cancer queries for 1 week in August 2001. From these 500 terms only 37 appeared ≥ 5 times/day over the trial test week in 17208 queries. Using these 37 terms, 204165 instances of cancer queries were found in the Ask.com query logs for the actual test period of June-August 2001. Of these, 7500 individual user questions were randomly selected for detailed analysis and assigned to appropriate categories. The exact language of sample queries is presented.

Results

Considering multiples of the same questions, the sample of 7500 individual user queries represented 76077 queries (37% of the total 3-month pool). Overall 78.37% of sampled Cancer queries asked about 14 specific cancer types. Within each cancer type, queries were sorted into appropriate subcategories including at least the following: General Information, Symptoms, Diagnosis and Testing, Treatment, Statistics, Definition, and Cause/Risk/Link. The most-common specific cancer types mentioned in queries were Digestive/Gastrointestinal/Bowel (15.0%), Breast (11.7%), Skin (11.3%), and Genitourinary (10.5%). Additional subcategories of queries about specific cancer types varied, depending on user input. Queries that were not specific to a cancer type were also tracked and categorized.

Conclusions

Natural-language searching affords users the opportunity to fully express their information needs and can aid users naïve to the content and vocabulary. The specific queries analyzed for this study reflect news and research studies reported during the study dates and would surely change with different study dates. Analyzing queries from search engines represents one way of knowing what kinds of content to provide to users of a given Web site. Users ask questions using whole sentences and keywords, often misspelling words. Providing the option for natural-language searching does not obviate the need for good information architecture, usability engineering, and user testing in order to optimize user experience.