Cancer-Related Information Seeking Among Cancer Survivors: Trends Over a Decade (2003-2013)

Prevalence and influencing factors of kinesiophobia in patients with heart disease: a meta-analysis and systematic review

This study aims to assess the global prevalence of kinesiophobia and the potential influencing factors among patients with heart disease. A comprehensive search was conducted in PubMed, Embase, Web of Science, PsycINFO, and Scopus databases to identify studies reporting on the prevalence of kinesiophobia and its influencing factors in heart disease patients up to January 2024. A random-effects model was employed to aggregate prevalence rates. Heterogeneity sources were investigated through subgroup analysis, while differences in the prevalence of kinesiophobia across regions, types of heart disease, and gender were evaluated. Additionally, a qualitative analysis of the factors influencing kinesiophobia was performed. This research incorporated 15 studies from six countries, with 14 providing data on the prevalence of kinesiophobia and nine exploring its potential influencing factors. The findings indicated that the overall prevalence of kinesiophobia among heart disease patients was 61.0% (95% CI 49.4-72.6%). Subgroup analysis revealed that the prevalence in upper-middle-income countries was 71.8% (95% CI 66.2-77.4%), while it stands at 49.9% (95% CI 30.2-69.5%) in high-income countries. The prevalence rates among patients with coronary artery disease, heart failure, and atrial fibrillation were 63.2% (95% CI 45.2-81.3%), 69.2% (95% CI 57.6-80.8%), and 71.6% (95% CI 67.1-76.1%), respectively. Gender-wise, no significant difference was observed in the prevalence of kinesiophobia between men and women (52.2% vs. 51.8%). A total of 24 potential influencing factors of kinesiophobia were identified, with education level, monthly income, anxiety, and exercise self-efficacy being the most recognized. The prevalence of kinesiophobia in patients with heart disease is notably high and is influenced by a multitude of factors. Early implementation of targeted preventive measures is imperative to mitigate the incidence of kinesiophobia in this population.

Attitudes toward subsequent primary cancer prevention among survivors of childhood, adolescent, and young adult (CAYA) cancer in Japan: results of a comprehensive questionnaire survey on long-term women's health after CAYA cancer

OBJECTIVE

Prevention of subsequent primary cancer (SPC) is crucial for cancer survivors, particularly those who developed the disease during childhood, adolescence, and young adulthood (CAYA). The aim of this study was to assess the current status of SPC prevention among female CAYA cancer survivors.

METHODS

A survey regarding long-term health issues after cancer treatment was conducted using questionnaires that targeted women aged ≥20 years who had developed cancer before the age of 40 years. The survey assessed various health issues, and this paper focuses on the items related to the respondents' perceptions and attitudes toward SPC prevention.

RESULTS

A total of 1,026 respondents were analyzed. Over 60% of respondents were aware of SPC and the need for screening. The percentages of respondents who underwent regular SPC screening were 68.3%, 68.4%, 49.7%, 58.6%, and 57.0% for cervical, breast, lung, and gastric cancers, respectively. After adjusting for age, type of first cancer, and current follow-up, we found that receiving recommendations for SPC screening was the most critical factor in SPC screening uptake (odds ratio=3.836; 95% confidence interval=2.281-6.451; p<0.001 by logistic regression analysis). However, only 40.4% of the respondents received recommendations for SPC screening from their physicians.

CONCLUSION

Despite good awareness of SPC prevention, the uptake rate for cancer screening among cancer survivors was inadequate, indicating that preventive measures for SPC should be promoted. Because recommendations from others strongly influence SPC screening uptake, healthcare professionals should have accurate knowledge and provide guidance regarding SPC prevention.

"The Materials Didn't Really Seem to Apply to Me": A Focus-Group Study on Young Women's Needs and Perspectives on Breast Cancer Educational Material

Young women breast cancer survivors face unique challenges in navigating diagnosis and treatment information while also navigating their own life demands (i.e., fertility, childcare, careers). Special consideration to printed and online cancer educational materials distributed to young women should be evaluated for their suitability, but few studies have investigated the educational preferences and needs of young women cancer survivors. We sought to explore young women breast cancer survivors' needs and preferences regarding cancer educational material from diagnosis to survivorship. We used a qualitative design with convenience sampling of young women breast cancer survivors who completed active treatment at a medical center within the last 5 years to participate in semi-structured online focus groups from November 2020 to May 2021. Thirty-three young women (75.8% White, 12.1% Black, 12.1% other) participated in one of seven online focus groups, each lasting approximately 2 h. Four dominant themes emerged from the data: (1) initial interaction with online materials; (2) reasons for seeking printed and online materials; (3) disconnection of visuals; and (4) recommendations. Our findings revealed that young women were initially hesitant to seek online information, but later sought printed and online information after specific endorsement of materials. Current breast cancer materials lack content specific to young women's needs (i.e., reconstruction options), and graphics have little age and racial diversity. Oncology nurses may consider novel methods of education delivery, such as short videos to be shared easily on social media for specific content like scarring results and reconstruction options.

Accuracy, readability, and quality of websites about metastatic renal cell carcinoma treatment

OBJECTIVES

Patients with metastatic renal cell carcinoma (mRCC) face complex treatment decisions and frequently turn to the Internet for treatment information. The content of patient educational websites about mRCC treatment has not been evaluated. This study evaluated the accuracy, readability, and quality of websites about the treatment of mRCC.

METHODS

A total of 2,700 Internet queries were performed. Across 3 Internet search engines, 25 links of 36 permutations of mRCC keywords and their synonyms were screened for eligibility. Eligible websites were English-language websites containing information about mRCC treatments. Sponsored, social media, provider-facing, and news websites were excluded. Accuracy of eligible websites was evaluated in 2 domains: (1) Completeness by calculating the percentage of mRCC facts included in websites using an investigator-created checklist based on the NCI's RCC Treatment (PDQ®)-patient version, and (2) Correctness by identifying incorrect statements that were inconsistent with guidelines. Websites containing ≥60% of checklist items had a "passing" completeness score. Incorrect statements were tallied and qualitatively categorized. Readability was evaluated using the Fry and SMOG formulae, which calculate reading grade levels. Quality was evaluated using validated instruments that appraise health information quality: QUEST (scored 0-28), which focuses on online information, and DISCERN (scored 16-80), which focuses on treatment choices.

RESULTS

Thirty-nine websites were analyzed. Mean completeness score was 30% (range 0%-69%); only 2 (5%) websites had a passing score. Twelve (31%) websites had ≥1 incorrect statement, such as listing homeopathy or hormone therapy as mRCC treatment options, or including outdated statements. Mean readability levels were 11th and 12th grades for the Fry and SMOG methods, respectively. No website had a reading level lower than 9th grade. Mean QUEST score was 19 (range 9-28); authorship, complementarity, and currency items had the lowest scores. Mean DISCERN score was 56 (range 42-76), with 7 (18%) websites rated "excellent", 22 (56%) rated "good", and 10 (26%) rated fair.

CONCLUSIONS

Many websites about mRCC treatment have incomplete, inaccurate, and unreadable information. Quality is highly variable. Efforts to improve accuracy, readability, and quality are needed to ensure that patients with mRCC can make well-informed treatment decisions and avoid harm from misinformation.

Linking patient-centered communication with cancer information avoidance: The mediating roles of patient trust and literacy

OBJECTIVES

This study, drawing on the pathway mediation model developed by Street and his colleagues (2009) that links communication to health outcomes, explores how patient-centered communication affects cancer information avoidance.

METHODS

Data was gathered through online access panel surveys, utilizing stratified sampling across Germany, Switzerland, the Netherlands, and Austria. The final sample included 4910 non-cancer and 414 cancer patients, all receiving healthcare from clinicians within the past year.

RESULTS

The results demonstrated that patient-centered communication is directly associated with reduced cancer information avoidance, especially among cancer patients. Additionally, this association is indirectly mediated through patient trust and healthcare literacy.

CONCLUSION

The findings provide empirical evidence that reveals the underlying mechanism linking clinician-patient communication to patient health information behavior.

PRACTICE IMPLICATIONS

The potential of clinician-patient communication in addressing health information avoidance is highlighted by these findings. Future interventions in healthcare settings should consider adopting patient-centered communication strategies. Additionally, improving patient trust and literacy levels could be effective in reducing cancer information avoidance.

Exploring Health Information-Seeking Behavior and Information Source Preferences Among a Diverse Sample of Cancer Survivors: Implications for Patient Education

This study examined health information-seeking behavior among cancer survivors, including informational sources used and the factors correlated with information-seeking across different racial/ethnic groups. We used data from the Health Information National Trends Survey (2017-2022). Adjusted logistic regression was conducted to identify the predictors of information-seeking by race/ethnicity. Predicting variables were organized into demographic (age, education, race, income, and comorbidity), enabling (having health insurance, having a regular provider, and frequency of care visits), predisposing (quality of care, self-efficacy, and confidence in one's ability to get information), and reinforcing (patient-centered communication, ease of getting information, and confusing information available) factors based on the PRECEDE-PROCEED Model. We included 4723 cancer survivors, of which 15.41% have breast cancer, 17.50% have skin cancer, and 11.11% have prostate cancer. A majority (75.08%) had sought health information. Healthcare providers were the most preferred sources of information across demographic groups, followed by the Internet. Health insurance, a regular provider, and frequent visits were enabling factors that positively influenced information-seeking behavior. Confidence in getting information when needed and self-efficacy were predisposing factors positively associated with the information-seeking behavior. Finally, reinforcing factors (ease of getting information and non-confusion of the information available) were also positively associated with information-seeking. Study findings suggest that one-fourth of cancer survivors had not sought cancer-related information. The results have implications for identifying patients at increased risk for unmet information needs. They also contribute to our understanding of critical racial differences and similarities. Further, findings can help guide interventions to assist in information seeking based on patient preferences.

Cancer incidence and digital information seeking in Germany: a retrospective observational study

Awareness is vital for cancer prevention. US studies show a strong link between web searches and cancer incidence. In Europe, the relationship remains unclear. This study characterizes regional and temporal relationships between cancer incidence and web searches and investigates the content of searches related to breast, cervical, colorectal, lung, prostate, and testicular cancer, brain tumors, and melanoma in Germany (July 2018-December 2019). Aggregate data from Google Ads Keyword Planner and national cancer registry data were analyzed. Spearman's correlation coefficient (rS) examined associations between cancer incidence and web search, repeated measures correlation (rrm) assessed time trends and searches were qualitatively categorized. The frequency of malignancy-related web searches correlated with cancer incidence (rS = 0.88, P = 0.007), e.g., breast cancer had more queries than the lower-incidence cervical cancer. Seasonally, incidence and searches followed similar patterns, peaking in spring and fall, except for melanoma. Correlations between entity incidence and searches (0.037 ≤ rrm ≤ 0.208) varied regionally. Keywords mainly focused on diagnosis, symptoms, and general information, with variations between entities. In Germany, web searches correlated with regional and seasonal incidence, revealing differences between North/East and South/West. These insights may help improve prevention strategies by identifying regional needs and assessing impact of awareness campaigns.

Assessing the needs of patients with breast cancer and their families across various treatment phases using a Latent Dirichlet Allocation model: a text-mining approach to online health communities

PURPOSE

This study aimed to assess the different needs of patients with breast cancer and their families in online health communities at different treatment phases using a Latent Dirichlet Allocation (LDA) model.

METHODS

Using Python, breast cancer-related posts were collected from two online health communities: patient-to-patient and patient-to-doctor. After data cleaning, eligible posts were categorized based on the treatment phase. Subsequently, an LDA model identifying the distinct need-related topics for each phase of treatment, including data preprocessing and LDA topic modeling, was established. Additionally, the demographic and interactive features of the posts were manually analyzed.

RESULTS

We collected 84,043 posts, of which 9504 posts were included after data cleaning. Early diagnosis and rehabilitation treatment phases had the highest and lowest number of posts, respectively. LDA identified 11 topics: three in the initial diagnosis phase and two in each of the remaining treatment phases. The topics included disease outcomes, diagnosis analysis, treatment information, and emotional support in the initial diagnosis phase; surgical options and outcomes, postoperative care, and treatment planning in the perioperative treatment phase; treatment options and costs, side effects management, and disease prognosis assessment in the non-operative treatment phase; diagnosis and treatment options, disease prognosis, and emotional support in the relapse and metastasis treatment phase; and follow-up and recurrence concerns, physical symptoms, and lifestyle adjustments in the rehabilitation treatment phase.

CONCLUSION

The needs of patients with breast cancer and their families differ across various phases of cancer therapy. Therefore, specific information or emotional assistance should be tailored to each phase of treatment based on the unique needs of patients and their families.

'Only to reconcile with it'. The coping experience amongst middle-aged and older cancer survivors: A qualitative study

BACKGROUND

Cancer threat is relevant to age, and the threat of a foreshortened life coupled with a lengthy treatment process negatively affects middle-aged and older adults. Understanding the coping throughout the cancer experience in middle-aged and older cancer survivors will help develop supportive care to promote their physiological and psychological coping effects.

OBJECTIVES

To explore the cancer coping experiences of middle-aged adults aged 40-59 and older adults over 60.

DESIGN

A descriptive phenomenological study was employed.

METHODS

Face-to-face, in-depth, semistructured interviews were conducted with 22 oncology patients in a tertiary university hospital aged 40 or above from August to October 2023. The interview data were analyzed using thematic analysis procedures.

RESULTS

Five themes and 13 subthemes were formed through analysis: acceptance of cancer (considering cancer as chronic, believing in fate and attributing cancer to karma); having different information needs (desired to be truthfully informed, information-seeking behaviour, information avoidance behaviour); getting families involved (developing dependent behaviours, feeling emotional support, family members suffering worse); striving to maintain positive psychological state (positive thinking, seeking peer support) and negative experience (undesirable, low self-esteem).

CONCLUSION

Our study reveals that cancer survivors' attitudes towards having cancer have changed from a death sentence to a more positive perception of a chronic disease. Supportive programmes for developing coping strategies should consider the cultural traditions and religious beliefs, different information needs, involvement of family and promoting a positive psychological state while avoiding negative factors.

PATIENT OR PUBLIC CONTRIBUTION

Participants with experience of coping with cancer were involved in the semistructured interview.

Exploring how members of the public access and use health research and information: a scoping review

BACKGROUND

Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information.

PURPOSE

This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information.

METHODS

Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010-2022 on the public's access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews.

RESULTS

The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public's sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of 'health information' but a lack of reporting of the general public's access to and use of health research. It found that 'traditional' sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people's lived experiences, and the cultural knowledge required.

CONCLUSIONS

The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.

Understanding the Process of Family Cancer History Collection and Health Information Seeking

PROBLEM ADDRESSED

To better understand the factors associated with family cancer history (FCH) information and cancer information seeking, we model the process an individual undergoes when assessing whether to gather FCH and seek cancer information and compare models by sociodemographics and family history of cancer. We used cross-sectional data from the Health Information National Trends Survey (HINTS 5, Cycle 2) and variables (e.g., emotion and self-efficacy) associated with the Theory of Motivated Information Management to assess the process of FCH gathering and information seeking. We completed path analysis to assess the process of FCH gathering and stratified path models.

RESULTS

Those who felt they could lower their chances of getting cancer (emotion) were more confident in their ability to complete FCH on a medical form (self-efficacy; B = 0.11, p < .0001) and more likely to have discussed FCH with family members (B = 0.07, p < .0001). Those who were more confident in their ability to complete a summary of their family history on a medical form were more likely to have discussed FCH with family members (B = 0.34, p < .0001) and seek other health information (B = 0.24, p < .0001). Stratified models showed differences in this process by age, race/ethnicity, and family history of cancer.

IMPLICATIONS FOR PUBLIC HEALTH RESEARCH AND PRACTICE

Tailoring outreach and education strategies to address differences in perceived ability to lower chances of getting cancer (emotion) and confidence in the ability to complete FCH (self-efficacy) could help encourage less engaged individuals to learn about their FCH and gather cancer information.

Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults

There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.

Hematopoietic Cell Transplantation Patient-Caregiver Dyad Perspectives on Participation in a Digital Storytelling Intervention: A Qualitative Approach

Storytelling has long been considered an effective means of communication, allowing the teller to process their emotions in light of particular life challenges. Effects on the listener also have been demonstrated to be beneficial, especially if the listener is faced with a similar life challenge. Less is known regarding the potential effects of storytelling on listening dyads and opportunities for joint processing following exposure to relevant stories. We sought to study these phenomena in the context of hematopoietic cell transplantation (HCT), a demanding medical procedure requiring intensive informal caregiving and thus great patient-caregiver entwinement. The purpose of this qualitative descriptive study was to explore participants' perceptions of a 4-week web-based digital storytelling (DST) intervention using both quantitative ratings of acceptability and qualitative coding of interviews conducted after intervention completion. A total of 202 participants (101 HCT patient-caregiver dyads) were recruited from the Mayo Clinic Arizona and randomized into either a DST arm or an Information Control (IC) arm. Participants in the DST arm rated the acceptability of the intervention and were asked to participate in a 30-minute phone interview to discuss their experience with the DST intervention. All interviews were recorded and transcribed verbatim and imported into NVivo 12 for coding and analysis, using a combination of deductive and inductive approaches to organize the data, create categories, and develop themes and subthemes. A total of 38 participants (19 HCT patient-caregiver dyads) completed the post-intervention interviews. Patients were 63% male and 82% White, 68% received allogeneic HCT, and their mean age was 55 years. The median time from HCT was 25 days (range, 6 to 56 days). Caregivers were mostly patients' spouses (73%) and female (69%), with a mean age of 56 years. In general, the 4-week web-based DST intervention was well accepted and liked by both patients and caregivers regarding the duration, dyadic participation, and convenience of participating in the intervention at home. Patients and caregivers who completed the DST intervention indicated that they were satisfied with the intervention (mean score, 4.5 of 5), were likely to recommend it to others (mean score, 4.4), would watch more stories (mean score, 4.1), and that the experience was worth their time (mean score, 4.6). Major themes that emerged from the qualitative analysis included (1) building communal connection through engaging with the stories; (2) positive emotional growth after HCT; (3) value of gaining the other's perspective; and (4) impact of open communication on the patient-caregiver relationship. A web-based DST intervention provides an attractive format through which to deliver a nonpharmacologic psychosocial intervention to HCT patient-caregiver dyads. Watching the emotional content in digital stories may help patients and caregivers cope with psychoemotional challenges together and provide an opportunity for emotional disclosure. Further work on determining optimal paths to disclosure is warranted.

Evaluation of quality, readability, suitability, and usefulness of online resources available to cancer survivors

PURPOSE

The aim of this study was to evaluate the quality, readability, suitability, and usefulness of resources publicly available to adult cancer survivors (aged 18 +) who have completed primary treatment.

METHODS

Resources were identified in July 2021 through Google. Search completeness was verified using Yahoo, Bing, and MedlinePlus. Retrieved resources were assessed for quality using the DISCERN, readability, suitability using the Suitability Assessment Measure (SAM), and usefulness based on a list of unmet needs and self-management skills derived from the literature. Descriptive analyses were conducted, and a cluster analysis identified the highest-scoring resources.

RESULTS

Forty-five resources were included. The mean DISCERN score was fair at 63.3% (SD 13.7%) with low-rated items being sources, publication date, and risks and mechanisms of treatment. The mean reading grade level was 11.19 (SD 1.61, range 8-16) with only one resource scoring an 8. The mean SAM score was in the adequate range at 48.2% (SD 10.6%), with graphics being the lowest-rated section. On average, included resources addressed 57.7% (SD 27.3%) of the unmet needs and 48.4% (SD 20.9%) of the self-management skills, the least addressed being problem-solving.

CONCLUSION

Quality and suitability were fair, whereas readability exceeded recommended levels. Only one resource had a superior score in both quality and suitability.

IMPLICATIONS FOR CANCER SURVIVORS

The most pressing need is to develop resources for cancer survivors that address their unmet needs and are accessible in terms of literacy. Study findings outline the highest-scoring resources currently available to survivors, families, and clinicians.

Chronic Diseases and Sociodemographic Characteristics Associated With Online Health Information Seeking and Using Social Networking Sites: Nationally Representative Cross-sectional Survey in Japan

BACKGROUND

In an aging society, worsening chronic diseases increase the burden on patients and the health care system. Using online health information including health information via social networking sites (SNSs), such as Facebook and YouTube, may play an important role in the self-management of chronic diseases and health promotion for internet users.

OBJECTIVE

This study aims to improve strategies for promoting access to reliable information for the self-management of chronic diseases via the internet, and to identify populations facing barriers to using the internet for health, we examined chronic diseases and characteristics associated with online health information seeking and the use of SNSs.

METHODS

This study used data from the INFORM Study 2020, which was a nationally representative cross-sectional postal mail survey conducted using a self-administered questionnaire in 2020. The dependent variables were online health information seeking and SNS use. Online health information seeking was assessed using 1 question about whether respondents used the internet to find health or medical information. SNS use was assessed by inquiring about the following 4 aspects: visiting SNSs, sharing health information on SNSs, writing in an online diary or blog, and watching a health-related video on YouTube. The independent variables were 8 chronic diseases. Other independent variables were sex, age, education status, work, marital status, household income, health literacy, and self-reported health status. We conducted a multivariable logistic regression model adjusted for all independent variables to examine the associations of chronic diseases and other variables with online health information seeking and SNS use.

RESULTS

The final sample for analysis comprised 2481 internet users. Hypertension or high blood pressure, chronic lung diseases, depression or anxiety disorder, and cancer were reported by 24.5%, 10.1%, 7.7%, and 7.2% of respondents, respectively. The odds ratio of online health information seeking among respondents with cancer was 2.19 (95% CI 1.47-3.27) compared with that among those without cancer, and the odds ratio among those with depression or anxiety disorder was 2.27 (95% CI 1.46-3.53) compared with that among those without. Further, the odds ratio for watching a health-related YouTube video among those with chronic lung diseases was 1.42 (95% CI 1.05-1.93) compared with that among those without these diseases. Women, younger age, higher level of education, and high health literacy were positively associated with online health information seeking and SNS use.

CONCLUSIONS

For patients with cancer, strategies for promoting access to websites with reliable cancer-related information as well as access among patients with chronic lung diseases to YouTube videos providing reliable information may be beneficial for the management of these diseases. Moreover, it is important to improve the online environment to encourage men, older adults, internet users with lower education levels, and those with low health literacy to access online health information.

Toward an Extended Infodemiology Framework: Leveraging Social Media Data and Web Search Queries as Digital Pulse on Cancer Communication

This study aims to extend the infodemiology framework by postulating that effective use of digital data sources for cancer communication should consider four components: (a) content: key topics that people are concerned with, (b) congruence: how interest in cancer topics differ between public posts (i.e., tweets) and private web searches, (c) context: the influence of the information environment, and (d) information conduits. We compared tweets (n = 36, 968) and Google web searches on breast, lung, and prostate cancer between the National Cancer Prevention Month and a non-cancer awareness month in 2018. There are three key findings. First, reliance on public tweets alone may result in lost opportunities to identify potential cancer misinformation detected from private web searches. Second, lung cancer tweets were most sensitive to external information environment - tweets became substantially pessimistic after the end of cancer awareness month. Finally, the cancer communication landscape was largely democratized, with no prominent conduits dominating conversations on Twitter.

Understanding the Pathway of Cancer Information Seeking: Cancer Information Services as a Supplement to Information from Other Sources

Cancer information services (CISs) can play an important role within the pathway of cancer information seeking, but so far, this role is not well understood. Callers (n = 6,255) who contacted the largest provider of cancer information in Germany participated in a survey in which they reported their information sources, information level, and needs leading to the call. Persons with prior information from a physician (n = 1,507) were compared to people with prior online information (n = 901) and people with prior information from both sources (n = 2,776). Nearly all callers (96.7%) stated prior sources, while physicians and the Internet were the most frequently reported sources. People, who only talked to a doctor before, are more likely to be a patient and in the disease stages during/after the first treatment or with recurrence than prior Internet users. The two groups do not differ in their prior information level but did differ in their information needs. CISs are an important supplement to other sources, while the information repertoire depends on patients' stages during the cancer journey. Specific characteristics and needs of callers with different prior information sources help to individualize the service of CISs and similar providers.

The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis

BACKGROUND

With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors.

OBJECTIVE

To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis.

METHODS

The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale.

RESULTS

Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors.

CONCLUSIONS

Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.

Ethnic differences in utilization of online health information sources: A test of the social inequality hypotheses

The goal of the current study was to understand ethnic differences in use of online health information sources. Social stratification and social diversification hypotheses were used as study’s theoretical framework. The data were obtained from the 2017 Israel Social Survey (N = 2166). Multinomial and logistic regression techniques were used for the multivariate analysis. The results suggest that Israeli Arab respondents were less likely than Israeli-born Jewish respondents to seek health information using the Health Funds’ call centers or websites, other websites, and to utilize any number of the online health information sources. The findings provide a strong support for the social stratification hypothesis. The findings imply that members of minority population should be more encouraged to use (public) online health information sources as a means of taking greater responsibility for their health as well as for the health of their communities.

Cultural Differences in Cancer Information Acquisition: Cancer Risk Perceptions, Fatalistic Beliefs, and Worry as Predictors of Cancer Information Seeking and Avoidance in the U.S. and China

Cancer is one of the most common causes of death in China and the United States. Past studies found that cancer risk perceptions, fatalistic beliefs, and worry were prominent predictors of health-related behaviors. Perceived cancer risks, fatalistic beliefs, and worry were associated with cancer information acquisition in the United States. However, little is known about whether these factors played comparable roles in China. This study investigates the psychological antecedents of cancer information acquisition using data from Health Information National Trends Surveys (HINTS) in both countries. Results showed that cancer worry was negatively related to cancer information avoidance in the U.S. but positively related to information avoidance in China. Also, whereas cancer fatalistic beliefs were negatively associated with cancer information seeking in the U.S., the relationships between fatalistic beliefs and cancer information seeking exhibited more complex patterns in China. Implications for cancer communication in different cultures are discussed.

Feasibility of a Digital Storytelling Intervention for Hematopoietic Cell Transplant Patients

Patients undergoing hematopoietic cell transplantation (HCT) are at risk for psychological and social impairment given the rigors and multiple sequelae of treatment. The purpose of this pilot study was to test the feasibility of a digital storytelling (DS) intervention for HCT patients, and to examine limited efficacy of the intervention relative to control arm on psychological distress and perceived social support. Adult HCT patients (n = 40, M age = 59.2 years) were enrolled immediately post-HCT and randomly assigned to either DS intervention or information control (IC). DS participants viewed four 3-min personal, emotionally rich digital stories, and IC condition participants viewed four videos containing information about post-HCT care. Feasibility regarding recruitment, enrollment efforts, and change scores from pre- to post-intervention (Δs) on depression, anxiety, and perceived social support were tracked. Fifty-four (51.4%) of 105 eligible patients consented. Forty (74%) patients completed the intervention. All but one completed the post-intervention assessments demonstrating that HCT patients can be recruited and retained for this intervention. On average, perceived social support increased for the DS group (Δ = 0.06) but decreased for the IC group (Δ = - 0.05). Anxiety and depression improved over time in both conditions. Viewing digital stories with content evoking emotional contexts similar to one's own health challenges may improve perceptions of social support among HCT patients. How DS can improve perceived social support for both short-term and longer-term sustained effects in a longitudinal study is an area ripe for additional investigation.

The usefulness of YouTube videos on lung cancer

BACKGROUND

The use of social media as a source of health information is increasing, and the usefulness of the content may vary depending on the specific disease. Thus, this study was designed to assess the content, viewer engagement and usefulness of the most viewed YouTube videos on lung cancer.

METHODS

167 videos were reviewed, and 143 met the eligibility criteria. Two authors evaluated the videos separately, and data on views, likes, dislikes and comments were extracted, and data on the source of uploader, duration and content quality were recorded.

RESULTS

89 videos (62%) were classified as useful, 8 (6%) as misleading and 46 (32%) as neither. The misleading videos were significantly more popular in terms of views and likes compared with the useful videos: 845 643 versus 81 700, P = 0.003 and 12 170 versus 415, P < 0.001, respectively.

CONCLUSIONS

This study shows that YouTube videos on lung cancer are popular and that around two-thirds of the videos are useful in terms of patient education. However, the misleading videos are currently attracting higher viewer interaction and might compose a future challenge in terms of the spread of misinformation as the algorithms will prioritize popular videos rather than videos with evidence-based information.

Nutrition and physical activity in cancer patients: a survey on their information sources

BACKGROUND

Many cancer patients suffer from problems concerning nutrition and physical activity (PA) during and after their treatment. Forwarding reliable health information could help to alleviate severe symptoms. The present study aimed to examine cancer patients' commonly used information sources on nutrition and PA.

METHODS

An anonymous questionnaire was developed and distributed to German cancer patients in different settings. In total, 90 questionnaires have been completed between October 2021 and March 2022. For analysis, descriptive statistics were used and associations between information sources and patients' lifestyle behaviour explored utilising Spearman's Rho, Mann-Whitney U, and Pearson's Chi Square tests.

RESULTS

The cancer patients received information on nutrition and PA most frequently from physicians (70.9%), family and friends (68%) and browsing the internet (61.3%). Half of the patients (51.1%) had questions concerning these topics during the time of their disease. The majority of those patients (81.8%) reported that their questions were answered. The topics were addressed primarily with outpatient oncologists (60.0%) and in rehabilitation clinics (53.3%). Just about half of the patients (55.3%) felt satisfactorily informed on nutrition and PA in their cancer disease, more so if they talked to their oncologist or family physician (Z = - 2.450, p = 0.014 and Z = - 3.425, p = 0.001 resp.).

CONCLUSION

Cancer patients receive information on nutrition and PA predominantly after their initial treatment. Since they might be missing significant information to alleviate severe symptoms during their treatment, the importance of nutrition and PA should be emphasised by clinicians early on in treatment.

TRIAL REGISTRATION

Trial Registration Number (May 7, 2021): 2021-2149-Bef.

The Past and Present of Breast Cancer Resources: A Re-evaluation of the Quality of Online Resources After Eight Years

Background and objective

The internet has become a major resource of information for cancer patients. However, the quality of these resources is variable, and a better understanding is needed to guide physicians as to how to best support patients in their online searches. We previously evaluated the quality of online breast cancer resources in 2011. Nearly a decade later, we aimed to assess the present quality of online breast cancer-related information and to compare our current analysis with data collected in 2011.

Methods

A list of 100 breast cancer websites was systematically compiled using meta-search engines Yippy and Dogpile and the search engine Google using the search term “breast cancer”. Content accuracy and quality markers, including authorship, attribu­tion, currency, site organization, and readability were assessed by using a previously validated standardized rating tool. Results were analyzed using descriptive statistics and Fisher’s exact test. The same strategy was used in both 2011 and 2019.

Results

When comparing 2011 data to the current one, 27% of websites had been updated in the previous two years in 2011 compared to 65% in 2019 (p<0.00001). Both data sets remained similar in terms of website disclosures and objectivity. Only 30% of websites analyzed in 2019 used two or more reliable sources, while 63% had no reliable sources or no sources cited. From 2011 to 2019, resources with readability above grade 12 increased from 4% to 30% (p<0.0001), while websites offering educational support rose from 8% to 35% (p<0.0001). In 2019, treatment and etiology/risk factors were the most accurately covered areas (64% and 63% of websites, respectively). In 2011, 63% of websites were found to be globally accurate. Prognosis coverage increased from 18% to 33% from 2011 to 2019 (p=0.02). In 2019, survivorship was also evaluated and found to be covered in only 24% of resources.

Conclusion

Over the past eight years, there have been variable changes in the quality of online breast cancer resources. Promisingly, websites are being updated more frequently and the educational support offered is expanding. Furthermore, there has been significant improvement in the coverage of prognosis, although this requires further progress. Unfortunately, websites are becoming increasingly challenging to understand for the average patient, and coverage of survivorship is lacking. Our study provides vital information to healthcare providers on these trends in online breast cancer resources and how to best support patients in their internet searches.

Association of the Extent of Cancer Patients’ Internet Use with Social Support among Patients and Change in Patient-reported Treatment Outcomes during Inpatient Rehabilitation: Cross-Sectional and Longitudinal Study. (Preprint)

BACKGROUND

Given the increasing number of cancer survivors and their rising survival rates, rehabilitation plays an increasingly important role. Social support among patients is an essential element of inpatient and day care rehabilitation. The internet can empower patients with cancer to become more active health care consumers and facilitate information and supportive care needs. By contrast, therapists suspect that high internet use during rehabilitation may severely limit social interactions between patients, thus interfering with the patients' rehabilitation program and jeopardizing treatment success.

OBJECTIVE

We hypothesized that the extent of internet use would be negatively related to social support among patients with cancer during their clinical stay as well as fewer improvements in patient-reported treatment outcomes from the first to the last day of their clinical stay.

METHODS

Patients with cancer participated during their inpatient rehabilitation. Cross-sectional data, such as the extent of participants' internet use and perceived social support among patients, were collected during the last week of their clinic stay. The treatment outcomes, that is, participants' levels of distress, fatigue, and pain, were collected on the first and last day of the clinic stay. We used multiple linear regression analysis to study the association between the extent of internet use and social support among patients with cancer. We used linear mixed model analyses to study the association between the extent of internet use by patients with cancer and the change in patient-reported treatment outcomes.

RESULTS

Of the 323 participants, 279 (86.4%) participants reported that they used the internet. The extent of the internet use (t₃₁₅=0.78; P=.43) was not significantly associated with the perceived social support among the participants during their clinical stay. In addition, the extent of participants' internet use during their clinical stay was not associated with changes in participants' levels of distress (F_1,299=0.12; P=.73), fatigue (F_1,299=0.19; P=.67), and pain (F_1,303=0.92; P=.34) from the first to the last day of their clinical stay.

CONCLUSIONS

The extent of internet use does not seem to be negatively associated with the perceived social support among patients with cancer or with the change in patients' levels of distress, fatigue, or pain from the first to the last day of their clinical stay.

Filling the gaps of patient information needs and information perception in chronic myeloid leukemia with the patient-physician co-produced web-based platform CMyLife

BACKGROUND

For patients with chronic myeloid leukemia, a web-based platform CMyLife was developed. Its aim is to enhance patient empowerment, by adequate information provision, among others. Before evaluating its effect, information provision and needs in current care were assessed.

OBJECTIVE

To assess patients' evaluation of received information and information needs before CMyLife utilization and whether this information source is used correspondingly. Additionally, we explored predicting patient factors in information perception.

PATIENT INVOLVEMENT

CMyLife platform was developed with active patient participation.

METHODS

We conducted a cross-sectional survey among 203 CML patients before launch of the CMyLife platform, using validated questionnaires on information provision and predictive factors. We focused on website utilization during the first 3 years, using Google Analytics. Regression analyses were performed to determine influence of patient factors on information perception.

RESULTS

Global perceived information provision was scored 42.8 (0-100). Information on other services such as rehabilitation and psychological support, and effects of treatment on sexuality showed room for improvement. One out of 3 knew where to find useful health information online. But more information was desired by 36% of them. Age ≥65 years, time since diagnosis and low education were positively associated with this need. Pages on medication and side effects were visited the most.

DISCUSSION

To fill the gap in perceived provision and needs, information should be adjusted more to the individual in content, manner and timing. Age, time since diagnosis, and educational level are of influence in perceived information, and specific needs within these groups should be further explored.

PRACTICAL VALUE

CMyLife provides reliable and up-to-date information for low eHealth literacy skilled patients concerning multiple topics indicated by patients.

Correlates of Information Seeking Behaviors and Experiences Among Adult Cancer Survivors in the USA

Understanding information seeking behaviors and experiences is essential for designing educational and supportive interventions to promote survivor's self-management post treatment. This study examined health and cancer information seeking, use of internet to find cancer information, and information seeking experiences among breast, colorectal, and prostate cancer survivors. Nationally representative data collected in 2017-2018 from 2 cycles of the Health Information National Trends Survey (HINTS 5, cycles 1 and 2 were merged with combined replicate weights using the jackknife replication method (n = 373). Regression analysis for three information seeking behaviors (i.e., health information, cancer information, and internet for cancer information) were modeled, including sociodemographic and clinical factors as predictors. In addition, separate regression analysis predicted three experiences of information seeking (effort, quality, and hard to understand) with sociodemographic and clinical factors. A majority of survivors (84.7%) sought health information. Factors significantly associated with seeking health information were gender (p = 0.024), education (p = 0.0021), and income (p = 0.018). Only 38% of survivors used the internet to seek cancer-related information. The only factor significantly associated with using the internet to seek cancer-related information was time since diagnosis (p = 0.0002). The factor significantly associated with difficulty understanding information was annual household income (p = 0.026). This study fills an important gap by identifying sociodemographic and cancer-related factors associated with information seeking behaviors and experiences. These findings highlight a need to tailor information for low socioeconomic status survivors to account for the lack of skills, resources, and motivation to seek information about health and cancer related topics independently.

Results of the ECHO (Eating habits CHanges in Oncologic patients) Survey: An Italian Cross-Sectional Multicentric Study to Explore Dietary Changes and Dietary Supplement Use, in Breast Cancer Survivors

The role of a healthy diet in cancer prevention is well recognized. Recent data indicate that following the same advices can also improve cancer survivors’ quality of life. Breast cancer (BC) patients are commonly concerned about diet and nutrition and frequently express the need to obtain health-related information and the will to change their diet and lifestyle. Hence, be aware of survivors’ dietary changes and information needs is crucial for healthcare professionals to guide them toward optimal lifestyle choices. In order to investigate eating habits changes in a BC survivors’ population, we conceived the cross-sectional multicentric study ECHO (Eating habits CHanges in Oncologic patients) Survey. Data were collected from 684 patients, diagnosed with invasive breast cancer, in order to investigate their changes in food consumption, use of supplements, or the beginning of a specific diet, after BC diagnosis. We also examined the sources of information used and if any modification in their diets was reported to the oncologist. We primarily observed that patients increased their consumption of vegetables, pulses, nuts, fruits, wholemeal bread/pasta, grains and fish; while decreasing red and processed meat, refined bread/pasta, baked good and animal fat consumption. Survivors also reported the use of dietary supplements, mainly vitamins, aimed at counteracting therapies’ side effects. Changes in nutritional habits were often adopted without asking or informing the oncologist. Despite BC survivors made some positive changes in their nutritional habits, those modifications were mostly pursued by less than half of them, while the majority of patients consumed nutritional supplements after diagnosis. These results, as well as the failure to communicate with the physicians, reinforce the need to both improve the patient-healthcare professional relationship and to develop tailored nutrition counselling and intervention programs for cancer survivors.

Identifying the gaps in Irish cancer care: Patient, public and providers' perspectives

BACKGROUND

The University of Limerick Cancer network (ULCaN) was established in 2019 with funding from the Health Research Institute at the University of Limerick in order to build a network between individuals in academia, primary and secondary care and the general public so that cancer services can be coordinated and more effective. The aim of this paper is to outline our experience of engaging with stakeholders to identify gaps in the cancer journey locally.

METHODS

Four focus group discussions were conducted with patients; their carers; members of the public; and healthcare providers with 2 main aims: 1) to investigate gaps in cancer services; 2) to identify knowledge, attitudes and opportunities available to promote cancer research. The focus groups were audio recorded, transcribed and thematically analysed.

RESULTS

15 themes within the topics of cancer care, palliation, communication, clinical trials, diet and exercise and public and patient involvement in research and advocacy were identified. These include directing people to reliable information and navigating misinformation and stigma linked with cancer, promoting awareness of clinical trials and palliative care services and improving communication when multiple healthcare providers are involved.

CONCLUSION

The need to make more coherent, efficient and integrated cancer research amongst local stakeholders was evident. Embedding patients and members of the public into ULCaN is an important deliverable for collaborative research.

Youtube as a Source of Patients' and Specialists' Information on Hemorrhoids and Hemorrhoid Surgery

BACKGROUND

In the past, most people sought medical information by consulting health care professionals. Nowadays, many people started to use online resources to access medical information.

OBJECTIVE

The study aims to investigate whether YouTube videos on hemorrhoids and hemorrhoid surgery can be a useful e-learning source for the general population, surgical trainees and specialists.

METHODS

A YouTube search was performed in October 2019 using the keywords "hemorrhoids" and "hemorrhoid surgery", and the videos were divided into 2 groups according to the keywords. Three independent researchers assessed the metadata and classified them according to the level of accuracy (hemorrhoid group) and the level of usefulness (hemorrhoid surgery group). Cohen's test and Kappa (K) value were used to evaluate the inter-investigators agreement.

RESULTS

A total of 200 videos were analyzed, 100 for each keyword. Regarding the hemorrhoid group, 43 videos (48.3%) were misleading, 9 were accurate (10.1%), 18 were approximate (20.2%), and 19 were considered a personal experience (21.4%). Regarding the hemorrhoid surgery group, around 60% of the videos were lacking a clear explanation, while about 16% were inaccurate. Only the remaining 24% were considered useful for teaching.

CONCLUSION

Around half of the YouTube videos regarding hemorrhoids topic were found to be misleading or inaccurate and present a risk of harmful consequences. Credible videos with accurate information need to be uploaded by medical professionals and medical institutions and some sort of filtering, using categories by the staff of YouTube, appears to be necessary. Care must be taken to produce clear, high-quality operative clips with proper scientific commentary.

The unique information and communication needs of men affected by prostate cancer: A qualitative study of men's experience

OBJECTIVE

The objective of this study is to explore the specific information and communication needs of men affected by prostate cancer to inform the development of educational materials for clinicians.

METHODS

This is a qualitative descriptive study. A purposive sampling strategy was used to identify men at different cancer stages and with experience of different treatment regimens. Semistructured interviews (25) were conducted with 19 men and six carers over the phone. Interview data were analysed using a framework approach.

RESULTS

Four themes emerged: gaps in the information provided by secondary care doctors and nurses, communication skills needed in effective clinical information provision, a need for individualised information and alternative information sources used to meet unmet needs. Regardless of cancer stage and treatment, men with prostate cancer and their carers found information regarding common and burdensome adverse effects of prostate cancer treatment particularly lacking, and their ongoing and changing information needs often overlooked. They needed information delivered in a compassionate and individually tailored manner, considering content, timing and emotional support within the context of their unique life circumstances.

CONCLUSION

Clinicians often fail to recognise the need for or deliver patient-centred conversations about treatment, managing side effects and prognosis. The findings will be used to develop clinician-facing educational materials.

A qualitative study of online information-seeking preferences among cancer survivors

Purpose

As the cancer survivor population increases, diminished health care provider capacity will place more responsibility on survivors to obtain health information. Many survivors search for cancer information online, yet there is a dearth of research on how survivors obtain and engage with this information. This study examined cancer survivors’ information-seeking behaviors and perceptions during a self-guided online search task.

Methods

Ten adult cancer survivors (largely breast and thyroid) completed a task in which they searched for online cancer-related information of their choice. Participants were asked to verbally narrate the procedural aspects of the task and provide real-time responses to the search results and experiences related to the task. Transcripts were analyzed using a qualitative descriptive approach, and codes and themes were examined and interpreted.

Results

Participants searched primarily for information specific to their cancer type and stage, seeking personalized information about risk factors, prognosis, and treatments. Additionally, participants reported having to engage in excessive navigation to find relevant cancer information, citing aesthetic, usability, and credibility features of the websites that they considered barriers to obtaining this information.

Conclusions

Survivors’ online health information needs require streamlined cancer information resources that are disaggregated by cancer type, stage, and treatment course and located on websites with aesthetic and usability features that facilitate expedient searches for personally relevant cancer information.

Implications for Cancer Survivors

This study provides useful perspectives of cancer survivors that may inform the development of online cancer resources to better serve this population.

Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study

Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE.

Predictors of Health Information-Seeking Behavior: Systematic Literature Review and Network Analysis

Background

People engage in health information–seeking behavior to support health outcomes, and being able to predict such behavior can inform the development of interventions to guide effective health information seeking. Obtaining a comprehensive list of the predictors of health information–seeking behavior through a systematic search of the literature and exploring the interrelationship of these predictors are critical first steps in this process.

Objective

This study aims to identify significant predictors of health information–seeking behavior in the primary literature, develop a common taxonomy for these predictors, and identify the evolution of the concerned research field.

Methods

A systematic search of PsycINFO, Scopus, and PubMed was conducted for all years up to and including December 10, 2019. Quantitative studies identifying significant predictors of health information–seeking behavior were included. Information seeking was broadly defined and not restricted to any source of health information. Data extraction of significant predictors was performed by 2 authors, and network analysis was conducted to observe the relationships between predictors with time.

Results

A total of 9549 articles were retrieved, and after the screening, 344 studies were retained for analysis. A total of 1595 significant predictors were identified. These predictors were categorized into 67 predictor categories, with the most central predictors being age, education, gender, health condition, and financial income. With time, the interrelationship of predictors in the network became denser, with the growth of new predictor grouping reaching saturation (1 new predictor identified) in the past 7 years, despite increasing publication rates.

Conclusions

A common taxonomy was developed to classify 67 significant predictors of health information–seeking behavior. A time-aggregated network method was developed to track the evolution of the research field, showing the maturation of new predictor terms and an increase in primary studies reporting multiple significant predictors of health information–seeking behavior. The literature has evolved with a decreased characterization of novel predictors of health information–seeking behavior. In contrast, we identified a parallel increase in the complexity of predicting health information–seeking behavior, with an increase in the literature describing multiple significant predictors.

Meeting the Information and Support Needs of Blood Cancer Patients and Caregivers: A Longitudinal Study of a Model of Patient-Centered Information Delivery

Access to reliable, up-to-date information and resources can assist individuals managing and living with cancer. The Leukemia & Lymphoma Society, through its Information Resource Center, provides personalized information and support to individuals affected by blood cancer. To examine its value and impact, we conducted qualitative interviews (n = 18) and an online survey of patients and caregivers (N = 515) after they talked with an Information Resource Center Information Specialist by phone, with a follow-up survey about 6 months later. Respondents most commonly contacted the Information Resource Center to get referrals to support programs (40.4%) and to obtain information about getting a second opinion (36.5%) and financial assistance (36.2%). After talking with an Information Specialist, respondents felt more hopeful (85.9%), more confident in managing care (82.9%), and more knowledgeable about their diagnosis (49.5%) and financial resources (42.4%). After speaking with an Information Specialist, respondents changed how they advocated for themselves/loved one (23.8%), changed how they communicated with doctors/other providers and family/friends (both 15.9%), received financial assistance (22.2%), and took other actions. Among respondents who took actions, most said that the conversation(s) had positively impacted the action. Respondents who spoke with an Information Specialist more than once were more likely to report positive impacts, including changing how they advocate for themselves/loved one and communicate with providers (both p < 0.05). Respondents diagnosed more recently were also more likely to report positive impact, including changing the way they communicate with providers (p < 0.05). Findings highlight the value of cancer helplines and suggest ways they can be most effective.

Cancer Clinicians' Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study

BACKGROUND

Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients' needs and can provide further insight into the type of app and features that might be most beneficial.

OBJECTIVE

This study aims to explore cancer clinicians' views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored.

METHODS

A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians' workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients' age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition.

CONCLUSIONS

This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process.

Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey

INTRODUCTION

Discussion of cancer genetic testing with health-care providers (HCPs) is necessary to undergo testing to inform cancer risk assessment and prevention. Given the rapid evolution in genetic testing practice in oncology, we describe the current landscape of population-level cancer genetic testing behaviors.

METHODS

A questionnaire including items regarding discussion of cancer genetic testing with HCPs was administered to a nonprobability sample (N = 2,029) of the Texas population.

RESULTS

Overall, 11% of respondents discussed cancer genetic testing with HCPs. In multivariable analysis, discussion was significantly related to having a personal history of breast/ovarian/colon cancer (OR = 11.57, 95% CI = 5.34-25.03), personal history of other cancer (OR = 3.18, 95% CI = 1.69-5.97), and health information-seeking behaviors (OR = 1.73, 95% CI = 1.12-2.66). Surprisingly, respondents who believed that inherited predispositions in addition to other modifiable risk factors cause cancer were less likely to discuss genetic testing compared to those who did not believe that inherited cancer predispositions cause cancer (OR = 0.54, 95% CI = 0.36-0.79).

DISCUSSION

The high discussion rate may be attributed to increased public awareness of genetic testing and adoption of more inclusive clinical genetic testing guidelines. The findings suggest that efforts to increase public awareness of the utility of genetic testing on personalized cancer risk assessment and cancer prevention are needed.

Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States

Background

In response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends.

Methods

We used Google Trends to query search terms related to cancer types for short-term (September 2019–September 2020) and long-term (September 2016–September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation.

Results

General search interest declined for all cancer types beginning in March 2020, with changes in search interest for “Breast cancer,” “Colorectal cancer,” and “Melanoma” of − 30.6%, − 28.2%, and − 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for “Telemedicine” has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020.

Conclusion

We observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10552-021-01409-1.

Feel Worried, Overloaded, or Fatalistic? The Determinants of Cancer Uncertainty Management Preferences

Uncertainty in the context of cancer involves a complex and conflicting decision-making process. Individual preferences of seeking or avoiding information in the decisions of maintaining, reducing, or increasing uncertainty often depend on key cancer-related beliefs. The present study investigates whether cancer worry (CW), information overload (CIO), or fatalism (CF) can predict four constructs of uncertainty management preferences - avoid to maintain hope, avoid insufficient information, seek to increase uncertainty, and seek to reduce uncertainty. A hybrid model with structural and measurement components was specified and tested. The model analysis shows that cancer-related beliefs influenced individuals' needs and preferences for uncertainty management through seeking or avoiding information. CW was positively related to all but avoiding insufficient information. CIO was positively associated with all four preferences. CF was only associated with avoiding to maintain uncertainty. Theoretical and practical implications were discussed.

Development of a New Tool for Better Social Recognition of Cancer Information and Support Activities Under the National Cancer Control Policy in Japan

Under the recent trend of an increasing number of cancer survivors, there is a need to devise measures for visualization of medical care and public health programs related to cancer control, which will enable better overview of the activities at hospitals and local communities and allow various stakeholders to share the information about such activities. The aim of this study was to propose a new tool for proper implementation of cancer information and support programs provided under the national cancer control policy in Japan. Considering 5 elements reported by Handler et al (macro context, mission, structural capacity, processes, and outcomes), we conducted the focus group discussions to confirm the goals of activities of Cancer Information and Support Centers. Eventually, 2 final goals ("reduction in the number of patients/families having difficulties related to cancer" and "being able to live at ease even after diagnosis of cancer") were identified, accompanied by 5 semifinal goals and 16 prerequisite conditions needed to achieve the final goals, as well as the necessary states and the activity indicators corresponding to them. This tool was utilized by 180 (42.7%) of 422 cancer care hospitals designated by the government of Japan (designated cancer care hospitals [DCCHs]) in 2016 and by 336 (77.1%) of 436 DCCHs in 2018, which were the data at 6 months and 3 years after introduction of the tool, respectively. Thus, the tool for evaluating the Cancer Information and Support Centers' activity presented here is expected to stimulate the stakeholders involved in providing supports in various fields of each local community, to share the final goals, to evaluate the status of their achievement, and to further advance their own activities.

Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey

BACKGROUND

Despite being motivated to improve nutrition and physical activity behaviors, cancer survivors are still burdened by suboptimal dietary intake and low levels of physical activity.

OBJECTIVE

The aim of this study was to assess changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, barriers to eating a healthy diet and staying physically active, and sources for seeking nutrition advice reported by breast cancer survivors.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

The study included 315 survivors of breast cancer who were recruited through social media and provided completed responses to an online exploratory survey.

MAIN OUTCOME MEASURES

Self-reported changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, perceived barriers to healthy eating and physical activity, and sources of nutrition advice were measured.

STATISTICAL ANALYSIS

Frequency distribution of nutrition and physical activity behaviors and changes, barriers to healthy eating and physical activity, and sources of nutrition advice were estimated.

RESULTS

About 84.4% of the breast cancer survivors reported at least 1 positive behavior for improving nutrition and physical activity after cancer diagnosis or treatment. Fatigue was the top barrier to both making healthy food choices (72.1%) and staying physically active (65.7%), followed by stress (69.5%) and treatment-related changes in eating habits (eg, change in tastes, loss of appetite, and craving unhealthy food) (31.4% to 48.6%) as barriers to healthy eating, and pain or discomfort (53.7%) as barriers to being physically active. Internet search (74.9%) was the primary source for seeking nutrition advice. Fewer than half reported seeking nutrition advice from health care providers.

CONCLUSIONS

Despite making positive changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, breast cancer survivors experience treatment-related barriers to eating a healthy diet and staying physically active. Our results reinforce the need for developing tailored intervention programs and integrating nutrition into oncology care.

Odds of Meeting Cancer Prevention Behavior Recommendations by Health Information Seeking Behavior: a Cross-Sectional HINTS Analysis

People who seek health information frequently may be more likely to meet health behavior goals; however, people use many different information sources. The purpose of this paper is to assess how different sources of health information influence likelihood of meeting cancer prevention behavior guidelines. Logistic regression of cross-sectional data from 6 years of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included first source of health information, gender, age, race, education level, income, cancer history, general health, and data year; dependent variables were fruit and vegetable intake, exercise, smoking, mammography, Pap test, and colon cancer screening. Those who seek health information from doctors, the internet, or publications had higher odds of meeting more cancer prevention guidelines than those who do not seek health information. Those who used healthcare providers as an initial information source had higher odds of meeting diet, cervical, and colon cancer screening recommendations, while using the internet as an initial source of health information was associated with higher odds of meeting diet, smoking, and colon cancer screening recommendations. No health information source was associated with meeting either exercise or mammography recommendations. People should be encouraged to seek health information to help them meet their behavior goals, especially from sources that are more likely to be accurate and encourage cancer prevention behavior. Future research is needed to understand the accuracy of health information and what kinds of health information have positive influences on cancer prevention behavior.

Cancer Information-seeking in an Age of COVID-19: Findings from the National Cancer Institute's Cancer Information Service

Seeking cancer information is recognized as an important, life-saving behavior under normal circumstances. However, given the significant impact of COVID-19 on society, the healthcare system, and individuals and their families, it is important to understand how the pandemic has affected cancer information needs in a crisis context and, in turn, how public health agencies have responded to meeting the information needs of various audiences. Using data from the National Cancer Institute's Cancer Information Service (CIS) - a long-standing, multi-channel resource for trusted cancer information in English and Spanish - this descriptive analysis explored differences in cancer information-seeking among cancer survivors, caregivers, tobacco users, and members of the general public during the onset and continuation of the COVID-19 pandemic (February - September 2020), specifically comparing interactions that involved a discussion of COVID-19 to those that did not. During the study period, COVID-19 discussions were more likely to involve survivors or caregivers compared to tobacco users and the general public. Specific patterns emerged across the four user types and their respective discussions of COVID-19 related to language of service, point of CIS access, stage on the cancer continuum, subject of interaction, cancer site discussed, and referrals provided by the CIS. These results provide insights that may help public health agencies deliver, prioritize, and tailor their messaging and response to specific audiences based on heightened health information needs during a crisis.

The Influence of Patient-Provider Communication on Cancer Screening

Few studies have examined how different qualities and modes (face-to-face vs electronic) of patient-provider communication (PPC) influence cancer screening uptake. Our objective was to determine whether receiving a breast, cervical, and colorectal cancer screening is influenced by (1) qualities of face-to-face and (2) the use of e-mail PPC. We analyzed Health Information National Trends Survey 4, cycles 1 to 4 data. To assess qualities of face-to-face PPC, adults reported how often physicians spent enough time with them, explained so they understood, gave them a chance to ask questions, addressed feelings and emotions, involved them in decisions, confirmed understanding, and helped them with uncertainty. Adults reported whether they used e-mail PPC. We used multivariable logistic regression to evaluate the odds of receiving cancer screenings based on face-to-face and e-mail PPC. Adults whose health-care providers involved them in decision-making had highest odds of receiving breast (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.11-1.71), cervical (OR = 1.30; 95% CI = 1.06-1.60), and colorectal (OR = 1.25; 95% CI = 1.03-1.51) cancer screenings. No significant associations were observed between e-mail PPC and cancer screenings. More research is needed to explore this association.

Decisional involvement and information preferences of patients with hematologic malignancies

Understanding decisional involvement and information preferences in patients with hematologic malignancies may help to optimize physician-patient communication about treatment decisions and align the decision-making processes with patients' preferences. We described and examined factors associated with preferences of patients with hematologic malignancies for decisional involvement, information sources, and presentation of information. In a multicenter observational study, we recruited 216 patients with hematologic malignancies of any stage from September 2003 to June 2007. Patients were asked about their decisional involvement preferences (Control Preferences Scale), information sources (including most useful source of information), and preferences for their oncologists' presentation of treatment success information. We used multivariate logistic regressions to identify factors associated with decisional involvement preferences and usefulness of information sources (physicians vs nonphysicians). Patient-directed, shared, and physician-directed approaches were preferred in 34%, 38%, and 28% of patients, respectively. Physicians and computer/Internet were the most common information sources; 42% perceived physicians as the most useful source. On multivariate analysis, patients with less than a college education (vs postgraduate education) were less likely to perceive their physician as the most useful source (adjusted odds ratio [AOR], 0.46; 95% confidence interval (CI), 0.21-1.00), whereas patients with acute leukemia (vs other blood cancers) were more likely to perceive their physician as the most useful source (AOR, 2.49; 95% CI, 1.07-5.80). In terms of communicating treatment success rates, 70% preferred ≥1 method(s), and 88% preferred presentation in percentages. Our study suggests that decisional involvement and information preferences vary and should be assessed explicitly as part of each decision-making encounter.

General and Health-Related Internet Use Among Cancer Survivors in the United States: A 2013-2018 Cross-Sectional Analysis

BACKGROUND

A significant proportion of cancer survivors endorse ongoing health information needs and may use the internet to access information. We assessed patterns and predictors of general and health-specific internet use among cancer survivors.

METHODS

Using data from the National Health Interview Survey (NHIS), which was administered in 2013 through 2018, for adults reporting a cancer diagnosis, sample weight-adjusted estimates defined prevalence and multivariable logistic regressions defined adjusted odds ratios (aORs) of general and health-specific internet use, adjusting for relevant sociodemographic covariates, including healthcare satisfaction as the primary independent variable. The analysis for health-specific internet use was also repeated including a sex (female vs male)*healthcare satisfaction (very satisfied/somewhat satisfied vs somewhat dissatisfied/very dissatisfied) interaction term.

RESULTS

Among 12,970 survivors of cancer, general and health-specific internet use increased from 2013 to 2018 (from 63.2% to 70.8% and from 46.8% to 52.2%, respectively; P<.05 for both). Survivors who were very dissatisfied with healthcare were more likely to use the internet for health information compared with those who were very satisfied (59.5% vs 48.0%; aOR, 1.78; 95% CI, 1.20-2.64; P=.004). Younger age, female sex, higher educational attainment, and higher socioeconomic status were all associated with increased reported use of the internet for both general and health-specific purposes (P<.001 for all). There was a significant sex*healthcare satisfaction interaction (P=.009) such that for female survivors, healthcare dissatisfaction was associated with higher odds of health-specific internet use (61.4% vs 52.5%; P<.001; men, P=.97). No association was found between healthcare satisfaction and general internet use (P=.42).

CONCLUSIONS

The increasing proportion of survivors of cancer using the internet for health-specific information may be associated with self-reported dissatisfaction with healthcare. Efforts are needed to improve both access to the internet and the quality of cancer-relevant online health information, and to enhance patients' online health literacy.

Who Enrolls in an Online Cancer Survivorship Program? Reach of the INSPIRE Randomized Controlled Trial for Hematopoietic Cell Transplantation Survivors

The internet can be a valuable tool in delivering survivorship care to hematopoietic cell transplantation (HCT) cancer survivors. We describe the reach of INSPIRE, an Internet and social media-based randomized controlled trial, to address healthcare and psychosocial needs of HCT survivors. All survivors 2-10 years after HCT for hematologic malignancy or myelodysplasia from 6 transplantation centers in the US were approached by mail and follow-up calls. Eligible participants had access to the Internet, an email address, and did not have active disease in the past 2 years. We used logistic regression to determine characteristics of eligible survivors who were more or less likely to enroll. Of 2578 eligible HCT survivors, 1065 (41%) enrolled in the study. The mean age of enrollees was 56.3 ± 12.6 years (range, 19 to 89 years), 52% were male, and 94% were white. Survivors less likely to enroll included those who were male, age <40 years, and who received an autologous transplant (all P < .001). Compared with white survivors, African Americans were less likely to enroll (P < .001), whereas Native Americans/Alaska Natives were more likely to join the study (P = .03). The reach of the INSPIRE program was broad, including to survivors who traditionally have less access to resources, such as Native Americans/Alaskan Natives and rural residents. Strategies are still needed to improve the enrollment of online studies of survivorship resources for males, young adults, African American, and autologous HCT survivors because their use may improve outcomes.

Beliefs and Information Seeking in Patients With Cancer in Southwest China: Survey Study

Background

Although previous studies have reported the cancer information-seeking behaviors among patients in high-income countries, the cancer information-seeking practices of patients living in low- and middle-income areas are less known.

Objective

This study investigated the beliefs and information-seeking patterns of cancer patients in southwest China.

Methods

A questionnaire was designed, and data were collected in two hospitals (N=285) in southwest China. Statistical analyses included bivariate analyses and regressions.

Results

Patients’ attitudes towards cancer fatalism were significantly influenced by marital status (P<.001), education (P<.001), and household income (P<.001). Moreover, endorsing fatalistic belief was positively associated with age (r=0.35, P<.001). The regression model showed that younger patients (odds ratio [OR] 0.96, 95% CI 0.93-0.99) and those with higher education (OR 1.75, 95% CI 1.09-2.81) were more likely to seek information. Additionally, patients who were less confident in getting information were more likely to find information (OR 1.70, 95% CI 1.15-2.52), while fatalism belief was not significant in the regression (OR 0.65, 95% CI 0.22-1.95).

Conclusions

This study explored the information-seeking patterns of cancer patients in southwest China. It was found that many Chinese people endorsed cancer fatalism. These pessimistic beliefs about the potential to prevent and to cure cancer correlate with rather than cause cancer-related information seeking. However, self-efficacy about the confidence in finding needed cancer information was a significant predictor of information-seeking.

Exploring the topic structure and evolution of associations in information behavior research through co-word analysis

This study aims to reveal the distribution of topics, and the associations among them, in information behavior research from 2009 to 2018. Working with a collection of 6744 publications from the Web of Science database, co-word analysis is used to investigate the overall topic structure, the associations among the topics, and their evolution in different years, which is supplemented by visualization with science maps. The results uncovered an unbalanced distribution of topics, and that the topics cluster into six communities representing subdivisions of this field: information behavior in patient-centered studies; information interaction in the digital environment; information literacy in health and academic contexts; health literacy on the Internet; information behavior in child-centered studies; and information behavior in medical informatics. The findings supplement and provide refinements to work on the state of this field, and help researchers obtain an overview of the past decade to guide their future work.