The who and the what of usage of two cancer online communities

"Online, the counselor can't see me cry": a systematic literature review on emotion and computer-mediated care

Introduction

Computer-mediated care is becoming increasingly popular, but little research has been done on it and its effects on emotion-related outcomes. This systematic literature review aims to create an overview that addresses the research question: "Is there a relationship between computer-mediated care and emotional expression, perception, and emotional and (long-term) emotion outcomes?"

Method

This systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used five eligibility criteria, namely, (1) participants: adults seeking support; (2) intervention: eHealth; (3) diagnostic criteria: transdiagnostic concept of difficulty identifying, expressing, and/or regulating emotions (e.g., alexithymia); (4) comparator: either face-to-face care or no comparator; and (5) study design: quantitative studies or qualitative studies. Quality was assessed using the QualSyst tool.

Results

The analysis includes 25 research papers. Self-paced interventions appear to have a positive effect on emotion regulation. Videoconferencing interventions improved emotion regulation from before to after treatment but worsened emotion regulation compared with face-to-face treatment.

Discussion

The lack of variation in the modalities studied and the emotion measurements used make it difficult to draw responsible conclusions. Future research should examine how different modalities affect the real-time communication of emotions and how non-verbal cues influence this.

Online listening responses and e-learning performance

Purpose

This research investigates the impact of learners' non-substantive responses in online course forums, referred to as online listening responses, on e-learning performance. A common type of response in online course forums, online listening responses consist of brief, non-substantive replies/comments (e.g. “agree,” “I see,” “thank you,” “me too”) and non-textual inputs (e.g. post-voting, emoticons) in online discussions. Extant literature on online forum participation focuses on learners' active participation with substantive inputs and overlooks online listening responses. This research, by contrast, stresses the value of online listening responses in e-learning and their heterogeneous effects across learner characteristics. It calls for recognition and encouragement from online instructors and online forum designers to support this activity.

Design/methodology/approach

The large-scale proprietary dataset comes from a leading MOOC (massive open online courses) platform in China. The dataset includes 68,126 records of learners in five MOOCs during 2014–2018. An ordinary least squares model is used to analyze the data and test the hypotheses.

Findings

Online listening responses in course forums, along with learners' substantive inputs, positively influence learner performance in online courses. The effects are heterogeneous across learner characteristics, being more prominent for early course registrants, learners with full-time jobs and learners with more e-learning experience, but weaker for female learners.

Originality/value

This research distinguishes learners' brief, non-substantive responses (online listening responses) and substantive inputs (online speaking) as two types of active participation in online forums and provides empirical evidence for the importance of online listening responses in e-learning. It contributes to online forum research by advancing the active-passive dichotomy of online forum participation to a nuanced classification of learner behaviors. It also adds to e-learning research by generating insights into the positive and heterogeneous value of learners' online listening responses to e-learning outcomes. Finally, it enriches online listening research by introducing and examining online listening responses, thereby providing a new avenue to probe online discussions and e-learning performance.

Comparative Analysis of Social Support in Online Health Communities Using a Word Co-Occurrence Network Analysis Approach

Online health communities (OHCs) have become a major source of social support for people with health problems. Members of OHCs interact online with others facing similar health problems and receive multiple types of social support, including but not limited to informational support, emotional support, and companionship. The aim of this study is to examine the differences in social support communication among people with different types of cancers. A novel approach is developed to better understand the types of social support embedded in OHC posts. Our approach, based on the word co-occurrence network analysis, preserves the semantic structures of the texts. Information extraction from the semantic structures is supported by the interplay of quantitative and qualitative analyses of the network structures. Our analysis shows that significant differences in social support exist across cancer types, and evidence for the differences across diseases in terms of communication preferences and language use is also identified. Overall, this study can establish a new venue for extracting and analyzing information, so as to inform social support for clinical care.

A scoping review of the characteristics and benefits of online prostate cancer communities

OBJECTIVE

Online prostate cancer communities (OPCaCs) have emerged as a new source of support, not bounded by geographic barriers, for men living with prostate cancer. This scoping review mapped the existing literature to explore the characteristics and benefits of OPCaCs, identify knowledge gaps, and direct future research.

METHODS

A six-step methodological framework for scoping reviews was followed. Four electronic databases were searched for relevant studies. Two authors independently screened titles and abstracts, and full texts, against predefined criteria: empirical research, post 1990, in English-language peer-reviewed journals; participants included prostate cancer survivors; and research explored online peer support. Data were extracted from the studies and quality assessed.

RESULTS

The search yielded 905 studies, with 21 selected for synthesis. Despite significant increases in online forum membership, in the last decade, nearly half of the research was conducted over a decade ago. Three studies were rated high quality, the rest moderate. All but one of the studies were observational and cross-sectional. Men reported that sharing information helped them deal with their diagnosis and treatment side effects. They also gained a sense of camaraderie with men who shared similar experiences. Due to divergent methodologies and reporting standards, assessment regarding OPCaC efficacy is not possible.

CONCLUSION

OPCaCs may be a cost-effective and accessible resource for delivering peer support to men living with prostate cancer. While self-reported evidence as to the benefits of OPCaCs exists, more longitudinal comparative studies, utilising consistent measurement approaches, are needed to support the claims.

Online peer-to-peer support for persons affected by prostate cancer: A systematic review

OBJECTIVE

Little is known about online peer-to-peer support for persons affected by prostate cancer (PC) and its potential effects.

METHODS

Our systematic review of the literature followed the PRISMA statement and revealed a total of 2372 records. Finally, 24 studies about online peer-to-peer support for persons affected by PC were selected for qualitative synthesis. Due to a lack of suitable quantitative results, the intended meta-analysis was not possible.

RESULTS

Available studies were almost exclusively descriptive. Only one randomized controlled trial (RCT) included 40 PC survivors. In this study, quality of life improved in online support group (OSG) users and decreased in the control group. However, it returned to baseline in both groups after eight weeks. As a summary across all studies, OSGs play a significant role in patients' treatment decision-making and for the social environment of PC patients. Information exchange in OSGs was predominant, but emotional and supportive content also had an important function.

CONCLUSION

Due to the inconsistent methodology and the lack of reporting standards, a synthesis from the available studies is very limited.

PRACTICE IMPLICATIONS

Population-based studies should focus on the actual use of OSGs. The effectiveness of OSGs needs to be investigated in RCTs.

Using an Innovative Discussion Platform to Give Voice to Aging-Related Experiences: A Pilot Study

Exchanging information with peers may support older adults' management of aging-related health changes, including frailty. The current pilot study used a mixed-methods approach to develop and evaluate an online virtual community for older adults to discuss aging-related health issues and management strategies. Eight older adults (mean age = 84) were enrolled at the start of the study. During a 10-week moderated discussion, participants contributed a total of 133 responses. Common themes included (a) symptoms (e.g., pain, weakness/tiredness, sleep difficulties) and (b) management strategies (e.g., health behavior changes, psychosocial support). A positive trend of change was noted in participants' average self-reported health and chronic disease management self-efficacy scores. This platform could facilitate information exchange among older adults, empowering them to leverage their own knowledge to improve their health management strategies. Future research should expand on this study to include older adults of diverse racial, educational, and cultural backgrounds. [Journal of Gerontological Nursing, 45(12), 33-40.].

Online Support Group Participation and Social Support: Incorporating Identification and Interpersonal Bonds

An increasing number of people with chronic diseases exchange social support using online support groups (OSGs). However, there is little understanding of group communication mechanisms that underpin the relationship between OSG participation and social support. Drawing on Prentice, Miller, and Lightdale’s common-identity and common-bond framework, we propose and test a theoretical model that explains group communication mechanisms through which members’ participation influences their perceived social support. In the process, we identified and empirically validated a three-factor solution for an OSG participation scale. Based on 356 users across 12 popular OSGs, we find that two group communication mechanisms—identification with the community and interpersonal bonds with other members—mediate the relationship between OSG participation and perceived social support. Specifically, identification has a stronger mediating effect than interpersonal bonds in the relationship between OSG participation and perceived social support. We also discuss theoretical and practical implications.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Understanding Health Care Social Media Use From Different Stakeholder Perspectives: A Content Analysis of an Online Health Community

Background

Health care social media used for health information exchange and emotional communication involves different types of users, including patients, caregivers, and health professionals. However, it is difficult to identify different stakeholders because user identification data are lacking due to privacy protection and proprietary interests. Therefore, identifying the concerns of different stakeholders and how they use health care social media when confronted with huge amounts of health-related messages posted by users is a critical problem.

Objective

We aimed to develop a new content analysis method using text mining techniques applied in health care social media to (1) identify different health care stakeholders, (2) determine hot topics of concern, and (3) measure sentiment expression by different stakeholders.

Methods

We collected 138,161 messages posted by 39,606 members in lung cancer, diabetes, and breast cancer forums in the online community MedHelp.org over 10 years (January 2007 to October 2016) as experimental data. We used text mining techniques to process text data to identify different stakeholders and determine health-related hot topics, and then analyzed sentiment expression.

Results

We identified 3 significantly different stakeholder groups using expectation maximization clustering (3 performance metrics: Rand=0.802, Jaccard=0.393, Fowlkes-Mallows=0.537; P<.001), in which patients (24,429/39,606, 61.68%) and caregivers (12,232/39,606, 30.88%) represented the majority of the population, in contrast to specialists (2945/39,606, 7.43%). We identified 5 significantly different health-related topics: symptom, examination, drug, procedure, and complication (Rand=0.783, Jaccard=0.369, Fowlkes-Mallows=0.495; P<.001). Patients were concerned most about symptom topics related to lung cancer (536/1657, 32.34%), drug topics related to diabetes (1883/5904, 31.89%), and examination topics related to breast cancer (8728/23,934, 36.47%). By comparison, caregivers were more concerned about drug topics related to lung cancer (300/2721, 11.03% vs 109/1657, 6.58%), procedure topics related to breast cancer (3952/13,954, 28.32% vs 5822/23,934, 24.33%), and complication topics (4449/25,701, 17.31% vs 4070/31,495, 12.92%). In addition, patients (9040/36,081, 25.05%) were more likely than caregivers (2659/18,470, 14.39%) and specialists (17,943/83,610, 21.46%) to express their emotions. However, patients’ sentiment intensity score (2.46) was lower than those of caregivers (4.66) and specialists (5.14). In particular, for caregivers, negative sentiment scores were higher than positive scores (2.56 vs 2.18), with the opposite among specialists (2.62 vs 2.46). Overall, the proportion of negative messages was greater than that of positive messages related to symptom, complication, and examination. The pattern was opposite for drug and procedure topics. A trend analysis showed that patients and caregivers gradually changed their emotional state in a positive direction.

Conclusions

The hot topics of interest and sentiment expression differed significantly among different stakeholders in different disease forums. These findings could help improve social media services to facilitate diverse stakeholder engagement for health information sharing and social interaction more effectively.

The Social Construction of Inflammatory Bowel Disease Using Social Media Technologies

Many people with inflammatory bowel disease (IBD), sometimes lacking adequate face-to-face sources of support, turn to online communities to meet others with the disease. These online communities are places of support and education, but through the use of social media communication technologies, people with IBD are redefining what it means to live with the disease. This ethnographic study followed 14 online communities to understand how people with IBD used social media technologies to construct their own meanings about living with the disease. The following redefinitions were observed: the refiguring of the body is beautiful; inflammatory bowel disease is serious and deadly; inflammatory bowel disease is humorous; the disease makes one stronger; and the disease is invisible, but needs to be made visible. This study will help health communication scholars understand how technology is appropriated by patients, and will help practitioners understand how their patients conceptualize their disease.

Information quality and dynamics of patients' interactions on tonsillectomy web resources

Information technologies have drastically altered the way patients gather health-related information. By analysing web resources on tonsillectomy, we expose information quality and dynamics of patients' interactions in the online continuum. Readability was assessed using Flesch Reading Ease (FRE), Flesch Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFI). Comprehensibility and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT). Metrics of forums included author characteristics (level of disclosure, gender, age, avatar image, etc.), posts' motive (community support vs. medical information) and content (word count, emoticon use, number of replies, etc.). Analysis of 6 professional medical websites, of 10 health information portals, and of 3 discussion forums totalizing 1369 posts on 358 threads, from January 1, 2007 to December 31, 2014, reveals that online resources exceed understandability recommendations. Women were more present on online health forums (68.2% of authors disclosing their gender) and invested themselves more in their avatar. Authors replying were significantly older than authors of original posts (39.7 ± 0.8 years vs. 29.2 ± 0.9 years, p < 0.001). The degree of self-disclosure was inversely proportional to the requests for medical information (p < 0.001). Men and women were equally seeking medical information (men: 74.0%, women: 77.0%) and community support (men: 65.7%, women: 70.4%), however women responded more supportively (women 86.2%, men 59.1%, p < 0.001). The dynamics of patients' interactions used to overcome accessibility difficulties encountered is complex. This work outlines the necessity for comprehensible medical information to adequately answer patients' needs.

Sentiment analysis to determine the impact of online messages on smokers' choices to use varenicline

BACKGROUND

Social networks are a prominent component of online smoking cessation interventions. This study applied sentiment analysis-a data processing technique that codes textual data for emotional polarity-to examine how exposure to messages about the cessation drug varenicline affects smokers' decision making around its use.

METHODS

Data were from QuitNet, an online social network dedicated to smoking cessation and relapse prevention. Self-reported medication choice at registration and at 30 days was coded among new QuitNet registrants who participated in at least one forum discussion mentioning varenicline between January 31, 2005 and March 9, 2008. Commercially available software was used to code the sentiment of forum messages mentioning varenicline that occurred during this time frame. Logistic regression analyses examined whether forum message exposure predicted medication choice.

RESULTS

The sample of 2132 registrants comprised mostly women (78.3%), white participants (83.4%), averaged 41.2 years of age (SD = 10.9), and smoked on average 21.5 (SD = 9.7) cigarettes/day. After adjusting for potential confounders, as exposure to positive varenicline messages outweighed negative messages, the odds of switching to varenicline (odds ratio = 2.05, 95% confidence interval = 1.66 to 2.54) and continuing to use varenicline (odds ratio = 2.46, 95% confidence interval = 1.96 to 3.10) statistically significantly increased.

CONCLUSIONS

Sentiment analysis is a useful tool for analyzing text-based data to examine their impact on behavior change. Greater exposure to positive sentiment in online conversations about varenicline is associated with a greater likelihood that smokers will choose to use varenicline in a quit attempt.

Characteristics of patients seeking health information online via social health networks versus general Internet sites: a comparative study

BACKGROUND

Camoni.co.il, a Hebrew-language social health network offers advice, consultation, and connection to others with chronic illness. This study compared characteristics and objectives of Camoni.co.il users and individuals seeking medical information through general Internet sites.

METHODS

Similar questionnaires were sent to 1009 Internet and 900 Camoni users. Cluster analysis defined four modes of online social health network use: "acquiring information and support", "communicating", "networking" and "browsing".

RESULTS

Six hundred and five Internet and 125 Camoni users responded. Diabetes, hypertension, obesity and lung diseases were found more often among general Internet users than Camoni users. Among Camoni users, "acquiring information and support" was the main motivation for individuals over age 55 years, women, those with lower income, chronic pain, obesity and depression. "Communicating" was the main incentive of men, those 20-34 years old, those with less education, or an eating disorder. "Networking" was the most significant motivation for those with multiple sclerosis or depression. Browsing was most frequent among individuals with multiple sclerosis.

CONCLUSIONS

Identifying needs of social health network surfers will allow planning unique contents and enhancing social health sites. Physicians might advise patients to use them to obtain support and information regarding their conditions, possibly leading to improved compliance and self-management.

Online activity and participation in treatment affects the perceived efficacy of social health networks among patients with chronic illness

Background

The use of online health-related social networks for support, peer-to-peer connections, and obtaining health information has increased dramatically. Participation in an online health-related social network can enhance patients’ self-efficacy and empowerment, as they are given knowledge and tools to manage their chronic health condition more effectively. Thus, we can deduce that patient activation, the extent to which individuals are able to manage their own health care, also increases. However, little is known about the effects of participation in online health-related social networks and patient activation on the perceived usefulness of a website across disease groups.

Objective

The intent of the study was to evaluate the effects and benefits of participation in an online health-related social network and to determine which variables predict perceived site usefulness, while examining patient activation.

Methods

Data were collected from “Camoni”, the first health-related social network in the Hebrew language. It offers medical advice, including blogs, forums, support groups, internal mail, chats, and an opportunity to consult with experts. This study focused on the site’s five largest and most active communities: diabetes, heart disease, kidney disease, spinal injury, and depression/anxiety. Recruitment was conducted during a three-month period in which a link to the study questionnaire was displayed on the Camoni home page. Three questionnaires were used: a 13-item measure of perceived usefulness (Cronbach alpha=.93) to estimate the extent to which an individual found the website helpful and informative, a 9-item measure of active involvement in the website (Cronbach alpha=.84), and The Patient Activation Measure (PAM-13, Cronbach alpha=.86), which assesses a patient’s level of active participation in his or her health care.

Results

There were 296 participants. Men 30-39 years of age scored higher in active involvement than those 40-49 years (P=.03), 50-64 years (P=.004), or 65+ years (P=.01). Respondents 20-29 years of age scored higher in perceived usefulness than those 50-64 years (P=.04) and those 65+ years (P=.049). Those aged 20-29 years scored significantly lower on the PAM-13 scale than those aged 30-39 years (P=.01) and 50-64 years (P=.049). Men and women had similar PAM-13 scores (F_9,283=0.17, P=.76). Several variables were significant predictors of perceived usefulness. Age was a negative predictor; younger age was indicative of higher perceived usefulness. Active involvement was a positive predictor. There was a negative relationship found between PAM-13 scores and perceived usefulness, as taking a less active role in one’s own medical care predicted higher perceived website usefulness. A trend toward higher frequency of website activity was associated with increased perception of usefulness.

Conclusions

Online health-related social networks can be particularly helpful to individuals with lower patient activation. Our findings add information regarding the social and medical importance of such websites, which are gradually becoming an inseparable part of day-to-day chronic disease management in the community.

An evaluation of an online peer support forum for university students with depressive symptoms

BACKGROUND

Depression is the most common mental health problem among young people, particularly university students, with prevalence rates as high as 48% reported. This population however, is reluctant to seek professional help. Online interventions may be particularly appealing to students, with evidence suggesting that they use the Internet for mental health support. While there are many mental health resources on the Internet few focus specifically on the needs of young people and few have been evaluated. This research aimed to develop and pilot test an online peer support intervention for students experiencing depressive symptoms.

METHODS

A depression support Web site (www.losetheblues.ie) was designed specifically for 18-24 year old students. The study used a mixed method, involving quantitative descriptive, pre- and post-test and qualitative descriptive designs. Data were collected using the Centre for Epidemiological Studies Depression Scale (CES-D), a background questionnaire and online forum posts.

RESULTS

The sample consisted of 117 university students with self-reported depressive symptoms. Results from participants in the pre- and post-test element of the study, showed no statistical significance. The forum posts revealed that the participants' main difficulties were loneliness and perceived lack of socialization skills. The Web site provided a place for sharing, offering and receiving emotional and informational support.

CONCLUSION

Developing health care interventions in an online environment presents unique challenges to the research process, however they have the potential to provide mental health care that is accessible and affordable.

Identifying gender-preferred communication styles within online cancer communities: a retrospective, longitudinal analysis

BACKGROUND

The goal of this research is to determine if different gender-preferred social styles can be observed within the user interactions at an online cancer community. To achieve this goal, we identify and measure variables that pertain to each gender-specific social style.

METHODS AND FINDINGS

We perform social network and statistical analysis on the communication flow of 8,388 members at six different cancer forums over eight years. Kruskal-Wallis tests were conducted to measure the difference between the number of intimate (and highly intimate) dyads, relationship length, and number of communications. We determine that two patients are more likely to form an intimate bond on a gender-specific cancer forum (ovarian P = <0.0001, breast P = 0.0089, prostate P = 0.0021). Two female patients are more likely to form a highly intimate bond on a female-specific cancer forum (Ovarian P<0.0001, Breast P<0.01). Typically a male patient communicates with more members than a female patient (Ovarian forum P = 0.0406, Breast forum P = 0.0013). A relationship between two patients is longer on the gender-specific cancer forums than a connection between two members not identified as patients (ovarian forum P = 0.00406, breast forum P = 0.00013, prostate forum P = .0.0003).

CONCLUSION

The high level of interconnectedness among the prostate patients supports the hypothesis that men prefer to socialize in large, interconnected, less-intimate groups. A female patient is more likely to form a highly intimate connection with another female patient; this finding is consistent with the hypothesis that woman prefer fewer, more intimate connections. The relationships of same-gender cancer patients last longer than other relationships; this finding demonstrates homophily within these online communities. Our findings regarding online communication preferences are in agreement with research findings from person-to-person communication preference studies. These findings should be considered when designing online communities as well as designing and evaluating psychosocial and educational interventions for cancer patients.

Comparison of social support content within online communities for high- and low-survival-rate cancers

People experiencing cancer use the Internet for many reasons, particularly for social support. This study sought to determine how social support content within online support communities for different cancers varied according to cancer survival rate. A quantitative content analysis was conducted on 3717 posts from eight online communities focused on cancers with high and low 5-year relative survival rates. Using Optimal Matching Theory, we predicted that low-survival-rate communities would have more emotional support content than high-survival-rate communities, and high-survival-rate communities would have more informational support content than low-survival-rate communities. Emotional support content was consistently more common than informational support. Overall, high-survival-rate communities had a greater proportion of posts containing emotional support content (75%) than low-survival-rate communities (66%) (χ1 = 20.89 [n = 2235], P < .001). Furthermore, low-survival-rate communities had a greater proportion of posts containing informational support content (46%) than high-survival-rate communities (36%) (χ1 = 21.13 [n = 2235], P< .001). Although the relationships between survival rate and support types were significant, they were not as hypothesized. Deviations from theoretically predicted results suggest that individuals experiencing low-survival-rate cancers may have a greater desire for informational support online than individuals experiencing high-survival-rate cancers.

Expression and reception of treatment information in breast cancer support groups: how health self-efficacy moderates effects on emotional well-being

OBJECTIVES

To examine the effects of exchanging treatment information within computer-mediated breast cancer support groups on emotional well-being, and to explore whether this relationship is moderated by health self-efficacy.

SAMPLE

177 breast cancer patients using an electronic Health (eHealth) program with discussion group.

MEASURE

expression and reception of treatment information; emotional well-being scale (0, 4 months).

ANALYSES

hierarchical regression.

RESULTS

Effects of expression and reception of treatment information on emotional well-being were significantly greater for those who have higher health self-efficacy.

CONCLUSIONS

Results conditionally support prior research finding positive effects of treatment information exchanges among breast cancer patients. Such exchanges had a positive impact on emotional well-being for those with higher health self-efficacy, but they had a negative influence for those with lower health self-efficacy.

PRACTICE IMPLICATIONS

Given that the association between emotional well-being and exchanging treatment information was moderated by health self-efficacy, clinicians should explain the role of health self-efficacy before encouraging patients to use eHealth systems for treatment exchanges.

Gender differences in computer-mediated communication: a systematic literature review of online health-related support groups

OBJECTIVE

Previous research has contended that the unique characteristics of the Internet might remove some of the gender differences that exist in face-to-face healthcare. The aims of the present study were to systematically review studies that have examined gender differences in communication within online health communities.

METHODS

A literature search was conducted to identify studies addressing gender differences in messages posted to online health-related support groups. Out of the 1186 articles identified, twelve were retrieved for review.

RESULTS

Half of the studies examined gender differences by comparing male and female cancer discussion boards. The literature review revealed that some gender differences were observed in these studies. However, for studies that analysed mixed-gender communities, gender differences were less evident.

CONCLUSION

Results seemed to reveal gender differences in communications in single-sex online health support groups, and similarities in communication patterns in mixed-sex online health support groups. However, findings should be treated with caution due to the diversity in studies and methodological issues highlighted in the present review.

PRACTICE IMPLICATIONS

There is a need for health care professionals to take into account a range of situational and contextual factors that may affect how men and women use online health support groups. However, more robust research is needed before concrete guidelines can be developed to help health care professionals develop effective online support interventions.

Understanding treatment decision making: contexts, commonalities, complexities, and challenges

BACKGROUND

The diagnosis of cancer sets off a cascade of complex decisions at a time when patients feel vulnerable and distressed. Although clinical decisions used to follow one standard, many guidelines now outline several options and include explicit recognition of the need to incorporate patients' preferences to determine the most appropriate treatment.

PURPOSE

The purpose of this article is to provide a brief overview of empirical studies about cancer patients' treatment-related decision making, to highlight the areas of congruence and divergence in that empirical literature, and then to generate a framework that points to future interventions and research.

METHODS

Through a group discussion with a range of experts in the field, we generated a framework for the critical treatment decisions and key issues within those decisions. Then, we reviewed the literature describing the experiences of cancer patients and evaluating interventions designed to improve the quality of treatment decisions.

RESULTS

We identified four major differences that influence decision making across cancers and across individuals with the same diagnosis. We also identified four common themes across situations and people. There is considerable evidence that decision aids can improve the quality of decisions across a range of diseases, although the data for cancer treatment decision making are limited. Other interventions such as navigation-skill training are promising but have little evidence of benefit for cancer decisions.

CONCLUSIONS

There are many opportunities for behavioral research to extend and contribute to the understanding and improvement of cancer treatment decision making. Some key areas in need of research include developing taxonomies of disease and patient characteristics and increasing understanding of the lived experiences of cancer survivors, of the influence of time and timing, of the relationship of information and preferences, and of participation in randomized clinical trials.