Provider-patient dialogue about Internet health information: an exploration of strategies to improve the provider-patient relationship

An evaluation of TikTok videos as a source of information for orthognathic surgery

As social media platforms like TikTok become increasingly popular, patients are turning to them for information about surgical procedures, including orthognathic surgery. This study aimed to evaluate the content quality, reliability, and educational value of videos related to orthognathic surgery on TikTok. A total of 84 videos were analysed using two standardised assessment scales: the modified 5-point DISCERN scale and the Global Quality Score (GQS). These videos were sourced through search terms #JawSurgery and #OrthognathicSurgery, and the data were extracted using a web-scraping tool. The analysis revealed that TikTok videos on orthognathic surgery had a mean DISCERN score of 1.6/5 and a mean GQS of 2.2/5, indicating generally poor quality. Most videos were uploaded by patients (46/84), while 33/84 were by healthcare professionals, particularly maxillofacial surgeons and orthodontists. Despite the high viewership (246 million views across all videos), many videos were limited in content, with 52/84 not containing any information on the procedure, and only 4/84 mentioning risks beyond swelling and bruising. Notably, 82 of the 84 videos had patients interacting in the comments, seeking advice or sharing experiences. While TikTok serves as an important information platform, it also highlights a significant gap in reliable, comprehensive content. Healthcare professionals should direct patients to high quality sources of information that have been approved by them to mitigate the risks of misinformation and anxiety for prospective patients.

Navigating Disagreements on Health Information: How Patients With Cancer Perceive Health Care Providers' Approaches to Discussing Patient-Identified Information

PURPOSE

Although publicly available cancer-related information online and offline could help patients make informed decisions, it also poses challenges due to prevalent misinformation. Patients need proper provider guidance to ensure they use valid and relevant information in decisions. We identify effective communication approaches for providers when (1) discussing patient-identified information and (2) disagreeing with it.

METHODS

From June to August 2023, people living with cancer were reached via online communities and asked first about their actual experiences discussing patient-identified information with their providers. Respondents were then randomly assigned into an experiment with three hypothetical scenarios where providers disagreed with patient-identified information. Provider responses included (1) dismissal, (2) explanation, and (3) explanation with relationship-building elements. Pearson correlation and multivariable analysis of variance were used to evaluate differences in patient perceptions.

RESULTS

One hundred seventy-five respondents completed the survey. Mean age: 53 years; 45% female; and 88% White, 10% Black, and 2% others. Forty-six percent held Bachelor's degrees or higher, 11% lived rurally, 36% reported financial difficulties, and 46% rated their health as good/excellent. Between 31% and 37% of respondents reported their provider used communication approaches that negatively correlated with discussion outcomes. The approaches included avoidance of such conversations due to limited time, discouragement of future information searches, or judgmental comments. In the experiment, respondents randomly assigned to receive relationship-building elements were significantly more comfortable sharing information, felt more satisfied, respected, and trusted their provider's opinion more than those receiving the dismissal scenario. The explanation scenario was not perceived differently compared with the dismissal scenario.

CONCLUSION

More than a third of respondents reported negative communication when sharing patient-identified information with their provider. Provider prioritization of relationship-building alongside explanations could foster trust and facilitate open information exchange, supporting informed decisions.

From Online to Offline: How Different Sources of Online Health Information Seeking Affect Patient-Centered Communication in Chinese Older Adults? The Roles of Patient Activation and Patient-Provider Discussion of Online Health Information

Despite the increasing prevalence of online health information seeking (OHIS) among older adults, its impact on patient-centered communication (PCC) outcomes remains unclear. Drawing from Street's ecological framework of communication in medical encounters, the present study examined the mediation role of patient activation in the relationship between OHIS across three media channels - social media, search engines, and mobile health applications (mHealth apps) - and PCC. Furthermore, it examines the moderation effect of patient-provider discussions of online health information. A national survey of 916 older Chinese adults aged 60-78 was conducted. The findings indicate that OHIS across the three channels can indirectly enhance PCC through patient activation. Moreover, OHIS via mHealth apps is positively associated with PCC, while the relationship between OHIS via social media/search engines and PCC is not significant. The interaction between patients and healthcare providers regarding online health information positively moderated all indirect paths. Notably, a great proportion of older adults (77.7%) engaged in discussions about online health information with healthcare providers. These findings emphasize the importance of considering various media channels and highlight the pivotal role of patient activation in bridging the gap between OHIS and satisfactory healthcare interactions, especially in the Chinese context.

Examining the role of pre-visit anxiety on patient uncertainty and breast cancer patient-provider communication

OBJECTIVE

Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well-being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre-appointment anxiety and illness uncertainty affect patient-provider communication in breast cancer surgical consultations and subsequent post-appointment well-being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient-provider communication.

METHODS

This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre-appointment anxiety influences pre-appointment patient uncertainty, patient-provider communication during the appointment, and subsequent post-appointment uncertainty.

RESULTS

The proposed model achieved good fit to the data such that more pre-appointment anxiety was associated with more pre-appointment uncertainty, more pre-appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post-appointment uncertainty.

CONCLUSIONS

Results indicate breast cancer patients with anxiety pre-appointment are at-risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety.

Physician Perspectives on Internet-Informed Patients: Systematic Review

BACKGROUND

The internet has become a prevalent source of health information for patients. However, its accuracy and relevance are often questionable. While patients seek physicians' expertise in interpreting internet health information, physicians' perspectives on patients' information-seeking behavior are less explored.

OBJECTIVE

This review aims to understand physicians' perceptions of patients' internet health information-seeking behavior as well as their communication strategies and the challenges and needs they face with internet-informed patients.

METHODS

An initial search in PubMed, Scopus, CINAHL, Communication and Mass Media Complete, and PsycINFO was conducted to collect studies published from January 1990 to August 1, 2022. A subsequent search on December 24, 2023, targeted recent studies published after the initial search cutoff date. Two reviewers independently performed title, abstract, and full-text screening, adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. Thematic analysis was then used to identify key themes and systematically categorize evidence from both qualitative and quantitative studies under these themes.

RESULTS

A total of 22 qualifying articles were identified after the search and screening process. Physicians were found to hold diverse views on patients' internet searches, which can be viewed as a continuous spectrum of opinions ranging from positive to negative. While some physicians leaned distinctly toward either positive or negative perspectives, a significant number expressed more balanced views. These physicians recognized both the benefits, such as increased patient health knowledge and informed decision-making, and the potential harms, including misinformation and the triggering of negative emotions, such as patient anxiety or confusion, associated with patients' internet health information seeking. Two communicative strategies were identified: the participative and defensive approaches. While the former seeks to guide internet-informed patients to use internet information with physicians' expertise, the latter aims to discourage patients from using the internet to seek health information. Physicians' perceptions were linked to their strategies: those holding positive views tended to adopt a participative approach, while those with negative views favored a defensive strategy. Some physicians claimed to shift between the 2 approaches depending on their interaction with a certain patient. We also identified several challenges and needs of physicians in dealing with internet-informed patients, including the time pressure to address internet-informed patient demands, a lack of structured training, and being uninformed about trustworthy internet sites that can be recommended to internet-informed patients.

CONCLUSIONS

This review highlights the diverse perceptions that physicians hold toward internet-informed patients, as well as the interplay between their perceptions, communication strategies, and their interactions with individual patients. Incorporating elements into the medical teaching curriculum that introduce physicians to reliable internet health resources for patient guidance, coupled with providing updates on technological advancements, could be instrumental in equipping physicians to more effectively manage internet-informed patients.

TRIAL REGISTRATION

PROSPERO CRD42022356317; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=356317.

Talking with clinicians about online cancer information: a survey of cancer patients and surrogate information seekers

OBJECTIVES

To describe patients' and surrogate information seekers' experiences talking to clinicians about online cancer information. To assess the impact of clinicians telling patients or surrogate seekers not to search for information online.

DESIGN

Cross-sectional survey.

SAMPLE

A total of 282 participants, including 185 individuals with cancer and 97 surrogate seekers.

METHODS

Individuals were recruited through a broad consent registry and completed a 20-min survey.

FINDINGS

Cancer patients and surrogate seekers did not differ significantly in their experiences talking with clinicians about online cancer information. Nearly all patients and surrogate seekers who were told by a clinician not to go online for cancer information did so anyway.

IMPLICATIONS

Interventions for improving cancer information seeking and communication with clinicians should target both patients and surrogate seekers. Clinicians should be educated about effective ways to communicate with patients and surrogate seekers about online cancer information.

Patient Journey und krankheitsbezogene Nutzung digitaler Medien: Eine Querschnittsstudie unter Dermatologie-Patienten in Deutschland: Patient journey and disease-related digital media usage: A cross-sectional study among dermatology patients across Germany

Hintergrund und Ziele

Ziel dieser Studie war es, die Auswirkungen der Nutzung gesundheitsbezogener digitaler Medien auf die Arzt‐Patienten‐Beziehung und die Patient Journey (Weg des Patienten durch alle Phasen seiner Erkrankung) zu untersuchen, um positive Veränderungen in der dermatologischen Praxis zu bewirken.

Patienten und Methodik

Von Juni bis November 2022 füllten Personen mit Hautkrankheiten in Deutschland einen Fragebogen zur Bewertung der gesundheitsbezogenen Nutzung digitaler Medien, der E‐Health‐Kompetenz, des Einflusses der Nutzung digitaler Medien auf die Arzt‐Patienten‐Beziehung und die Patient Journey sowie soziodemografischer und gesundheitlicher Merkmale aus. Die Daten wurden deskriptiv und mittels linearer Regressionen analysiert.

Ergebnisse

Insgesamt wurden 919 Teilnehmer analysiert (medianes Alter: 47,00, Interquartilsbereich [28,00; 61,00] Jahre, weiblich: 53,6%, Nutzer digitaler Medien im Kontext der Erkrankung: 56,8%). Google und Online‐Enzyklopädien wurden am häufigsten vor und nach der dermatologischen Konsultation genutzt. Online‐Selbsthilfegruppen wurden von 76,3% der nicht behandelten Teilnehmer in Anspruch genommen. Die Nutzung digitaler Medien hatte keinen Einfluss auf die Arzt‐Patienten‐Beziehung und wirkte sich positiv auf die Patient Journey aus. Positive Auswirkungen wurden mit höherer E‐Health‐Kompetenz, Zufriedenheit mit der Qualität digitaler Medien, Bedeutung digitaler Medien, ländlichem Wohnsitz, höherem Bildungsniveau und Vertrauen in Dermatologen in Verbindung gebracht.

Schlussfolgerungen

Die dermatologische Versorgung in Arztpraxen kann vom Potenzial digitaler Gesundheitsmedien profitieren. Eine evidenzbasierte digitale Gesundheitsplattform ist erforderlich, um die E‐Health‐Kompetenz der Betroffenen zu erhöhen und ihre Zufriedenheit mit der Qualität digitaler Medien zu verbessern.

Patient journey and disease-related digital media usage: A cross-sectional study among dermatology patients across Germany

BACKGROUND AND OBJECTIVES

This study aimed to fill the gap of evidence-based data by examining the impact of health-related digital media use's impact on the patient-physician relationship and patient journey, with the goal of driving positive changes in office-based dermatological practice.

PATIENTS AND METHODS

German individuals with skin conditions completed a questionnaire assessing health-related digital media use, eHealth literacy, impact of digital media use on the patient-physician relationship and patient journey, and sociodemographic and health characteristics from June to November 2022, followed by descriptive analysis and linear regressions.

RESULTS

Overall, 919 participants were analyzed (median age: 47.00, interquartile range [28.00; 61.00] years, female: 53.6%, health-related digital media users: 56.8%). Google and online encyclopedias were commonly used before and after dermatological consultations. Online self-help groups were used by 75% of non-treated participants. Digital media use had no impact on the patient-physician relationship and a positive impact on the patient journey. Positive impacts were associated with higher eHealth literacy, satisfaction with digital media quality, importance of digital media, rural residence, high education, and trust in dermatologists.

CONCLUSIONS

The potential of health-related digital media in office-based dermatological care necessitates the drive of an evidence-based digital health platform to improve eHealth literacy and satisfaction with the quality of digital media among affected individuals.

YouTube as a source of information about rubber dam: quality and content analysis

Objectives

This study aimed to evaluate the content, quality and demographics of YouTube videos about rubber dam as an information source for clinicians and dental students.

Materials and Methods

"Rubber dam," "rubber dam application," "dental isolation," "rubber dam isolation," and "dental dam" were determined as keywords for the detection of YouTube videos related to rubber dam. Seventy 3 videos were evaluated and a total of 34 videos met the inclusion criteria. All selected videos were evaluated according to 8 parameters. The videos were scored 1 if the videos contained information about the selected parameter, but if the videos did not contain enough information, they were scored 0. The data were statistically analyzed with the analysis of variance and post hoc Tukey test (p < 0.05).

Results

We found that 41% of the videos have poor, 47% have moderate, and 12% have good information. There is a statistically significant difference in time between poor and good information content (p < 0.05). There is a statistically significant difference between the poor and good information in the video information and quality index 1.

Conclusions

Rubber dam-related videos available on YouTube are generally moderately informed and insufficient. YouTube is currently not sufficient as a source of information for patients and clinicians at the moment. The YouTube platform should be developed and enriched with quality information on current and dental issues.

Communicating about online health information with patients: Exploring determinants among telemental health providers

Objective

To investigate determinants of telemental health (TMH) providers' openness to discuss and confidence to use online mental health information with patients, focusing on providers' eHealth literacy and perceived usefulness of online MH information.

Methods

TMH providers (N = 472) completed a web-based survey with questions about discussing and using online health information with patients, perceived usefulness of the Internet as a source of patient information, and eHealth literacy.

Results

Providers were open to discussing online health information with patients if they were not treating substance abuse disorders (b = -0.83), felt the Internet was a useful resource (b = 0.18), and felt confident in their skills to evaluate the online information (b = 0.21). Providers were confident using online health information if they worked in a small clinic (b = 0.37), felt the Internet was a useful resource (b = 0.31), knew where to access relevant online health information (b = 0.13), and had skills to help their patients find (b = 0.17) and evaluate (b = 0.54) online information.

Conclusion

TMH providers are likely to use online health information resources if they know where and how to find them and perceive the Internet as a useful resource.

Innovation

To effectively discuss online health information with patients, providers require skills to evaluate the information with patients.

Clinician Communication With Patients About Cancer Misinformation: A Qualitative Study

PURPOSE

Clinicians regularly face conversations about information that patients have found online. Given the prevalence of misinformation, these conversations can include cancer-related misinformation, which is often harmful. Clinicians are in a key position as trusted sources of information to educate patients. However, there is no research on clinician-patient conversations about cancer-related misinformation. As a first step, the objective of this study was to describe how cancer clinicians report communicating with patients about online cancer misinformation.

METHODS

We used convenience and snowball sampling to contact 59 cancer clinicians by e-mail. Contacted clinicians predominately worked at academic centers across the United States. Clinicians who agreed participated in semistructured interviews about communication in health care. For this study, we focused specifically on clinicians' experiences discussing online cancer-related misinformation with patients. We conducted a thematic analysis using a constant comparative approach to identify how clinicians address misinformation during clinical visits.

RESULTS

Twenty-one cancer clinicians participated in the study. Nineteen were physicians, one was a physician assistant, and one was a nurse practitioner. The majority (62%) were female. We identified four themes that describe how cancer clinicians address misinformation: (1) work to understand the misinformation; (2) correct misinformation through education; (3) advise about future online searches, and (4) preserve the clinician-patient relationship.

CONCLUSION

Our study identified four strategies that clinicians use to address online cancer-related misinformation with their patients. These findings provide a foundation for future research, allowing us to test these strategies in larger samples to examine their effectiveness.

Current Situations and Challenges in the Development of Health Information Literacy

Health information literacy (HIL) is a significant concept that has gradually become known to the broader public in recent years. Although the definitions of HIL and health literacy seem to overlap, as an independent subconcept, HIL still shows a unique influence on improvements in people's health and health education. Remarkable evidence indicates that online health information (OHI) can effectively enrich people's knowledge and encourage patients to actively join the medical process, which is also accompanied by the emergence of various assessment tools. Although the current assessment tools, to a certain extent, can help people identify their shortcomings and improve their HIL, many studies have indicated that the deficiencies of the scales induce incomplete or unreal results of their HIL. In addition, continuing research has revealed an increasing number of influencing factors that have great effects on HIL and even regulate the different trends in doctor-patient relationships. Simultaneously, most of the uncensored OHI broadcasts have also affected the improvement in HIL in various ways. Thus, this review aims to summarize the assessment tools, influencing factors and current situations and challenges related to HIL. Further studies are required to provide more trusted and deeper references for the development of HIL.

Accuracy of Online Pictorial Resources for Common Hand Surgery Procedures

Background: Online medical platforms can provide patients with easily accessible information and greater opportunities to self-advocate. However, the lack of quality control and presence of inaccurate information can lead to miscommunications between the physician and the patient. The objective of this study was to examine the quality and accuracy of online pictorial information regarding common hand conditions. Methods: Medical image information was searched on the search engine Google (http://www.google.com) using the terms "de Quervain's tenosynovitis," "carpal tunnel syndrome," and "trigger finger." The first 20 illustrations to appear on the search were recorded along with the type of source. The images were then examined for veracity of information conveyed. Results: Sixty images were collected from 48 different Web sources. Nonacademic/private medical institutions were the most common image source (35%). The rate of erroneous images was 40%. Web sites of academic hospitals were most frequently the source of incorrect images. Of the conditions, trigger finger had the highest rate of errors (55%), most commonly occurring in positioning of the annular pulleys. The search results did not contain any Web sites from professional hand societies. Conclusion: The quality of online medical information is a significant but often overlooked aspect of health professional and patient education. This study demonstrates the prevalence of incorrect information online and the misunderstandings that patients can have about common conditions. Higher quality online resources are needed to improve patient education and patient-physician interactions. Avenues for improvement are to provide greater accessibility of educational resources offered by professional hand surgery organizations.

The Effect of Online Health Information Seeking on Physician-Patient Relationships: Systematic Review

BACKGROUND

The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has been found that OHI can affect the physician-patient relationship by influencing patient behaviors.

OBJECTIVE

This study aims to systematically investigate the impact of OHI-seeking behavior on the physician-patient relationship.

METHODS

Literature retrieval was conducted on 4 databases (Web of Science, PubMed, China National Knowledge Infrastructure, SinoMed), and the time limit for literature publication was before August 1, 2021.

RESULTS

We selected 53 target papers (42 [79%] English papers and 11 [21%] Chinese papers) that met the inclusion criteria. Of these, 31 (58%) papers believe that patients' OHI behavior can enable them to participate in their own medical care, improve patient compliance, and improve the physician-patient relationship. In addition, 14 (26%) papers maintain a neutral attitude, some believing that OHI behavior has no significant effect on doctors and patients and others believing that due to changes in the factors affecting OHI behavior, they will have a negative or a positive impact. Furthermore, 8 (15%) papers believe that OHI search behavior has a negative impact on doctors and patients, while 6 (11%) papers show that OHI reduces Chinese patients' trust in doctors.

CONCLUSIONS

Our main findings showed that (1) OHI-seeking behavior has an impact on patients' psychology, behavior, and evaluation of doctors; (2) whether patients choose to discuss OHI with doctors has different effects on the physician-patient relationship; and (3) the negative impact of OHI on China's internet users is worthy of attention. Due to the low quality of OHI, poor health information literacy, short physician-patient communication time, and various types of negative news, patients' trust in doctors has declined, thus affecting the physician-patient relationship. Improvement of people's health information literacy and the quality of OHI are important factors that promote the positive impact of OHI on the physician-patient relationship.

Attitude of Veterinarians Toward Self-Informed Animal Owners Affects Shared Decision Making

The aims of this study were to investigate the role of the veterinarian characteristics (e.g., age, gender, self-estimation, use of the internet), and their attitudes concerning animal owners seeking self-information. A particular focus was laid on any association between shared decision making (SDM), age and gender. In an online survey, 527 German veterinarians were asked about their attitude regarding SDM principles and their experiences with self-informed animal owners. The factors associated with veterinarians' perception of SDM were investigated in a multivariable linear regression model. A recently published structural equation model consolidated the application of SDM, empathic behavior, and veterinarians' evaluation of self-education as latent factors. Interconnected questionnaire items were processed using an exploratory factor analysis to 11 interpretable factors. Veterinarians who assumed therapy failure was associated with themselves had significantly higher rates of SDM (p = 0.002). In contrast, SDM was significantly lower (p = 0.002) if they assumed that therapy failure was due to the animal's owners. SDM was negatively associated with the perceived quality of the pet owners' self-information (p < 0.001) and if skepticism was perceived as the reason for seeking the self-information (p = 0.001). Veterinarians who advised against self-information (p = 0.006) and those who assumed that self-information of animal owners goes along with uncertainty (p = 0.001) had low SDM values (p = 0.006). Asking the animal owner for self-information (p = 0.001), and recommendations of good information sources (p = 0.022) were positively associated with SDM. Looking at the influence of age and gender on the application of SDM, older people and males rated higher. However, the evaluation of the latent factor SDM was based on the self-estimation of the participants. Assuming that younger women were less self-confident, we cannot exclude that young female participants self-evaluated their SDM skills lower than older male participants, although both groups would objectively have the same SDM level. Practitioners who have a positive attitude toward animal owners, who enjoy contact with animal owners and welcome their interest in further (self-)information, show empathic behavior, and have a positive attitude toward SDM are more likely to have better veterinarian-animal owner-relationships.

Awareness and Expectations Surrounding Family Planning and Pregnancy Among Danish Patients with Chronic Inflammatory Disease of the Skin or Joints: Results from an Online Survey

Background

Patients with chronic inflammatory diseases (CIDs) may encounter challenges in their family planning journey. Here, we report on the access to family planning and pregnancy (FPP) information and the concerns among patients in Denmark with CIDs.

Methods

Patients aged 18–50 years with CIDs participated in an online survey. Patients were recruited through patient advocacy groups and were asked to report information on their diagnosis, concerns related to FPP and perceptions of access to FPP information. Descriptive statistics were applied.

Results

Of the eligible respondents, 368 had rheumatological diagnoses (rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis or axial spondyloarthritis; mean age 40 years; 83% women, 17% men) and 95 had dermatological diagnoses (psoriasis or psoriatic arthritis; mean age 38 years; 67% women, 33% men). Approximately 70% of all patients reported seeking FPP information from patient advocacy groups; 57% of both cohorts used the internet as information sources; and 73% and 42% of rheumatological and dermatological cohorts used their hospital and specialist doctor, respectively. Despite this, 58% and 67% of patients with rheumatological and dermatological diagnoses reported limited or no access to FPP information, with > 70% of dermatological patients of early/mid-reproductive age reporting a lack of access to this information. Overall, 68% of patients with rheumatological and 73% with dermatological diagnoses had biological children, amongst whom 24% and 18%, respectively, indicated their disease affected the number of children they ultimately decided to have. The most frequent FPP concerns among patients who did not want any/more biological children were disease worsening, heredity and taking care of the child.

Conclusions

Despite awareness of available sources of FPP information, patients expressed experiencing a feeling of limited access to information and having concerns that affect key decisions regarding FPP. The results of this survey highlight a need for improved and more standardised FPP information for patients with CIDs in Denmark.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40744-021-00348-2.

Information on the Internet about clear aligner treatment-an assessment of content, quality, and readability

Purpose

The goal was to evaluate the content, quality, and readability of the information available about clear aligner treatment on the Internet.

Materials and methods

The search terms “aligner,” “clear aligner,” and “Invisalign” (Align Technology, Tempe, AZ, USA) were analyzed in three search engines (Google [Google LLC, Mountain View, CA, USA], Bing [Microsoft, Redmond, WA, USA], and Yahoo [Yahoo, Sunnyvale, CA, USA]). The first 50 websites for each keyword in each search engine were screened. Duplicate websites, advertisements, links to scientific articles, videos, and other irrelevant websites were excluded. The quality of the remaining websites was analyzed using the DISCERN and Journal of American Medical Association (JAMA) benchmark instruments together with the Health on the Net code (HONcode, Health On the Net Foundation, Geneva, Switzerland). The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Statistical analyses were performed by one-way analysis of variance, Kruskal–Wallis and Fischer’s exact tests, with p < 0.05 accepted to be statistically significant.

Results

Among 111 evaluated websites, most belonged to multidisciplinary dental clinics (n = 49; 44.2%), followed by aligner companies (n = 26; 23.4%), orthodontists (n = 26; 23.4%), and professional organizations (n = 10; 9%). The mean DISCERN score (sections 1 and 2) for all websites was 29.95/75. The average FRES and FKGL were 55.77 and 9.74, respectively. Professional organization websites had significantly higher DISCERN scores than others (p < 0.001), and together with multidisciplinary dental clinic websites, they showed better compliance with JAMA benchmark criteria. Professional organization websites’ FRES and FKGL were also higher than other websites (p > 0.05).

Conclusions

Overall, the quality of web-based information about clear aligners was poor and the readability of the data was insufficient. Websites presenting high-quality data with better readability are needed for potential aligner patients.

The good, the bad, and the contingency: How patients' treatment verification behaviors are linked to doctors' reactions

OBJECTIVE

This article introducesTreatment Verification Behavior (TVB) to conceptualize patient proactivity. The article also aims to examine doctors' responses to patients' TVBs.

METHODS

A doctor-patient paired, two-wave data set was collected from eight hospitals in North China. We collected data from 304 doctor-patient dyads with each doctor rating, on average, three inpatients.

RESULTS

The results show that when patients consulted their doctors about information regarding a diagnosis or treatment (i.e.,consulting TVB), it improved doctors' perception of the patients' ability, which further increased doctors' work engagement. Alternatively, when patients challenged doctors about information regarding a diagnosis or treatment (i.e., challenging TVB), it induced doctors' perception of threat but without significantly decreasing doctors' work engagement. In addition, when doctors felt respected by patients, this feeling moderated the effects of patients' TVBs on doctors' reactions.

CONCLUSION

Both the content (the "what") and the manner (the "how") of patients' proactive communications with their doctors will influence doctors' responses.

PRACTICE IMPLICATIONS

These insights suggest that patient and doctor communication training should include components that address both the content and performance of communication.

Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model

In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.

Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information

OBJECTIVE

This study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking.

METHODS

We analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy.

RESULTS

Half of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients' online health information-seeking seriously or affirming patients' beliefs.

CONCLUSION

This exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients' online health information-seeking.

PRACTICE IMPLICATIONS

Results of this study could guide interventions to train providers in talking about patients' online health information-seeking.

Paediatric clinicians' experiences of parental online health information seeking: A qualitative study

AIM

The aim of this research was to explore clinicians' experiences of parents' online health information seeking (OHIS) behaviour about selective dorsal rhizotomy for the management of cerebral palsy.

METHODS

Using qualitative methodology, clinicians likely to have had experience with parents requesting selective dorsal rhizotomy were invited to participate in semi-structured interviews. Interviews with 13 clinicians were recorded, transcribed and inductive content analysis was used to identify, code and organise the data into themes.

RESULTS

Participants highlighted how parental OHIS was changing clinical communication. Negative effects included a shift in clinicians' attention from giving advice and guidance to spending time discussing online findings, justifying how this information applies to a particular child and managing parents' judgments about clinical views. Positive effects included more collaboration and sharing of ideas. These results are presented in three main themes: (i) the informed parent; (ii) the clinicians' role; and (iii) a new clinical dynamic.

CONCLUSION

This research reinforces the notion that OHIS is changing the communication dynamic and clinicians' and parents' roles within the clinical encounter. Of significance was the number of challenges clinicians are facing as a result of online information, including managing parental understanding of non-evidenced information and responding to negative feedback about their practice. This research suggests a need for educational support and ongoing professional development for clinicians to assist them to adjust to new goals and expectations of clinical interactions with 'informed' parents.

YouTube as a source of information about orthodontic clear aligners

OBJECTIVES

To evaluate the content, reliability, and quality of videos about orthodontic clear aligners on YouTube.

MATERIALS AND METHODS

Researchers used the Google Trends website to determine that the most frequently used search term for orthodontic clear aligners on the Internet was: "Invisalign." A search was then conducted on YouTube using the key word "Invisalign." From the first 140 results, 100 videos were selected for analysis. A 13-point content score was used to classify poor-content and rich-content videos, and the global quality scale (GQS) was used to examine quality of the videos. To evaluate reliability of the information, a five-question scale was used. The Mann-Whitney U-test, χ2 test, and Pearson correlation coefficients were used for statistical evaluations.

RESULTS

Of the YouTube videos, 33 were classified as rich content and 67 as poor content. Most videos (73%) were uploaded by laypeople, and most uploaders (71%) were women. The most commonly discussed content was instructions (65%), followed by procedure (57%) and pain (52%). Regarding the GQS, most of the videos were evaluated as moderate quality (51%). Compared with the poor-content video group, the rich-content video group had a significantly higher GQS score (P = .004). There was no significant difference between the poor-content and rich-content groups regarding information reliability (P > .05).

CONCLUSIONS

Video content on YouTube relating to aligner orthodontics was generally insufficient. The quality of videos was moderate, but the reliability of information was generally poor. Specialists should refer patients to reliable sources of information.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.

"But Dr Google said…" - Training medical students how to communicate with E-patients

Purpose: Patients who have access to information online may feel empowered and also confront their physicians with more detailed questions. Medical students are not well-prepared for dealing with so-called "e-patients." We created a teaching module to deal with this, and evaluate its effectiveness.Method: Senior medical students had to manage encounters with standardized patients (SPE) in a cross-over design. They received blended-learning teaching on e-patients and a control intervention according to their randomization group (EI/LI = early/late intervention). Each SPE was rated by two blinded video raters, the SP and the student.Results: N = 46 students could be included. After the intervention, each group (EI, LI) significantly improved their competency in dealing with e-patients as judged by expert video raters (EI: M_T0 = 9.75 (2.51) versus M_T1 = 16.60 (2.80); LI: M_T0 = 8.70 (2.14) versus M_T2 = 15.20 (2.84); both p < 0.001) and SP (EI: M_T0 = 24.13 (4.83) versus M_T1 = 26.52 (3.06); LI: M_T0 = 23.37 (3.10) versus M_T2 = 27.47 (4.38); both p < 0.001). Students' rating showed a similar non-significant trend.Conclusions: Students, SP and expert video raters determined that blended-learning teaching can improve students' competencies when dealing with e-patients. Within the study period, this effect was lasting; however, further studies should look at long-term outcomes.

Patients' Online Information-Seeking Behavior Throughout Treatment: The Impact on Medication Beliefs and Medication Adherence

Research on the longitudinal impact of using the internet as an information source on patients' beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients' online information seeking behavior is particular relevant in affecting patients' beliefs and medication adherence.

Primary Health Care Nurses' Experiences of Consultations With Internet-Informed Patients: Qualitative Study

Background

Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients.

Objective

The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet.

Methods

This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines.

Results

The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information.

Conclusions

Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

Online health information seeking by adults hospitalized for acute coronary syndromes: Who looks for information, and who discusses it with healthcare providers?

OBJECTIVE

To describe characteristics associated with online health information-seeking and discussing resulting information with healthcare providers among adults with acute coronary syndromes (ACS).

METHODS

Consecutive patients hospitalized with ACS in 6 hospitals in Massachusetts and Georgia who reported Internet use in the past 4 weeks (online patients) were asked about online health information-seeking and whether they discussed information with healthcare providers. Participants reported demographic and psychosocial characteristics; clinical characteristics were abstracted from medical records. Logistic regression models estimated associations with information-seeking and provider communication.

RESULTS

Online patients (N = 1142) were on average aged 58.8 (SD: 10.6) years, 30.3% female, and 82.8% non-Hispanic white; 56.7% reported online health information-seeking. Patients with higher education and difficulty accessing medical care were more likely to report information-seeking; patients hospitalized with myocardial infarction, and those with impaired health numeracy and limited social networks were less likely. Among information-seekers, 33.9% discussed information with healthcare providers. More education and more frequent online information-seeking were associated with provider discussions.

CONCLUSION

Over half of online patients with ACS seek health information online, but only 1 in 3 of these discuss information with healthcare providers.

PRACTICE IMPLICATIONS

Clinician awareness of patient information-seeking may enhance communication including referral to evidence-based online resources.

Online Health Searches and Their Perceived Effects on Patients and Patient-Clinician Relationships: ASystematic Review

Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from January 1, 1990 to January 29, 2016 for studies in which patients searched online for any aspect of health care and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, although the nature of the effect could depend on the clinician's response to patient queries about the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship and commonly raised concerns about the accuracy of online content. Significant methodologic heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking.

Mature or Emerging? The Impact of Treatment-Related Internet Health Information Seeking on Patients' Trust in Physicians

Years of clinical trials have proven the maturity and safety of certain treatments, however, some of these mature treatments may not be highly effective. Several treatments have emerged through technological innovations, but their long-term safety, efficacy, and adverse effects remain unknown. At present, many patients seek information related to their treatments on the Internet, which may impact their attitudes towards different treatments and their trust in physicians. In this study, a research model was developed to examine how patients’ trust in their physicians is influenced by related online information on mature or emerging treatments. The hypotheses were tested using confirmatory factor analysis (CFA) and structural equation modelling (SEM). A total of 336 valid responses were collected through an online survey. Mature treatments related health information was found to significantly improve patients’ trust. Thus, physicians should pay more attention to mature treatments, and encourage their patients to seek related information online. Moreover, the quality of online information should be developed further to increase patients’ satisfaction. Physicians should also consider their patients’ psychological safety in communication with patients to strengthen their trust.

Exploring Online Asynchronous Counseling With Tobacco Treatment Specialists in the QUIT-PRIMO and National Dental PBRN HI-QUIT Studies: Who Uses It and What Do They Say?

PURPOSE

To describe the content of messages sent by smokers through asynchronous counseling within a Web-based smoking cessation intervention.

DESIGN

Qualitative.

SETTING

National community-based setting of patients who had been engaged by the medical or dental practices at which they attended or via Google advertisements.

PARTICIPANTS

Adults older than 19 years who were current smokers and interested in quitting. Participants throughout the United States referred to a Web-based cessation intervention by their medical or dental provider or by clicking on a Google advertisement.

METHODS

We conducted a qualitative review of 742 asynchronous counseling messages sent by 270 Web site users. Messages were reviewed, analyzed, and organized into qualitative themes by the investigative team.

RESULTS

The asynchronous counseling feature of the intervention was used most frequently by smokers who were white (87%), female (67%), aged 45 to 54 (32%), and who had at least some college-level education (70%). Qualitative analysis yielded 7 basic themes-Talk about the Process of Quitting, Barriers to Quitting, Reasons to Quit, Quit History, Support and Strategies for Quitting, Quitting with Medication, and Quit Progress. The most common theme was Support and Strategies for Quitting with 255 references among all messages.

CONCLUSION

We found rich communication across the spectrum of the quit process, from persons preparing to quit to those who had successfully quit. Asynchronous smoking cessation counseling provides a promising means of social support for smokers during the quit process.

Nuclear Medicine and Resources for Patients: How Complex Are Online Patient Educational Materials?

The Internet is a major source of health care information for patients. The American Medical Association and the National Institutes of Health recommend that consumer health care websites be written at a third- to seventh-grade level. The purpose of this study was to evaluate the level of readability of patient education websites pertaining to nuclear medicine. Methods: We searched for 10 terms on Google, collected the top 10 links for each term, and analyzed their level of readability using 10 well-established readability scales. Results: Collectively, the 99 articles were written at a grade level of 11.8 (SD, 3.4). Only 5 of the 99 articles were written at the third- to seventh-grade level recommended by the National Institutes of Health and the American Medical Association. Conclusion: There is a clear discordance between the readability level of nuclear medicine-related imaging terms and the National Institutes of Health and American Medical Association guidelines. This discordance may have a negative impact on patient understanding, contributing to poor health outcomes.

How do health professionals acknowledge Web-based knowledge in pregnancy consultations?

Websites for pregnancy health are an important source of information for pregnant women, but how different cadres of health professionals value and utilize pregnant women's e-health literacy (e-HL) and Web-based knowledge in pregnancy consultations is not well understood. Using a qualitative research design and pelvic girdle pain as a tracer condition, we explored how Norwegian doctors, midwives and physiotherapists manage women's e-HL and Web-based knowledge in pregnancy consultations. The recognition of pregnant women's e-HL and Web-based knowledge differed across professional groups and produced dismissive, reactive and proactive attitudes depending on time pressure, professional identity and Internet experience.

The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study

Background

Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive.

Objective

The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables.

Methods

We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits.

Results

We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01).

Conclusions

The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits.

Factors Influencing Health-Related Internet Activities and Their Outcomes

This study explores why people participate in health-related Internet activities and what the potential impacts of such activities are. Specifically, this study examines how trust in health information (i.e., from a physician and from the Internet) determines individuals' health-related Internet activities and whether this use subsequently improves outcomes such as discussion with doctors about online health information and satisfaction with health care. Findings from a Web-based survey in South Korea indicated that trust in health information from doctors decreased communication activities, whereas trust in online health information increased both communication and information activities. Both communication and information activities increased discussions with doctors about online health information, which subsequently led to satisfaction with health care.

Expressing and negotiating face in community pharmacist-patient interactions

BACKGROUND

A collaborative patient-pharmacist interaction is fundamental to greater patient satisfaction with pharmacy care and improved medication adherence. Effective pharmacist-patient communication occurs when both pharmacist and patient are able to successfully attend to not only the typical tasks and goals of the interaction but also basic face needs that underlie all social interaction; autonomy, competence or esteem, and fellowship. Addressing face needs occurs through conventional and strategic communication strategies that respond to the emerging needs throughout an interaction. Pharmacist-patient interactions are not just about transfer of information and medications. Both parties assess the situation, the others' intentions within the context of their own goals and this influences how they choose to act throughout the interaction. Face-work Theory provides a framework to understand these interaction processes in pharmacist-patient communication.

OBJECTIVES

The aim of this study was to determine face needs, threats and the strategic communication strategies used to address these within community pharmacist-patient interactions.

METHODS

This exploratory descriptive study drew upon principles of ethology to first describe naturally occurring behaviour and then to interpret this behaviour within the context of Face-work theory. Twenty-five audio-recorded community pharmacist-patient interactions were collected and analyzed. The average length of these interactions was 3:67 min with a range of 0.39 s-9:35 min.

RESULTS

Multiple face needs for both pharmacist and patient were evident in most interactions. Autonomy, competence and fellowship face needs were negotiated in the following contexts: participative relationships, concordant role expectations, sensitive topics, and negotiating expertise and knowledge. Competence face needs for both parties were the most dominant need found in negotiating role expectations. The most common communication strategies used to support face were solidarity based strategies while indirect and depersonalized questions were commonly employed to mitigate face threat.

IMPLICATIONS AND SIGNIFICANCE

Face-work Theory is a novel approach to understand processes and outcomes of patient-pharmacist interactions in community pharmacies. Linking speech acts with face needs and threats may help to elucidate how pharmacist-patient interactions achieve both task oriented and interpersonal goals.

The Informed Patient: An Analysis of Information Seeking Behavior and Surgical Outcomes Among Men With Benign Prostatic Hyperplasia

The Internet has placed considerable information at the disposal of patients, but the sources for credible and accurate information may be difficult for a layperson to discern. Benign prostatic hyperplasia (BPH) in elderly men can be treated with different surgical interventions. The purpose of this research was to determine information seeking behaviors (ISB) of BPH patients before and after each type of surgery. All patients who underwent surgical intervention for BPH at a tertiary training center between January 2007 and January 2013 were included in this study. A comprehensive questionnaire regarding their ISB was sent through a third-party survey center. The following areas were examined: (1) the patient's opinion regarding information sources of BPH and its treatment, (2) the extent of ISB for each patient and its relation to the type of surgical intervention he eventually underwent, and (3) the relationship between the extent of ISB and the patient's final satisfaction. The results indicated that the majority of patients felt that it is relatively easy to find information about BPH and its treatment. Most of the patient started with either general online search engines or used the hospital website. Patients who explored more sources of information ended up choosing a more specific and sophisticated procedure. Generally, patients used fewer sources postoperatively regardless of the procedure they underwent. There was no correlation between the extent of ISB and overall satisfaction ( r = -0.0719, p = .1610) and regret ( r = -0.0436, p = .3945).

Online health anxiety and consultation satisfaction: A quantitative exploratory study on their relations

OBJECTIVE

The present study explores how seeking online information may affect satisfaction with the doctor consultation and what role health anxiety plays in this context.

METHODS

A survey was conducted asking patients in doctors' offices about their online seeking for health information and measuring health anxiety prior to the consultation, and their satisfaction with the consultation afterwards (N= 239).

RESULTS

Results showed that health anxiety is positively related to seeking online health information and that health anxious people are less satisfied with the doctor consultation. Furthermore, people searching more extensively appreciated the duration of their physician's consultation less, but only if they were relatively health anxious.

CONCLUSIONS

The internet has significantly changed how patients can prepare themselves prior to the doctor consultation. This may have a negative effect on the satisfaction with the consultation, especially for people that are health anxious.

PRACTICAL IMPLICATIONS

Doctors should be aware that online health information seeking affects the satisfaction with the consultation, especially for health anxious individuals.

Patients' views on electronic patient information leaflets

Background:

Information in society and in health care is currently undergoing a transition from paper to digital formats, and the main source of information will probably be electronic in the future.

Objective:

To explore patients’ use and perceptions of the patient information leaflet included in the medication package, and their attitude towards a transition to an electronic version.

Methods:

The data was collected during October to November 2014 among individuals in South-Eastern Sweden, using a questionnaire (n=406, response rate 78%) and interviews (n=15).

Results:

The questionnaire showed that the majority of the respondents (52%) occasionally read the patient information leaflet, 37% always read it, and 11% never read it. Almost half of the patients (41%) were positive towards reading the patient information leaflet electronically while 32% were hesitant and 26% neutral. A majority of the patients would request to get the patient information leaflet printed at the pharmacy if it was not included in the package. There were differences in attitude related to age and gender. The interviews showed that patients had mixed views on a transition to an electronic patient information leaflet. The patients perceived several positive aspects with an electronic patient information leaflet but were concerned about elderly patients.

Conclusion:

Although many were positive towards reading the patient information leaflet electronically, the majority prefer the patient information leaflet in paper form. Providing appropriate and useful eHealth services for patients to access the patient information leaflet electronically, along with education, could prepare patients for a transition to electronic patient information leaflet.

"I Use Weed for My ADHD": A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD

Background

Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for problematic cannabis use. However, clinical and anecdotal evidence suggest an increasingly popular perception that cannabis is therapeutic for ADHD, including via online resources. Given that the Internet is increasingly utilized as a source of healthcare information and may influence perceptions, we conducted a qualitative analysis of online forum discussions, also referred to as threads, on the effects of cannabis on ADHD to systematically characterize the content patients and caregivers may encounter about ADHD and cannabis.

Methods

A total of 268 separate forum threads were identified. Twenty percent (20%) were randomly selected, which yielded 55 separate forum threads (mean number of individual posts per forum thread = 17.53) scored by three raters (Cohen’s kappa = 0.74). A final sample of 401 posts in these forum threads received at least one endorsement on predetermined topics following qualitative coding procedures.

Results

Twenty-five (25%) percent of individual posts indicated that cannabis is therapeutic for ADHD, as opposed to 8% that it is harmful, 5% that it is both therapeutic and harmful, and 2% that it has no effect on ADHD. This pattern was generally consistent when the year of each post was considered. The greater endorsement of therapeutic versus harmful effects of cannabis did not generalize to mood, other (non-ADHD) psychiatric conditions, or overall domains of daily life. Additional themes emerged (e.g., cannabis being considered sanctioned by healthcare providers).

Conclusions

Despite that there are no clinical recommendations or systematic research supporting the beneficial effects of cannabis use for ADHD, online discussions indicate that cannabis is considered therapeutic for ADHD—this is the first study to identify such a trend. This type of online information could shape ADHD patient and caregiver perceptions, and influence cannabis use and clinical care.

The web-surfing bariatic patient: the role of the internet in the decision-making process

BACKGROUND

Health-related information on the Internet is constantly increasing, but its quality and accountability are difficult to assess. Patients browse the Net to get more information, but the impact of the Internet on their decisions about surgical techniques, referral centers, or surgeon choice are still not clear. This study aimed to describe the role of the Internet in the decision-making process of obese patients seeking bariatric surgery.

METHODS

Two hundred and twelve candidates for bariatric surgery were asked to answer a questionnaire evaluating their access to the Internet, the usefulness and trustworthiness of Internet-retrieved information, the verification of the information, and the role of the information in the decision-making process.

RESULTS

Two hundred and twelve patients answered the questionnaire. Of these, 95.1% had access to the Internet and 77.8% reported having researched about bariatric surgery. Their main interests were the surgical techniques (81.4%) and other patients' experiences (72.3%). The favorite Web sites were those affiliated to public hospitals or edited by other patients. The accountability of the e-information was mainly evaluated by discussion with the general practitioner (GP) (83.0%) or family members and friends (46.8%). One patient in four decided to undergo bariatric surgery mainly based on e-information, while discussion about treatment options with the GP and the hospital reputation were taken into account in 77.8 and 51.7% of cases, respectively.

CONCLUSIONS

Most patients seeking bariatric surgery search for health information online. E-information seems to have an important role in the decision-making process of patients who are candidates for bariatric surgery.

SoundSpace Online: The Development of an Online Resource About Hearing Loss

PURPOSE

The Internet has been a growing source of health information on hearing loss, but the information provided often varies in quality, readability, and usability. Additionally, the information is provided across a wide range of domains, making access challenging to those who need it. This research forum article describes the development of a new website, SoundSpace Online (Ng, Archbold, Mayer, & Mulla, 2014), which aims to tackle these issues and bring together information and resource s f or all those concerned with hearing loss.

METHOD

The SoundSpace Online website’s current developmental state was reached through the following methods: (a) discussions with a group of individuals that included experts in e-learning, education, research, and hearing loss; (b) interviews with different target groups (e.g., users, families, and professionals); and (c) collaboration with contributors.

RESULT

The website is structured to become a g o-to resource on various topics related to hearing loss, providing accurate, comprehensive, and functional information and resources at varying levels of complexity for the intended users.

CONCLUSION

The literature and the range of interest have illustrated the need for an up-to-date website providing information and resources on hearing loss. Challenges include monitoring and keeping the website up to date; in this article, a plan of action is discussed. The website is currently in development, with plans for a launch in the near future.

Separating 'emotion' from 'the science': Exploring the perceived value of information for parents and families of children with autistic spectrum disorder

Autistic spectrum disorder (ASD) is a life-long condition. In recent years, there has been a rise in the number of children diagnosed with ASD and a greater recognition that parents need clear, accessible information communicated through different modalities. The objective of this research was to explore the views of stakeholders regarding their information needs, current information modalities and the perceived barriers and complexities of information. Three focus groups with the same stakeholders were conducted with a range of individuals from a variety of backgrounds, all of whom had a personal and/or professional interest in ASD. The same stakeholders were included in all three groups to promote depth of analysis and to facilitate rapport. All focus groups were audio-recorded, transcribed and analysed using thematic analysis. Three main issues were identified, including (1) the value of particular information sources; (2) the vulnerability of families and (3) the need for validated evidence. It was concluded, therefore, that information should be available through a multitude of modalities, accounting for the educational ability and economic status of families. The information should also be communicated in an accessible style, should be presented as trustworthy and clinical professionals may play a key role in translating information. Such information also needs to account for practical problems inherent to having a child with ASD, including time constraints and fatigue.

Does a Directive to an Internet Site Enhance the Doctor-Patient Interaction? A Prospective Randomized Study for Patients with Carpal Tunnel Syndrome

BACKGROUND

Sixty-two percent of patients would like their doctor to recommend a specific web site to find health information, but only 3% of patients receive such recommendations. We investigated whether providing patients with an Internet web-site link recommended by their physician would improve patient knowledge and satisfaction. Our hypothesis was that directing patients to a reliable web site would improve both.

METHODS

Sixty patients with a new diagnosis of carpal tunnel syndrome were prospectively randomized into two groups. Twenty-three patients in the control group had a traditional physician office visit and received standard care for carpal tunnel syndrome. Thirty-seven patients in the treatment group received a handout that directed them to the American Society for Surgery of the Hand (ASSH) web page on carpal tunnel syndrome in addition to the standard care provided in the office visit. Patients later completed a ten-question true-or-false knowledge questionnaire and a six-item satisfaction survey. Differences in scores were analyzed using two-sample t tests.

RESULTS

Less than half (48%) of the patients who were given the Internet directive reported that they had visited the recommended web site. The mean scores on the knowledge assessment (6.84 of 10 for the treatment group and 6.96 of 10 for the control group) and the satisfaction survey (4.49 of 5 for the treatment group and 4.43 of 5 for the control group) were similar for both groups. The mean score for knowledge was similar for the patients who had used the ASSH web site and for those who had not (6.89 and 6.97 respectively). Moreover, compared with patients who had not used the Internet at all to learn about carpal tunnel syndrome, patients who used the Internet scored 6.6% better (mean score, 7.14 for those who used the Internet compared with 6.70 for those who had not; p > 0.05). Regardless of Internet usage, most patients scored well on the knowledge assessment and reported a high level of satisfaction.

CONCLUSIONS

Whether the patient was given a handout or had visited the ASSH or other Internet web sites, the knowledge and satisfaction scores for all patients were similar. Since the physician was the common denominator in both groups, the results indicate that the patient-physician relationship may be more valuable than the Internet in providing patient education.

CLINICAL RELEVANCE

Effective communication between patients and practitioners is at the cornerstone of delivering excellent care and building trusting relationships. This study examines whether reliable Internet information should be embraced as a tool to enhance patient-surgeon communication in a clinical context.