Internet use leads cancer patients to be active health care consumers

ChatGPT Is Moderately Accurate in Providing a General Overview of Orthopaedic Conditions

Background

ChatGPT is an artificial intelligence chatbot capable of providing human-like responses for virtually every possible inquiry. This advancement has provoked public interest regarding the use of ChatGPT, including in health care. The purpose of the present study was to investigate the quantity and accuracy of ChatGPT outputs for general patient-focused inquiries regarding 40 orthopaedic conditions.

Methods

For each of the 40 conditions, ChatGPT (GPT-3.5) was prompted with the text "I have been diagnosed with [condition]. Can you tell me more about it?" The numbers of treatment options, risk factors, and symptoms given for each condition were compared with the number in the corresponding American Academy of Orthopaedic Surgeons (AAOS) OrthoInfo website article for information quantity assessment. For accuracy assessment, an attending orthopaedic surgeon ranked the outputs in the categories of <50%, 50% to 74%, 75% to 99%, and 100% accurate. An orthopaedics sports medicine fellow also independently ranked output accuracy.

Results

Compared with the AAOS OrthoInfo website, ChatGPT provided significantly fewer treatment options (mean difference, -2.5; p < 0.001) and risk factors (mean difference, -1.1; p = 0.02) but did not differ in the number of symptoms given (mean difference, -0.5; p = 0.31). The surgical treatment options given by ChatGPT were often nondescript (n = 20 outputs), such as "surgery" as the only operative treatment option. Regarding accuracy, most conditions (26 of 40; 65%) were ranked as mostly (75% to 99%) accurate, with the others (14 of 40; 35%) ranked as moderately (50% to 74%) accurate, by an attending surgeon. Neither surgeon ranked any condition as mostly inaccurate (<50% accurate). Interobserver agreement between accuracy ratings was poor (κ = 0.03; p = 0.30).

Conclusions

ChatGPT provides at least moderately accurate outputs for general inquiries of orthopaedic conditions but is lacking in the quantity of information it provides for risk factors and treatment options. Professional organizations, such as the AAOS, are the preferred source of musculoskeletal information when compared with ChatGPT.

Clinical Relevance

ChatGPT is an emerging technology with potential roles and limitations in patient education that are still being explored.

Cancer-related fatigue: Quality, credibility, usability, and readability of information on websites of health care institutions in Germany

OBJECTIVES

This study aimed to portray available information on cancer-related fatigue on German health care institution websites considering the idea of patient empowerment.

METHODS

Based on website quality criteria, we developed a website-rating tool comprising 18 items. Descriptive analyses, a KruskalWallis test, and corresponding post hoc tests comparing rating sum scores between institution groups were performed.

RESULTS

Websites of 283 systematically compiled health care institutions were included in the rating. Cancer-related fatigue was introduced on 21.9% and detailed information was provided on 27.9% of the websites. Information material was offered on 9.2% of the websites, while fatigue treatment offers were presented on 21.6% of the websites. The rating sum scores differed between institution groups (p < 0.001), with Comprehensive Cancer Centers scoring significantly higher than the others.

CONCLUSION

The rating revealed an overall sparse provision of information, with fatigue being addressed on less than half of the websites.

PRACTICE IMPLICATIONS

For patients who have access to at least one introduction about fatigue, institutions need to extend their websites. Patients could further be referred to external institutions or information booklets. The naming of contact persons may help linking patients to providers.

Insights into Colorectal Cancer Screening Awareness: A Study in the Community of Taif City

Colorectal cancer (CRC) is highly prevalent among Saudi males and females. Understanding its symptoms, risk factors, and screening is vital. This study aims to gauge CRC awareness in Taif City, Saudi Arabia, based on demographics. An observational study in Taif City surveyed awareness on colorectal screening, gathering data from March-April 2023 via a questionnaire covering demographics, screening knowledge, symptoms, and risk factors. Involving 551 participants, most were 19-40 years old (59.2%), female (65.9%), and had a bachelor's degree (71.3%). Notably, 49.2% hadn't visited a family doctor. Awareness on CRC screening was low. 37.7% knew about fecal occult blood tests, 32.7% about sigmoidoscopy, and 34.8% about colonoscopy. Only 27.6% knew the recommended screening age, and 2.4% the frequency. Participants sought information mainly online (45.7%) or from friends (24.1%). Recognized risk factors included family history (57.0%), blood in stool (58.8%), and abdominal pain (47.9%). The study highlights inadequate awareness about CRC screening in Taif. It underscores the necessity for targeted education campaigns, collaboration with healthcare professionals, and diverse information sources to improve understanding among the population.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Characteristics, Uses, and Biases of Studies Related to Malignancies Using Google Trends: Systematic Review

BACKGROUND

The internet is a primary source of health information for patients, supplementing physician care. Google Trends (GT), a popular tool, allows the exploration of public interest in health-related phenomena. Despite the growing volume of GT studies, none have focused explicitly on oncology, creating a need for a systematic review to bridge this gap.

OBJECTIVE

We aimed to systematically characterize studies related to oncology using GT to describe its utilities and biases.

METHODS

We included all studies that used GT to analyze Google searches related to malignancies. We excluded studies written in languages other than English. The search was performed using the PubMed engine on August 1, 2022. We used the following search input: "Google trends" AND ("oncology" OR "cancer" or "malignancy" OR "tumor" OR "lymphoma" OR "multiple myeloma" OR "leukemia"). We analyzed sources of bias that included using search terms instead of topics, lack of confrontation of GT statistics with real-world data, and absence of sensitivity analysis. We performed descriptive statistics.

RESULTS

A total of 85 articles were included. The first study using GT for oncology research was published in 2013, and since then, the number of publications has increased annually. The studies were categorized as follows: 22% (19/85) were related to prophylaxis, 20% (17/85) pertained to awareness events, 11% (9/85) were celebrity-related, 13% (11/85) were related to COVID-19, and 47% (40/85) fell into other categories. The most frequently analyzed cancers were breast (n=28), prostate (n=26), lung (n=18), and colorectal cancers (n=18). We discovered that of the 85 studies, 17 (20%) acknowledged using GT topics instead of search terms, 79 (93%) disclosed all search input details necessary for replicating their results, and 34 (40%) compared GT statistics with real-world data. The most prevalent methods for analyzing the GT data were correlation analysis (55/85, 65%) and peak analysis (43/85, 51%). The authors of only 11% (9/85) of the studies performed a sensitivity analysis.

CONCLUSIONS

The number of studies related to oncology using GT data has increased annually. The studies included in this systematic review demonstrate a variety of concerning topics, search strategies, and statistical methodologies. The most frequently analyzed cancers were breast, prostate, lung, colorectal, skin, and cervical cancers, potentially reflecting their prevalence in the population or public interest. Although most researchers provided reproducible search inputs, only one-fifth used GT topics instead of search terms, and many studies lacked a sensitivity analysis. Scientists using GT for medical research should ensure the quality of studies by providing a transparent search strategy to reproduce results, preferring to use topics over search terms, and performing robust statistical calculations coupled with sensitivity analysis.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Key drivers involved in the telemonitoring of covid-19 for self-health management: an exploratory factor analysis

Background

The recent COVID-19 pandemic and the shortage of general practitioners has determined a strong pressure on the Italian health system. This critical issue highlighted the fundamental support of e-health services not only to lighten the workload of doctors, but also to offer patients a health service tailored to real needs. Therefore, the digital engagement platforms represent a valid aid, as they reconcile the efficiency needs of the healthcare system with the benefits for the patients involved. In this perspective, little is known about the main factors associated with use of telemonitoring platforms and their effectiveness. This paper investigates the critical success factors of telemonitoring platforms during COVID-19 in order to understand the mechanisms underlying patient participation with the health engagement platforms.

Methods

An exploratory factor analysis was used to explain the main dimensions of patient participation in the COVID-19 telemonitoring. A sample of 119 patients with a suspected or confirmed infection was used in the investigation. Moreover, an analysis of variance was calculated to identify the differences between three types of patients (infected, uninfected, with suspected infection) and verify the effectiveness of the platform.

Main Findings

There are six main factors underlying the use of the COVID-19 telemonitoring platform. “Self-Health Engagement” emerges as a novel factor. Moreover, compared to other platforms, cognitive engagement is a crucial trigger for effective telemonitoring.

Discussion

By identifying the main triggers involved in the use of health engagement platforms, we can improve the satisfaction of telemonitoring services for appropriate health-crisis management. Furthermore, the COVID-19 telemonitoring platform appears to improve health management for both patients and health care providers as it provides the patient with the necessary tools for Self-Health Management (SHM), as well as helping to enrich the literature on health care.

Conclusion

A new construct emerges in the study of digital telemonitoring platforms: “health self-engagement”, that is, an engagement based on self-care that demonstrates the decisive role assumed by both digital technology and patient participation in self-management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07828-3.

Digesting the Contents: an Analysis of Online Colorectal Cancer Education Websites

Online educational resources have an impact on patient understanding, opinion, and behavior. More colorectal cancer patients are being diagnosed and using the internet to search for information. This study aims to provide the most in-depth and comprehensive examination of online colorectal resources to date. An internet search using the terms "colorectal cancer," "colon cancer," and "rectal cancer" were performed, with meta-search engines "Dogpile," "Yippy," and "Google." A total of 741, 759, and 703 websites were returned by the search engines respectively. A list of the "top 100 websites" was compiled by placing the sites in average rank order. The websites were evaluated using a validated structured rating tool. Inter-rater reliability was evaluated using kappa statistics, and the results were analyzed using descriptive statistics. Website affiliations were 40% commercial and 35% from non-profit organizations. Most websites disclosed ownership (93%) and had no apparent bias (94%). Authorship disclosure was poor (17%). Most sites were interactive (84%) and organized (70% with at least 4/5 features). Readability was at a senior high school level on average. Content coverage and accuracy were the highest in the areas of etiology (96% coverage) and symptoms (95% coverage) and lowest in areas of treatment (72% coverage) and prognosis (43% coverage).Colorectal cancer online information can be improved in accountability, readability, content accuracy, and completeness. Author disclosure, more accurate and updated citations, and a lower grade level of readability are needed. More complete and accurate information are needed, especially in the areas of treatment and prognosis.

A Review of Web-Based Nutrition Information in Spanish for Cancer Patients and Survivors

Nutrition education resources are of interest for cancer patients and survivors throughout the cancer continuum. We examined the web-based nutrition information in Spanish for cancer patients and survivors provided by national cancer organizations (NCOs). The Guide to Internet Resources for Cancer and the membership list of the Union for International Cancer Control were searched to identify the NCOs. The International Patients Decisions Aid Standards (IPDAS) was used to describe the quality of the available information. We identified 20 NCOs that provided nutrition information aimed at a general audience on their websites. Web-based resources of nine NCOs were selected for presentation in this review. Website scores ranged between 20 and 24 in the IPDAS scale (maximum score = 31). The selected NCOs offered reliable and safe information. Healthy eating information for cancer patients and management of side-effects was provided by all websites. Information was more limited for cancer survivors. We recommend that NCOs increase the possibilities for personalized recommendations and interaction with the content by including instrumental tools on their websites.

Correlates of Older Adults' E-Health Information-Seeking Behaviors

Introduction

The Internet is an important source for health information and a medium for older adults' empowerment in health decision-making and self-caring. Therefore, we aimed to identify the potential motivators and probable barriers of e-health information-seeking behaviors (e-HISB) among older Iranian adults.

Methods

A cross-sectional study assessed the usefulness of self-efficacy, perceived encouragement, positive attitude toward e-HISB, perceived usefulness, challenges of being visited by physicians, and perceived barriers in predicting e-HISB in a sample of 320 older adults in Tabriz, Iran.

Results

The self-efficacy for online information seeking, positive attitude toward e-HISB, and perceived usefulness increased the odds of e-HISB by 12.00%, 24.00%, and 15.00%, respectively. In addition, e-health literacy, conflicting information, distrust of online information, and web designs that were not senior-friendly were the major barriers to e-HISB.

Discussion/Conclusion

The theoretical and practical implications of the motivators and barriers of e-HISB can be instrumental in designing and executing programs aimed at improving e-health literacy among older adults especially during the COVID-19 pandemic.

Differences in Internet Use and eHealth Needs of Adolescent and Young Adult Versus Older Cancer Patients; Results from the PROFILES Registry

Simple Summary

The internet has become an important health information source for patients with cancer. AYAs (adolescents and young adults; 18–39 years at time of diagnosis) can be considered as digital natives; they work with the internet and related technologies in their daily lives. It is likely that AYAs are more used to using the internet, while older cancer patients might prefer former ways of information provision to obtain health-related information. The question arises whether internet use and eHealth needs of AYA cancer patients are comparable to those of older ones. By conducting a cross-sectional survey, we evaluated differences in cancer-related internet patterns between AYAs and older cancer patients (40+ years at time of diagnosis). A better understanding of differences between generations will help inform healthcare providers on how to guide cancer patients of different ages regarding cancer-related internet use.

Abstract

Background: Our aim was to evaluate differences in cancer-related internet patterns between AYAs (adolescents and young adults; 18–39 years at time of diagnosis) and older adult cancer patients (40+ years). Methods: Cross-sectional surveys were distributed among AYA and older adult cancer patients regarding cancer-related internet use and eHealth needs. Results: 299 AYAs (mean age 31.8 years) and 270 older adults (mean age 55.8 years) participated. AYAs searched significantly more often on the internet on a daily basis just before diagnosis (45% vs. 37%), right after diagnosis (71% vs. 62%) and during treatment (65% vs. 59%) compared to older adults. During follow up, there was a trend that AYAs searched less often on the internet compared to older adults (15% vs. 17%). AYAs searched more often on topics, such as alternative or complementary therapies, treatment guidelines, fertility, end of life, sexuality and intimacy, lifestyle and insurance. AYAs felt significantly better informed (75%) after searching for cancer-related information compared to older adults (65%) and had significantly less unmet needs regarding access to their own medical information (22% vs. 47%). AYAs search more on the internet on a daily basis/several times per week in the diagnosis and treatment phase than older cancer patients. They search on different topics than older adults and seems to have less unmet eHealth needs.It is important that these are easy to find and reliable.

External support factors utilized by patients in coping with cancer: a European perspective

PURPOSE

The article presents the results of research on psychosocial aspects of living with cancer in the Slovak Republic focusing on hospitalized and outpatient cancer patients in treatment during the curative stage of the disease. Assessing cancer patient's interest in receiving help from individual members of a multidisciplinary team was a part of the research.

METHODS

The research was done through a questionnaire designed to focus on individual psychosocial aspects of cancer treatment. The research sample included 67 hospitalized patients and 61 outpatients. Execution of research was conducted in the individual clinical workplaces.

RESULTS

When calculating the interest of cancer patients in spiritual counseling during oncological treatment, hospitalized patients indicated significant interest (p = .014). Similarly, hospitalized patients indicated more interest in using psychological counseling (p = .040) as well as in consultation with the social worker with a significant difference of (p = .017). Interest in the aid of a physical therapist was exhibited more significantly with hospitalized patients (p = .000). Significant interest in hospitalized patients using additional members of the multidisciplinary team was statistically significant (p = .017). Outpatient cancer patients indicated significant interest in finding information about medical conditions on the Internet (p = .000). For items addressing an interest in meeting people with cancer in self-help groups, there was no significant difference between outpatient and hospital patients (p = .298) as with talking to other patients who had cancer (p = .207).

CONCLUSION

External support factors are important in helping patients cope with cancer. Health professionals can help patients mitigate the various difficulties associated with cancer.

Patients With Cancer Searching for Cancer- or Health-Specific Web-Based Information: Performance Test Analysis

Background

Searching the internet for cancer-related information helps patients with cancer satisfy their unmet information needs and empowers them to play a more active role in the management of their disease. However, to benefit from the search, patients need a sufficient level of skill to search, select, appraise, and apply web-based health information.

Objective

We aim to study the operational, navigational, information, and evaluation skills and problems of patients with cancer performing cancer-related search tasks using the internet.

Methods

A total of 21 patients with cancer were recruited during their stay at the rehabilitation clinic for oncological rehabilitation. Participants performed eight cancer-related search tasks using the internet. The participants were asked to think aloud while performing the tasks, and the screen activities were recorded. The types and frequencies of performance problems were identified and coded into categories following an inductive coding process. In addition, the performance and strategic characteristics of task execution were summarized descriptively.

Results

All participants experienced problems or difficulties in executing the tasks, and a substantial percentage of tasks (57/142, 40.1%) could not be completed successfully. The participants’ performance problems were coded into four categories, namely operating the computer and web browser, navigating and orientating, using search strategies, and evaluating the relevance and reliability of web-based information. The most frequent problems occurred in the third and fourth categories. A total of 90% (19/21) of participants used nontask-related search terms or nonspecific search terms. A total of 95% (20/21) of participants did not control for the source or topicality of the information found. In addition, none of the participants verified the information on 1 website with that on another website for each task.

Conclusions

A substantial group of patients with cancer did not have the necessary skills to benefit from cancer-related internet searches. Future interventions are needed to support patients in the development of sufficient internet-searching skills, focusing particularly on information and evaluation skills.

Assessing how health information needs of individuals with colorectal cancer are met across the care continuum: an international cross-sectional survey

BACKGROUND

Studies evaluating health information needs in colorectal cancer (CRC) lack specificity in terms of study samples involving patients. We assessed how health information needs of individuals with CRC are met across the care continuum.

METHODS

We administered an international, online based survey. Participants were eligible for the study if they: 1) were 18 years of age or older; 2) received a diagnosis of CRC; and 3) were able to complete the online health survey in English, French, Spanish, or Mandarin. We grouped participants according to treatment status. The survey comprised sections: 1) demographic and cancer characteristics; 2) health information needs; and 3) health status and quality of life. We used multivariable regression models to identify factors associated with having health information needs met and evaluated impacts on health-related outcomes.

RESULTS

We analyzed survey responses from 1041 participants including 258 who were currently undergoing treatment and 783 who had completed treatment. Findings suggest that information needs regarding CRC treatments were largely met. However, we found unmet information needs regarding psychosocial impacts of CRC. This includes work/employment, mental health, sexual activity, and nutrition and diet. We did not identify significant predictors of having met health information needs, however, among participants undergoing treatment, those with colon cancer were more likely to have met health information needs regarding their treatments as compared to those with rectal cancer (0.125, 95% CI, 0.00 to 0.25, p-value = 0.051).

CONCLUSIONS

Our study provides a comprehensive assessment of health information needs among individuals with CRC across the care continuum.

IC-Health Project: Development of MOOCs to Promote Digital Health Literacy: First Results and Future Challenges

Digital health literacy (DHL) is the ability to search, understand and evaluate information from digital media and apply that knowledge to solve health problems. However, currently many citizens have not developed these skills, and this compromises not only the self-management of their health, but the possibility that health services are socially sustainable. The objective of this article was to present the objectives, activities and results of the IC-Health project whose objective was to develop a series of massive open online courses (MOOCs) to improve the DHL skills of European citizens. An exploratory report on DHL’s current evidence was developed. Furthermore, a survey, focus groups and group interviews were conducted to determine DHL levels and the needs of population cohorts (children; adolescents; pregnant and lactating women; the elderly; and people affected by type 1 and type 2 diabetes). A participation strategy with end users was designed through a community of practice for the creation of MOOCs with the seven European countries that participated in the consortium. Thirty-five MOOCs were developed in eight different languages and a descriptive and exploratory assessment of MOOCs was conducted with new participants. This first evaluation indicated that MOOCs can be an effective educational resource for DHL and a facilitator of shared decision-making processes. The process of co-creation of MOOCs, the components, the challenges and the opportunities identified in this European project could be useful for other developers of MOOCs who want to co-create interventions with beneficiaries in similar settings. Further longer-term actions are still needed to improve citizens’ DHL.

Gaps in Online Breast Cancer Treatment Information for Older Women

BACKGROUND

For women older than 70 years with early-stage breast cancer, the routine use of sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy offers no overall survival benefit and may be perceived as undesirable by many women. National guidelines allow possible omission of these practices for older women. This study aimed to assess the availability of web-based educational materials targeting older women and their age-specific treatment recommendations.

METHODS

The study systematically assessed the websites of the top 25 "Best Hospitals for Cancer" ranked by the U.S. News & World Report, as well as the websites of four prominent national cancer organizations.

RESULTS

Websites for the leading cancer hospitals and national cancer organizations contain extremely limited information directed toward older patients with breast cancer. Both SLNB and adjuvant radiotherapy are described as treatments "typically," "most often," or "usually" used in combination with breast-conserving surgery without circumstances noted for possible omission. Specifically, no hospital website and only one national organization in this study included information on the recommendation to avoid routine SLNB. Only two hospitals and two national organizations included information suggesting possible omission of adjuvant radiotherapy for patients older than 70 years.

CONCLUSION

The absence of online material for older patients with breast cancer represents a gap potentially contributing to overtreatment by framing SLNB and adjuvant radiotherapy as necessary. Informational resources available to women aged 70 years or older may aid in informed physician-patient communication and decision-making, which may reduce SLNB and adjuvant radiotherapy for patients who might opt out of these procedures if fully informed about them.

[Development of an evaluation system for online self-help groups by using the example of German-speaking cancer forums]

Development of an evaluation system for online self-help groups by using the example of German-speaking cancer forums Objectives: This paper pursues the question how the quality of forums can be evaluated. Therefor a grading system was designed and 23 German-speaking cancer forums were evaluated by content and formal criteria Methods: Using a keyword-based internet search, 23 forums were identified. Data was gathered about: number of themes, posts and members, structure, key subjects and type of financing. Furthermore, an evaluation system was developed, with which the forums where assessed. Results: The forums were divided in forums with (n = 10) and without (n = 9) focus on a type of cancer. Four are health portals with forum-function. The quality of online cancer forums is heterogeneous, the evaluation resulted an average quality index of 2.7 for the total cancer forums Conclusion: A good information editing, moderation, data protection and transparency are important quality criteria. The evaluation of forums may help the patients, to autonomously value the quality of the presented information.

Differences in coping strategies among young adults and the elderly with cancer

BACKGROUND

Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer.

METHODS

Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions).

RESULTS

Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment.

CONCLUSION

Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.

Assessing Electronic Health Literacy in the State of Kuwait: Survey of Internet Users From an Arab State

Background

The internet and social media have become an important source for health information. In 2017, the State of Kuwait ranked first in mobile subscription penetration in the Arab world; nearly 90% of its population uses the internet. Electronic health (eHealth) literacy is important in populations that have easy and affordable access to internet resources to more effectively manage health conditions as well as improve general population health.

Objective

The aim of this study was to assess eHealth literacy levels across internet users in Kuwait and identify demographic characteristics that influence eHealth literacy. Furthermore, the study aimed to identify the reasons and type of information that people seek online. Finally, this study examined the utilization of various social media channels for accessing online health information. The social media platforms considered were as follows: WhatsApp, Twitter, Instagram, YouTube, Facebook, and Snapchat.

Methods

A cross-sectional anonymous Web-based survey was used to collect data about eHealth literacy and related information. The eHealth literacy scale (eHEALS), originally developed by Norman and Skinner, is measured using 8 Likert-type scales. A linear regression model estimates the effect of demographic variables such as age, gender, and education on eHealth literacy while controlling for participants’ perceived usefulness and importance of the internet. Participants were also surveyed about their frequency in using social media platforms for seeking health information.

Results

Kuwait’s composite eHEALS, based on a sample of 386 participants, was 28.63, which is very similar to eHEALS observed among adult populations in other developed countries. Females in Kuwait demonstrated a higher average eHEALS compared with males. Among the social media platforms, the survey results indicated that YouTube is the most frequently used to seek health information, with Facebook being the least frequently used.

Conclusions

Internet users in Kuwait appear confident in their ability to search for health-related information online compared with other populations, as indicated by aggregate eHEALS scores. Considering this finding, government and health care organizations should shift more efforts from traditional media toward online health information, focusing on the social media outlets that people in Kuwait find more useful for seeking health information.

New Integrated Model Approach to Understand the Factors That Drive Electronic Health Record Portal Adoption: Cross-Sectional National Survey

Background

The future of health care delivery is becoming more patient-focused, and electronic health record (EHR) portals are gaining more attention from worldwide governments that consider this technology as a valuable asset for the future sustainability of the national health care systems. Overall, this makes the adoption of EHR portals an important field to study.

Objective

The aim of this study is to understand the factors that drive individuals to adopt EHR portals.

Methods

We applied a new adoption model that combines 3 different theories, namely, extended unified theory of acceptance and use of technology, health belief model, and the diffusion of innovation; all the 3 theories provided relevant contributions for the understanding of EHR portals. To test the research model, we used the partial least squares causal modeling approach. We executed a national survey based on randomly generated mobile phone numbers. We collected 139 questionnaires.

Results

Performance expectancy (beta=.203; t=2.699), compatibility (beta=.530; t=6.189), and habit (beta=.251; t=2.660) have a statistically significant impact on behavior intention (R²=76.0%). Habit (beta=.378; t=3.821), self-perception (beta=.233; t=2.971), and behavior intention (beta=.263; t=2.379) have a statistically significant impact on use behavior (R²=61.8%). In addition, behavior intention (beta=.747; t=10.737) has a statistically significant impact on intention to recommend (R²=69.0%), results demonstrability (beta=.403; t=2.888) and compatibility (beta=.337; t=2.243) have a statistically significant impact on effort expectancy (R²=48.3%), and compatibility (beta=.594; t=6.141) has a statistically significant impact on performance expectancy (R²=42.7%).

Conclusions

Our research model yields very good results, with relevant R² in the most important dependent variables that help explain the adoption of EHR portals, behavior intention, and use behavior.

Perspectives of healthcare professionals on patient Internet use during the cancer experience

In this study, we document cancer healthcare professionals' views of patients' use of cancer-related Internet information (CRII) and their views on how it informs the ways patients interact with healthcare professionals and services from the point of view of health professionals. We used an interpretive descriptive approach, conducting interviews and focus groups with oncology healthcare professionals (n = 21) at a University-affiliated western Canadian cancer treatment centre. Data were analysed using thematic analysis. We present an initial understanding of how CRII alters, informs and modulates patients' cancer experience and relates to their interactions with healthcare professionals and services. Findings were synthesised into two thematic categories: pragmatic concerns and priorities; and processes and practices. Healthcare professionals were supportive of patients' needs for more information, particularly at key points in the cancer trajectory when information may be lacking. Participants concurred that CRII could positively benefit patients and, if shared with their healthcare professional, could benefit the patient-healthcare professional relationship. Oncology healthcare professionals provide pivotal information to patients; thus, they are well situated to engage patients in discussions about CRII and incorporate this into patient encounters. These actions may open new lines of communication with patients, strengthen the patient-professional relationship and empower patients to be engaged in their own care.

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.

Internet Use by Gynecologic Oncology Patients and Its Relationship with Anxiety

This study describes the use of the Internet for health information research by patients attending a gynecologic oncology practice and examines the association between its use and anxiety. A self-administered survey assessed patients' demographic information and Internet use. The Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI) were administered concurrently. Of 212 patients who consented to the study, 98 (46%) had an appointment because of a cancer diagnosis. Of 199 respondents, 91 (46%) reported searching the Internet for information about their condition. Internet searching was unassociated with race/ethnicity and positively associated with education level, annual household income, and married/partnered civil status. Only 16% of the patients reported that a health-care provider recommended use of the Internet for research. Comparing patients who used the Internet for research with those who did not, the STAI state and trait anxiety scores were similar. The HADS anxiety subscale score was higher for those who used the Internet versus those who did not, which suggests heightened anxiety. Internet use for research is common in gynecologic oncology patients, and its use is associated with increased anxiety. Physicians can use this medium to educate patients about their disease, build trust, and alleviate fear.

Predictors of Smartphone Uses for Health Information Seeking in the Korean Elderly

The purpose of this research is to examine the predictors of smartphone uses for health information-seeking (SHIS) in the Korean elderly. This research applies the comprehensive model of information seeking as a theoretical framework. Data reported in this study are from the 2016 Dementia Literacy Survey, and 235 elderly smartphone users were included in logistic regression model. SHIS was significantly predicted by younger age, higher education levels, having a regular exercise, higher medical expenditures, and health literacy. The findings of this study can help social workers understand the specific features of health information seeking in the Korean elderly.

Information sources of self-care strategies for persons living with HIV

OBJECTIVES

A number of studies have been conducted to identify the self-care strategies that are used by persons living with chronic illnesses to manage their symptoms, but little work has been done to identify the primary information source for these self-care strategies.

METHODS

We conducted an anonymous online survey with 1373 persons living with HIV to identify the self-care strategies they use to manage 28 commonly experienced symptoms. Following their report of their symptoms and self-care strategies, we asked an open-ended question to identify where the participant obtained the information. We applied iterative content analysis of the narrative data and multi-nominal regression to identify which demographic factors were significantly related to each information source category.

RESULTS

Respondents reported a total of 8539 information sources for their self-care strategies categorized as follows: Common sense/Self-experience, Healthcare professional, Internet, Literature, Multiple Sources, Social Support, and TV ads.

CONCLUSIONS

We found that respondents with no college education were significantly more likely to report the use of the Internet as the information source for their self-care strategies. On the other hand, males as compared to females were significantly less likely to use the Internet and significantly more likely to use TV ads.

"Others Like Me". An Approach to the Use of the Internet and Social Networks in Adolescents and Young Adults Diagnosed with Cancer

The purpose of this study is to improve comprehension about how adolescents and young adults (AYA) diagnosed with cancer use the Internet and social networks to seek information about their illness and to establish relationships between them. A group of 20 AYA patients and survivors of cancer (ages 14 to 29) were interviewed from a qualitative approach. Most of the respondents (N = 16) sought information about their disease on the Internet. They looked for information using search engines (mainly Google) and general concepts as their own cancer name. In general, they did not share the information obtained with their parents or professional healthcare providers. The interviewees think that the information is difficult to understand because of jargon and that it is not aimed at a young audience. All (N = 20) have presence in social networking sites. AYAs with cancer are starting to create content themselves: three started a blog in order to explain their experience to others like them. The study shows that is necessary to increase efforts on adapting content to these age groups in order to help them learn more about their own disease. This may contribute to increment their adherence to treatment and to maintain surveillance of potential consequences and health problems post-treatment.

Visualizing risks in cancer communication: A systematic review of computer-supported visual aids

OBJECTIVE

Health websites are becoming important sources for cancer information. Lay users, patients and carers seek support for critical decisions, but they are prone to common biases when quantitative information is presented. Graphical representations of risk data can facilitate comprehension, and interactive visualizations are popular. This review summarizes the evidence on computer-supported graphs that present risk data and their effects on various measures.

METHODS

The systematic literature search was conducted in several databases, including MEDLINE, EMBASE and CINAHL. Only studies with a controlled design were included. Relevant publications were carefully selected and critically appraised by two reviewers.

RESULTS

Thirteen studies were included. Ten studies evaluated static graphs and three dynamic formats. Most decision scenarios were hypothetical. Static graphs could improve accuracy, comprehension, and behavioural intention. But the results were heterogeneous and inconsistent among the studies. Dynamic formats were not superior or even impaired performance compared to static formats.

CONCLUSIONS

Static graphs show promising but inconsistent results, while research on dynamic visualizations is scarce and must be interpreted cautiously due to methodical limitations.

PRACTICE IMPLICATIONS

Well-designed and context-specific static graphs can support web-based cancer risk communication in particular populations. The application of dynamic formats cannot be recommended and needs further research.

Electronic Health Record Portal Adoption: a cross country analysis

BACKGROUND

This study's goal is to understand the factors that drive individuals to adopt Electronic Health Record (EHR) portals and to estimate if there are differences between countries with different healthcare models.

METHODS

We applied a new adoption model using as a starting point the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) by incorporating the Concern for Information Privacy (CFIP) framework. To evaluate the research model we used the partial least squares (PLS) - structural equation modelling (SEM) approach. An online questionnaire was administrated in the United States (US) and Europe (Portugal). We collected 597 valid responses.

RESULTS

The statistically significant factors of behavioural intention are performance expectancy ([Formula: see text] _total = 0.285; P < 0.01), effort expectancy ([Formula: see text] _total = 0.160; P < 0.01), social influence ([Formula: see text] _total = 0.198; P < 0.01), hedonic motivation ([Formula: see text] _total = -0.141; P < 0.01), price value ([Formula: see text] _total = 0.152; P < 0.01), and habit ([Formula: see text] _total = 0.255; P < 0.01). The predictors of use behaviour are habit ([Formula: see text] _total = 0.145; P < 0.01), and behavioural intention ([Formula: see text] _total = 0.480; P < 0.01). Social influence, hedonic motivation, and price value are only predictors in the US group. The model explained 53% of the variance in behavioural intention and 36% of the variance in use behaviour.

CONCLUSIONS

Our study identified critical factors for the adoption of EHR portals and significant differences between the countries. Confidentiality issues do not seem to influence acceptance. The EHR portals usage patterns are significantly higher in US compared to Portugal.

Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology

BACKGROUND AND PURPOSE

More than 75 million Americans have less than adequate health literacy skills according to the National Center for Education Statistics. Readability scores are used as a measure of how well populations read and understand patient education materials. The purpose of this study was to assess the readability of Web sites dedicated to patient education for radiologic spine imaging and interventions.

MATERIALS AND METHODS

Eleven search terms relevant to radiologic spine imaging were searched on the public Internet, and the top 10 links for each term were collected and analyzed to determine readability scores by using 10 well-validated quantitative readability assessments from patient-centered education Web sites. The search terms included the following: x-ray spine, CT spine, MR imaging spine, lumbar puncture, kyphoplasty, vertebroplasty, discogram, myelogram, cervical spine, thoracic spine, and lumbar spine.

RESULTS

Collectively, the 110 articles were written at an 11.3 grade level (grade range, 7.1-16.9). None of the articles were written at the American Medical Association and National Institutes of Health recommended 3rd-to-7th grade reading levels. The vertebroplasty articles were written at a statistically significant (P < .05) more advanced level than the articles for x-ray spine, CT spine, and MR imaging spine.

CONCLUSIONS

Increasing use of the Internet to obtain health information has made it imperative that on-line patient education be written for easy comprehension by the average American. However, given the discordance between readability scores of the articles and the American Medical Association and National Institutes of Health recommended guidelines, it is likely that many patients do not fully benefit from these resources.

Radiology Online Patient Education Materials Provided by Major University Hospitals: Do They Conform to NIH and AMA Guidelines?

AIMS

The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making. Owing to health literacy variations in the general population, the American Medical Association and National Institutes of Health recommend patient education resources to be written between the third and seventh grade levels. Our purpose is to quantitatively assess the readability levels of online radiology educational materials, written for the public, in 20 major university hospitals.

MATERIALS AND METHODS

In September and October 2016, we identified 20 major university hospitals with radiology residency-affiliated hospital systems. On each hospital׳s website, we downloaded all radiology-related articles written for patient use. A total of 375 articles were analyzed for readability level using 9 quantitative readability scales that are well validated in the medical literature.

RESULTS

The 375 articles from 20 hospital systems were collectively written at an 11.4 ± 3.0 grade level (range: 8.4-17.1). Only 11 (2.9%) articles were written at the recommended third to seventh grade levels. Overall, 126 (33.6%) were written above a full high-school reading level. University of Washington Medical Center׳s articles were the most readable with a reading level corresponding to 7.9 ± 0.9.

CONCLUSIONS

The vast majority of websites at major academic hospitals with radiology residencies designed to provide patients with information about imaging were written above the nationally recommended health literacy guidelines to meet the needs of the average American. This may limit the benefit that patients can derive from these educational materials.

Connectivity to computers and the Internet among patients with schizophrenia spectrum disorders: a cross-sectional study

PURPOSE

Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs).

PATIENTS AND METHODS

A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients' medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics.

RESULTS

In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and >30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45-65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P<0.001), and younger people and those with higher education were associated with more active use.

CONCLUSION

Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.

Peer-Generated Health Information: The Role of Online Communities in Patient and Caregiver Health Decisions

Individuals increasingly access peer-generated health information (PGHI) through social media, especially online health communities (OHCs). Previous research has documented PGHI topics, credibility assessment strategies, and PGHI's connection with well-being. However, there is limited evidence on where, when, and why individuals seek PGHI and how they use PGHI in health decisions. We conducted in-person and online focus groups with verified OHC members (N = 89)-representing 50 different medical conditions and 77 OHCs-to explore these topics. Two researchers independently coded transcripts with NVivo 9.2 and thematically analyzed responses. Most individuals accidentally discovered PGHI during Web searches rather than intentionally seeking it. Individuals valued PGHI primarily as an alternative information source about treatment options, self-care activities, and health care provider questions rather than a source of emotional support, and they acknowledged PGHI's limitation as anecdotal evidence. Individuals used PGHI as a springboard for additional research and patient-provider discussions, ultimately making treatment decisions alongside providers. These findings suggest that individuals use PGHI in much the same way they use traditional online health information and that PGHI facilitates, rather than obstructs, shared decision making with health care providers.

Health Literacy in Adolescents and Young Adults: Perspectives from Australian Cancer Survivors

PURPOSE

Health literacy is a critical determinant of health and an emerging public health concern. Little is known about the health literacy of adolescents and young adults (AYAs) or about the ability of young patients to communicate health needs and critically evaluate information. We used qualitative methods to investigate the three aspects of health literacy (functional, communicative, and critical) in Australian AYA cancer survivors.

METHODS

Forty Australian AYA cancer survivors, aged 15-29 either at diagnosis or recruitment, participated in semistructured interviews. Participants were asked about sources of information and ability to understand information, communicate questions, and critically evaluate the validity, reliability, and relevancy of information to their situation. Self-reported adherence levels and advice for AYA-specific care was also obtained. Interviews were coded and analyzed for emergent themes using QSR NVivo 10.

RESULTS

Almost all AYAs named their doctor as the primary source of information. Most AYAs reported no difficulties with understanding, communicating, or assessing relevancy of information. Conversely, few AYAs reported confidence in assessment of validity and reliability of information. The doctor-patient relationship appeared to be an influential factor in all aspects of health literacy.

CONCLUSIONS

AYAs frequently reported having a good understanding and communication around health information; however, few AYAs described engaging in critical evaluations of this information. The potential impact of the doctor-patient relationship across several domains of health literacy suggests that more focus could be placed on promoting health literacy at physician, community, and societal levels, in addition to promoting individual skills.

User Experiences of the McMaster Optimal Aging Portal's Evidence Summaries and Blog Posts: Usability Study

BACKGROUND

Evidence summaries and blogs can support evidence-informed healthy aging, by presenting high-quality health research evidence in plain language for a nonprofessional (citizen) audience.

OBJECTIVE

Our objective was to explore citizens' perceptions about the usability of evidence summaries and blog posts on the Web-based McMaster Optimal Aging Portal.

METHODS

Twenty-two citizens (aged 50 years and older) and informal caregivers participated in a qualitative study using a think-aloud method and semistructured interviews. Eleven interviews were conducted in person, 7 over the telephone, and 4 by Skype.

RESULTS

We identified themes that fell under 4 user-experience categories: (1) desirability: personal relevance, (2) understandability: language comprehension, grasping the message, dealing with uncertainty, (3) usability: volume of information, use of numbers, and (4) usefulness: intention to use, facility for sharing.

CONCLUSIONS

Participants recognized that high-quality evidence on aging was valuable. Their intended use of the information was influenced by how much it applied to their own health circumstances or those of a loved one. Some specific formatting features that were preferred included consistent layout, content organized by subheadings, catchy titles, numerical information summarized in a table, and inclusion of a glossary.

Cartilage-Repair Innovation at a Standstill: Methodologic and Regulatory Pathways to Breaking Free

Articular cartilage defects strongly predispose patients to developing early joint degeneration and osteoarthritis, but for more than 15 years, no new cartilage-repair technologies that we know of have been approved by the U.S. Food and Drug Administration. Many studies examining novel approaches to cartilage repair, including cell, tissue, or matrix-based techniques, have shown great promise, but completing randomized controlled trials (RCTs) to establish safety and efficacy has been challenging, providing a major barrier to bringing these innovations into clinical use. In this article, we review reasons that surgical innovations are not well-suited for testing through RCTs. We also discuss how analytical methods for reducing bias, such as propensity scoring, make prospective observational studies a potentially viable alternative for testing the safety and efficacy of cartilage-repair and other novel therapies, offering the real possibility of therapeutic innovation.

Paper-Based Survivorship Care Plans May be Less Helpful for Cancer Patients Who Search for Disease-Related Information on the Internet: Results of the Registrationsystem Oncological Gynecology (ROGY) Care Randomized Trial

Background

The Institute of Medicine recommends Survivorship Care Plans (SCPs) for all cancer survivors. However, it is unclear whether certain patient groups may or may not benefit from SCPs.

Objective

The aim was to assess whether the effects of an automatically generated paper SCP on patients’ satisfaction with information provision and care, illness perceptions, and health care utilization were moderated by disease-related Internet use.

Methods

Twelve hospitals were randomized to either SCP care or usual care in the pragmatic cluster randomized Registrationsystem Oncological GYnecology (ROGY) Care trial. Newly diagnosed endometrial cancer patients completed questionnaires after diagnosis (N=221; response: 74.7%, 221/296), 6 months (n=158), and 12 months (n=147), including patients’ satisfaction with information provision and care, illness perceptions, health care utilization (how many times patients visited a medical specialist or primary care physician about their cancer in the past 6 months), and disease-related Internet use (whether patients used the Internet to look for information about cancer).

Results

In total, 80 of 221 (36.2%) patients used the Internet to obtain disease-related information. Disease-related Internet use moderated the SCP care effect on the amount of information received about the disease (P=.03) and medical tests (P=.01), helpfulness of the information (P=.01), and how well patients understood their illness (P=.04). All stratified analyses were not statistically significant. However, it appeared that patients who did not seek disease-related information on the Internet in the SCP care arm reported receiving more information about their disease (mean 63.9, SD 20.1 vs mean 58.3, SD 23.7) and medical tests (mean 70.6, SD 23.5 vs mean 64.7, SD 24.9), finding the information more helpful (76.7, SD 22.9 vs mean 67.8, SD 27.2; scale 0-100), and understanding their illness better (mean 6.6, SD 3.0 vs mean 6.1, SD 3.2; scale 1-10) than patients in the usual care arm did. In addition, although all stratified analyses were not significant, patients who did seek disease-related information on the Internet in the SCP care arm appeared to receive less information about their disease (mean 65.7, SD 23.4 vs mean 67.1, SD 20.7) and medical tests (mean 72.4, SD 23.5 vs mean 75.3, SD 21.6), did not find the information more helpful (mean 78.6, SD 21.2 vs mean 76.0, SD 22.0), and reported less understanding of their illness (mean 6.3, SD 2.8 vs mean 7.1, SD 2.7) than patients in the usual care arm did.

Conclusions

Paper SCPs appear to improve the amount of information received about the disease and medical tests, the helpfulness of the information, and understanding of the illness for patients who do not search for disease-related information on the Internet. In contrast, paper SCPs do not seem beneficial for patients who do seek disease-related information on the Internet.

Trial Registration

ClinicalTrials.gov NCT01185626; https://clinicaltrials.gov/ct2/show/NCT01185626 (Archived by WebCite at http://www.webcitation.org/6fpaMXsDn)

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.

Electronic Health Record Patient Portal Adoption by Health Care Consumers: An Acceptance Model and Survey

Background

The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand.

Objective

The aim of this study is to understand the factors that drive individuals to adopt EHR portals.

Methods

We applied a new adoption model using, as a starting point, Ventkatesh's Unified Theory of Acceptance and Use of Technology in a consumer context (UTAUT2) by integrating a new construct specific to health care, a new moderator, and new relationships. To test the research model, we used the partial least squares (PLS) causal modelling approach. An online questionnaire was administrated. We collected 360 valid responses.

Results

The statistically significant drivers of behavioral intention are performance expectancy (beta=.200; t=3.619), effort expectancy (beta=.185; t=2.907), habit (beta=.388; t=7.320), and self-perception (beta=.098; t=2.285). The predictors of use behavior are habit (beta=0.206; t=2.752) and behavioral intention (beta=0.258; t=4.036). The model explained 49.7% of the variance in behavioral intention and 26.8% of the variance in use behavior.

Conclusions

Our research helps to understand the desired technology characteristics of EHR portals. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not. The inclusion of specific constructs and relationships related to the health care consumer area also had a significant impact on understanding the adoption of EHR portals.

Online Patient Education for Chronic Disease Management: Consumer Perspectives

Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management.

The Impact of Information Technology on Patient Engagement and Health Behavior Change: A Systematic Review of the Literature

Background

Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change.

Objective

Our aim was to systematically review the (1) impact of IT platforms used to promote patients’ engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes.

Methods

PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria.

Results

A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170).

Conclusions

In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes.

The Technological Growth in eHealth Services

The infusion of information communication technology (ICT) into health services is emerging as an active area of research. It has several advantages but perhaps the most important one is providing medical benefits to one and all irrespective of geographic boundaries in a cost effective manner, providing global expertise and holistic services, in a time bound manner. This paper provides a systematic review of technological growth in eHealth services. The present study reviews and analyzes the role of four important technologies, namely, satellite, internet, mobile, and cloud for providing health services.

Undesirable effects related to oral antineoplastic drugs: comparison between patients' internet narratives and a national pharmacovigilance database

BACKGROUND

The Internet is changing the way people learn about health and illness. Over the previous decade, the oral antineoplastic (OAN) agents have changed patient management allowing more ambulatory care. In this regard, websites could be an interesting source of data about OAN-induced adverse events (AEs).

OBJECTIVE

The aim of the study was to describe the characteristics of AEs, as reported on websites by patients exposed to OAN agents, and to compare these to those recorded in the French pharmacovigilance database (FPVD).

METHODS

We performed a retrospective study to collect AEs reported by patients in five of the best-known website forums in France over 1 year (2011). For each report, we recorded demographic data, cancer type, drug involved and AEs. The same analysis was done in the FPVD for OAN-induced adverse drug reactions (ADRs).

RESULTS

A total of 202 AEs were identified in website posts and 1,448 ADRs were found in the FPVD. The most cited drugs in websites were protein kinase inhibitors (n = 88, 43.5%) and hormone antagonists (n = 61, 30.2%). More musculoskeletal disorder reports were found in the patient websites compared with the FPVD (16.34 vs. 4.70%, p < 0.001). As for skin disorders, we collected fewer reports in the patient website forums than in the FPVD (13.37 vs. 22.17%, p = 0.004). AEs reported in the patient websites were less serious (n = 10, 4.95%) than ADRs recorded in the FPVD (n = 999, 68.99%) (p < 0.001).

CONCLUSIONS

AEs reported in the website forums are considered by patients to be relevant enough to be shared. Data from patient websites could be used as a source of data to detect AEs alongside conventional pharmacovigilance.

Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits

Objectives:

To describe the communication behaviors of patients and physicians and patient participation in communication about treatment decision-making during consultation visits for localized prostate cancer (LPCa).

Methods:

This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed); “low” (patient listening only); “moderate” (patient providing information or asking questions); and “high” (patient providing information and asking questions).

Results:

Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories; 2) “low” in discussing survival/mortality; 3) “low and moderate” in discussing treatment options; 4) “none and low” in discussing treatment impacts; and 5) “low” in discussing treatment preferences.

Conclusions:

Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.

Socioeconomic and sociodemographic predictors of cancer-related information sources used by cancer survivors

With 14 million cancer survivors in the United States, identifying and categorizing their use of sources of cancer-related information is vital for targeting effective communications to this growing population. In addition, recognizing socioeconomic and sociodemographic differences in the use of cancer-related information sources is a potential mechanism for reducing health disparities in survivorship. Fourteen sources of information survivors (N = 519) used for cancer-related information were factor-analyzed to create a taxonomy of source use. The association between social determinants and use of these source types was analyzed in regression models. Factor analysis revealed 5 categories of information source use (mass media; Internet and print; support organizations; family and friends; health care providers), and use varied based on sociodemographic and socioeconomic characteristics. Higher education predicted increased use of all source categories except mass media. African American cancer survivors turned to health care providers as a source for cancer-related information less often than did White survivors. Social determinants predicted differences in the type of cancer-related information sources used. Providers and health communicators should target communication platforms based on the demographic profile of specific survivor audiences.