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Chen JJ, Brown AM, Garda AE, Kim E, McAvoy SA, Perni S, Rooney MK, Shiue K, Tonning KL, Warren LE, Golden DW, Croke JM. Patient Education Practices and Preferences of Radiation Oncologists and Interprofessional Radiation Therapy Care Teams: A Mixed-Methods Study Exploring Strategies for Effective Patient Education Delivery. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00332-8. [PMID: 38437924 DOI: 10.1016/j.ijrobp.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/02/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Patients' understanding of radiation therapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. METHODS AND MATERIALS An anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. The Fisher exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. RESULTS One hundred thirteen Radiation Oncology Education Collaborative Study Group members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices among radiation oncologists differed according to RT clinical workflow timing (consultation versus simulation versus first RT, respectively): one-on-one teaching: 88.5% versus 49.4% versus 56.3%, P < .01, and paper handouts: 69.0% versus 28.7% versus 16.1%, P < .01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. CONCLUSIONS Radiation oncologists and interprofessional RO team members engage in PE, with most using institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery.
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Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Anna M Brown
- Aspirus Regional Cancer Center, Wausau, Wisconsin
| | - Allison E Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ellen Kim
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah A McAvoy
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Subha Perni
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael K Rooney
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kristi L Tonning
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Laura E Warren
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Daniel W Golden
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Jennifer M Croke
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Ferraris G, Coppini V, Monzani D, Grasso R, Kirac I, Horgan D, Pietrobon R, Galvão V, Pravettoni G. Addressing disparities in European cancer outcomes: a qualitative study Protocol of the BEACON project. Front Psychol 2024; 15:1252832. [PMID: 38469221 PMCID: PMC10925749 DOI: 10.3389/fpsyg.2024.1252832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Health disparities represent a crucial factor in cancer survival rates, awareness, quality of life, and mental health of people receiving a cancer diagnosis and their families. Income, education, geographic location, and ethnicity are some of the most important underlying reasons for health disparities in cancer across Europe. Costs of healthcare, access to information, psycho-oncological support options, integration of cancer research and innovative care, and multidisciplinary cancer teams are the main target areas when it comes to addressing disparities in the cancer context. As part of the Beacon Project (BEACON), we developed a protocol for a qualitative study to explore and identify any relevant reasons for cancer inequalities and disparities in Europe. Methods Our four stakeholders namely, cancer patients, healthcare providers, researchers, and policymakers will be recruited online, facilitated by collaborative efforts with cancer organizations from various European countries, including but not limited to Italy, Croatia, Estonia, and Slovenia. Qualitative online focus group discussions for each stakeholder will be conducted and transcribed. Subsequently, thematic analysis will be used to identify reasons and aspects that may contribute to the existing disparities in cancer outcomes at various levels of engagement and from different stakeholders' perspectives. Results from focus groups will inform a subsequent Delphi study and a SWOT analysis methodology. Discussion Although advances in medical research, cancer screening and treatment options are constantly progressing, disparities in access to and awareness of healthcare in cancer patients are even more noticeable. Thus, mapping the capacity and capability of cancer centres in the European Union, creating decision support tools that will assist the four stakeholders' information needs and improving the quality of European cancer centres will be the main objectives of the BEACON project. The current protocol will outline the methodological and practical procedures to conduct online focus group discussions with different stakeholders.
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Affiliation(s)
- Giulia Ferraris
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Veronica Coppini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Psychology, Educational Science and Human Movement (SPPEFF), University of Palermo, Palermo, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Iva Kirac
- Genetic Counseling Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Denis Horgan
- European Alliance for Personalized Medicine, Maribor, Slovenia
| | | | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Gandamihardja TA, Liyanage S, Coutee T, Peled AW, Masannat YA. The Role of Social Media and Breast Cancer: How Does It Impact Patients? Breast Care (Basel) 2023; 18:203-208. [PMID: 37928814 PMCID: PMC10624053 DOI: 10.1159/000530433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/25/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Patients are increasingly turning to other sources for their health information. Social media has become mainstream, and the easy access to online communities, health professionals, and shared experiences of other patients has made social media a place where many patients turn to. Methods In this qualitative report, 2 patients who have had breast cancer describe the reasons why they use social media, what they perceive the advantages and disadvantages are, and what the impact of social media has been through their cancer treatment and beyond. Results The reasons why patients turn to social media are varied. These can include information gathering, peer support, shared experiences, and advocacy. There appear to be advantages and disadvantages; however, overall, the impact seems to be a positive one when used judiciously. Discussion It is clear that social media has a role to play in healthcare, whether by providing meaningful social connections, delivery of information, or psychological support. Healthcare professionals perhaps should consider the importance of social media in their practice.
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Affiliation(s)
- Tasha A.K. Gandamihardja
- The Chelmsford Breast Unit, Broomfield Hospital, Mid Essex Hospitals NHS Trust, Chelmsford Essex, UK
| | | | | | - Anne W. Peled
- Sutter Health California Pacific Medical Center Breast Cancer Program, San Francisco, CA, USA
| | - Yazan A. Masannat
- The Breast Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- The School of Medicine, Medical Sciences and Nutrition, The University of Aberdeen, Aberdeen, UK
- iBreastBook, Aberdeen, UK
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4
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Benedict C, Dauber-Decker KL, Ford JS, King D, Spiegel D, Schapira L, Simon P, Diefenbach M. Development of a Web-Based Decision Aid and Planning Tool for Family Building After Cancer (Roadmap to Parenthood): Usability Testing. JMIR Cancer 2022; 8:e33304. [PMID: 35639461 PMCID: PMC9198824 DOI: 10.2196/33304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/26/2022] [Accepted: 04/18/2022] [Indexed: 01/22/2023] Open
Abstract
Background Owing to gonadotoxic cancer treatments, young adult female survivors often report uncertainty about their fertility, reproductive potential, and family-building options after treatment. Roadmap to Parenthood is a web-based decision aid and planning tool for family building after cancer. Objective As part of a patient-centered development process, this study evaluated the usability of the decision aid website to inform design modifications and improve user experience. Methods In total, 2 rounds of usability testing were conducted with the target population of young adult female cancer survivors. During the testing sessions, participants viewed the website twice; first, as a think-aloud exercise, and second, while a researcher interrupted at key points to obtain user feedback. Quantitative and qualitative data were collected to assess website usability. Quantitative measures included the System Usability Scale, WebQual, and eHealth Impact Questionnaire. An exit interview with open-ended questions gathered feedback on likes and dislikes and suggestions for improvement. Results Participants (N=10) were young adult women, with average age of 30.9 (SD 4.51) years, and average time since treatment was 4.44 (SD 3.56) years. Website usability scores improved on the System Usability Scale from “acceptable” in round 1 to “excellent” in round 2 after making design changes based on user feedback (scores of 68 and 89.4, respectively). WebQual scores showed similar improvement from round 1 to round 2 of testing (mean 5.6 to 6.25; range 1-7). On the eHealth Impact Questionnaire, the information and presentation of the website was perceived as comprehensive, easy to understand, and trustworthy. Participants also reported improved confidence to discuss and manage fertility and family-building issues and felt encouraged to play a more active role in managing their fertility. In all, 3 usability themes were identified from the qualitative feedback: ease of use, visibility and navigation, and informational content and usefulness. Overall feedback was positive, and participants reported intentions to use the decision aid website in the future. In total, 10% (1/10) of the participants reported negative emotions when learning about infertility risks and potential family-building challenges. Conclusions Website usability improved after design changes were made in response to user feedback. Young adult female survivors reported positive views about the website and indicated that the decision aid would be useful in decision-making about family building after cancer. Future studies will include further design modifications to consider the emotional experiences of users and any additional navigational features or content to optimize the ease of use and support provided by the tool.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | | | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, NY, United States
| | - D'Arcy King
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - David Spiegel
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | - Lidia Schapira
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | - Pamela Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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5
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Melhem SJ, Nabhani-Gebara S, Kayyali R. Informational needs and predictors of Jordanian breast and colorectal cancer survivors: a national cross-sectional study. Support Care Cancer 2022; 30:6827-6837. [PMID: 35538325 PMCID: PMC9213385 DOI: 10.1007/s00520-022-07110-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the informational gap and predictors of information-seeking behaviour amongst survivors to inform survivorship planning and supportive cancer services for the population. METHODS A national cross-sectional survey of breast and colorectal cancer survivors was conducted in 2020 using a representative sample of those diagnosed in 2015/2016 as recruited from Jordan's Cancer Registry (JCR). Participants responded to a 3-domain questionnaire: background information (9 items); information typologies (13 items) measured on a 5-point Likert scale (from very interested to extremely not interested); timing of developing the information needs (13 items) (ranging from immediately after diagnosis to after recurrence). Logistic regression was used to determine the independent association between demographics and information-seeking behaviour amongst survivors. The chi-square test was employed to examine the association between categorical variables. ANOVA was used to compare the means of interest in cancer-related information between more than two groups. RESULTS Results show a relatively high overall information needs amongst survivors (3.68 ± 1.53). The most prevalent typologies were cancer staging (3.77 ± 1.593), treatment options (3.76 ± 1.55), and doctors' communications (3.73 ± 1.62). ANOVA revealed no statistically significant differences between cancer types. 55.8% of patients desired information immediately after diagnosis and 23.3% developed their needs within 2 months. There was a statistically significant difference across all information typologies and educational attainment, age groups, monthly income, and employment (P < 0.05). Age was the only independent predictor of high information requirements amongst cancer survivors. CONCLUSION Survivors reported high cancer information needs, suggesting that they may have been under-informed. Effective health communication programmes should be implemented to meet the informational needs.
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Affiliation(s)
- Samar J Melhem
- Department of Pharmacy, Kingston University London, Penrhyn Road, Kingston, KT1 2EE, England, UK.
| | - Shereen Nabhani-Gebara
- Department of Pharmacy, Kingston University London, Penrhyn Road, Kingston, KT1 2EE, England, UK
| | - Reem Kayyali
- Department of Pharmacy, Kingston University London, Penrhyn Road, Kingston, KT1 2EE, England, UK
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Tran HTT, Nguyen MH, Pham TTM, Kim GB, Nguyen HT, Nguyen NM, Dam HTB, Duong TH, Nguyen YH, Do TT, Nguyen TTP, Le TT, Do HTT, Nguyen TT, Pham KM, Duong TV. Predictors of eHealth Literacy and Its Associations with Preventive Behaviors, Fear of COVID-19, Anxiety, and Depression among Undergraduate Nursing Students: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073766. [PMID: 35409448 PMCID: PMC8997661 DOI: 10.3390/ijerph19073766] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/14/2022] [Accepted: 03/19/2022] [Indexed: 01/09/2023]
Abstract
Background: The infodemic has been co-existing with the COVID-19 pandemic with an influx of misinformation and conspiracy theories. These affect people’s psychological health and adherence to preventive measures. eHealth literacy (eHEALS) may help with alleviating the negative effects of the infodemic. As nursing students are future healthcare professionals, having adequate eHEALS skills is critically important in their clinical practice, safety, and health. This study aimed to (1) explore the eHEALS level and its associated factors, and (2) examine the associations of eHEALS with preventive behaviors, fear of COVID-19 (FCV-19S), anxiety, and depression among nursing students. Methods: We surveyed 1851 nursing students from 7 April to 31 May 2020 from eight universities across Vietnam. Data were collected, including demographic characteristics, eHEALS, adherence to preventive behaviors (handwashing, mask-wearing, physical distancing), FCV-19S, anxiety, and depression. Linear and logistic regression analyses were performed appropriately to examine associations. Results: The mean score of eHEALS was 31.4 ± 4.4. The eHEALS score was significantly higher in males (unstandardized regression coefficient, B, 0.94; 95% confidence interval, 95% CI, 0.15 to 1.73; p = 0.019), and students with a better ability to pay for medication (B, 0.79; 95% CI, 0.39 to 1.19; p < 0.001), as compared to their counterparts. Nursing students with a higher eHEALS score had a higher likelihood of adhering to hand-washing (odds ratio, OR, 1.18; 95% CI, 1.15 to 1.22; p < 0.001), mask-wearing (OR, 1.15; 95% CI, 1.12 to 1.19; p < 0.001), keeping a safe physical distance (OR, 1.20; 95% CI, 1.15 to 1.25; p < 0.001), and had a lower anxiety likelihood (OR, 0.95; 95% CI, 0.92 to 0.99; p = 0.011). Conclusions: Nursing students who were men and with better ability to pay for medication had higher eHEALS scores. Those with higher eHEALS scores had better adherence to preventive measures, and better psychological health. The development of strategies to improve eHEALS of nursing students may contribute to COVID-19 containment and improve their psychological health.
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Affiliation(s)
- Ha T. T. Tran
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam; (H.T.T.T.); (T.T.M.P.); (T.T.N.); (K.M.P.)
| | - Minh H. Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
| | - Thu T. M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam; (H.T.T.T.); (T.T.M.P.); (T.T.N.); (K.M.P.)
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
| | - Giang B. Kim
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 115-20, Vietnam;
- Center for Assessment and Quality Assurance, Hanoi Medical University, Hanoi 115-20, Vietnam
| | - Hiep T. Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh 725-10, Vietnam; (H.T.N.); (N.-M.N.)
- Pham Ngoc Thach Clinic, Pham Ngoc Thach University of Medicine, Ho Chi Minh 725-10, Vietnam
| | - Ngoc-Minh Nguyen
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh 725-10, Vietnam; (H.T.N.); (N.-M.N.)
| | - Hoa T. B. Dam
- Department of Psychiatry, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam;
| | - Thai H. Duong
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam;
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Yen H. Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho 941-17, Vietnam;
- Department of Pharmacy, Can Tho University of Medicine and Pharmacy Hospital, Can Tho 941-17, Vietnam
| | - Thao T. Do
- Department of Oral Pathology and Periodontology, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho 941-17, Vietnam;
| | - Thao T. P. Nguyen
- Health Personnel Training Institute, Hue University of Medicine and Pharmacy, Thua Thien Hue 491-20, Vietnam;
| | - Thuy T. Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang 502-06, Vietnam;
| | - Hien T. T. Do
- Faculty of Nursing, Hai Duong Medical Technical University, Hai Duong 031-17, Vietnam;
| | - Tham T. Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam; (H.T.T.T.); (T.T.M.P.); (T.T.N.); (K.M.P.)
| | - Khue M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam; (H.T.T.T.); (T.T.M.P.); (T.T.N.); (K.M.P.)
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 6545)
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7
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Quality Analysis of Online Patient Resources for Hepatocellular Carcinoma. J Clin Gastroenterol 2022; 56:64-71. [PMID: 33337639 DOI: 10.1097/mcg.0000000000001477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/30/2020] [Indexed: 12/10/2022]
Abstract
GOAL This study aims to evaluate the quality of online hepatocellular carcinoma (primary liver cancer) resources by using a validated tool to determine the strengths and limitations of hepatocellular carcinoma Web sites designed for patient education. BACKGROUND In recent years, online health information-seeking behavior has become more prevalent. Meanwhile, hepatocellular carcinoma incidence rates have also increased. However, there is currently limited literature assessing the quality of online hepatocellular carcinoma information. MATERIALS AND METHODS The term "hepatocellular carcinoma" was searched using the search engine Google and the meta-search engines Dogpile and Yippy. A validated rating tool was used to assign quality scores to 100 Web sites based on the domains of Web site affiliation, accountability, interactivity, structure and organization, readability, and content quality. Overall quality scores were tallied for all Web sites. RESULTS Noncommercial hepatocellular carcinoma Web sites received significantly higher overall quality scores compared with their commercial counterparts. Overall, 30% of the Web sites identified their author(s), 42% cited sources, and 33% were updated within the past 2 years. The majority of Web sites utilized at least 1 interactive feature and 4 structural tools. Average readability was at a grade 11.8 level using the Flesch-Kincaid grading system, which is significantly higher than the recommended grade 6 level. Definition and treatment were the most commonly covered topics, while prevention and prognosis were the least commonly covered. CONCLUSIONS The quality of online hepatocellular carcinoma information is highly variable. Health care professionals should be aware of its limitations and be proactive in guiding patients to reliable resources.
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Nguyen TT, Nguyen MH, Pham TTM, Le VTT, Nguyen TT, Luong TC, Do BN, Dao HK, Nguyen HC, Ha TH, Pham LV, Nguyen PB, Nguyen HTT, Do TV, Nguyen HQ, Trinh MV, Le TT, Tra AL, Nguyen TTP, Nguyen KT, Phan DT, Pham KM, Bai CH, Duong TV. Negative Impacts of COVID-19 Induced Lockdown on Changes in Eating Behavior, Physical Activity, and Mental Health as Modified by Digital Healthy Diet Literacy and eHealth Literacy. Front Nutr 2021; 8:774328. [PMID: 34869540 PMCID: PMC8633895 DOI: 10.3389/fnut.2021.774328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The COVID-19-induced lockdown has been implemented in many countries, which may cause unfavorable changes in lifestyles and psychological health. People's health literacy, healthy diet, and lifestyles play important roles in mitigating the negative impacts of the pandemic. Therefore, we aimed to examine associations of COVID-19 lockdown with changes in eating behavior, physical activity, and mental health; and the modification effects by digital healthy diet literacy (DDL) and eHealth literacy (eHEALS) on the associations. Methods: We conducted an observational study on 4,348 outpatients from 7th April to 31st May 2020. Data from 11 hospitals in Vietnam included demographic characteristics, DDL, eHEALS, eating behavior, physical activity, and mental health changes. Multiple logistic regression and interaction models were performed to examine associations. Results: Patients under lockdown had a lower likelihood of having “unchanged or healthier” eating behavior (odds ratio, OR, 0.38; 95% confidence interval, 95%CI, 0.29 to 0.51; p < 0.001), “unchanged or more” physical activity (OR, 0.79; 95% CI, 0.69 to 0.90; p < 0.001), and “stable or better” mental health (OR, 0.77; 95% CI, 0.67 to 0.89; p < 0.001), as compared to those after lockdown. In interaction models, as compared to patients after lockdown and with the lowest DDL score, those under lockdown and with a one-score increment of DDL had a higher likelihood of having “unchanged or healthier” eating behavior (OR, 1.05; 95% CI, 1.02 to 1.07; p < 0.001), and “stable or better” mental health (OR, 1.02; 95% CI, 1.01 to 1.04; p < 0.001). Similarly, as compared to patients after lockdown and with the lowest eHEALS score, those under lockdown and with a one-score increment of eHEALS had a higher likelihood of having an “unchanged or more” physical activity (OR, 1.03; 95% CI, 1.01 to 1.05; p < 0.001). Conclusion: The COVID-19 lockdown measure could negatively affect eating behavior, physical activity, and mental health among outpatients. Better DDL and eHEALS were found to mitigate the negative impacts of the lockdown, which may empower outpatients to maintain healthy lifestyles and protect mental health. However, this study holds several limitations that may undermine the certainty of reported findings.
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Affiliation(s)
- Tham T Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Minh H Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Thu T M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Vinh-Tuyen T Le
- Department of Pharmacognosy-Traditional Pharmacy-Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Tan T Nguyen
- Department of Orthopedics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Director Office, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Thuc C Luong
- Director Office, Military Hospital 103, Hanoi, Vietnam.,Department of Cardiology, Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Hung K Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | - Huu C Nguyen
- Director Office, E Hospital, Hanoi, Vietnam.,Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Linh V Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam.,Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | | | - Hoai T T Nguyen
- Training and Direction of Healthcare Activity Center, Kien An Hospital, Hai Phong, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thuy T Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.,President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Anh L Tra
- Department of Physiotherapy and Rehabilitation, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Thao T P Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam.,Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam.,President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Chyi-Huey Bai
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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9
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Li ZHJ, Wang M, Ingledew PA. Depression in cancer: quality assessment of online patient education resources. Psychooncology 2021; 30:400-407. [PMID: 33179340 DOI: 10.1002/pon.5591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Psychiatric comorbidities are common among cancer patients. However, little is known about the quality of online information regarding these conditions. This study uses a validated tool to systematically determine the strengths and limitations of websites addressing depression in cancer patients. METHODS The term "depression in cancer patients" was searched online using the search engines Google, Yippy, and Dogpile. A set of predetermined inclusion/exclusion criteria was applied to all search results, which yielded 48 websites for inclusion. A validated rating tool was used to score the websites based on the six domains of Affiliation, Accountability, Interactivity, Structure & Organization, Readability, and Content Quality. The results were analyzed using descriptive statistics. RESULTS Of the 48 websites evaluated, 50% were commercial. 63% of websites identified authorship, 54% cited reliable sources, 37% provided links, and 38% were updated within the last 2 years. 94% of websites featured a search engine and 60% had at least four structural tools. Average readability was at a grade 12.3 level using the Flesch-Kincaid scale and 11.3 using the Simple Measure of Gobbledygook Index. The most completely and accurately covered topics of depression were symptoms and treatment-83% and 73% respectively. Its prevention and prognosis were not covered by any of the websites. CONCLUSIONS A validated rating tool was applied to evaluate the quality of online information for depression in cancer patients. Website accountability was poor, readability was often at a level that is too difficult for the lay audience, and the topics of prevention and prognosis were seldom covered.
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Affiliation(s)
- Zhang Hao Jim Li
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mingyang Wang
- Discipline of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Paris-Ann Ingledew
- Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
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10
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Hashemi-Demne J, Izadi-Avanji F, Kafaei-Atrian M. Development and psychometric properties of the online health information-seeking skill scale. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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The Experiences and Support Needs of Women With Gestational Breast Cancer in Singapore: A Descriptive Qualitative Study. Cancer Nurs 2020; 45:E263-E269. [PMID: 33252405 DOI: 10.1097/ncc.0000000000000912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gestational breast cancer is diagnosed during pregnancy or within the first postpartum year. There is a lack of studies on the experiences of ethnically diverse Asian women with gestational breast cancer. OBJECTIVE The aim of this study was to explore the experiences of Asian women with gestational breast cancer so necessary support can be rendered. METHODS This qualitative descriptive study used purposive sampling to recruit 7 women with gestational breast cancer who were following up at the breast center of a tertiary women's hospital in Singapore. Semistructured, individual, face-to-face, audio-recorded interviews were used to explore the in-depth experiences of these women. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS Three main themes emerged from the thematic analysis: (1) being a sick woman, (2) juggling between being a mother and a patient, and (3) seeking normalcy. Women had to contend with disruptive changes from gestational breast cancer, both emotionally and physically. They were constantly distressed by their altered body images, and family support was vital to help these women cope with their treatments. Alternative support sources included healthcare professionals and the Internet. CONCLUSION Gestational breast cancer experiences varied based on the women's encounter perceptions and existing support. Their experiences may be improved through further support to mediate their coping efforts. Future quantitative and qualitative research should explore and evaluate the various aspects of the long-term disease and psychosocial effects of gestational breast cancer. IMPLICATIONS FOR PRACTICE Hospitals should include support strategies in antenatal classes and postnatal workshops to lessen disruptions of the motherhood experiences.
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12
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Murchison S, Soo J, Kassam A, Ingledew PA, Hamilton S. Breast Cancer Patients' Perceptions of Adjuvant Radiotherapy: an Assessment of Pre-Treatment Knowledge and Informational Needs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:661-668. [PMID: 30852787 DOI: 10.1007/s13187-019-01507-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is little knowledge about breast cancer patients' information-seeking behaviors, needs, and perceptions of breast radiation therapy (BRT) prior to radiation oncology consultation. This study assessed these parameters to evaluate potential gaps and overlaps in the BRT educational process. Breast cancer patients > 18 years referred for adjuvant BRT at a tertiary cancer center completed an anonymous survey prior to their consultation. Response rate was 86% (118/137). The most commonly reported sources of information about BRT were healthcare providers (55%), family or friends treated with BRT (53%), and the Internet (45%). Most (79%) had little or no knowledge about BRT. Sixty-seven percent were a little or moderately concerned about BRT, while 29% were very concerned. Half were unsure about the benefit of BRT and 46% thought it would provide a moderate to significant benefit. While seeking information about BRT, a wide range of topics were encountered. The most common ones were fatigue (68%), skin care (57%), skin problems (54%), effects on healthy body tissues (43%), the immune system (37%), and pain (34%). Topics considered most important for the radiation oncologist to address were BRT effects on the heart (74%), second cancers (74%), immune system (66%), pain (64%), and lungs (62%). Although commonly encountered, fatigue (56%) and skin care (49%) were of lesser importance. In conclusion, breast cancer patients encounter a broad range of information about BRT prior to their radiation oncology consultation, which may contribute to worry and misconceptions. Potentially rare and serious side effects were considered important to address.
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Affiliation(s)
- Sonja Murchison
- University of British Columbia, Vancouver, BC, Canada.
- Department of Radiation Oncology, BC Cancer - Vancouver Center, Vancouver, BC, Canada.
| | - Jenny Soo
- Department of Radiation Therapy, BC Cancer - Vancouver Center, Vancouver, BC, Canada
| | - Aneeta Kassam
- Department of Radiation Therapy, BC Cancer - Vancouver Center, Vancouver, BC, Canada
| | - Paris-Ann Ingledew
- University of British Columbia, Vancouver, BC, Canada
- Department of Radiation Oncology, BC Cancer - Vancouver Center, Vancouver, BC, Canada
| | - Sarah Hamilton
- University of British Columbia, Vancouver, BC, Canada
- Department of Radiation Oncology, BC Cancer - Vancouver Center, Vancouver, BC, Canada
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13
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Li Y, Ye S, Zhou Y, Mao F, Guo H, Lin Y, Zhang X, Shen S, Shi N, Wang X, Sun Q. Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study. J Med Internet Res 2020; 22:e16768. [PMID: 32301740 PMCID: PMC7316180 DOI: 10.2196/16768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/26/2020] [Accepted: 02/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. Objective This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. Methods Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients’ medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. Results A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01–1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). Conclusions The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer.
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Affiliation(s)
- Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Ye
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hailing Guo
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Shi
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojie Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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14
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Nixon NA, Simmons C, Lemieux J, Verma S. Research priorities in metastatic breast cancer: A James Lind Alliance Priority Setting Partnership. Breast J 2020; 26:488-493. [DOI: 10.1111/tbj.13525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 01/05/2023]
Affiliation(s)
| | | | - Julie Lemieux
- Centre Hospitalier Universitaire de Quebec Quebec QC Canada
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15
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Bootsma TI, Duijveman P, Pijpe A, Scheelings PC, Witkamp AJ, Bleiker EMA. Unmet information needs of men with breast cancer and health professionals. Psychooncology 2020; 29:851-860. [PMID: 32040237 PMCID: PMC7317856 DOI: 10.1002/pon.5356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/26/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022]
Abstract
Objective Male breast cancer (MBC) is rare. Information about breast cancer is usually designed for female patients. However, in males this disease and some side effects differ from its female counterpart. Therefore, there is a need for male‐specific information. The aim was to assess unmet information needs of (a) MBC patients and (b) health professionals. Methods Dutch MBC patients (diagnosed between 2011 and 2016 in 21 hospitals), patient advocates and partners were invited to participate in focus groups and/or complete a paper‐based questionnaire on information needs. In addition, an online questionnaire on information needs was sent to health professionals involved in MBC patient care. Results In three focus groups with MBC patients (N = 12) and partners (N = 2) the following unmet information themes were identified: patients' experiences/photographs, symptoms, (delay of) diagnosis, treatments, side effects, follow‐up, psychological impact/coping, genetics and family, research and raising awareness. 77 of 107 MBC patients (72%) completed the questionnaire: most patients lacked information about acute (65%) or late (56%) side effects, particularly sexual side effects. Among health professionals, 110 of 139 (79%) had searched for MBC‐related information, specifically: patient information, anti‐hormonal therapy, genetic testing, research, and psychosocial issues. Conclusions Unmet information needs in MBC patients and health professionals were identified. Specific information on MBC should be developed to improve timely diagnosis, quality of life, treatment, and survival. A targeted website is an ideal tool to meet these needs. Therefore, we integrated these results into a user‐centered design to develop an informative website, www.mannenmetborstkanker.nl.
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Affiliation(s)
- Tom I Bootsma
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Petra Duijveman
- Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Anouk Pijpe
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pernilla C Scheelings
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arjen J Witkamp
- Division of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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16
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Wyatt KD, Jenkins SM, Plevak MF, Venegas Pont MR, Pruthi S. A personalized, web-based breast cancer decision making application: a pre-post survey. BMC Med Inform Decis Mak 2019; 19:196. [PMID: 31638964 PMCID: PMC6805417 DOI: 10.1186/s12911-019-0924-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Every case of breast cancer is unique, and treatment must be personalized to incorporate a woman’s values and preferences. We developed an individually-tailored mobile patient education application for women with breast cancer. Methods Pre-post surveys were completed by 255 women who used the tool. Results Patients thought the application included helpful information (N = 184, 72%) and was easy to navigate (N = 156, 61%). Most patients thought the amount of information in the tool was “about right” (N = 193, 87%). Decision making confidence increased by an average of 0.8 points (10-point scale) following a consultation and use of the tool (p < 0.001). Conclusions Tailored mobile applications may optimize care by facilitating shared decision making and knowledge transfer, and they may also enhance the experience of patients as they navigate through their breast cancer journey.
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Affiliation(s)
- Kirk D Wyatt
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | | | - Sandhya Pruthi
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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17
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van Eenbergen MCHJ, Vromans RD, Boll D, Kil PJM, Vos CM, Krahmer EJ, Mols F, van de Poll-Franse LV. Changes in internet use and wishes of cancer survivors: A comparison between 2005 and 2017. Cancer 2019; 126:408-415. [PMID: 31580497 PMCID: PMC7004117 DOI: 10.1002/cncr.32524] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 12/16/2022]
Abstract
Background Given the major changes in internet use for health communication, the objective of the current study was to compare the internet use and wishes of cancer survivors between 2005 and 2017. Methods The authors drew a sample of 390 patients in 2005 and 539 patients in 2017 who were diagnosed with breast (128 patients in 2005 and 143 patients in 2017), prostate (96 patients in 2005 and 126 patients in 2017), or gynecologic (89 patients in 2005 and 188 patients in 2017) cancer or lymphoma (77 patients in 2005 and 82 patients in 2017) in 4 different hospitals for the periods 2002 through 2004 and 2014 through 2016. These patients were sent a paper‐based questionnaire that contained 45 questions regarding demographics and 4 functions of internet use: content, communication, community, and e‐health. Results The response in 2017 (53%) was lower than that in 2005 (75%). Survivors browsed the internet most frequently to search for information regarding cancer shortly after being diagnosed and while waiting for treatment. There was little change noted with regard to the relative importance attached to the various subjects. In 2017, significant increases were evident with regard to finances (+33%), health care insurance (+29%), and genetics and/or heritability (+27%). The wishes expressed in 2005 by patients were realized in part in 2017. Conclusions A significant sample of cancer survivors in the Netherlands have indicated that the internet is an important source of information regarding their illness. However, little change was evident over the past 15 years with regard to patients' priorities regarding their wishes for internet use. The wishes of users in 2005 were found to accurately reflect the internet use of the majority of patients in 2017. The results of the current study support the belief that health care professionals should expand their online services and tailor them toward the needs and wishes of their patients. The internet wishes of patients with cancer reported in 2005 accurately reflect the internet use of the majority of patients in 2017. The current study supports the belief that health care professionals should expand their online services and tailor them toward the needs and desires of their patients.
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Affiliation(s)
- Mies C H J van Eenbergen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Department of Communication and Cognition, Tilburg University, Tilburg, the Netherlands
| | - Ruben D Vromans
- Department of Communication and Cognition, Tilburg University, Tilburg, the Netherlands
| | - Dorry Boll
- Department of Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul J M Kil
- Department of Urology, Elisabeth-Tweesteden Hospital, Tilburg and Waalwijk, the Netherlands
| | - Caroline M Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, the Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg University, Tilburg, the Netherlands
| | - Floortje Mols
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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18
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Li S, Lee-Won RJ, McKnight J. Effects of Online Physician Reviews and Physician Gender on Perceptions of Physician Skills and Primary Care Physician (PCP) Selection. HEALTH COMMUNICATION 2019; 34:1250-1258. [PMID: 29792519 DOI: 10.1080/10410236.2018.1475192] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physician review websites have become more relevant and important in people's selection of physicians. The current study experimentally examined how online physician reviews endorsing a primary care physician's (PCP's) technical or interpersonal skills, along with a physician's gender, may influence people's perceptions of the physician's skills and their willingness to choose the physician. Participants were randomly assigned to view a mockup physician review web page and to imagine that they needed to find a new PCP in a new city. They were then asked to report their perceptions of the physician and willingness to choose the physician as their PCP. The results suggested that people's willingness to choose a PCP was affected by physician reviews through their influence on people's perceptions of the PCP's technical and interpersonal skills. More importantly, this study found that when physician reviews endorsed a PCP's technical skills people perceived a female PCP to be more interpersonally competent than a male PCP and thus were more likely to choose the female PCP. The gendered perception, however, was not extended to a PCP's technical skills. Practical implications for health providers and consumers are discussed.
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Affiliation(s)
- Siyue Li
- School of Communication, The Ohio State University
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19
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Costa N, Nielsen M, Jull G, Claus AP, Hodges PW. Low back pain websites do not meet the needs of consumers: A study of online resources at three time points. Health Inf Manag 2019; 49:137-149. [PMID: 31266366 DOI: 10.1177/1833358319857354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The popularity of the Internet as a source of health-related information for low back pain (LBP) is growing. Although research has evaluated information quality in health-related websites, few studies have considered whether content and presentation match consumer preferences. OBJECTIVE The aim of this study was to evaluate whether LBP website content and presentation matched preferences of consumers with LBP, whether matching preference of consumers changed over 8 years as recognition of people-centred healthcare has developed and whether this differs between countries of Internet searching. METHOD The most prominent and top 20 LBP websites were identified using common search engines in 2010, 2015 and 2018. Websites identified in the top 20 in 2010 were followed up if not identified in 2015 and 2018. Two reviewers independently evaluated websites with a 16-item checklist developed from research of consumer preferences. In 2015, websites were identified using searches conducted using IP addresses from Australia, the United States of America (USA), the United Kingdom and Canada. After removal of duplicates, 55 websites were evaluated in 2010. In 2015 and 2018, 33 and 28 new sites, respectively, were identified, and 37 previous websites were re-evaluated. RESULTS In 2010 and 2015, websites predominantly originated from USA and were sponsored by "for-profit" organisations. In 2018, most websites originated from Australian "not-for-profit" organisations. None of the websites provided information on all content areas. At least 55% of websites were rated as poor or fair. No site rated as excellent overall. There was some worsening over time. Country of search did not affect results. CONCLUSION Websites retrieved using typical searches did not meet information and presentation preferences of people with LBP.
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Affiliation(s)
| | - Mandy Nielsen
- Griffith University, Australia.,Metro South Health, Australia
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20
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Schuy K, Brants L, Dors S, Horzetzky M, Willmund G, Zimmermann P, Ströhle A, Rau H, Siegel S. Psychological stigma costs as barriers to healthcare use in former soldiers of the German Armed Forces: A qualitative analysis. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1598228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Katrin Schuy
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Loni Brants
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Simone Dors
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Marie Horzetzky
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Gerd Willmund
- Psychotraumazentrum, Military Hospital, Berlin, Germany
| | | | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotraumazentrum, Military Hospital, Berlin, Germany
| | - Stefan Siegel
- Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
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21
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Ahamad A, Wallner P, Salenius S, Ross R, Fernandez E. Information Needs Expressed During Patient-Oriented Oncology Consultations: Quantity, Variation, and Barriers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:488-497. [PMID: 29435742 DOI: 10.1007/s13187-018-1329-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
High-quality oncology consultation includes patient-oriented communication tailored to patients' individualized needs. Common methods used in studies to increase question-asking are prompt lists and coaching pre-consultations. However, our patients were encouraged to ask questions by the physician during their visit. We aimed to estimate the quantity, nature, and variation of their questions when they were invited to ask by their oncologist. During radiotherapy consultations from 2012 to 2016, patient's questions were deliberately elicited and physician-transcribed. We derived mean and median number of questions per patient, variance by patient factors, and a taxonomy of subjects using thematic analysis. Three hundred ninety-six patients asked 2386 questions, median asked per patient = 6 (interquartile range = 4). We found significant variance with age (mean = 6.9 questions for < 60 years, 5.4 for ≥ 70 years) p = 0.018, insurance type (mean = 4.7 for Medicaid, 7.2 for private insurance) p = 0.0004, and tumor site (mean number of questions: skin = 4.6, lymphoma = 5.2, lung = 5.8, breast = 6.1, prostate = 6.3, rectum = 6.7 head and neck = 6.9, brain = 7.0, bladder = 7.2, anus = 8.8, others = 5.8) p = 0.0440. Of the diverse set of 57 topics, the commonest were 1. logistics, 2. radiotherapy details, 3. side effects, 4. diagnosis, and 5. stage and prognosis. Only 17 topics were asked by more > 10% of patients and 40 topics were asked by < 10% of patients. With median of 6 questions, it is practicable to routinely elicit and address individualized information needs. Potential barriers may be older and underinsured patients. The wide variety of topics, often pertaining to individuals' case, suggests that cancer clinicians should take time-out during consultation to elicit patients' questions to accomplish best-practice communication.
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Affiliation(s)
- Anesa Ahamad
- Department of Radiation Oncology, 21st Century Oncology, 3426 North Roosevelt Boulevard, Key West, FL, 33040, USA.
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Lennar Foundation Medical Center, 5555 Ponce de Leon Blvd. Suite 140, Coral Gables, FL, 33146, USA.
| | - Paul Wallner
- Department of Radiation Oncology, 21st Century Oncology, Inc. 146 Sarazen Drive, Moorestown, NJ, 08057, USA
| | - Sharon Salenius
- Department of Research and Education, 21st Century Oncology, 2234 Colonial Boulevard, Fort Myers, FL, 33907, USA
| | - Rudi Ross
- Department of Research and Education, 21st Century Oncology, 2234 Colonial Boulevard, Fort Myers, FL, 33907, USA
| | - Eduardo Fernandez
- Department of Radiation Oncology, 21st Century Oncology, 350 NW 84th Ave # 102, Plantation, FL, 33324, USA
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22
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Marcu A, Muller C, Ream E, Whitaker KL. Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool. J Med Internet Res 2019; 21:e12400. [PMID: 30724741 PMCID: PMC6381403 DOI: 10.2196/12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process. Objective We explored women’s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker. Methods An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites. Results The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage “Paget disease of the nipple” being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2. Conclusions Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms.
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Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Cecile Muller
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma Ream
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Katriina L Whitaker
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
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Ahmed A, Saeed F, Arshad MU, Afzaal M, Imran A, Ali SW, Niaz B, Ahmad A, Imran M. Impact of intermittent fasting on human health: an extended review of metabolic cascades. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2019. [DOI: 10.1080/10942912.2018.1560312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Aftab Ahmed
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Farhan Saeed
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Umair Arshad
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Afzaal
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Ali Imran
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Shinawar Waseem Ali
- Institute of Agricultural Sciences, University of the Punjab, Lahore, Pakistan
| | - Bushra Niaz
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Awais Ahmad
- Institute of Home & Food Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Imran
- Faculty of Allied Health Sciences, University Institute of Diet and Nutritional Sciences, The University of Lahore, Lahore, Pakistan
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24
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Villani D, Cognetta C, Repetto C, Serino S, Toniolo D, Scanzi F, Riva G. Promoting Emotional Well-Being in Older Breast Cancer Patients: Results From an eHealth Intervention. Front Psychol 2018; 9:2279. [PMID: 30538650 PMCID: PMC6277478 DOI: 10.3389/fpsyg.2018.02279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most common cancer in women worldwide, with increases in diagnoses at all ages. Due to several age-related factors, older breast cancer patients show particular difficulties in adjusting to breast cancer and its related treatments. One consistent indicator of vulnerability to long-term complications is emotional distress occurring within 3 months of diagnosis. Thus, it is critical to develop early interventions specifically aimed at mitigating distress and promoting emotional wellbeing in older breast cancer patients. By taking advantage of the opportunities of online interventions, the present study aimed to test the efficacy of a 2 weeks e-health stress inoculation training (SIT) intervention on emotion regulation and cancer-related well-being, compared with a control group without such intervention. Twenty-nine women with a diagnosis of breast cancer, who had received radical surgery and who were suitable candidates for adjuvant chemotherapy with anthracyclines and taxanes (mean age = 62.76; SD = 6.19) voluntarily took part in the current study after giving written informed consent. To test intervention efficacy, self-report questionnaires were administered to all participants at baseline, at the end of the 2 weeks intervention, and 3 months after the end of the intervention. Results showed that after 2 weeks of ehealth intervention, patients did not achieve significant change, however, they significantly reduced emotional suppression and increased cancer-related emotional well-being 3 months after the end of the intervention. Furthermore, by monitoring at a distance the emotional experience during the online intervention, we found an increase in relaxation and a reduction of anxiety. Finally, patients in the experimental group reported a good level of acceptance of the ehealth intervention. To conclude, designing and developing eHealth interventions as part of the regular care path for breast cancer patients of all ages represents both a challenge and an opportunity; in particular, online interventions can be an important step in universal psychosocial care within a tiered model of care.
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Affiliation(s)
- Daniela Villani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Chiara Cognetta
- Department of Medical Oncology, G.Salvini ASST Rhodense, Milan, Italy
| | - Claudia Repetto
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Davide Toniolo
- Department of Medical Oncology, G.Salvini ASST Rhodense, Milan, Italy
| | - Francesco Scanzi
- U.O. Oncologia Medica, Ospedale S. Giuseppe-Multimedica, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
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25
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Cancer information needs according to cancer type: A content analysis of data from Japan's largest cancer information website. Prev Med Rep 2018; 12:245-252. [PMID: 30377575 PMCID: PMC6205331 DOI: 10.1016/j.pmedr.2018.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 01/05/2023] Open
Abstract
The provision of information about cancer is an important aspect of cancer care. Cancer information provided online is expected to meet the needs of information seekers. Whether information needs vary according to tumor site is largely unknown. We aimed to examine similarities and differences in informational needs by cancer type. Data were collected using a questionnaire administered on Japan's largest cancer information website, “Ganjoho service”. A total of 2782 free descriptive responses in the period from April 2012 to December 2017 were analyzed using text-mining software. We identified the top 10 informational need contents, in order of appearance frequency, for eight tumor sites: gastric, colorectal, esophageal, lung, pancreatic, breast, cervical, and prostate cancer. Frequent information needs common to all tumor sites included symptoms, disease stages, treatments, chance of cure, recovery, metastasis, and recurrence. A need for information about diet, pain, side effects of treatments, complementary and alternative medicine was frequent for some tumor sites. Tumor site-specific information should include the following, according to cancer type: information of scirrhous carcinoma for gastric cancer; unusual feces for colorectal cancer; lung X-ray images for lung cancer; early detection for pancreatic cancer; adenocarcinoma, sexual activity, pregnancy, and childbirth for cervical cancer; breast conservation or reconstruction and triple negative cancer for breast cancer; test values and diagnosis and urinary problems for prostate cancer; and hormone therapy for breast and prostate cancer. Cancer information provided online should meet these frequent informational needs, considering similarities and differences of the information required according to tumor site. We examined similarities and differences in cancer information needs by tumor site. Common needs are symptoms, stages, treatment, cure, recovery, metastasis, recurrence. Site-specific needs include diet, pain, side effects, early detection, test values. Cancer information should be provided to meet frequent needs, by tumor site.
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26
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Bruendl J, Rothbauer C, Ludwig B, Dotzler B, Wolff C, Reimann S, Borgmann H, Burger M, Breyer J. Accordance of Online Health Information on Prostate Cancer with the European Association of Urology Guidelines. Urol Int 2018. [PMID: 29514140 DOI: 10.1159/000487146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The internet is an emerging source of information for prostate cancer (PCa) patients. Since little is known about the quality of information on PCa provided online, we investigated its accordance to the latest European Association of Urology (EAU) guidelines. METHODS A total of 89 German web pages were included for analysis. A quality model classifying the provider of information and its expertise was introduced. Correctness of provided information was systematically compared to the EAU guidelines. RESULTS Information was provided by medical experts (41%), media (11%), and pharmaceutical companies (6%). Certificates were found in 23% with a significantly higher rate if provided by medical experts (p = 0.003). The minority of web pages showed information in accordance with the EAU guidelines regarding screening (63%), diagnosis (32%), classification (39%), therapy (36%), complications (8%), and follow-up (27%). Web pages by medical experts as well as websites with any kind of certification showed a significantly higher guideline conformity regarding diagnosis (p = 0.027, p = 0.002), therapy (p = 0.010, p = 0.011), follow-up (p = 0.005, p < 0.001), and availability of references (p = 0.017, p = 0.003). CONCLUSIONS The present study reveals that online health information on PCa lacks concordance to current guidelines. Certified websites or websites provided by medical experts showed a significantly higher quality and accordance with guidelines.
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Affiliation(s)
- Johannes Bruendl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Clemens Rothbauer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Bernd Ludwig
- Institute of Information, Media, Language and Culture, University of Regensburg, Regensburg, Germany
| | - Bernhard Dotzler
- Institute of Information, Media, Language and Culture, University of Regensburg, Regensburg, Germany
| | - Christian Wolff
- Institute of Information, Media, Language and Culture, University of Regensburg, Regensburg, Germany
| | - Sandra Reimann
- Institute of German Language and Literary Studies, University of Regensburg, Regensburg, Germany
| | | | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
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Jenkins V, Payne H, Mason M, May S, Matthews L, Catt S. EXTREQOL Identifies Ongoing Challenges in Maximising Quality of Survival in Men with Metastatic Castrate-resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:331-333. [PMID: 29459101 DOI: 10.1016/j.clon.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK.
| | - H Payne
- Department of Oncology, University College Hospital London, London, UK
| | - M Mason
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Velindre Hospital, Cardiff, UK
| | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - L Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - S Catt
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Pierrisnard C, Baciuchka M, Mancini J, Rathelot P, Vanelle P, Montana M. Body image and psychological distress in women with breast cancer: a French online survey on patients' perceptions and expectations. Breast Cancer 2017; 25:303-308. [PMID: 29288390 DOI: 10.1007/s12282-017-0828-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/25/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Altered body image caused by alopecia, loss of eyebrows or eyelashes, or mastectomy is a major source of psychological distress in women with breast cancer. OBJECTIVE To identify and to assess patients' perceptions and expectations regarding altered body image. METHOD Opinion survey conducted among patients treated for breast cancer and member of French online support groups. Anonymous online self-administered survey sent to women with breast cancer. RESULTS 85% of the women interviewed experienced alopecia during treatment and 67% of them loss of eyebrows or eyelashes. About half of patients suffering alopecia and loss of eyebrows or eyelashes reported fearing what others think. Mastectomy was experienced by 84% of the women in our study, but only 32% of them reported fearing what others think. 87% of our study cohort received information about the possibility of adverse events. 70, 56, and 60% of women felt helped by information they received for the management of alopecia, loss of eyebrows or eyelashes, or mastectomy, respectively. CONCLUSION This study confirms that altered body image is a critical psychosocial issue for women with breast cancer. Effective information can be a source of reassurance and may constitute one of the most important sources of emotional support.
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Affiliation(s)
- Camille Pierrisnard
- Aix Marseille University, APHM, Oncopharma Unit, Chemin des Bourrely, 13015, Marseille, France
| | - Marjorie Baciuchka
- Aix Marseille University, APHM, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Chemin des Bourrely, 13015, Marseille, France
| | - Julien Mancini
- Aix-Marseille University, Inserm, IRD, UMR912, SESSTIM, "Cancers, Biomedicine & Society" Group, Institut Paoli-Calmettes, 232 Bd Ste Marguerite, 13273, Marseille, France.,APHM, BiosTIC, La Timone Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Pascal Rathelot
- Aix-Marseille University, APHM, Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP, Marseille, France.,Aix-Marseille University, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France
| | - Patrice Vanelle
- Aix-Marseille University, APHM, Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP, Marseille, France.,Aix-Marseille University, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France
| | - Marc Montana
- Aix Marseille University, APHM, Oncopharma Unit, Chemin des Bourrely, 13015, Marseille, France. .,Aix-Marseille University, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France.
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eHealth literacy, Internet and eHealth service usage: a survey among cancer patients and their relatives. J Cancer Res Clin Oncol 2017; 143:2291-2299. [PMID: 28699035 DOI: 10.1007/s00432-017-2475-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of our study was to investigate Internet and eHealth usage, with respect to eHealth literacy, by cancer patients and their relatives. PATIENTS AND METHODS Using a standardized questionnaire we asked patients who attended lectures on complementary medicine in 2016. RESULTS We received 142 questionnaires. The frequency of general Internet usage was directly associated with younger age and better Internet connection. Younger participants were not only more confident in allocating health-related Internet information into reliable or unreliable facts, but also more confident and capable of gaining medical knowledge through eHealth services. A regular use of eHealth services facilitated the decision-making process. Reading ability was associated with a better understanding regarding eHealth offers. CONCLUSION In a modern health care system, emphasis should be on skills contributing to eHealth literacy among patients to improve their ability to profit from eHealth offers and improve health care.
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Exploring the Person-Centeredness of an Innovative E-Supportive System Aimed at Person-Centered Care: Prototype Evaluation of the Care Expert. Comput Inform Nurs 2017; 34:231-9. [PMID: 26909537 DOI: 10.1097/cin.0000000000000225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Integrated in a multiphase development project, the Care Expert is a prototype of a novel e-supportive system aiming to mediate person-centered care in the context of outpatient oncology. At this early stage of development, the current study was conducted aiming at exploring the person-centeredness concept underlying the Care Expert version 1.0 and its usability for patients receiving outpatient chemotherapy for breast cancer. Within a user-centered design, we followed a mixed-methods approach entailing subjective assessment and diagnostic evaluation of the prototype. Four women undergoing outpatient chemotherapy participated in individual sessions and rated highly the system's usability. Their accounts led to identifying three supportive functions: continuous communication, reinforcement of self-driven agency, and cooperative agency with a sense of being looked after. We discuss the results in relation to theoretical fields that might guide further the development of the supportive system and usability recommendations. Care Expert has the potential to mediate person-centered care in outpatient oncology. Nevertheless, additional cycles of iterative development with the software team and of participatory design focusing on oncology nurses' perspectives are required before departing to the feasibility phase in intervention research.
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Villani D, Cognetta C, Toniolo D, Scanzi F, Riva G. Engaging Elderly Breast Cancer Patients: The Potential of eHealth Interventions. Front Psychol 2016; 7:1825. [PMID: 27899909 PMCID: PMC5110527 DOI: 10.3389/fpsyg.2016.01825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Daniela Villani
- Department of Psychology, Università Cattolica del Sacro Cuore Milan, Italy
| | - Chiara Cognetta
- Department of Medical Oncology, "G.Salvini" ASST Rhodense Milan, Italy
| | - Davide Toniolo
- Department of Medical Oncology, "G.Salvini" ASST Rhodense Milan, Italy
| | - Francesco Scanzi
- U.O. Oncologia Medica, Ospedale S. Giuseppe-Multimedica Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro CuoreMilan, Italy; Applied Technology for Neuro-Psychology Lab, Istituto Auxologico ItalianoMilan, Italy
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32
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Kimiafar K, Sarbaz M, Shahid Sales S, Esmaeili M, Javame Ghazvini Z. Breast cancer patients' information needs and information-seeking behavior in a developing country. Breast 2016; 28:156-60. [DOI: 10.1016/j.breast.2016.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/29/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022] Open
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Engler J, Adami S, Adam Y, Keller B, Repke T, Fügemann H, Lucius-Hoene G, Müller-Nordhorn J, Holmberg C. Using others' experiences. Cancer patients' expectations and navigation of a website providing narratives on prostate, breast and colorectal cancer. PATIENT EDUCATION AND COUNSELING 2016; 99:1325-1332. [PMID: 27067064 DOI: 10.1016/j.pec.2016.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/01/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To understand what cancer patients expect and may learn from other patients' experiences, as analyzed and sorted for presentation on a website called krankheitserfahrungen.de (meaning "illness experiences"). METHODS Mixed methods approach including log file analyses, survey data analyses and thematic analysis of focus group discussions. RESULTS Users highly valued the wide range of patient experiences presented. The academic leadership of krankheitserfahrungen.de made them trust the information quality. Reading, watching and listening to other cancer patients' experiences gave users a feeling of hope and confidence. Searching for persons with similar experiences was a major way of navigating the website. CONCLUSION Patient narratives as presented on krankheitserfahrungen.de provide a helpful resource, supporting cancer patients' engagement with their disease. Having access to such research-informed accounts of everyday cancer experiences was seen as a great contribution to existing available patient information. PRACTICE IMPLICATIONS When health information websites include experiences, they should adhere to quality standards of qualitative research and encompass a wide range, so that users are able to find patients similar to themselves. Filter options are a helpful tool. A mix of written text and videos is beneficial, as users have different preferences. The inclusion of patient photographs and video interviews facilitates authenticity and closeness.
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Affiliation(s)
- Jennifer Engler
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Sandra Adami
- Department of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Yvonne Adam
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Keller
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Repke
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hella Fügemann
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Christine Holmberg
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Jenkins VA, Fallowfield LJ. No man's land: information needs and resources of men with metastatic castrate resistant prostate cancer. Support Care Cancer 2016; 24:4471-3. [PMID: 27470260 DOI: 10.1007/s00520-016-3358-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
Abstract
The majority of men treated for prostate cancer will eventually develop castrate-resistant disease (CRPC) with metastases (mCRPC). There are several options for further treatment: chemotherapy, third-line hormone therapy, radium, immunotherapy, and palliation. Current ASCO guidelines for survivors of prostate cancer recommend that an individual's information needs at all stages of disease are assessed and that patients are provided with or referred to the appropriate sources for information and support. Earlier reviews have highlighted the dearth of such services and we wished to see if the situation had improved more recently. Unfortunately, we conclude that there is still a lack of good-quality congruent information easily accessible specifically for men with mCRPC and insufficient data regarding the risks, harms, and benefits of different management plans. More research providing a clear evidence base about treatment consequences using patient reported outcome measures is required.
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Affiliation(s)
- V A Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9RX, UK.
| | - L J Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9RX, UK
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35
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Kanera IM, Bolman CAW, Willems RA, Mesters I, Lechner L. Lifestyle-related effects of the web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) intervention for cancer survivors: a randomized controlled trial. J Cancer Surviv 2016; 10:883-97. [PMID: 26984534 PMCID: PMC5018034 DOI: 10.1007/s11764-016-0535-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
Purpose The web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) responds to the needs of cancer survivors and oncology care providers to improve the counseling related to self-management of lifestyle and psychosocial challenges. In present study, overall intervention effects and the effects of using specific components were evaluated on vegetable, fruit, whole grain bread, and fish consumption, physical activity (PA), and smoking behavior. Methods Cancer survivors from 21 Dutch hospitals were recruited for a randomized controlled trial (N = 432). Intervention effects after 6 months were evaluated using multilevel linear regression analysis (complete cases and intention-to-treat). By conducting moderation analyses, additional effects of following the behavior-related modules were explored. The false discovery rate correction was applied to account for multiple testing. Results After 6 months, 409 participants completed follow-up (dropout = 11.5 %). Indications were found that access to the intervention may result in increases of moderate PA and vegetable intake. The moderate PA increase was meaningful: 74.74 min p/w higher increase in the intervention condition. Effect sizes of moderate PA (d = .25) and vegetable (d = .37) consumption were comparable to prior effective interventions. Visiting behavior-related modules affected moderate PA, fruit, and fish consumption. However, after correction for multiple testing, significances expired. No significant intervention effect was found on smoking behavior due to low numbers of smokers. Implications for Cancer Survivors Although the effectiveness was only shown only to a limited extend, this study provided several indications that this theory-based, comprehensive, and personalized eHealth intervention provides valuable content to complement usual cancer aftercare.
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Affiliation(s)
- Iris M. Kanera
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Catherine A. W. Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Roy A. Willems
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Ilse Mesters
- CAPHRI School for Public Health and Primary Care, Optimizing Patient Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401 DL Heerlen, The Netherlands
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Kelly L, Ziebland S, Jenkinson C. Measuring the effects of online health information: Scale validation for the e-Health Impact Questionnaire. PATIENT EDUCATION AND COUNSELING 2015; 98:1418-1424. [PMID: 26162953 DOI: 10.1016/j.pec.2015.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/09/2015] [Accepted: 06/13/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Health-related websites have developed to be much more than information sites: they are used to exchange experiences and find support as well as information and advice. This paper documents the development of a tool to compare the potential consequences and experiences a person may encounter when using health-related websites. METHODS Questionnaire items were developed following a review of relevant literature and qualitative secondary analysis of interviews relating to experiences of health. Item reduction steps were performed on pilot survey data (n=167). Tests of validity and reliability were subsequently performed (n=170) to determine the psychometric properties of the questionnaire. RESULTS Two independent item pools entered psychometric testing: (1) Items relating to general views of using the internet in relation to health and, (2) Items relating to the consequences of using a specific health-related website. Identified sub-scales were found to have high construct validity, internal consistency and test-retest reliability. CONCLUSION Analyses confirmed good psychometric properties in the eHIQ-Part 1 (11 items) and the eHIQ-Part 2 (26 items). PRACTICE IMPLICATIONS This tool will facilitate the measurement of the potential consequences of using websites containing different types of material (scientific facts and figures, blogs, experiences, images) across a range of health conditions.
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Affiliation(s)
- Laura Kelly
- The Nuffield Department of Population Health and the Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
| | - Sue Ziebland
- The Nuffield Department of Population Health and the Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - Crispin Jenkinson
- The Nuffield Department of Population Health and the Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
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Willems RA, Bolman CAW, Mesters I, Kanera IM, Beaulen AAJM, Lechner L. The Kanker Nazorg Wijzer (Cancer Aftercare Guide) protocol: the systematic development of a web-based computer tailored intervention providing psychosocial and lifestyle support for cancer survivors. BMC Cancer 2015; 15:580. [PMID: 26260318 PMCID: PMC4532144 DOI: 10.1186/s12885-015-1588-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/30/2015] [Indexed: 12/14/2022] Open
Abstract
Background After primary treatment, many cancer survivors experience psychosocial, physical, and lifestyle problems. To address these issues, we developed a web-based computer tailored intervention, the Kanker Nazorg Wijzer (Cancer Aftercare Guide), aimed at providing psychosocial and lifestyle support for cancer survivors. The purpose of this article is to describe the systematic development and the study design for evaluation of this theory and empirical based intervention. Methods/design For the development of the intervention, the steps of the Intervention Mapping protocol were followed. A needs assessment was performed consisting of a literature study, focus group interviews, and a survey study to get more insight into cancer survivors’ health issues. This resulted in seven problem areas that were addressed in the intervention: cancer-related fatigue, return to work, anxiety and depression, social relationships and intimacy, physical activity, diet, and smoking. To address these problem areas, the principles of problem-solving therapy and cognitive behavioral therapy are used. At the start of the intervention, participants have to fill in a screening questionnaire. Based on their answers, participants receive tailored advice about which problem areas deserve their attention. Participants were recruited from November 2013 through June 2014 by hospital staff from 21 hospitals in the Netherlands. Patients were selected either during follow-up visits to the hospital or from reviews of the patients’ files. The effectiveness of the intervention is being tested in a randomized controlled trial consisting of an intervention group (n = 231) and waiting list control group (n = 231) with a baseline measurement and follow-up measurements at 3, 6, and 12 months. Discussion Using the Intervention Mapping protocol resulted in a theory and evidence-based intervention providing tailored advice to cancer survivors on how to cope with psychosocial and lifestyle issues after primary treatment. Trial registration Dutch Trial Register NTR3375
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Affiliation(s)
- Roy A Willems
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Catherine A W Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Ilse Mesters
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Iris M Kanera
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Audrey A J M Beaulen
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
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Panteli D, Wagner C, Verheyen F, Busse R. 'Know before you go': information-seeking behaviour of German patients receiving health services abroad in light of the provisions of Directive 2011/24/EU. J Health Serv Res Policy 2015; 20:154-61. [PMID: 25899483 DOI: 10.1177/1355819615580003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE While Directive 2011/24/EU on cross-border patient mobility makes specific provisions in relation to information availability and accessibility, little empirical evidence exists to guide best practice. This paper explores the information-seeking behaviour of German patients who received planned care abroad. METHODS A postal survey among German patients treated in other European countries was carried out by Techniker Krankenkasse, a major German sickness fund. The influence of certain predictors on whether patients informed themselves before travelling for care was investigated using multiple logistic regression. Types and sources of information were analysed using descriptive statistics. RESULTS Information activity was contingent on patients' level of education, type of service, regularity of treatment abroad and awareness of entitlement to cross-border services. Respondents most frequently enquired about elements of reimbursement, entitlement to services and cost-saving, and consulted their sickness fund for information. Differences in both content and medium of choice were observed between patient groups. CONCLUSION A structured and inclusive approach to information provision should be adopted. National Contact Points should collaborate with a range of stakeholders, who will vary depending on the health care system; however, patient organizations, health professionals and third-party payers should always be represented. Dynamically monitoring cross-border movements can help determine the range, medium and language of relevant information.
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Affiliation(s)
- Dimitra Panteli
- Research Fellow, Department of Health Care Management, Berlin University of Technology, Germany
| | - Caroline Wagner
- Health Economist, Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Frank Verheyen
- Director, Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Reinhard Busse
- Head of Department, Department of Health Care Management, Berlin University of Technology, Germany
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