Patient-centered approaches to creating understandable health information

Bridging the gap: Evaluating ChatGPT-generated, personalized, patient-centered prostate biopsy reports

OBJECTIVE

The highly specialized language used in prostate biopsy pathology reports coupled with low rates of health literacy leave some patients unable to comprehend their medical information. Patients' use of online search engines can lead to misinterpretation of results and emotional distress. Artificial intelligence (AI) tools such as ChatGPT (OpenAI) could simplify complex texts and help patients. This study evaluates patient-centered prostate biopsy reports generated by ChatGPT.

METHODS

Thirty-five self-generated prostate biopsy reports were synthesized using National Comprehensive Cancer Network guidelines. Each report was entered into ChatGPT, version 4, with the same instructions, and the explanations were evaluated by 5 urologists and 5 pathologists.

RESULTS

Respondents rated the AI-generated reports as mostly accurate and complete. All but 1 report was rated complete and grammatically correct by the majority of physicians. Pathologists did not rate any reports as having severe potential for harm, but 1 or more urologists rated severe concern in 20% of the reports. For 80% of the reports, all 5 pathologists felt comfortable sharing them with a patient or another clinician, but all 5 urologists reached the same consensus for only 40% of reports. Although every report required edits, all physicians agreed that they could modify the ChatGPT report faster than they could write an original report.

CONCLUSIONS

ChatGPT can save physicians substantial time by generating patient-centered reports appropriate for patient and physician audiences with low potential to cause harm. Surveyed physicians have confidence in the overall utility of ChatGPT, supporting further investigation of how AI could be integrated into physicians' workflows.

Communicating cancer treatment with pictogram-based timeline visualizations

OBJECTIVE

This study evaluated the legibility, comprehension, and clinical usability of visual timelines for communicating cancer treatment paths. We examined how these visual aids enhance participants' and patients' understanding of their treatment plans.

MATERIALS AND METHODS

The study included 2 online surveys and 1 in-person survey with hematology cancer patients. The online surveys involved 306 and 160 participants, respectively, while the clinical evaluation included 30 patients (11 re-surveyed) and 24 medical doctors. Participants were assessed on their ability to understand treatment paths provided with audio information alone or with visual aids. The study also evaluated the comprehensibility of key treatment terms and the ability of patients to recall their cancer treatment paths.

RESULTS

Visual representations effectively communicated treatment terms, with 7 out of 8 terms achieving over 85% transparency as pictograms, compared to 5 out of 8 for comics and 4 out of 8 for photos. Visual treatment timelines improved the proportion of correct responses, increased confidence, and were rated higher in information quality than audio-only information. In the clinical evaluation, patients showed good comprehension (mean proportion correct: 0.82) and recall (mean proportion correct: 0.71 after several weeks), and both patients and physicians found the visual aids helpful.

DISCUSSION

We discuss that visual timelines enhance patient comprehension and confidence in cancer communication. We also discuss limitations of the online surveys and clinical evaluation. The importance of accessible visual aids in patient consultations is emphasized, with potential benefits for diverse patient populations.

CONCLUSION

Visual aids in the form of treatment timelines improve the legibility and comprehension of cancer treatment paths. Both patients and physicians support integrating these tools into cancer treatment communication.

Collaborating with patients and caregivers to create web-based educational resources for people affected by cirrhosis

Objective

To describe the development of multimodal, web-based educational resources about cirrhosis alongside patients and caregivers.

Methods

We used an iterative process that was guided by the Strategy for Patient Oriented Research (SPOR) patient engagement framework in describing patient engagement activities to partner with a team of 16 patients and caregivers (Patient Advisory Team (PAT)). This process included five phases: a) Prioritize and gather content, b) design and build the website and videos, c) gather and integrate feedback, d) improve user accessibility, and e) assess usability and knowledge uptake for users.

Results

This 2-year process resulted in a 55-page website and 78 animated and live-action videos on cirrhosis complications, procedures, nutrition, and exercise. We implemented usability testing through pre-defined tasks and a think-aloud method from individuals with no previous exposure to the website to assess navigation, appearance, and content issues. Following usability testing, we have been gathering quantitative data from each unique page about relevance and ease of use, as well as qualitative data on the value of the content itself.

Conclusions

Collaboration between clinicians, patients, and caregivers is key to developing high-quality digital educational resources. Lessons from our process may help other organizations looking to address disease-specific knowledge gaps. Next steps with www.cirrhosiscare.ca will be continued iterative refinement and structured impact evaluation.

Innovation

This project used a patient-centered approach to develop a comprehensive online educational resource for patients with cirrhosis. By having patients with cirrhosis as a key part of our team, we ensured that the site met the needs of this unique population.

Developing a framework for understanding health information behavior change from avoidance to acquisition: a grounded theory exploration

BACKGROUND

Health information avoidance is common in real life, but because it is not always conducive to health promotion and maintenance, people often actively switch to health information acquisition. Understanding this process of active change can facilitate intervention in unreasonable avoidance behaviors. However, studies so far have mostly focused on why and how avoidance takes place, little is known about the process of active change from avoidance to acquisition. We thus use a grounded theory approach (GT) to explore how the active change takes place, and to generate a grounded theoretical framework capable of illustrating stages and influencing factors involved in the active change process.

METHODS

Straussian grounded theory (Corbin & Strauss, 2015) was used to analyze data collected through semi-structured interviews with 30 adults (14 in good health, 11 with disease, 5 in other health status) who had experienced health information behavior change from avoidance to acquisition. These interviews focused on how the change occurred and what effected the change.

RESULTS

The core category of Health Information Avoidance Change and 12 categories were identified and integrated to form a theoretical framework termed the Health Information Avoidance Change Model (HIACM). This model describes the process using five non-linear stage variables (initiation, preparation, action, maintenance, and abandonment) and seven moderating factor variables (cognitive change, social stimulus, beliefs and attitudes, intrapsychic literacy, social resources, information source, time and material resources).

CONCLUSIONS

HIACM can be used to explain the process of active change from health information avoidance to health information acquisition. HIAC is a non-linear and holistic process, and it is necessary to dynamically analyze the impact of relevant factors and take targeted intervention measures in stages. HIAC is usually not only an individual behavior, but also a socialized behavior requiring the collaboration of individuals, families, health information providers, healthcare providers, and governments.

Exploring Urological Malignancies on Pinterest: Content Analysis (Preprint)

Background

Pinterest is a visually oriented social media platform with over 250 million monthly users. Previous studies have found misinformative content on genitourinary malignancies to be broadly disseminated on YouTube; however, no study has assessed the quality of this content on Pinterest.

Objective

Our objective was to evaluate the quality, understandability, and actionability of genitourinary malignancy content on Pinterest.

Methods

We examined 540 Pinterest posts or pins, using the following search terms: “bladder cancer,” “kidney cancer,” “prostate cancer,” and “testicular cancer.” The pins were limited to English language and topic-specific content, resulting in the following exclusions: bladder (n=88), kidney (n=4), prostate (n=79), and testicular cancer (n=10), leaving 359 pins as the final analytic sample. Pinterest pins were classified based on publisher and perceived race or ethnicity. Content was assessed using 2 validated grading systems: DISCERN quality criteria and the Patient Education Materials Assessment Tool. The presence of misinformation was evaluated using a published Likert scale ranging from 1=none to 5=high.

Results

Overall, 359 pins with a total of 8507 repins were evaluated. The primary publisher of genitourinary malignancy pins were health and wellness groups (n=162, 45%). Across all genitourinary malignancy pins with people, only 3% (n=7) were perceived as Black. Additionally, Asian (n=2, 1%) and Latinx (n=1, 0.5%) individuals were underrepresented in all pins. Nearly 75% (n=298) of the pins had moderate- to poor-quality information. Misinformative content was apparent in 4%-26% of all genitourinary cancer pins. Understandability and actionability were poor in 55% (n=198) and 100% (n=359) of the pins, respectively.

Conclusions

On Pinterest, the majority of the urological oncology patient-centric content is of low quality and lacks diversity. This widely used, yet unregulated platform has the ability to influence consumers’ health knowledge and decision-making. Ultimately, this can lead to consumers making suboptimal medical decisions. Moreover, our findings demonstrate underrepresentation across many racial and ethnic groups. Efforts should be made to ensure the dissemination of diverse, high-quality, and accurate health care information to the millions of users on Pinterest and other social media platforms.

Rural cancer survivors' health information needs post-treatment

OBJECTIVE

This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs.

METHODS

Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics.

RESULTS

Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs.

CONCLUSIONS

Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support.

PRACTICE IMPLICATIONS

The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.

A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study

BACKGROUND

Inadequate patient education and preparation for office-based procedures often leads to delayed care, poor patient satisfaction, and increased costs to the health care system. We developed and deployed a mobile health (mHealth) reminder and education program for patients scheduled for transrectal prostate biopsy.

OBJECTIVE

We aimed to evaluate the impact of an mHealth reminder and education program on appointment cancellation rates, communication frequency, and patient satisfaction.

METHODS

We developed a text message (SMS, short message service)-based program with seven reminders containing links to Web-based content and surveys sent over an 18-day period (14 days before through 3 days after prostate biopsy). Messages contained educational content, reminders, and readiness questionnaires. Demographic information, appointment cancellations or change data, and patient/provider communication events were collected for 6 months before and after launching the intervention. Patient satisfaction was evaluated in the postintervention cohort.

RESULTS

The preintervention (n=473) and postintervention (n=359) cohorts were composed of men of similar median age and racial/ethnic distribution living a similar distance from clinic. The postintervention cohort had significantly fewer canceled or rescheduled appointments (33.8% vs 21.2%, P<.001) and fewer same-day cancellations (3.8% vs 0.5%, P<.001). There was a significant increase in preprocedural telephone calls (0.6 vs 0.8 calls per patient, P=.02) in the postintervention cohort, but not a detectable change in postprocedural calls. The mean satisfaction with the program was 4.5 out of 5 (SD 0.9).

CONCLUSIONS

An mHealth periprocedural outreach program significantly lowered appointment cancellation and rescheduling and was associated with high patient satisfaction scores with a slight increase in preprocedural telephone calls. This led to fewer underused procedure appointments and high patient satisfaction.