The Internet and prostate cancer patients: searching for and finding information

Prostate cancer, online health information and communication technology - Bibliometric analysis of field with research frontiers

OBJECTIVES

The purpose of this study is to conduct the first bibliometric analysis which examines eHealth communication technologies in prostate cancer care, and the utilization of internet-based health information and communication technology by men with prostate cancer.

METHODS

Original articles were extracted from the Science Citation Index Expanded (SCI-E) on Web of Science (WOS) and analyzed concerning their distributions. Quantitative guidance directed investigation of findings from previous studies and trending issues within the field. The WOS, VOSViewer and CiteSpace IV were used for information analysis.

RESULTS

302 articles were included in the final analysis. There has been a 165 % increase in productivity over the past decade. The leading country by publication was the USA (145 articles = 48.02 %). Journals which published the highest number of original articles were the Journal of Medical Internet Research (6.95 %), and Patient Education and Counseling (4.64 %).

DISCUSSION AND PRACTICE IMPLICATIONS

The field of research which examines utilization and impacts of internet-based health information on men with prostate cancer is growing and diverse. Research frontiers are 'Information quality and diversity', 'eHealth literacy', 'decision making', and 'survivorship and advanced disease'. Clinicians should be aware of several significant limitations which exist within the current field of research.

Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study

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.

'Prostate Cancer' Information on the Internet: Fact or Fiction?

Background/Aims

In today's information era, patients often seek information regarding health using the internet. We assessed reliability and validity of internet information regarding 'prostate cancer'.

Methods

Search term 'prostate cancer' used on Google website (June 2017). Critical analysis was performed on first 100 hits using JAMA benchmarks, DISCERN score, Health on the Net.

Results

33 500 000 hits returned. Top 100 hits were critically analyzed. Ten links [duplicate links (n = 7), book reviews (n = 1), dead sites (n = 2)] were excluded, therefore 90 were analyzed. Subcategories assessed included: commercial (53.33%), university/medical center (24.44%), government (13.33%); non-governmental/ non-profit organizations (8.89%). Sub-type of information content assessed included: factual (74.44%), clinical trials (18.89%); stories (5.56%); question and answer (1.11%). Website rated as HONcode seal positive (14,44%) or seal negative (85,56%). Website content based on JAMA benchmarks: 0 benchmarks (4.44%), 1 benchmark (16.67%), 2 benchmarks (34.44%), 3 benchmarks (27.78%), 4 benchmarks (16.67%). DISCERN score rated: 'low' score (16-32) = 12 websites (13.33%), 'moderate' score (33-64 points) = 68 websites (75.56%), 'high' score (≥ 65 points) = 10 websites (11.11%).

Conclusion

Critical assessment of 'Prostate Cancer' information on the internet, showed that overall quality was observed to be accurate, however majority of individual websites are unreliable as a source of information by itself for patients. Doctors and patients need to be aware of this 'quality vs quantity' discrepancy when sourcing PCa information on the internet.

[Internet use after prostate cancer : Search for information and trust in disease-related information in long-term survivors]

BACKGROUND AND OBJECTIVE

The internet provides numerous sources of information about prostate cancer (PCa). The present study investigated internet use among long-term PCa survivors, trust in online PCa-related information, and associated factors.

MATERIALS AND METHODS

Based on the German national research project Familial Prostate Cancer long-term PCa survivors were asked about their internet use in 2017. Associations with sociodemographic (age at survey, children, intimate relationship, education) and disease-related parameters (time since diagnosis, PCa family history, progress) were analyzed using multivariable logistic regression.

RESULTS

In all, 4636 long-term PCa survivors were included in the analysis (mean age 76.9 years; standard deviation 6.6 years). Mean follow-up was 14.0 years. Of long-term PCa survivors, 62.1% were using the internet. Among non-users 23.5% expressed strong concerns, among users only 2.8%. Furthermore, 47.2% of internet users sought information about PCa, 18.0% of them indicated difficulties while searching for information. More than half of the users found the online information inappropriate. Lower age, shorter time since diagnosis, progress, and a more frequent internet use were associated with search for information. Only one-third fully trusted online information. Trust in online information was associated with high age, higher educational level, and frequent search for online information. Many survivors stressed that they were primarily trusting their treating urologist.

CONCLUSIONS

Two-thirds of long-term PCa survivors are using the internet. A significant proportion expressed difficulties finding proper and reliable information. Urologists should be familiar with online resources on PCa in order to offer advice to patients and to recommend adequate information on the internet.

Accordance of Online Health Information on Prostate Cancer with the European Association of Urology Guidelines

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.

Digital divide among people with disabilities: Analysis of data from a nationwide study for determinants of Internet use and activities performed online

Introduction

The Internet is both an opportunity as well as a challenge for people with disabilities. However, this segment of the population is usually indicated among social groups experiencing digital divide. The study is focused on the analysis of factors determining Internet usage and undertaking specific activities online among people with disabilities based on a nationwide study performed in 2013 in Poland.

Methods

Secondary analysis was performed on the data of persons who declared disability status in 2013 “Social Diagnosis” study. Multivariate logistic regression models were developed for the use of the Internet and performing three types of activities online.

Results

Among 3,556 respondents with disability 51.02% were females, 25.19% 65 years of age and over and 33.05% were Internet users. The predictors of Internet usage included the degree of disability, place of residence, level of education, marital status, occupational status, net income, use of health care service and the use of mobile phone. The odds ratio that a person with disability belonging to the oldest category will use the Internet was only 0.04 (95% CI 0.02–0.09), when compared to the youngest category. The odds that a person with disability from the highest category of education will use the Internet were 18 times higher than in the case of persons with only basic education (OR 18.17, 95% CI 11.70–28.21). Common predictors of online activities (accessing websites of public institutions, checking and sending emails, publishing own content on the Internet) included age category and net income.

Conclusions

People with disabilities in Poland are facing a significant digital divide. The factors determining the use of the Internet in this group are similar to those of the general population. On the other hand, people with disabilities who are active online, access diversified types of services including presentation of their own content online.

Patient choice, Internet based information sources, and perceptions of health care: Evidence from Sweden using survey data from 2010 and 2013

BACKGROUND

Several countries have increased patients' abilities to choose their health care providers, frequently under the assumption that patients are themselves the best agents to make such decisions. In parallel, national and regional health authorities have enhanced access to Internet based information sources (IBIS) to assist patients in making an informed choice. Relatively little, however, is known about the effect that the use of such sources has on key outcomes, including patients' perceptions of care. The aim of this study is to analyze the role of the Internet for patients' confidence in the provider and perceived access to care in the context of choice based reforms in Sweden.

METHODS

The study uses a regional, population health survey from the southern part of Sweden. Non-parametric chi-square tests are used to assess the nature of Internet users, including their gender, age and socioeconomic status. Logistic regression models are specified to analyze the role of IBIS on patient perceptions of care while controlling for other factors.

RESULTS

Actual use of Internet based information sources for health care was relatively low in 2010 and only somewhat higher in 2013. The characteristics of IBIS users varied significantly across different population groups, such that they were younger, more educated, female, and also considered themselves to be in better health compared with those who reported not using this source of health care information. Finally, the average IBIS user was less likely to report having a high level of satisfaction with respect to their primary care use; OR 0.69 [95 % CI: 0.54-0,87] and OR 0.52 [95 % CI: 0,41-0,66], for confidence in provider and perceived access to care, respectively, in 2013.

CONCLUSIONS

Despite health agencies' attempts to make information on health care providers available on the Internet, this source of health care information is not used to any large extent in the current sample. The fact that some people use this source of information more compared with others suggests the need to consider alternative ways of informing the general public about choice options. The use of Internet based sources may also be linked with the experience of actually using health services, which suggests a need to further analyze this complex consumer behavior process.

A cross-sectional study assessing determinants of the attitude to the introduction of eHealth services among patients suffering from chronic conditions

BACKGROUND

Provision of care to patients with chronic diseases remains a great challenge for modern health care systems. eHealth is indicated as one of the strategies which could improve care delivery to this group of patients. The main objective of this study was to assess determinants of the acceptance of the Internet use for provision of chosen health care services remaining in the scope of current nationwide eHealth initiative in Poland.

METHODS

The survey was carried out among patients with diagnosed chronic conditions who were treated in three health care facilities in Krakow, Poland. Survey data was used to develop univariate and multivariate logistic regression models for six outcome variables originating from the items assessing the acceptance of specific types of eHealth applications. The variables used as predictors were related to the sociodemographic characteristics of respondents, burden related to chronic disease, and the use of the Internet and its perceived usefulness in making personal health-related decisions.

RESULTS

Among 395 respondents, there were 60.3% of Internet users. Univariate logistic regression models developed for six types of eHealth solutions demonstrated their higher acceptance among younger respondents, living in urban areas, who have attained a higher level of education, used the Internet on their own, and were more confident about its usefulness in making health-related decisions. Furthermore, the duration of chronic disease and hospitalization due to chronic disease predicted the acceptance of some of eHealth applications. However, when combined in multivariate models, only the belief in the usefulness of the Internet (five of six models), level of education (four of six models), and previous hospitalization due to chronic disease (three of six models) maintained the effect on the independent variables.

CONCLUSIONS

The perception of the usefulness of the Internet in making health-related decision is a key determinant of the acceptance of provision of health care services online among patients with chronic diseases. Among sociodemographic factors, only the level of education demonstrates a consistent impact on the level of acceptance. Interestingly, a greater burden of chronic disease related to previous hospitalizations leads to lower acceptance of eHealth solutions.

The acceptance of e-health solutions among patients with chronic respiratory conditions

OBJECTIVE

The main objective of this study was to assess the acceptance of the use of e-health applications by patients suffering from bronchial asthma and other chronic respiratory conditions.

SUBJECTS AND METHODS

The questionnaire, consisting of 73 items, was distributed among 200 patients remaining under the care of a tertiary-care pulmonology center in Krakow, Poland (return rate, 82.5%; n=165).

RESULTS

The mean age (standard deviation) of respondents was 50.8 (14.9) years. Of the respondents, 48.5% (n=80) suffered from bronchial asthma, 29.1% (n=48) from chronic obstructive pulmonary disease, and 32.1% (n=53) from other respiratory diseases. The Internet was used by 58.2% (n=96) of respondents. The most frequent types of health-related information searched for online included diseases (59.4%) and treatments (medication, 54.2%; treatment options, 58.3%), as well as information about physicians and healthcare institutions (32.3% and 31.3%, respectively). The differences between acceptance scores for specific e-health applications were significant (analysis of variance, Friedman chi-squared=166.315, p<0.001). The respondents revealed the highest acceptance of e-health solutions allowing them to book appointments with physicians, access laboratory test results, view educational resources, and renew prescriptions. The acceptance of the most popular e-health applications depended on the duration of disease, respondent's age and education, and his or her use of computers and the Internet.

CONCLUSIONS

Patients suffering from chronic respiratory conditions demonstrate higher levels of acceptance of e-health applications such as appointment booking, prescription renewal, and access to information (laboratory test results, educational resources) than of solutions directly related to medical care (communication with healthcare providers, disease monitoring).

Evaluating the quality of Internet health resources in pediatric urology

PURPOSE

Many patients and their parents utilize the Internet for health-related information, but quality is largely uncontrolled and unregulated. The Health on the Net Foundation Code (HONcode) and DISCERN Plus were used to evaluate the pediatric urological search terms 'circumcision,' 'vesicoureteral reflux' and 'posterior urethral valves'.

MATERIALS AND METHODS

A google.com search was performed to identify the top 20 websites for each term. The HONcode toolbar was utilized to determine whether each website was HONcode accredited and report the overall frequency of accreditation for each term. The DISCERN Plus instrument was used to score each website in accordance with the DISCERN Handbook. High and low scoring criteria were then compared.

RESULTS

A total of 60 websites were identified. For the search terms 'circumcision', 'posterior urethral valves' and 'vesicoureteral reflux', 25-30% of the websites were HONcode certified. Out of the maximum score of 80, the average DISCERN Plus score was 60 (SD = 12, range 38-78), 40 (SD = 12, range 22-69) and 45 (SD = 19, range 16-78), respectively. The lowest scoring DISCERN criteria included: 'Does it describe how the treatment choices affect overall quality of life?', 'Does it describe the risks of each treatment?' and 'Does it provide details of additional sources of support and information?' (1.35, 1.83 and 1.95 out of 5, respectively).

CONCLUSIONS

These findings demonstrate the poor quality of information that patients and their parents may use in decision-making and treatment choices. The two lowest scoring DISCERN Plus criteria involved education on quality of life issues and risks of treatment. Physicians should know how to best use these tools to help guide patients and their parents to websites with valid information.

Factors related to use of the Internet as a source of health information by urological cancer patients

AIMS

The aims of this study were to describe the profile of urological cancer patients who look for health information on the Internet and to analyse the factors related to use of the Internet as a source of health information.

METHODOLOGY

A cross-sectional descriptive study using individual, semi-structured, questionnaire-based interviews was carried out in oncology clinics in a hospital in Granada (Spain) in a sample group of 169 patients with prostate, bladder and kidney cancer. The dependent variable was use of the Internet as a source of health information. The independent variables were sociodemographic variables, health status, relationship with healthcare services, patient's role in decision-making process, satisfaction with healthcare, Internet use, Internet skills and attitude. Data analyses include descriptive, bivariate and multivariate analyses.

RESULTS

Of the patients in the sample group, 72.2 % had prostate cancer, 19.4 % had bladder cancer and 8.3 % had kidney cancer. Only 11.2 % of patients in the group used the Internet as a source of health information. These patients were typically men of an average age of 62 years, who live in urban areas, who have completed secondary or university education, with a high income and who usually share the role of decision maker with their doctor. Patients who use the Internet as a source of health information usually look for support from psychological support groups, have family members who also look for information on the Internet and prefer sources of information other than those provided by the health services.

CONCLUSIONS

The study outlines the profile of urological cancer patients who use the Internet as a source of health information. Internet use is related to a patient's attitude towards decision making, level of education and whether or not they look for information from sources other than the health system itself.

Internet use among patients with psychosomatic disorders: what are the health-related demands and needs?

While Internet-based health-related offers for various disorders are increasing, little is known about the way patients with psychosomatic disorders use the Internet. We conducted a questionnaire survey in outpatient clinics at two university hospitals' Departments of Psychosomatic Medicine. Seventy-four percent of N = 274 patients had Internet home access and 60 percent of those patients reported health-related Internet use. Patients expressed the wish for more professional, evidence-based online information and expert-guided treatment. The survey results support the Internet's high potential in future treatment strategies for patients with psychosomatic disorders.

Social and psychological determinants of participation in internet-based cancer support groups

PURPOSE

In this study, we identified the social and psychological characteristics of Danish cancer patients that determine use of the internet for support.

MATERIALS AND METHODS

We invited 230 cancer patients taking part in a public rehabilitation program to participate in an internet module comprising training in the retrieval of cancer-related information from the internet and self-support groups. Persons who were motivated to join the internet groups (N = 100; 47%) were compared with persons who chose not to participate (N = 111) on the basis of self-reported baseline questionnaire data. Nineteen persons either did not return the questionnaire or had missing values in confounding variables.

RESULTS

Cancer patients who were motivated to participate in internet support groups belong to higher socioeconomic groups (based on household income and employment) compared to non-participants. We observed no difference between the two groups in quality of life or psychological well-being, while coping to some extent seemed related to participation in internet support groups.

CONCLUSION

This study adds to the discussion on social inequality in internet use by cancer patients, showing that patients who are not inclined to use internet-based interventions are characterized by social position and employ more passive coping strategies.

Quality of cystic fibrosis information on Italian websites

Given the increased attention on cystic fibrosis care during the last few years in Italy, this study was performed to evaluate content quality, characteristics and completeness of Italian cystic fibrosis websites. GOOGLE was used and retrieved websites were evaluated for the presence of predefined descriptive criteria and disease information. Their contents were compared with available evidence. Thirty sites were evaluated. Few fulfilled the criteria, such as listing authors (24 sites) and citing references (10). The amount of disease information varied, but 23 provided treatment information. Of these, 11 comparable sites were evaluated for adherence to guidelines and overall completeness. All information adhered to guidelines. One site provided very thorough information and was the most complete, whereas four were found to be half as complete as others. Patients can find accurate cystic fibrosis knowledge online, but may need to navigate between multiple sites to obtain comprehensive coverage of disease information. In Italy, a network of association websites exists to support patients and families. Website quality could be improved in terms of documentation (transparency) of the information provided in order to permit users to select well-documented, updated information.