Internet Health Resources and the Cancer Patient

When and how to enlighten citizens on genetics and hereditary cancer: a web survey of online video viewers

With the rapid expansion of genomic medicine, more citizens are compelled to think about genetics in their daily lives. This study aims to explore appropriate types of educational media and methods to enlighten activities for genetics and hereditary cancer. We presented an 18-min YouTube video on genetics and hereditary cancer to participants at a scientific event, Science Agora 2020, and administered a web questionnaire to investigate their opinions about when and how citizens should start learning about genetics and hereditary cancer. We recruited 133 participants who watched the video, and 26.3% (35/133) responded to the questionnaire. Most of them were evaluated to understand and appreciate the contents of the video. They identified websites, or videos as suitable learning media, irrespective of their sex, age, or profession. They highlighted upper elementary school or junior high school as appropriate educational stages to start learning about genetics and hereditary cancer to facilitate collecting their own genetic information by themselves. Our findings show that educational institutions should provide opportunities to learn about genetics and hereditary cancers, especially for upper elementary school and junior high school students, using learning media, such as videos, depending on their level or demand.

The unmet information needs, quality of life, and care experiences of patients with neuroendocrine tumours (NETs) at follow-up: 6 months from diagnosis

OBJECTIVES

To identify changes in the healthcare preferences, patient experiences, and quality of life of patients with NETs at 6-month follow-up, informing the design of supportive care services.

METHODS

This study presents 6-month follow-up data of a mixed-methods multi-site study. Demographic, clinical, and patient-reported outcome questionnaire data was collected.

RESULTS

High percentages of suboptimal experiences of care were reported. Patients reported less positive experiences with being involved in decisions about their care and treatment; their family or someone close to them having the opportunity to talk to their cancer doctor, or having their family or someone close to them receive all the information they need to help care for them at home. Patients also reported negative experiences for on the information about their cancer accessible online and the usefulness of the information they accessed. Differences between baseline and follow-up scores were mostly not significant apart from anxiety and sleep disturbance scales, CONCLUSIONS: Patients with NETs report difficulties in accessing and understanding written information that is persistent over time.

PRACTICE IMPLICATIONS

Outcomes will inform the design and development of an informational resource aimed at facilitating improved understanding for patients with NETs.

A randomized patient education trial investigating treatment-related distress and satisfaction with the use of an at-home gynecologic brachytherapy educational video

BACKGROUND

Physician explanation of gynecologic brachytherapy can be overwhelming or induce patient anxiety, and may be time-constrained given clinical limitations. We report the first randomized trial of an educational video intervention in gynecologic brachytherapy on patient-reported outcomes.

METHODS

Between February 2020 and January 2022, 80 gynecologic cancer patients prescribed brachytherapy were randomly assigned to either standard informed consent (Arm A) or a supplemental 16 min brachytherapy educational video (https://vimeo.com/403385455/d0716e3cc8) via the internet (Arm B). Primary outcome was treatment-related distress (National Comprehensive Cancer Network (NCCN) distress scale scored 0 (no distress) to 10 (maximum distress)). Secondary outcome was patient satisfaction (summated Likert-scale scored 11-55). Surveys were administered at baseline, after first treatment, and prior to brachytherapy completion.

RESULTS

All patients completed the prescribed brachytherapy. In Arm B, 19/40 (48%) patients and 10/40 (25%) patients' family/friends viewed the video. For patients that completed all surveys (Arm A n=29, Arm B n=28), there was no difference between arms in the sociodemographic, clinical, or treatment variables. Distress scores were low at baseline (Arm A median 4, Arm B median 4, p=0.65) and there was no detectable change in distress between arms on surveys 1 and 2 (β 0.36, p=0.67) or surveys 1 and 3 (β -1.02, p=0.29) in multivariable analysis. Satisfaction scores were high at baseline (Arm A median 54, Arm B median 54.5, p=0.64) and there was no detectable change in satisfaction between arms on surveys 1 and 2 (β 0.22, p=0.93) or surveys 1 and 3 (β 0.63, p=0.85) in multivariable analysis.

CONCLUSIONS

Among patients randomized to an educational video tool for gynecologic brachytherapy, approximately 50% of the cohort and 25% of the cohort's family/friends used the video. Overall, patients had low distress scores and high satisfaction scores with no significant differences between the standard and video intervention arms. Further work is needed to understand factors contributing to gynecologic brachytherapy anxiety.

TRIAL REGISTRATION NUMBER

NCT04363957.

Exploring the role of open book high-stakes examinations in 2021 and beyond

Performance on medical licensing examinations has been previously shown to be predictive of performance in practice. However, licensing examinations are closed-book and real-world medical practice increasingly requires doctors and patients to consult resources to make evidence-informed decisions. To best assess the ability of physicians and physicians-in-practice to avail themselves of point-of-care clinical resources and tools, open-book components may have an emerging role in high-stakes examinations.

Global online interest in cervical cancer care in the time of COVID-19: An infodemiology study

Introduction

Internet search trends may gauge public awareness and interest in cancer and help identify key areas for improvement in public health interventions and awareness campaigns. During the COVID-19 pandemic, cervical cancer screening significantly decreased, and we hypothesized that this would be mirrored by a decreased online interest in cervical cancer care.

Methods

Using the Google Trends database, we analyzed 2018-2021 global search trends in the following topics: cervical cancer, human papillomavirus, HPV vaccine, Cervarix, Gardasil, Pap test, HPV test, and colposcopy. Search trends were reported in the unit search volume index (SVI), which correlated with country-specific socioeconomic and epidemiologic characteristics.

Results

We found a sharp decline in global online search interest in cervical cancer following the declaration of the COVID-19 pandemic, after which interest gradually increased. During the pandemic, SVI for "cervical cancer" and "Pap test" significantly decreased, while SVI for "HPV vaccine" significantly increased. Higher online search interest in cervical cancer care was found in low- and middle-income countries, and countries in Latin America and the Caribbean, Asia, and Europe, reflecting their burden of disease and recent developments in cervical cancer control.

Conclusion

When the COVID-19 pandemic was declared, global online search interest in cervical cancer care decreased, reflective of the significant decline in cervical cancer screening rates during this time. Country-specific socioeconomic and epidemiologic characteristics correlated with online search interest in cervical cancer care. These global online search trends in cervical cancer may guide future public health interventions and awareness campaigns to eradicate this preventable disease worldwide.

The unmet supportive care needs, quality of life, and care experiences of patients with functioning and non-functioning Neuroendocrine tumours (NETs) at early diagnosis

OBJECTIVE

Healthcare experiences, quality of life and psychosocial needs of patients with Neuroendocrine tumours (NETs) will be assessed to identify differences between NET sub-groups and inform the design of supportive care services.

METHODS

This study constitutes phase one of a three-phase mixed-methods multi-site study with NET patients (n = 123). Demographic, clinical and patient reported outcome questionnaire data was collected.

RESULTS

No differences in patient reported outcomes were found beyond symptoms of diarrhoea and flushing between NET sub-groups. For combined NET patients, the majority reported negative experiences in their understanding of the explanation of what was wrong with them (67%); receiving written information about their cancer (69%), their family/carer receiving all the information required to care for them (61%); and the usefulness of information about NETs online (66%). NET patients reported at least one moderate-to-high need for disease specific information (63%). Medium- to large-sized differences in quality of life subscales were also observed with the functioning group reporting more anxiety compared to population norms.

CONCLUSIONS

There is a need to improve the current provision of information for people with NETs.

PRACTICE IMPLICATIONS

These findings will inform the design and development of an informational resource to facilitate improved understanding for patients with NETs.

Quality Analysis of Online Patient Resources for Hepatocellular Carcinoma

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.

Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE)

BACKGROUND

Patient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers.

PURPOSE

Given the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging.

METHODS

A 2⁶ balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets.

RESULTS

210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored.

CONCLUSIONS

Similar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies.

PRACTICE IMPLICATIONS

Patient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).

Depression in cancer: quality assessment of online patient education resources

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.

An Assessment of Health Information Resource Center and Supportive Program Needs

Objective:

No practical method or assessment tool for identifying patients' and their families' health information resource needs in a resource center exists. We sought to assess the health information and resource preferences of patients and their families to guide the planning of a health information resource center (HIRC).

Methods:

A needs assessment was conducted using convenience sample of patients and families drawn from the National Cancer Centre in Singapore. A survey was conducted to gather data from April 23, 2018, to May 11, 2018, at the Specialist Oncology Clinics (SOCs) and the Ambulatory Treatment Unit.

Results:

A total of 778 surveys were analyzed, and the majority of the respondents were Chinese (79.8%). There were 449 (57.7%) patients and 317 (40.7%) family members. Among the 778 respondents, the overall top item chosen for facilities, resources, and equipment were a quiet and comfortable area for reading and reflection (77.2%), information about education and support services offered by the center (71.6%), and computers with internet access (63.6%), respectively. The overall top three services needed in the resource center were advice on useful resources (70.6%); announcements on newly received materials, programs, and support services (64.8%); and resource personnel to assist with identifying materials/navigating through resources (53.2%). Written education pamphlets/brochures were rated as the most useful material (74.6%), followed by consumer health books (74.2%) and newsletter (59.6%). The top overall three supportive programs required were nutrition talks and cooking demonstrations (76.7%), counseling (individual, couples, family, and bereavement) (74.3%), and exercise (e.g., Tai Chi, yoga) (68.5%).

Conclusions:

The findings obtained from this assessment provide guidance to the development of a user-friendly, patient- and family-centric HIRC.

Caregivers of cancer patients: what are their information-seeking behaviours and resource preferences?

Cancer impacts not only the patient but also the family members who share the distressing trajectory of the patient. The literature indicates that caregivers have many unmet information needs while providing care and support to the cancer patients, and caregivers have to resort to seeking information to supplement their information needs. This study aims to establish the prevalence of health-information-seeking behaviours among caregivers of cancer patients as a means of ascertaining if their information needs have been met and their information source and resource preference. Data were obtained via a self-reported questionnaire from caregivers of cancer patients at the National Cancer Centre Singapore between 10 September and 7 December 2018. A total of 986 caregivers responded of which 180 (18%) caregivers did not undertake information search and the common reasons were ‘trust healthcare professionals’ (HCPs) more than other sources (64%), and ‘HCPs provide enough information’ (59%). Among the 795 caregivers who have searched for cancer information, about half of these caregivers (54%) have searched information on the Internet and another 15% have obtained their information from HCPs in their most recent search. A total of 371 (47%) caregivers have used their preferred source of information to conduct their most recent information search. The top three most commonly sought information was treatment (35.6%), disease (35.6%) and side effects (26.5%). Almost half (46%) of these caregivers was concerned about the quality of information they have found on the Internet. Our study supports that information-seeking is prevalent amongst caregivers of cancer patients and reveals the prevalence of Internet use and the concerns associated with its use. Patterns of information-seeking revealed a discrepancy between preferred and actual source. The results also suggest that HCPs play a significant role in the information-seeking behaviours of caregivers of cancer patients.

Quality of Patient Information by Urologists Is Associated with Mental Distress in Bladder Cancer Patients

AIMS

The study aimed to evaluate the prevalence of mental distress in patients with newly diagnosed bladder cancer, the cancer-information search behavior, and the influence of information seeking on distress.

METHODS

One hundred and one bladder cancer patients answered 2 established questionnaires ("Hospital Anxiety and Depression Scale" [HADS] and the "Fragebogen zur Belastung von Krebskranken" [FBK-R23]) for evaluation of mental distress and a self-developed questionnaire with questions concerning information seeking and socioeconomic facts.

RESULTS

Regarding risk group stratification, 57.4% were classified as high-risk and 42.6% as low-risk tumor-bearing patients. Analysis of mental distress showed that 23.2% had a score above the HADS-A cutoff, 25.3% above the HADS-D cutoff, and 21.4% showed a pathologic FBK-R23 score. Overall, 75% felt well informed about their illness. Risk group stratification did not correlate with HADS-A, HADS-D, or FBK-R23 score. Furthermore, active search for information or the use of the Internet did not correlate with the HADS-A, HADS-D, or FBK-R23 score. However, the quality of the urologist's information and the feeling of being informed correlated with the grade of mental distress.

CONCLUSION

Besides the treatment of bladder cancer, informing the patient about the disease in a psychologically wholesome manner and working together with psycho-oncologically trained psychologists are essential tasks for the treating urologist.

Differences in Perceptions of Health Information Between the Public and Health Care Professionals: Nonprobability Sampling Questionnaire Survey

Background

In the new media age, the public searches for information both online and offline. Many studies have examined how the public reads and understands this information but very few investigate how people assess the quality of journalistic articles as opposed to information generated by health professionals.

Objective

The aim of this study was to examine how public health care workers (HCWs) and the general public seek, read, and understand health information and to investigate the criteria by which they assess the quality of journalistic articles.

Methods

A Web-based nonprobability sampling questionnaire survey was distributed to Israeli HCWs and members of the public via 3 social media outlets: Facebook, WhatsApp, and Instagram. A total of 979 respondents participated in the online survey via the Qualtrics XM platform.

Results

The findings indicate that HCWs find academic articles more reliable than do members of the general public (44.4% and 28.4%, respectively, P<.001). Within each group, we found disparities between the places where people search for information and the sources they consider reliable. HCWs consider academic articles to be the most reliable, yet these are not their main information sources. In addition, HCWs often use social networks to search for information (18.2%, P<.001), despite considering them very unreliable (only 2.2% found them reliable, P<.001). The same paradoxes were found among the general public, where 37.5% (P<.001) seek information via social networks yet only 8.4% (P<.001) find them reliable. Out of 6 quality criteria, 4 were important both to HCWs and to the general public.

Conclusions

In the new media age where information is accessible to all, the quality of articles about health is of critical importance. It is important that the criteria examined in this research become the norm in health writing for all stakeholders who write about health, whether they are professional journalists or citizen journalists writing in the new media.

Exploring the Most Visible German Websites on Melanoma Immunotherapy: A Web-Based Analysis

Background

Patients diagnosed with melanoma frequently search the internet for treatment information, including novel and complex immunotherapy. However, health literacy is limited among half of the German population, and no assessment of websites on melanoma treatment has been performed so far.

Objective

The aim of this study was to identify and assess the most visible websites in German language on melanoma immunotherapy.

Methods

In accordance with the common Web-based information-seeking behavior of patients with cancer, the first 20 hits on Google, Yahoo, and Bing were searched for combinations of German synonyms for “melanoma” and “immunotherapy” in July 2017. Websites that met our predefined eligibility criteria were considered for assessment. Three reviewers independently assessed their quality by using the established DISCERN tool and by checking the presence of quality certification. Usability and reliability were evaluated by the LIDA tool and understandability by the Patient Education Materials Assessment Tool (PEMAT). The Flesch Reading Ease Score (FRES) was calculated to estimate the readability. The ALEXA and SISTRIX tools were used to investigate the websites’ popularity and visibility. The interrater agreement was determined by calculating Cronbach alpha. Subgroup differences were identified by t test, U test, or one-way analysis of variance.

Results

Of 480 hits, 45 single websites from 30 domains were assessed. Only 2 website domains displayed a German quality certification. The average assessment scores, mean (SD), were as follows: DISCERN, 48 (7.6); LIDA (usability), 40 (2.0); LIDA (reliability), 10 (1.6); PEMAT, 69% (16%); and FRES, 17 (14), indicating mediocre quality, good usability, and understandability but low reliability and an even very low readability of the included individual websites. SISTRIX scores ranged from 0 to 6872 and ALEXA scores ranged from 17 to 192,675, indicating heterogeneity of the visibility and popularity of German website domains providing information on melanoma immunotherapy.

Conclusions

Optimization of the most accessible German websites on melanoma immunotherapy is desirable. Especially, simplification of the readability of information and further adaption to reliability criteria are required to support the education of patients with melanoma and laypersons, and to enhance transparency.

Information sources and online information seeking behaviours of cancer patients in Singapore

The aim of this study was to investigate the prevalence of Internet usage among cancer patients in seeking health-related information and the type of information sought. Sources of information received from, preferences for information sources and the perceived usefulness of information from these sources were also examined in this study. A self-administered questionnaire was used to evaluate the information needs of patients undergoing cancer treatment. The questionnaire also evaluated the current source and preferred source of information as well as their online information seeking behaviours. A total of 411 patients with cancer were recruited from an ambulatory cancer centre. The patients' physicians and healthcare specialists comprised a large majority of the patients' information sources; they were also the most preferred source of information. 59.1% of the respondents used the Internet to search for cancer-related information, namely diagnosis and treatment options, side effects of treatment and complementary and alternative therapy; demonstrating the importance of the above information. Physicians (60.3%) and healthcare specialists (26.5%) were the largest and most preferred sources of information for cancer patients in our study. It was not uncommon for cancer patients to use the Internet to search for additional information demonstrating the need to integrate this tool more effectively for knowledge transfer for those patients who want it. It is important for healthcare professionals to help cancer patients by directing them to sources of quality information (including websites). In addition, the provision of guidelines on how to evaluate health information on the Internet would be helpful to cancer patients.

Cancer information needs according to cancer type: A content analysis of data from Japan's largest cancer information website

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.

Information-seeking and use of information resources among melanoma patients of German skin cancer centers

BACKGROUND

This study aimed to explore the information-seeking behavior (ISB) of melanoma patients (MPs) and MP subgroups, in order to provide data for needs-based adaptation of information provision.

METHODS

In a cross-sectional survey in 27 German skin cancer centers, we explored characteristics of the ISB of MPs with the aid of a standardized questionnaire. Sub-group differences were determined with the chi-squared test and predictors of media preferences with logistic regression.

RESULTS

67 % of the 529 participating MPs had clinical stage III or IV melanoma. Most of the participants (81 %) reported medical consultations as their regularly or frequently used information resource (IR). 58 % wished to have more advice about IRs from their physician. Only 8 % of MPs used the services of self-help groups and 12 % of MPs took advantage of the services of cancer counseling centers. The internet (63 %) and booklets (58 %) were reported to be the preferred media. Age, educational level, general need for information and lack of awareness of their own condition proved to be predictors for media preferences.

CONCLUSIONS

Most MPs expected their physician to advise them about IRs they could use in addition to medical consultations. Peer support services were quite underused by MPs. The various preferences of media by MPs should be considered when deve-loping and providing IRs.

Exploring Health Information-Seeking Preferences of Older Adults With Hypertension: Quasi-Experimental Design

BACKGROUND

Patients' engagement in health care decision making is constituted by at least two behaviors: health information seeking and active involvement in medical decisions. Previous research reported that older adults desire a lot of information, but want to participate in decision making to a lesser degree. However, there is only limited evidence on the effect of desire for health information on seniors' perceived confidence in making an informed choice (ie, decision self-efficacy).

OBJECTIVE

The goal of this study was to investigate the role desire for health information has for older patients. More specifically, it tested whether decision self-efficacy increases as a function of an assisted computer-based information search. Additionally, the study allowed insights into the sources seniors with hypertension prefer to consult.

METHODS

A sample of 101 senior citizens (aged ≥60 years) with high blood pressure in the Italian-speaking part of Switzerland answered a questionnaire before and after an informational intervention was applied. The intervention consisted of offering additional information on hypertension from five different sources and of providing the information the participant desired. Preference for receiving this information was the major independent variable. The main outcome measure was decision self-efficacy (assessed at baseline and posttest). Analyses of covariance were conducted to detect differences between and within who desired additional hypertension-related content (intervention group) and "information avoiders" (control group).

RESULTS

Health care professionals firmly remain the preferred and most trusted source of health information for senior patients. The second most consulted source was the internet (intervention group only). However, among the total sample, the internet obtained the lowest credibility score. A significant increase in decision self-efficacy occurred in seniors consulting additional information compared to information avoiders (F1,93=28.25, P<.001).

CONCLUSIONS

Consulting health information on a computer screen, and assistance by a computer-savvy person, may be a helpful activity to increase perceived confidence in making treatment decisions in seniors with hypertension.

A Review of Black Salve: Cancer Specificity, Cure, and Cosmesis

Black salve is a topical escharotic used for the treatment of skin cancer. Although promoted as a safe and effective alternative to conventional management by its proponents, limited clinical research has been undertaken to assess its efficacy and potential toxicities. Patients are increasingly utilizing the Internet as a source of health information. As a minimally regulated space, the quality and accuracy of this information vary considerably. This review explores four health claims made by black salve vendors, investigating its natural therapy credentials, tumour specificity, and equivalence to orthodox medicine in relation to skin cancer cure rates and cosmesis. Based upon an analysis of in vitro constituent cytotoxicity, in vivo post black salve histology, and experience with Mohs paste, black salve is likely to possess normal tissue toxicity with some cancer cell lines being relatively resistant to its effects. This may explain the incongruous case study reports of excessive scarring, deformity, and treatment failure.

Developing and assessing the utility of a You-Tube based clinical genetics video channel for families affected by inherited tumours

We have designed and implemented the first worldwide You Tube channel with 22 videos covering common questions asked in familial cancer susceptibility clinics. We discuss the use of the videos including demographics of registered You Tube users, and what lessons have been learnt about how the general public uses medical information online. The most popular video on inheritance patterns has been watched on average 84 times per month. The mostly highly viewed videos include inheritance patterns, breast cancer screening and hereditary non-polyposis colorectal cancer. Registered viewers were more commonly male and the average age of the registered user was 45-54 years; similar to that seen in Genetics Clinics suggesting that age may not be a major barrier to access to this type of information for patients. The videos have been viewed in more than 140 countries confirming that there is clearly an audience for this type of information. Patient feedback questionnaires indicate that these videos provide a useful aide memoir for the clinic appointment, and most people would recommend them to others. In summary, You Tube videos are easy and cost effective to make. They have the ability to disseminate genetics education to a worldwide audience and may be a useful adjunct to clinical appointments.

Sifting Through It All: Characterizing Melanoma Patients' Utilization of the Internet as an Information Source

This study describes how melanoma patients used the Internet as a melanoma information source and how it impacted their clinical encounter and treatment decision. From 2010 to 2013, melanoma patients were invited to complete a 23-question paper survey with open- and close-ended questions. Thirty-one of the 62 patients approached completed the survey. The majority (90 %) of respondents used the Internet as a melanoma information source. Most (90 %) had used the search engine Google. The most commonly searched topics were melanoma treatment (96 %), screening (64 %), and prevention (64 %). While most respondents (85 %) found the Internet was a useful melanoma information source, over half (54 %) found melanoma websites at least somewhat difficult to understand. Many (78 %) believed it increased their understanding of their diagnosis, 71 % thought it influenced their treatment decision, and 59 % felt it impacted their specialist consultation. This study informs health care professionals that many melanoma patients search the Internet for information regarding their diagnosis and that it may impact their disease understanding and treatment decisions.

Patient Preferences and Perspectives on Accessing Their Medical Records

BACKGROUND

Personal health record platforms and patient portals have the potential to empower patients by providing access to health records, but not all patients may be interested in this. The purpose of this study was to explore inpatients' opinions on their hospital paper medical records after they had incidental access to them.

METHODS

A survey and observational study were conducted in the computed tomography department at a large academic hospital. Patients in the computed tomography hallway were left with their paper records and either started reading them or not.

RESULTS

Of 174 patients receiving the survey, 102 returned the questionnaire (59% response rate); two were excluded. Among the 100 included patients, 65 read their records, and 35 did not; 37.1% (13/35) nonreaders indicated interest to access their records but did not know they had the legal right. The physician's notes was the section that most patients read (n = 35, 53.8%) followed by the laboratory reports (n = 31, 47.7%) and nurse's notes (n = 29, 44.6%). Overall, 70.8% (46/65) of readers found their records easy to understand, and most found their records correct (64.4%) or complete (58.5%) and did not find anything unexpected (63.1%) or distressing (66.2%). However, a significant minority found errors in their records (7.7%) including missing test results, medications, and a wrong birthday. According to multivariate analysis, being female (odds ratio [OR] = 2.8; 95% confidence interval [CI], 1.0-8.0), younger than 60 years (OR = 3.0; 95% CI, 1.2-8.0), and having a higher level of education (OR = 3.9; 95% CI, 1.4-10.8) predicted readership.

CONCLUSION

A surprisingly high number of patients are still unaware of their legal right to access their health record. Predictors for access suggest a "social divide" in motivation and ability to access health records.

Information needs and Internet use in urological and breast cancer patients

AIMS

This study aims to describe the information needs of urological and breast cancer patients and factors related to use of the Internet as a source of health information.

METHODOLOGY

A cross-sectional descriptive study was carried out, using individual questionnaire-based interviews held during the oncology appointments of 169 patients with urological cancer and 100 with breast cancer at the Virgen de las Nieves University Hospital in Granada, Spain. The variables studied were use of the Internet as a source of health information, health status, patient's role in the decision-making process, information sources, satisfaction with the health-care system, type of information received, and Internet use. A multivariate logistic regression analysis was carried out.

RESULTS

Breast cancer patients are more concerned with long-term results and the effects on their family and personal life. They are also interested in the experiences of other patients and support groups or staff who could help them to cope with their illness. The information needs of patients with urological cancer are linked to short-term alternative treatments, their sex life, keeping healthy, and exercise. More clinical aspects, such as tests and experiments linked to their treatment, are not a frequent information need. The factors linked to use of the Internet as a source of health information are younger age, high level of education, the patient's active role in the decision-making process, and undergoing more aggressive treatment. There is no link between using the Internet as a source of health information and level of satisfaction with the health-care system, or with Internet use in general.

CONCLUSION

Patients need additional information about their illness on top of that given to them by health-care staff, and they often use the Internet to find it. The greatest information need is related to the effects of their illness on their day-to-day life. Health-care staff should provide patients with advice about reliable websites and how to search the Internet.

Do cancer-specific websites meet patient's information needs?

OBJECTIVE

To evaluate commonly used cancer websites' information provision, we developed and applied an Information Comprehensiveness Tool to breast and prostate cancer websites.

METHODS

We first collated questions from a systematic literature review on patient information needs. We then classified the questions in terms of spectrum of care, theme, and nature of question. "Breast cancer" and "prostate cancer" were typed into Google, and websites listed on the first page of results were selected. Two researchers, blind to each others' scores, assessed the same websites using the coding system. Each question was scored on a 3-point scale as not (0%), partially (50%) and fully (100%) answered by two researchers. Average scores were calculated across all questions. Inter-rater reliability was assessed.

RESULTS

We identified 79 general, 5 breast, and 5 prostate cancer questions. Inter-rater reliability was good, with an intraclass coefficient of 0.756 (95% CIs 0.729-0.781). 17 questions were not answered thoroughly by any website. Questions about "future planning", "monitoring", and "decision-making" were discussed least. Biomedical questions scored highest.

CONCLUSIONS

More comprehensive information needs to be provided on breast and prostate cancer websites.

PRACTICE IMPLICATIONS

This ICT can improve cancer information online and enable patients to engage more actively regarding their information needs.

Systematic review of educational tools used during the BRCA1/2 genetic testing process

This review describes the characteristics of available educational tools used for BRCA1/2 genetic testing. To identify the tools, we conducted a systematic search in electronic databases, and contacted over 1000 cancer genetics professionals. This review is based on 68 tools from the USA, Canada, Australia, the UK, France and Ireland. The tools vary in format and scope depending on the genetic testing phase for which they are intended. We found that a wide diversity of educational materials are available and used for BRCA1/2 genetic testing around the world. However, a substantial number of tools fail to address important aspects of genetic testing.

Iterative evaluation of a web-based health information resource

This article presents the research process and methods used to evaluate and improve a web-based health information resource, called "Community Connect to Research," intended for the public. The research process was iterative and involved collaboration with many partners. Two formal evaluations were conducted in 2009 and 2010 using key informant interviews, usability interviews, focus groups, an online survey, and readability and suitability assessment tools. These methods provided users' perspectives on the overall design, content, and literacy demands of the website as well as valuable feedback on their interaction with the website. The authors subsequently redesigned Community Connect to Research, making significant improvements on the basis of what they learned from the evaluation. The second evaluation revealed that the redesign addressed many issues found in the first evaluation and identified additional areas of possible improvement. Overall, both evaluations suggested that participants believed that the website was useful and valuable, indicating that Community Connect to Research is a health information resource that provides patients and families with accessible, relevant, and high-quality information. Regular formal evaluation is an essential tool for effective ongoing enhancement of health information resources meant for the public.

Survey of quality, readability, and social reach of websites on osteosarcoma in adolescents

OBJECTIVE

Little is known about Internet resources for adolescent patients. This study assessed the quality, readability, and social reach of websites on an illustrative adolescent cancer diagnosis, osteosarcoma.

METHODS

The top 50 results from four queries in two search engines were screened. Quality and readability were determined using standard DISCERN tool, Flesch Reading Ease and Flesch-Kinkaid Grade. Social reach was gauged by social networking links, global website traffic, and a pilot adolescent-specificity measure.

RESULTS

Of 400 websites assessed, 56 (14%) met inclusion criteria. Websites' mean quality was fair (49.8 on 75-point scale; range 31.0-66.0, poor to excellent); 86% failed readability standards (Grade>8); 75% offered at least one social networking link; and 34% offered site-specific social media. More than 60% received over 50,000 visits in the past month. Only 12.5% included adolescent-specific content. Of the 10 websites ranked highest for quality, only one achieved both readability targets and adolescent-specific content.

CONCLUSIONS

Although some patient-oriented websites on osteosarcoma are of acceptable quality, most failed readability targets, and few appeared to address adolescents.

PRACTICE IMPLICATIONS

Better awareness of Internet health resources and social media for adolescents with cancer is needed to address gaps, promote health literacy and facilitate patient-provider communication.

Health literacy programs for older adults: a systematic literature review

Older adults make up the fastest growing age group in North America. This has demanded increased attention in supporting the health and well-being of this population and, in particular, the role of health information in promoting the health and well-being of older adults. Increased availability and accessibility of information as well as a greater emphasis on self-management and care have raised concern about an individual's health literacy skills. The purpose of this study is to conduct a systematic literature review using explicit systematic literature review methodology. This includes a detailed online search process of recent publications on programs that focus on health literacy in the older adult population using the Rychetnik et al. guiding questions and the Population Intervention Comparison Outcome framework. The search yielded nine articles describing functional (n = 4) and interactive (n = 5) health literacy programs. Overall, the selected articles demonstrated positive outcomes in supporting the health literacy skills of older adults. However, there are limitations in study designs and evaluation measures and outcomes of the programs remain unknown in demonstrating long-term impact in supporting health literacy skills. Further high quality studies with clear and strong research methodology are needed to develop and evaluate evidence-based interactive health literacy programs targeted specifically to older adults.

Self-reported use of internet by cervical cancer clients in two National Referral Hospitals in Kenya

Background

Cervical cancer remains a devastating disease in Kenya accounting for more than 2000 deaths each year. Lack of information on cervical cancer prevention and management has been attributed to the apathy among women in seeking health interventions. Use of internet-based and mobile e-health tools could increase information access among cervical cancer patients. The objective of the study was; to establish the extent of use of mobile phones and internet by cervical cancer patients in accessing information related to cancer treatment and management.; find out the characteristics of patients associated with internet use and identify barriers faced by the patients in internet use. A cross sectional descriptive survey of 199 cervical patients visiting the two main referral hospitals in Kenya was done. A structured questionnaire was used to collect data.

Findings

The average length of illness was 2.43 years (SD ± 3.0). Only 7.5 %( n=15) reported to having used the internet as a source of information. 92.5 %( n=184) did not use internet. With Multiple options, 70.9% did not know how to use a computer, 29.2% did not have access to a computer, 14.6% lacked the money to use computers at the local cyber cafe while other barriers identified accounted for 11.1%. Patients reported that the internet had an important role in the management of cancer of the cervix in health education (17.6%), online consultation (14.6%), booking of patients (13.6%), referrals (8.5%) and collecting data (7%). The 96.5% of the respondents who had access to a mobile phone, recommended mobile phones for health education messages (31.7%), reminder alerts for medication (29.7%) and booking appointments (21.6%). There was a statistically significant association between income of the patients and internet use (p = 0.026) in this study.

Conclusions

There is low level use of the internet by cervical cancer clients attended in Public referral facilities in Kenya. This was attributed to; lack of knowledge on how to use computers and lack of access to a computer. High level of access to mobile phones was reported. This is an indicator of great potential for use of mobile phones in the management of cervical cancer through short messaging services (sms), without internet connectivity. There is even greater potential to internet use through web access via mobile phones.

Design and process evaluation of an informative website tailored to breast cancer survivors' and intimate partners' post-treatment care needs

Background

On-line provision of information during the transition phase after treatment carries great promise in meeting shortcomings in post-treatment care for breast cancer survivors and their partners. The objectives of this study are to describe the development and process evaluation of a tailored informative website and to assess which characteristics of survivors and partners, participating in the feasibility study, are related to visiting the website.

Methods

The development process included quantitative and qualitative assessments of survivors’ and partners’ care needs and preferences. Participants’ use and evaluation of the website were explored by conducting baseline and post-measurements. During the intervening 10–12 weeks 57 survivors and 28 partners were granted access to the website.

Results

Fifty-seven percent (n=21) of survivors who took part in the post-measurement indicated that they had visited the website. Compared to non-visitors (n=16), they were more likely to have a partner and a higher income, reported higher levels of self-esteem and had completed treatment for a longer period of time. Partners who consulted the on-line information (42%, n=8) were younger and reported lower levels of social support compared to partners who did not visit the website (n=11). Visitors generally evaluated the content and lay-out positively, yet some believed the information was incomplete and impersonal.

Conclusions

The website reached only about half of survivors and partners, yet was mostly well-received. Besides other ways of providing information and support, a website containing clear-cut and tailored information could be a useful tool in post-treatment care provision.

The commercialization of robotic surgery: unsubstantiated marketing of gynecologic surgery by hospitals

OBJECTIVE

We analyzed the content, quality, and accuracy of information provided on hospital web sites about robotic gynecologic surgery.

STUDY DESIGN

An analysis of hospitals with more than 200 beds from a selection of states was performed. Hospital web sites were analyzed for the content and quality of data regarding robotic-assisted surgery.

RESULTS

Among 432 hospitals, the web sites of 192 (44.4%) contained marketing for robotic gynecologic surgery. Stock images (64.1%) and text (24.0%) derived from the robot manufacturer were frequent. Although most sites reported improved perioperative outcomes, limitations of robotics including cost, complications, and operative time were discussed only 3.7%, 1.6%, and 3.7% of the time, respectively. Only 47.9% of the web sites described a comparison group.

CONCLUSION

Marketing of robotic gynecologic surgery is widespread. Much of the content is not based on high-quality data, fails to present alternative procedures, and relies on stock text and images.

Looking beyond the Internet: examining socioeconomic inequalities in cancer information seeking among cancer patients

The gap in cancer information seeking between high-socioeconomic-status (high-SES) cancer patients and low-SES cancer patients deserves serious attention, considering the importance of information and knowledge in cancer control. We thus explored the association of SES, as measured by education, with cancer patients' overall cancer information seeking, and with seeking from each source (i.e., the Internet, mass media, medical sources, and nonmedical interpersonal sources) and across two topic categories (i.e., treatment, quality of life). We then asked whether the effect of education on treatment information seeking is reduced among those who are particularly motivated to control treatment choices. We conducted a survey with breast, prostate, and colon cancer patients diagnosed in 2005 (n = 2,013), who were randomly drawn from the Pennsylvania Cancer Registry in the fall of 2006. We found that education was more strongly associated with Internet use than with the use of other sources regardless of topics. Also, when information was sought from mass media, education had a greater association with treatment information seeking than with quality-of-life information seeking. Preference for active participation in treatment decision making, however, did not moderate the effect of education on treatment information seeking. The implications of these findings for public health research and cancer patient education were discussed.

Exploring older adults' health information seeking behaviors

OBJECTIVE

To explore older adults' (55-70 years) health information-seeking behaviors.

METHODS

Using a qualitative methodology, based on grounded theory, data were collected using in-depth interviews. Participants were community-living, older adults in Toronto, Canada who independently seek nutrition and health information. Interview transcripts were analyzed using a qualitative thematic coding framework.

RESULTS

Twenty participants were interviewed, at which point theoretical saturation of data was achieved. Three themes describing older adults' health information-seeking behaviors emerged. This article will focus on one theme: the enabling and disabling experience of seeking nutrition and health information to support an understanding of successful aging in this population.

CONCLUSIONS AND IMPLICATIONS

These findings are framed within the context of supporting older adults' information-seeking behaviors to contribute to their health and well-being. This is a relevant issue to public health professionals given the global emphasis on successful aging strategies.

Online information needs of cancer patients and their organizations

Increasingly patients, relatives and carers are accessing health information via the internet. However, the health profession and people affected by cancer are becoming concerned with the quality of that information. A European survey was conducted under the auspices of the FP7 European Commission funded Eurocancercoms project during the period September 2010-March 2011. Its aim was to assess current online information needs of people with cancer particularly those who seek information using online social media technologies and the internet more broadly. A literature review was undertaken to gain a greater understanding of health seeking behaviour regarding cancer patients' information needs and patient preferences for accessing different formats and media. This was used to inform the design and validation of online pan-European, multi-lingual questionnaires distributed via patient organizations and via specific Eurocancercoms partner organizations. This paper presents the results of this survey and suggests recommendations to be incorporated into the design of the online platform, ecancerHub, one of the intended outcomes of the Eurocancercoms project following this research. People want a wide variety of easy to find, easy to understand accurate information about cancer and how it is likely to impact on their everyday lives and on those close to them. They differ in the amount and detail of the information they would like and on their ability to identify quality information and understand it sufficiently to base their health-care decisions on. The majority of respondents raised the issue of quality of information and many requested recommendations of websites by the people who usually influence them most, the health professionals involved in their care.

Website quality, expectation, confirmation, and end user satisfaction: the knowledge-intensive website of the Korean National Cancer Information Center

BACKGROUND

The fact that patient satisfaction with primary care clinical practices and physician-patient communications has decreased gradually has brought a new opportunity to the online channel as a supplementary service to provide additional information.

OBJECTIVE

In this study, our objectives were to examine the process of cognitive knowledge expectation-confirmation from eHealth users and to recommend the attributes of a "knowledge-intensive website.". Knowledge expectation can be defined as users' existing attitudes or beliefs regarding expected levels of knowledge they may gain by accessing the website. Knowledge confirmation is the extent to which user's knowledge expectation of information systems use is realized during actual use. In our hypothesized research model, perceived information quality, presentation and attractiveness as well as knowledge expectation influence knowledge confirmation, which in turn influences perceived usefulness and end user satisfaction, which feeds back to knowledge expectation.

METHODS

An empirical study was conducted at the National Cancer Center (NCC), Republic of Korea (South Korea), by evaluating its official website. A user survey was administered containing items to measure subjectively perceived website quality and expectation-confirmation attributes. A study sample of 198 usable responses was used for further analysis. We used the structural equation model to test the proposed research model.

RESULTS

Knowledge expectation exhibited a positive effect on knowledge confirmation (beta = .27, P < .001). The paths from information quality, information presentation, and website attractiveness to knowledge confirmation were also positive and significant (beta = .24, P < .001; beta = .29, P < .001; beta = .18, P < .001, respectively). Moreover, the effect of knowledge confirmation on perceived usefulness was also positively significant (beta = .64, P < .001). Knowledge expectation together with knowledge confirmation and perceived usefulness also significantly affected end user satisfaction (beta = .22 P < .001; beta = .39, P < .001; beta = .25, P < .001, respectively).

CONCLUSIONS

Theoretically, this study has (1) identified knowledge-intensive website attributes, (2) enhanced the theoretical foundation of eHealth from the information systems (IS) perspective by adopting the expectation-confirmation theory (ECT), and (3) examined the importance of information and knowledge attributes and explained their impact on user satisfaction. Practically, our empirical results suggest that perceived website quality (ie, information quality, information presentation, and website attractiveness) is a core requirement for knowledge building. In addition, our study has also shown that knowledge confirmation has a greater effect on satisfaction than both knowledge expectation and perceived usefulness.

The effect of breast cancer awareness month on internet search activity--a comparison with awareness campaigns for lung and prostate cancer

BACKGROUND

This work aimed to assess the effects of the annual breast cancer awareness campaign on internet search activity, and to compare these effects with those of similar campaigns in prostate and lung cancer. We further aimed to assess overall levels of online activity relating to all three neoplasms between 2004 and 2009.

METHODS

Google Insights for Search was employed to examine search trends for the term "breast cancer", across all Google domains between January 2004 and December 2009 (6 years). Search trends for both "prostate cancer" and "lung cancer" across all domains were also analysed for the same period, and these trends were compared with those for "breast cancer". Repeated measures ANOVA and Tukey post-hoc analyses were performed to assess for significant differences in activity.

RESULTS

Increased levels of online activity relating to breast cancer are consistently generated each October. There is a significantly higher level of background activity in breast cancer compared with that in lung or prostate cancer (p < 0.001), and the October campaign stimulates online activity more effectively than equivalent campaigns for these other malignancies (p < 0.001).

CONCLUSIONS

The annual breast cancer awareness campaign is proving effective in stimulating online activity and may hold useful lessons for other cancer awareness initiatives.

Patient-oriented cancer information on the internet: a comparison of wikipedia and a professionally maintained database

PURPOSE

A wiki is a collaborative Web site, such as Wikipedia, that can be freely edited. Because of a wiki's lack of formal editorial control, we hypothesized that the content would be less complete and accurate than that of a professional peer-reviewed Web site. In this study, the coverage, accuracy, and readability of cancer information on Wikipedia were compared with those of the patient-orientated National Cancer Institute's Physician Data Query (PDQ) comprehensive cancer database.

METHODS

For each of 10 cancer types, medically trained personnel scored PDQ and Wikipedia articles for accuracy and presentation of controversies by using an appraisal form. Reliability was assessed by using interobserver variability and test-retest reproducibility. Readability was calculated from word and sentence length.

RESULTS

Evaluators were able to rapidly assess articles (18 minutes/article), with a test-retest reliability of 0.71 and interobserver variability of 0.53. For both Web sites, inaccuracies were rare, less than 2% of information examined. PDQ was significantly more readable than Wikipedia: Flesch-Kincaid grade level 9.6 versus 14.1. There was no difference in depth of coverage between PDQ and Wikipedia (29.9, 34.2, respectively; maximum possible score 72). Controversial aspects of cancer care were relatively poorly discussed in both resources (2.9 and 6.1 for PDQ and Wikipedia, respectively, NS; maximum possible score 18). A planned subanalysis comparing common and uncommon cancers demonstrated no difference.

CONCLUSION

Although the wiki resource had similar accuracy and depth as the professionally edited database, it was significantly less readable. Further research is required to assess how this influences patients' understanding and retention.

The Internet as a source of health information: experiences of cancer survivors and caregivers with healthcare providers

PURPOSE/OBJECTIVES

To describe the experiences of cancer survivors and caregivers with healthcare providers in the context of the Internet as a source of health information.

RESEARCH APPROACH

Qualitative description.

SETTING

Online cancer communities hosted by the Association of Cancer Online Resources.

PARTICIPANTS

Purposive sample of 488 cancer survivors, with varying cancer types and survivorship stages, and caregivers.

METHODOLOGIC APPROACH

Secondary data analysis using Krippendorff's thematic clustering technique of qualitative content analysis.

MAIN RESEARCH VARIABLES

Survivorship, healthcare relationships, and the Internet.

FINDINGS

Disenchantment with healthcare relationships was associated with failed expectations related to evidence-based practice, clinical expertise, informational support, and therapeutic interpersonal communication. Survivors and caregivers exercised power in healthcare relationships through collaboration, direct confrontation, becoming expert, and endorsement to influence and control care decisions.

CONCLUSIONS

Disenchantment propelled cancer survivors and caregivers to search the Internet for health information and resources. Conversely, Internet information-seeking precipitated the experience of disenchantment. Through online health information and resources, concealed failures in healthcare relationships were revealed and cancer survivors and caregivers were empowered to influence and control care decisions.

INTERPRETATION

The findings highlight failures in cancer survivorship care and underscore the importance of novel interdisciplinary programs and models of care that support evidence-informed decision making, self-management, and improved quality of life. Healthcare professionals need to receive education on survivors' use of the Internet as a source of health information and its impact on healthcare relationships. Future research should include studies examining the relationship between disenchantment and survivorship outcomes.

Left hanging in the air: experiences of living with cancer as expressed through E-mail communications with oncology nurses

BACKGROUND

Cancer patients experience many physical, psychosocial, and existential problems and worries during their illness. To support patients in managing their illness, we implemented an online patient-nurse communication (OPNC) service, where breast and prostate cancer patients could ask questions and receive advice from oncology nurses.

OBJECTIVE

The aim of this study was to explore the use and content of patients' e-mail messages sent to oncology nurses and thus gain a "snapshot" of patients' experiences of living with cancer as expressed through these messages.

METHODS

Using qualitative content analysis, 276 messages from 60 breast and prostate cancer patients were analyzed. Messages were coded into categories and major themes. Both manifest and latent content was coded.

RESULTS

Four main themes emerged from patients' messages: (1) living with symptoms and side effects, (2) living with a fear of relapse, (3) concerns for everyday life, and (4) unmet information needs from health care providers.

CONCLUSIONS

Patients used the OPNC service actively to pose questions and raise concerns related to symptom experiences, fear of relapses, and uncertainty in everyday life. However, patients also expressed experiences of being "left in a void" after being discharged from hospital and living with serious unmet informational needs.

IMPLICATIONS FOR PRACTICE

The study demonstrated that online communication can provide patients with a space for otherwise unmet questions and worries and that they will seek support from nurses online when given the opportunity. Therefore, OPNC can be an important means and supplement to traditional health care in the effort to support patients to better manage their illness.

Consumerism and its impact on robotic-assisted radical prostatectomy

OBJECTIVES

• Many experts consider that media coverage, marketing and/or direct-to-consumer advertising, particularly Internet-based forms, are fundamental to the widespread adoption of robotic-assisted prostatectomy (RARP). However, this has not been explored previously. • The primary objective of the present study was to delineate the role of media coverage and marketing of RARP on the Internet, whereas the secondary goal focused on website quality with respect to the presentation of prostatectomy.

MATERIALS AND METHODS

• Website content was evaluated for direct-to-consumer advertising after the retrieval of the first 50 websites using Google and Yahoo for each of the terms: 'robotic prostatectomy, laparoscopic prostatectomy (LP) and open radical prostatectomy (ORP)'. • A linear regression analysis was performed for the annual number of Internet news hits over the last decade for each procedure. Website quality assessment was performed using WHO Honesty on the Internet (HON) code principles.

RESULTS

• Of the retrieved sites, the proportion containing direct-to-consumer advertising for RARP vs LP vs ORP using Google was 64% vs 14% vs 0%, respectively (P < 0.001) and, using Yahoo, 80% vs 16% vs 0%, respectively (P < 0.001). • In a linear regression analysis, the r(2) values for news hits for each year over the last 10 years were 0.89, 0.74 and 0.76 for RARP, LP and ORP, respectively. • Website quality assessment found that a minority of the websites were accredited with HONcode principles, with no difference between procedure types (P > 0.05).

CONCLUSIONS

• Media coverage and marketing of RARP on the Internet is more widespread compared to LP and ORP. • Disturbingly, the quality of websites using any technique for prostatectomy was of poor quality when using principles of honest information presenting and such findings need to be discussed with respect to obtaining informed consent from patients.