Use of the Internet and ratings of information sources for medical decisions: results from the DECISIONS survey

Quality of Popular Online Resources About Vestibular Migraine

Objective

To evaluate the readability, understandability, actionability, and accuracy of online resources covering vestibular migraine (VM).

Study Design

Cross-sectional descriptive study design.

Setting

Digital collection of websites appearing on Google search.

Methods

Google searches were conducted to identify common online resources for VM. We examined readability using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level scores, understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and accuracy by comparing the website contents to the consensus definition of "probable vestibular migraine."

Results

Eleven of the most popular websites were analyzed. Flesch-Kincaid Grade Level averaged at a 13th-grade level (range: 9th-18th). FRE scores averaged 35.5 (range: 9.1-54.4). No website had a readability grade level at the US Agency for Healthcare Research and Quality recommended 5th-grade level or an equivalent FRE score of 90 or greater. Understandability scores varied ranging from 49% to 88% (mean 70%). Actionability scores varied more, ranging from 12% to 87% (mean 44%). There was substantial inter-rater agreement for both PEMAT understandability scoring (mean κ = 0.76, SD = 0.08) and actionability scoring (mean κ = 0.65, SD = 0.08). Three sites included all 3 "probable vestibular migraine" diagnostic criteria as worded in the consensus statement.

Conclusion

The quality of online resources for VM is poor overall in terms of readability, actionability, and agreement with diagnostic criteria.

Reliability of information in YouTube™ videos on types of root resorption and related stimulating factors

BACKGROUND/AIM

Root resorption occurs for various reasons and can also be seen as a treatment complication in orthodontics. This study aimed to assess the reliability and quality of YouTube™ videos on root resorption and to assess whether the videos referred to orthodontic treatment and other stimulation factors.

MATERIALS AND METHODS

YouTube was searched using the keyword 'root resorption', which is the most searched term on Google Trends. The first 200 videos identified using the default filter 'sort by relevance' were used. Information such as the source, type, duration, and number of likes were recorded. Videos were analyzed using a 23-point content scale related to root resorption and divided into groups (poor, moderate, and excellent) based on the Global Quality Score.

RESULTS

A total of 95 videos were included in the study. Most were uploaded by dentists or dental clinics (n = 64, 67.4%). The mean number of days since upload was 1536 ± 1254, and the mean duration was 5 ± 4 min. The videos had a mean of 80 ± 515 likes and 7043 ± 35,382 views, and a mean viewing rate of 1131.71 ± 8736.83. The most discussed topic was radiographic signs of root resorption. While the highest content score for the videos was 21, the average score was only 4. The mean GQS was 2 ± 1. Grouping videos by GQS showed that 55 (57.9%) were poor, 38 (40%) were moderate, and 2 (2.1%) were excellent. There was a significant relationship between videos that mentioned orthodontics (n = 62; 65.3%) and higher GQS (p = .036), and a significant difference was between GQS groups for total content levels (p < .001).

CONCLUSIONS

YouTube videos related to root resorption lack sufficient information and clarity, and their quality needs to be improved. Oral health professionals should strive to produce higher-quality videos.

The 3-Level Approach to Facelift Planning: A Simple Paradigm for Surgical Rejuvenation of the Face

Our role as aesthetic surgeons demands individualized surgical planning that maximizes patient input and understanding. The value of such shared decision-making (SDM) in aesthetic surgery is becoming increasingly appreciated. This is particularly true for potential patients seeking surgical rejuvenation of the face, where the volume of "educational" information available on the internet, and through various social medial channels, may be overwhelming and even misleading. Presented is a "3-Level approach to facelift planning" named for the facial subregions targeted. This novel paradigm maximizes SDM with its simplicity and reproducibility, serves as an invaluable educational tool for patients, novice and seasoned surgeons alike, and facilitates communication between senior surgeons through its descriptive standardization. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Thyroid Ethanol and Radiofrequency Ablation: A Call for Patient-Friendly Online Resources

INTRODUCTION

The multiple treatment options available to patients with thyroid nodules can generate uncertainty and confusion. Radiofrequency ablation (RFA) and ethanol ablation (EA) are two alternative modalities to manage thyroid nodules. As patients more frequently utilize online resources to guide their decision-making, the quality of such resources must be evaluated. The goal of this study was to assess the quality of online patient materials relating to RFA and EA compared to standard thyroidectomy.

METHODS

The terms "thyroidectomy," "thyroid radiofrequency ablation," and "thyroid ethanol ablation" were searched on Google. Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Patient Education Materials Assessment Tool (PEMAT) understandability and actionability were calculated for each website. Statistical analysis was conducted on SPSS Statistics. Google trends were used to determine search interest for each term (May 2016 - May 2021).

RESULTS

Of the 77 websites that met our inclusion criteria (30 thyroidectomy sites, 30 RFA sites, and 17 EA sites), the average FRE, FKGL, and SMOG scores of the RFA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The FKGL and SMOG scores of the EA websites were significantly worse than those of the thyroidectomy websites (p < 0.05). The average understandability and actionability scores for thyroidectomy websites were significantly higher than those of RFA and EA websites (p < 0.05).

CONCLUSION

Ablation websites have lower search interest, readability, validity, understandability, and actionability scores in comparison to traditional thyroidectomy websites. Our findings emphasize the need to consider readability and PEMAT scores when developing online educational resources for ablative alternatives to thyroidectomy to allow for greater patient accessibility.

Accessing publicly funded donor insemination treatment in the UK: is funding information available on fertility clinic websites?

We sought to find out if information about public funding for regulated donor insemination (DI) was available on UK fertility clinic websites, and if so, what information was provided for same-sex couples and single women; and if the available information was easily readable. The 'Choose a fertility clinic' pages of the Human Fertilisation and Embryology Authority (HFEA) website were used to identify all licensed fertility clinics in the UK, and any available text on public funding for DI treatment was extracted. The Flesch reading ease scores were calculated to determine the readability of the extracted text. Of the 52 clinics included in the synthesis, 23 mentioned public funding, and for 16 of these, it was unclear whether public funding was available. Six of the 23 clinics mentioned public funding for same-sex couples, and two mentioned public funding for single women. The Flesch reading ease scores indicated that none of the text about funding for DI treatment on any of the clinic websites met the NHS-advised level of readability for health information. Fertility clinic websites should specify whether they offer publicly funded treatment, and to whom, as well as clearly stating the eligibility criteria, using suitably readable language to communicate this.

Comprehensiveness of online sources for patient education on hereditary hearing impairment

Introduction

The present study aimed at investigating the readability of online sources on hereditary hearing impairment (HHI).

Methods

In August 2022, the search terms "hereditary hearing impairment", "genetic deafness", hereditary hearing loss", and "sensorineural hearing loss of genetic origin" were entered into the Google search engine and educational materials were determined. The first 50 websites were determined for each search. The double hits were removed and websites with only graphics or tables were excluded. Websites were categorized into either a professional society, a clinical practice or a general health information website. The readability tests to evaluate the websites included: Flesch Reading Ease, Flesch-Kincaid grade level, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index.

Results

Twentynine websites were included and categorized as from 4 professional societies, 11 from clinical practices and 14 providing general information. All analyzed websites required higher reading levels than sixth grade. On average 12-16 years of education is required to read and understand the websites focused on HHI. Although general health information websites have better readability, the difference was not statistically significant.

Discussion

The readability scores of every type of online educational materials on HHI are above the recommended level indicating that not all patients and parents can comprehend the information they seek for on these websites.

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study

Rationale & Objective

Multidisciplinary chronic kidney disease (CKD) care has been associated with improved clinical outcomes in comparison to general nephrology care. However, there is little research examining the impact of multidisciplinary care on patient-centered outcomes. We examined if a multidisciplinary approach to CKD care was associated with 4 patient-centered outcomes.

Study Design

Cross-sectional study design using previously established surveys to assess patient-centered outcomes in participants with nondialysis CKD.

Setting & Participants

Adults with CKD stages 1-5 who had not undergone transplant or were not on dialysis.

Exposures

General nephrology care or multidisciplinary care. Patients receiving multidisciplinary care were seen by a pharmacist, social worker, dietitian, and nephrologist, whereas patients receiving general nephrology care only saw a nephrologist.

Outcomes

Four patient-centered outcomes: CKD-specific knowledge, disease-related stress, perception of overall health, and perception of health status compared to 1 year ago.

Analytical Approach

Differences were examined using a Welch 2-sample t test and linear regression model.

Results

Mean age of participants was 60 years with standard deviation of 17 years. 182 (77%) patients were White, and 230 (96%) had formal education greater than or equal to high school. 121 (49%) were women, and 215 (88%) had CKD stage 3-5. 77 (31%) received multidisciplinary care. We did not identify any significant differences in patient knowledge, stress, or perception of health between multidisciplinary and general nephrology care. However, notably, patients in multidisciplinary care were older and had more advanced CKD than those in general nephrology care.

Limitations

Cross-sectional study designs only identify associations. Study was conducted at clinics located within 30 miles of each other, limiting generalizability.

Conclusions

Our results suggest that a team-based approach to care can better support sicker, more vulnerable patients so that they can achieve similar patient-centered outcomes compared to patients who are younger and with less advanced CKD.

Internet Use for Obtaining Medicine Information: Cross-sectional Survey

BACKGROUND

The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information.

OBJECTIVE

The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites.

METHODS

This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users.

RESULTS

A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites.

CONCLUSIONS

Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.

Development of a video-based evidence synthesis knowledge translation resource: Drawing on a user-centred design approach

Objectives

We aimed to develop a video animation knowledge translation (KT) resource to explain the purpose, use and importance of evidence synthesis to the public regarding healthcare decision-making.

Methods

We drew on a user-centred design approach to develop a spoken animated video (SAV) by conducting two cycles of idea generation, prototyping, user testing, analysis, and refinement. Six researchers identified the initial key messages of the SAV and informed the first draft of the storyboard and script. Seven members of the public provided input on this draft and the key messages through think-aloud interviews, which we used to develop an SAV prototype. Seven additional members of the public participated in think-aloud interviews while watching the video prototype. All members of the public also completed a questionnaire on perceived usefulness, desirability, clarity and credibility. We subsequently synthesised all data to develop the final SAV.

Results

Researchers identified the initial key messages as 1) the importance of evidence synthesis, 2) what an evidence synthesis is and 3) how evidence synthesis can impact healthcare decision-making. Members of the public rated the initial video prototype as 9/10 for usefulness, 8/10 for desirability, 8/10 for clarity and 9/10 for credibility. Using their guidance and feedback, we produced a three-and-a-half-minute video animation. The video was uploaded on YouTube, has since been translated into two languages, and viewed over 12,000 times to date.

Conclusions

Drawing on user-centred design methods provided a structured and transparent approach to the development of our SAV. Involving members of the public enhanced the credibility and usefulness of the resource. Future work could explore involving the public from the outset to identify key messages in developing KT resources explaining methodological topics. This study describes the systematic development of a KT resource with limited resources and provides transferrable learnings for others wishing to do similar.

What Patients Find on the Internet When Looking for Information About Percutaneous Coronary Intervention: Multilanguage Cross-sectional Assessment

BACKGROUND

The internet provides general users with wide access to medical information. However, regulating and controlling the quality and reliability of the considerable volume of available data is challenging, thus generating concerns about the consequences of inaccurate health care-related documentation. Several tools have been proposed to increase the transparency and overall trustworthiness of medical information present on the web.

OBJECTIVE

We aimed to analyze and compare the quality and reliability of information about percutaneous coronary intervention on English, German, Hungarian, Romanian, and Russian language websites.

METHODS

Following a rigorous protocol, 125 websites were selected, 25 for each language sub-sample. The websites were assessed concerning their general characteristics, compliance with a set of eEurope 2002 credibility criteria, and quality of the informational content (namely completeness and accuracy), based on a topic-specific benchmark. Completeness and accuracy were graded independently by 2 evaluators. Scores were reported on a scale from 0 to 10. The 5 language subsamples were compared regarding credibility, completeness, and accuracy. Correlations between credibility scores on the one hand, and completeness and accuracy scores, on the other hand, were tested within each language subsample.

RESULTS

The websites' compliance with credibility criteria was average at best with scores between 3.0 and 6.0. In terms of completeness and accuracy, the website subsets qualified as poor or average, with scores ranging from 2.4 to 4.6 and 3.6 to 5.3, respectively. English language websites scored significantly higher in all 3 aspects, followed by German and Hungarian language websites. Only German language websites showed a significant correlation between credibility and information quality.

CONCLUSIONS

The quality of websites in English, German, Hungarian, Romanian, and Russian languages about percutaneous coronary intervention was rather inadequate and may raise concerns regarding their impact on informed decision-making. Using credibility criteria as indicators of information quality may not be warranted, as credibility scores were only exceptionally correlated with content quality. The study brings valuable descriptive data on the quality of web-based information regarding percutaneous coronary intervention in multiple languages and raises awareness about the need for responsible use of health-related web resources.

Can online health information sources really improve patient satisfaction?

Internet information has become the main way for individuals to obtain health information. The purpose of this paper is to explore the role online information sources play in health decision-making. Specifically, we investigated the relationship between online information sources and patient satisfaction, as well as their moderating effects as compared to those of other information sources. Using logistical regression analysis, we conducted the longitudinal data on 54,027 doctors and 952,877 online doctor reviews from 3,525 hospitals in 31 provinces to test a proposed research model. The results showed that patient satisfaction was generally lower for individuals who found a doctor through online information sources. Therefore, we suggest that patients consider the doctor quality, the doctor popularity, and patient involvement. In addition, we found that the doctor popularity had a negative moderating effect between online information sources and patient satisfaction, while patient involvement had a positive moderating effect between online information sources and patient satisfaction. The study provides strategic guidance and practical implications for policies, online healthcare community managers, and patients.

Access to Health Information in the Polish Healthcare System-Survey Research

Progress in medicine, transformations in healthcare organisation systems and access to new technologies have contributed to many changes in relations and communication between patients and healthcare personnel. The time to discuss and clarify doubts has shortened, while the period of waiting for an appointment and a consultation with a specialist has often been prolonged. Due to the lack or misunderstanding of information obtained from medical professionals, many people seek health information on their own account. The purpose of this document is to analyse the access Polish patients have to health information, the sources of and reasons for seeking that information, as well as the degree to which patients are satisfied with the information they find. We will also examine cases where patients choose self-healing. This is a survey based on an original questionnaire. The survey was conducted online and offline. The results of the survey were analysed by use of descriptive statistics. The analysis has indicated that access to health information is a universal need, which is independent of gender, age or education. Health information obtained from a doctor is most desired. The second-best source of information chosen by respondents is the Internet. Family members and friends are indicated as the third information source. Polish patients greatly appreciate doctors as a source of health information; however, given the difficulties connected with gaining direct access to information from healthcare personnel, they often search non-professional sources for information. The Internet and other media may be tools supporting the establishment of a safety culture, provided that the content published therein is consulted with medical professionals.

Motivations and Concerns of Preorthognathic Surgery Patients

PURPOSE

This study aims to investigate motivations, ways of gaining information, and concerns for orthognathic surgery of patients with skeletal dentomaxillofacial deformities before receiving the treatment, and to explore directions for improvement in doctor-patient communications in the clinical practice.

METHODS

Presurgical patients were asked to fill out a questionnaire about their basic information, the approaches via which they knew about the surgery, as well as their motivations and concerns for the surgery.

RESULTS

One hundred ninety two questionnaires were included in the analysis in total. Patients (females: males = 2.69:1) with an average age of 23.79 ± 4.36 mainly regarded facial esthetics (103, 53.65%) as a primary concern. Although about 80.20% of patients accessed medical information through the Internet, it was still an irreplaceable way to know through consulting specialists.

CONCLUSIONS

The majority of patients were young, unmarried women without a stable income. For most patients, the primary motivation to receive the surgery was an improvement in facial esthetics and the biggest concern was the operation effect. Access to medical information through the Internet has become very important access to medical knowledge.

Using Hyperrealistic Simulations to Improve Digital Informed Consent for Endourological Procedures

OBJECTIVES

To show that digital informed consent (DIC) improves the subjective understanding of information and, therefore, informed consent.

PATIENTS AND METHODS

A nonblinded randomized controlled trial was performed with 84 patients who had undergone a transurethral resection of bladder, transurethral resection of prostate, or ureterorenoscopy between July 2017 to March 2018. The DIC group watched a hyperrealistic simulation on a tablet device before surgery. After surgery and again 30 days later, both groups completed a validated questionnaire that measured subjective understanding, anxiety, and utility of and need for information.

RESULTS

The mean±SD age of participants was 68.7±11.1 years. Nine of 84 patients (10.7%) did not complete the questionnaire. 42 patients were allocated to the DIC group and 42 to the control group. The mean±SD score on immediate subjective understanding in the DIC group was 14.5% higher than in control group (72%±17.5% vs 57.5%±23.5%, respectively; p=0.006). There was no statistical difference among anxiety, utility of and need for information relative to delayed subjective understanding. In subgroup analysis, subjective understanding scores were higher, but not significantly so, among patients with low and higher education levels in the DIC group than in the control group (68%±18.1% vs 54%±22.5%, respectively, p=0.06; and 76%±18.3% vs and 66%±21.9%, respectively, (p=0.89).

CONCLUSION

Hyperrealistic simulations improved subjective understanding of information and, therefore, informed consent for endourological procedures.

Quality of Information about Accelerated Orthodontics on Instagram

Background/Aim: Social media has become popular in recent years in dentistry. This study aims to evaluate the posts shared on Instagram related to accelerated orthodontic treatment.

Material and Methods: The first 100 posts were selected for #acceleratedorthodontics and #speedbraces hashtags and analyzed. The type of posts, posts’ purpose, the source of posts, the number of likes and comments, the number of followers and followings of the users who uploaded the posts were recorded. Four posts in #speedbraces were irrelevant and the remaining 196 posts were evaluated.

Results: The sources of the posts include 60 orthodontists, 20 dental pages, 9 dental clinics, 8 periodontologists, 3 surgeons in #acceleratedorthodontics hashtag. Also, 37 posts were preop-postopt, 34 of them were advertising, 14 of them were surgical information, 12 of them were professional information, and 3 of them were personal sharing in #acceleratedorthodontics hashtag. When the aims of the shares were evaluated, it was observed that 56 were for advertisement, 23 were for patient information, 7 were for entertainment, 6 were experience and 4 were preop-postop comparison in #speedbraces hashtag.

Conclusions: The posts related to accelerated orthodontics on Instagram are insufficient in terms of the content. The patients should be guided to reach the correct sources of information by orthodontists.

Información sanitaria en la red. Necesidades, expectativas y valoración de la calidad desde la perspectiva de los pacientes. Investigación cualitativa con grupos focales

Objetivo: Explorar y comprender necesidades, expectativas y valoración de la calidad desde el punto de vista de los pacientes cuando buscan información sobre salud en internet. Diseño: investigación cualitativa con grupos focales. Emplazamiento: Centro de Salud Profesor Jesús Marín, Molina de Segura. Región de Murcia. Participantes: tres grupos focales. Número = 17 participantes, 11 mujeres y 6 hombres, de entre 24 y 55 años, que habían usado recientemente internet para buscar información sobre salud. Método: muestreo de conveniencia con cuotas por edad y sexo. Grabación y transcripción de las discusiones grupales. Análisis de texto mediante segmentación, categorización e interpretación de los discursos. Triangulación por varios investigadores. Resultados: cuando los pacientes usan internet como fuente de información, valoran la accesibilidad, inmediatez y exhaustividad, así como la autonomía y el poder que les proporciona en su relación con el sistema sanitario. Los procesos de búsqueda son sencillos, breves, muy específicos y habitualmente se limitan a los resultados de la primera pantalla. Entre los criterios para seleccionar unas páginas web frente a otras, destacan su comprensibilidad, diseño y ausencia de publicidad. Para valorar la fiabilidad de la información, los pacientes utilizan como estrategias el contraste entre diversas fuentes y la intuición. Conclusiones: internet satisface necesidades no solo de información, sino de apoyo emocional y sitúa a los pacientes en un plano de igualdad con los profesionales. Para valorar la calidad y fiabilidad de la información encontrada, se utilizan criterios y estrategias que no coinciden con los que definen los profesionales. Globalmente, la experiencia de buscar en internet información sanitaria se percibe como muy positiva. Palabras clave: información de salud al consumidor, internet, Atención Primaria, grupos focales, investigación cualitativa, fiabilidad y validez.

Factors Affecting Engagement in Web-Based Health Care Patient Information: Narrative Review of the Literature

BACKGROUND

Web-based content is rapidly becoming the primary source of health care information. There is a pressing need for web-based health care content to not only be accurate but also be engaging. Improved engagement of people with web-based health care content has the potential to inform as well as influence behavioral change to enable people to make better health care choices. The factors associated with better engagement with web-based health care content have previously not been considered.

OBJECTIVE

The aims of this study are to identify the factors that affect engagement with web-based health care content and develop a framework to be considered when creating such content.

METHODS

A comprehensive search of the PubMed and MEDLINE database was performed from January 1, 1946, to January 5, 2020. The reference lists of all included studies were also searched. The Medical Subject Headings database was used to derive the following keywords: "patient information," "online," "internet," "web," and "content." All studies in English pertaining to the factors affecting engagement in web-based health care patient information were included. No restrictions were set on the study type. Analysis of the themes arising from the results was performed using inductive content analysis.

RESULTS

The search yielded 814 articles, of which 56 (6.9%) met our inclusion criteria. The studies ranged from observational and noncontrolled studies to quasi-experimental studies. Overall, there was significant heterogeneity in the types of interventions and outcome assessments, which made quantitative assessment difficult. Consensus among all authors of this study resulted in six categories that formed the basis of a framework to assess the factors affecting engagement in web-based health care content: easy to understand, support, adaptability, accessibility, visuals and content, and credibility and completeness.

CONCLUSIONS

There is a paucity of high-quality data relating to the factors that improve the quality of engagement with web-based health care content. Our framework summarizes the reported studies, which may be useful to health care content creators. An evaluation of the utility of web-based content to engage users is of significant importance and may be accessible through tools such as the Net Promoter score. Web 3.0 technology and development of the field of psychographics for health care offer further potential for development. Future work may also involve improvement of the framework through a co-design process.

Assessing the Educational and Supportive Care Needs of Canadian Metastatic Melanoma Patients and Survivors Attending an Outpatient Clinic

The rapid development of metastatic melanoma treatment options has significantly improved overall survival, but paralleled patient educational and supportive care resources have fallen behind. Particularly, the need for grassroots programs targeting environments outside urban centers has grown. Accordingly, an environmental scan of the Durham region in Ontario, Canada, showed the lack of melanoma-specific resources for outpatients. The goal of this study was to identify the needs of metastatic melanoma patients and survivors attending a large outpatient clinic in Durham, and then develop a patient-reviewed intervention plan. Needs were assessed in 5 domains through a melanoma-specific supportive care needs assessment survey. Among 75 surveyed melanoma patients and survivors, high-level needs were identified in 3 domains: psychological, health system information, and melanoma-specific information. Furthermore, domain-specific needs were heightened in specific sociodemographic groups. Based on these survey results, a multifaceted intervention plan was developed to mitigate future needs. The intervention plan was patient-reviewed in focus groups prior to implementation, refining the developed intervention plan.

Information on the Internet about clear aligner treatment-an assessment of content, quality, and readability

Purpose

The goal was to evaluate the content, quality, and readability of the information available about clear aligner treatment on the Internet.

Materials and methods

The search terms “aligner,” “clear aligner,” and “Invisalign” (Align Technology, Tempe, AZ, USA) were analyzed in three search engines (Google [Google LLC, Mountain View, CA, USA], Bing [Microsoft, Redmond, WA, USA], and Yahoo [Yahoo, Sunnyvale, CA, USA]). The first 50 websites for each keyword in each search engine were screened. Duplicate websites, advertisements, links to scientific articles, videos, and other irrelevant websites were excluded. The quality of the remaining websites was analyzed using the DISCERN and Journal of American Medical Association (JAMA) benchmark instruments together with the Health on the Net code (HONcode, Health On the Net Foundation, Geneva, Switzerland). The readability of the websites was evaluated by the Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Statistical analyses were performed by one-way analysis of variance, Kruskal–Wallis and Fischer’s exact tests, with p < 0.05 accepted to be statistically significant.

Results

Among 111 evaluated websites, most belonged to multidisciplinary dental clinics (n = 49; 44.2%), followed by aligner companies (n = 26; 23.4%), orthodontists (n = 26; 23.4%), and professional organizations (n = 10; 9%). The mean DISCERN score (sections 1 and 2) for all websites was 29.95/75. The average FRES and FKGL were 55.77 and 9.74, respectively. Professional organization websites had significantly higher DISCERN scores than others (p < 0.001), and together with multidisciplinary dental clinic websites, they showed better compliance with JAMA benchmark criteria. Professional organization websites’ FRES and FKGL were also higher than other websites (p > 0.05).

Conclusions

Overall, the quality of web-based information about clear aligners was poor and the readability of the data was insufficient. Websites presenting high-quality data with better readability are needed for potential aligner patients.

Correlates of Manual Therapy and Acupuncture Use Among Rural Patients Seeking Conventional Pain Management: A Cross-sectional Study

OBJECTIVE

In this cross-sectional study, we examined correlates of manual therapy (spinal manipulation, massage therapy) and/or acupuncture use in a population engaging in conventional pain care in West Virginia.

METHODS

Participants were patients (aged 18+ years) from 4 Appalachian pain and rheumatology clinics. Of those eligible (N = 343), 88% completed an anonymous survey including questions regarding health history, pain distress (Short Form Global Pain Scale), prescription medications, and current use of complementary health approaches for pain management. We used age-adjusted logistic regression to assess the relation of sociodemographic, lifestyle, and health-related factors to use of manual therapies and/or acupuncture for pain (complete-case N = 253).

RESULTS

The majority of participants were white (92%), female (56%), and middle aged (mean age, 54.8 ± 13.4 years). Nearly all reported current chronic pain (94%), and 56% reported ≥5 comorbidities (mean, 5.6 ± 3.1). Manual therapy and/or acupuncture was used by 26% of participants for pain management (n = 66). Current or prior opioid use was reported by 37% of those using manual therapies. Manual therapy and/or acupuncture use was significantly elevated in those using other complementary health approaches (adjusted odds ratio, 3.0; 95% confidence interval, 1.5-5.8). Overall Short Form Global Pain Scale scores were not significantly associated with use of manual therapies and/or acupuncture after adjustment (adjusted odds ratio per 1-point increase, 1.01; 95% confidence interval, 1.00-1.03).

CONCLUSION

We found no evidence for an association of pain-related distress and use of manual therapies and/or acupuncture, but identified a strong association with use of dietary supplements and mind-body therapies. Larger studies are needed to further examine these connections in the context of clinical outcomes and cost-effectiveness in rural adults given their high pain burden and unique challenges in access to care.

The influence of online health information on health decisions: A systematic review

OBJECTIVES

This systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.

METHODS

Eligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers' (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.

RESULTS

A total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.

CONCLUSION

Consumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.

PRACTICE IMPLICATIONS

Health care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.

Adverse Effects of Radiotherapy and Chemotherapy for Common Malignancies: What Is the Quality of Information Patients Are Finding Online?

Little is known about the availability of high-quality online health information (OHI) for adverse effects (AEs) of radiotherapy (RT) and chemotherapy (CHT). Optimal search strategies for gaining access to high-quality OHI for these topics are not well-established. This study explores the quality of, potential disparities in, and possible search strategies for OHI pertaining to AEs of RT and CHT. One hundred twenty phrases on generalized and malignancy site-specific AEs of RT and CHT were searched on Google. The Health on the Net Foundation (HONcode) framework was applied to assess the quality of the first 100 websites for each search phrase. Comparisons of the availability of high-quality OHI were made between different languages, malignancy sites, and treatment modalities (RT vs CHT). Of the 12,000 RT and CHT AE websites analyzed, approximately half of the first 10 websites returned for each search were HONcode-accredited; approximately a fifth of the first 100 websites returned were HONcode-accredited. Such low availability of high-quality OHI persisted throughout different languages (English, French, Spanish) and common malignancy sites (breast, prostate, lung), with some variations between languages, malignancy sites, and RT vs CHT. Despite the important role of OHI in cancer patients' approach to health information gathering and decision-making, the availability of high-quality OHI for the AEs of common oncologic treatments, RT and CHT, is low across different languages and common malignancy sites. Our findings demonstrate the need for improvement in the availability of high-quality OHI. Therefore, providers should take an active stance in directing patients to high-quality OHI.

Web-Based Versus Non-Web-Based Patient Referral Patterns and Factors Affecting Them

PURPOSE

To analyze the 8-year (2012-2019) change in the patient referral source trends to a plastic surgery practice and the factors affecting them.

METHODS

Data on demographics, referral source, and patient's concern were recorded. The web-based referral sources were website and Instagram and non-web-based included other patients (word-of-mouth), medical professionals (physician, nurse, and optometrist), and others (printed media, TV, and radio). Patients' concerns were divided into cosmetic and noncosmetic. The first (2012-2015) and second (2016-2019) half of the study period were also compared.

RESULTS

Included patients were 19,965. The 8-year referral sources, in order of frequency, were medical professionals (34%), other patients (32.7%), web-based sources (32.5%), and the others (0.7%). The web-based sources significantly increased by 2.4 times in the second half. While they had a third rank after the medical professionals and other patients in the first half of the study period, they became the first in the second half. The non-web-based source showed a decline during the study period. Type of referral sources was not significantly different between the 2 genders. A significantly higher percentage of the patients between 21 and 50 years of age were referred through web-based sources than the other age groups. Patients with cosmetic concerns were 2 times more likely to be referred through web-based sources.

CONCLUSION

The web-based referral sources have significantly grown from the third rank in the beginning to the first one from 2015 till the end of study.

Radiation Oncology Online: Quality, Strategies, and Disparities

Although much is known about the quality of online health information (OHI) for many malignancies, the availability of high-quality OHI for oncologic treatments remains undefined. Furthermore, search strategies that improve quality of radiation oncology OHI, and disparities in availability of high-quality OHI, are not well-described. Forty phrases describing malignancies and their treatment modalities (radiation, chemotherapy, and surgery), and 57 phrases describing radiation oncology treatments, including abbreviations for some treatments and translations in different languages, were generated. The Health on the Net Foundation framework for assessing OHI quality was applied to the top 100 websites listed for each search phrase. The availability of high-quality OHI between malignancies and treatment modalities, and among treatment modalities, was compared. The roles of radiation oncology term abbreviation, search result order, patient gender, and language, on availability of high-quality OHI, were also assessed. Among the first 10, 20, and 50 websites for each search phrase, there were significantly more high-quality websites for phrases describing malignancies compared with respective treatment modalities (P < 0.02 for all). There were no differences among treatment modalities. Among radiation oncology treatment phrases, there were no significant differences between searches for full-name phrases and their respective abbreviations, though earlier results were more likely to be of high quality. Gender did not affect quality of OHI, though language did. Availability of high-quality OHI for cancer treatments lags behind that of cancer OHI. For radiation oncology treatment OHI, search strategies and patient disparities highlight potential areas for provider intervention and increased quality of OHI.

Internet-Based Health Information-Seeking Behavior of Students Aged 12 to 14 Years: Mixed Methods Study

Background

Many children and adolescents are surrounded by smartphones, tablets, and computers and know how to search the internet for almost any information. However, very few of them know how to select proper information from reliable sources. This can become a problem when health issues are concerned, where it is vital to identify incorrect or misleading information. The competence to critically evaluate digital information on health issues is of increasing importance for adolescents.

Objective

The aim of this study was to assess how children and adolescents rate their internet-based health literacy and how their actual literacy differs from their ratings. In addition, there was a question on how their search performance is related to their self-efficacy. To evaluate these questions, a criteria-based analysis of the quality of the websites they visited was performed. Finally, the possibility to increase their internet-based health literacy in a 3-day workshop was explored.

Methods

A workshop with a focus on health literacy was attended by 14 children and adolescents in an Austrian secondary school. After prior assessments (Culture Fair Intelligence Test, revised German version; Reading Speed and Reading Comprehension Test for Grades 6 to 12, German; electronic health literacy scale [eHEALS]; and General Self-Efficacy Scale, Reversed Version, German), the students were asked to perform an internet-based search on a health-related issue. Browser histories and screenshots of all internet searches were gathered, clustered, and analyzed. After the workshop, the health literacy of the students was assessed again by using the eHEALS.

Results

The 14 students opened a total of 85 homepages, but only eight of these homepages were rated as good or fair by two experts (independent rating) based on specific criteria. The analysis showed that the students judged their own internet-based health literacy much higher than the actual value, and students who had rated themselves better did not visit websites of high quality. Internet-based health literacy correlated significantly with the self-efficacy of the students (r_s=0.794, P=.002).

Conclusions

Our study showed that it is possible to draw the attention of students to critical aspects of internet search and to slightly improve their search competence in a workshop. Targeted improvement of health literacy is urgently required, and students need special instruction for this purpose. Further investigations in this area with larger sets of data, which could be feasible with the help of a computer program, are urgently needed.

Quality and readability of English-language Internet information for vestibular disorders

BACKGROUND:

The Internet has become a powerful, accessible resource for many patients to use for their own medical management and knowledge. Vestibular disorders are prevalent, especially in the elderly. As the Internet is increasingly a major source of health-related information to the general public, it is often used to search for information regarding dizziness and vertigo. Ensuring that the information is accessible, unbiased, and appropriate can aid informed decision-making.

OBJECTIVE:

To evaluate the quality and readability of English-language Internet information related to vestibular disorders.

METHODS:

A cross-sectional website search using three keywords (nausea, dizziness, and vertigo) in five country-specific versions of the most commonly used Internet search engine was conducted in March 2018. The language was limited to English for all websites. Quality was assessed by presence of Health on the Net (HON) certification and DISCERN scores. Readability was assessed using the Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG).

RESULTS:

In total, 112 websites were included and analyzed. The majority were commercial (61%) websites. A total of 42% had obtained HON certification. No association was found between the presence of HON certification and the resource of the website. The DISCERN scores had a mean of 2.52 (SD 1.1). Readability measures indicated that an average of 14–18 years of education was required to read and understand the Internet information provided regarding vestibular disorders.

CONCLUSIONS:

To ensure the accessible to the general population, it is necessary to improve the quality and readability of Internet-based information regarding vestibular disorders.

Arthroplasty information on the internet: quality or quantity?

AIMS

Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients' quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online.

METHODS

We identified 10,800 websites using 18 TJR-related keywords (conditions and procedures) across the Australian, French, German and Spanish Google search engines. We used the Health on the Net (HON) toolbar to evaluate the first 150 websites downloaded for every keyword in each language. The quality of information on websites was inspected, accounting for differences by language and tertiles. We also undertook an analysis of English websites to explore types of website providers.

RESULTS

'Total joint replacement' had the most results returned (150 million websites), and 9% of websites are HON-accredited. Differences in information quality were seen across search terms (p < 0.001) and tertiles (p < 0.001), but not between languages (p = 0.226). A larger proportion of HON-accredited websites were seen from keywords in the condition and arthroplasty categories. The first tertile contained the highest number of HON-accredited websites for the majority of search terms. Government/educational bodies sponsored the majority of websites.

CONCLUSION

Clinicians must consider the shortage of websites providing validated information, with disparities in both number and quality of websites for TJR conditions and procedures. As such, the challenge for clinicians is to lead the design of reliable, accurate and ethical orthopaedic websites online and direct patients to them. This stands to reward both parties greatly.

Trends, Quality, and Readability of Online Health Resources on Proton Radiation Therapy

PURPOSE

Many patients weighing cancer treatment options may consider relatively novel options including proton radiation therapy (PRT) and turn to the Internet for online health resources (OHR). However, quality and readability of OHR for radiation oncology therapies has been shown to need improvement. Because the OHR that patients access can influence their treatment decisions, our study sought to understand the patterns of use, quality, and readability of OHR on PRT.

METHODS AND MATERIALS

To validate the need to assess OHR on PRT, we assessed search patterns in the United States for the search phrase "proton therapy" using Google Trends. The Google search engine was then queried for websites with PRT information using 10 search phrases. The subsequent websites were analyzed for readability by the Flesch-Kincaid Grade Level and a Composite Grade Level (CGL) metric comprised of 5 readability metrics. Quality was analyzed using the DISCERN instrument.

RESULTS

Search volume index for "proton therapy" increased by an average of 2.0% each year for the last 15 years (January 1, 2005 to June 1, 2019, P < .001). States that had a greater number of proton centers tended to have a greater relative search volume in Google (P < .001). Of the 45 unique websites identified, the mean Flesch-Kincaid Grade Level was 12.0 (range, 7.3-18.6) and the mean CGL was 12.4 (range, 7-18). In addition, 80% of PRT pages required greater than 11th grade CGL. The mean DISCERN score of all websites was 39.8 out of 75, which corresponds to "fair" quality OHR.

CONCLUSIONS

Despite increasing interest in PRT OHR, in general, PRT websites require reading levels much higher than currently recommended, making PRT OHR less accessible to the average patient. Provision of high-quality PRT OHR at the appropriate reading level may increase comprehension of PRT, improve patient autonomy, and facilitate informed decision-making among radiation oncology patients.

Assessment of eHealth behaviors in national surveys: a systematic review of instruments

Objectives

To conduct a systematic review of instruments used in national surveys of eHealth behaviors.

Materials and Methods

Major databases and websites of federal agencies were searched with pre-determined inclusion and exclusion criteria. National surveys with measures of eHealth behaviors were identified. The survey instruments were retrieved, and their measures of eHealth behaviors were categorized and critiqued.

Results

We located 13 national surveys containing eHealth behavior assessment questions that were administered from 1999 to 2017. Most surveys were conducted annually or biennially and typically covered topics on searching health information, obtaining social support, communicating with healthcare providers, and buying medicine online; recent surveys included items related to personal health management and use of mobile tools. There were redundant measures of searching health information online but insufficient measures of use of mobile apps, social media, and wearable devices.

Discussion

Future assessment of eHealth behaviors should reflect the growing varieties of behaviors enabled by technology development and reflect the current mobile ownership patterns in diverse social groups. More studies also need to include longitudinal surveys, integrative and standardized measures, and better designs to allow data linkage and comparison.

Conclusion

The existing survey instruments covering eHealth behaviors are rather limited compared to fast technological progress. We call for more national surveys on eHealth behaviors that are more responsive to technology development; we also advocate for more analysis and dissemination of existing national data on eHealth behaviors for evidence-based health policies.

The Use of Anecdotal Information in a Hypothetical Lung Cancer Treatment Decision

This mixed-methods study examined variables associated with use of experience-based (i.e., anecdotal) decisional strategies among 85 undergraduate students presented with 2 hypothetical lung cancer scenarios. Participants were asked to think aloud while they made their treatment choice. Eleven decisional strategies were identified and grouped into either data or experience-based strategies. Approximately, 25% of participants used experience-based strategies. Use of experience-based strategies was more likely if the participant reported involvement in the life of someone going through cancer treatment, and if they rated print-based media sources as less important. Use of experience-based strategies was associated with choosing surgery instead of radiation for lung cancer treatment.

Are publicly available internet resources enabling women to make informed fertility preservation decisions before starting cancer treatment: an environmental scan?

Background

To identify publicly available internet resources and assess their likelihood to support women making informed decisions about, and between, fertility preservation procedures before starting their cancer treatment.

Methods

A survey of publically available internet resources utilising an environmental scan method. Inclusion criteria were applied to hits from searches of three data sources (November 2015; repeated June 2017): Google (Chrome) for patient resources; repositories for clinical guidelines and projects; distribution email lists to contact patient decision aid experts. The Data Extraction Sheet applied to eligible resources elicited: resource characteristics; informed and shared decision making components; engagement health services.

Results

Four thousand eight hundred fifty one records were identified; 24 patient resources and 0 clinical guidelines met scan inclusion criteria. Most resources aimed to inform women with cancer about fertility preservation procedures and infertility treatment options, but not decision making between options. There was a lack of consistency about how health conditions, decision problems and treatment options were described, and resources were difficult to understand.

Conclusions

Unless developed as part of a patient decision aid project, resources did not include components to support proactively women’s fertility preservation decisions. Current guidelines help people deliver information relevant to treatment options within a single disease pathway; we identified five additional components for patient decision aid checklists to support more effectively people’s treatment decision making across health pathways, linking current with future health problems.

Electronic supplementary material

The online version of this article (10.1186/s12911-018-0698-3) contains supplementary material, which is available to authorized users.

Online health information and public knowledge, attitudes, and behaviours regarding antibiotics in the UK: Multiple regression analysis of Wellcome Monitor and Eurobarometer Data

Background

Antimicrobial resistance is a global public health problem with some socially patterned drivers. The objective of the study was to investigate associations between use of and trust in the Internet as a source of health-related information and the public’s knowledge, attitudes, and behaviours regarding antibiotics.

Methods

Two representative cross-sectional surveys (the 2015 Wellcome Monitor (n = 1524) and UK segment (n = 1330) of the 2016 Eurobarometer 85.1) covering knowledge about antibiotics and antibiotic consumption were analysed. Knowledge, attitude, and behaviour variables were analysed using regression in relation to demographic characteristics and use and trust in the Internet as a source of information.

Results

The key findings of the analysis are that both use of the Internet as a source of medical research information (variable from the Wellcome Monitor) and trust in the Internet as a source of information about antibiotics (variable from the Eurobarometer) were independently and positively associated with knowledge, attitude, and behaviour regarding antibiotics. Additionally, knowledge about antibiotics was positively associated with behaviour with antibiotics (Wellcome Monitor) and attitude towards finishing antibiotic prescriptions (Eurobarometer). Higher levels of education were associated with better knowledge about antibiotics in both datasets. Older age was positively associated with behaviour and attitude regarding antibiotic consumption.

Conclusions

The Internet is a resource for disseminating quality health information that has the potential to improve stewardship of antibiotics in the community. This study suggests that members of the UK public that use the Internet as a source of health-related information are more likely to be better informed about, and be more responsible with, antibiotics. This mode of information dissemination should be capitalised on to improve antimicrobial stewardship, and further research should examine what the most effective online information sources are in the UK and to what extent their association with behaviour is causal.

Disparities between English and Spanish in readability of online endodontic information for laypeople

BACKGROUND

In this study, the authors assessed the readability of online endodontic information in English and Spanish.

METHODS

The authors performed a systematic search in Google in May 2016. Search queries were "root canal treatment" and "¿Qué es una endodoncia?" without limits or filters. The authors assessed English readability by using Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, Gunning Fog Index, Coleman-Liau index, automated readability index, and Simple Measure of Gobbledygook (SMOG) index. The authors calculated readability for Spanish by using the Fernández-Huerta index and INFLESZ (Ines-Barrio).

RESULTS

The authors assessed the first 100 consecutive sites identified with each search strategy and selected 117 sites. Readability scores for English-language sites were in the category of normal to read, easily understood by 13- through 15-year-old students (Flesch Reading Ease Score, 63, interquartile range (IQR) [53.9-66.2]; Gunning Fog Index, 10.4, IQR [8.8-12]; Coleman-Liau index, 12.5, IQR [11.6-13.3]; and automated readability index, 8.6, IQR [6.7-9.8]). SMOG results led to the estimation that only 7 years of education would be needed to understand these contents (SMOG, 7.6, IQR [6.5-8.8]). Spanish-language sites had a readability index normal for an adult, equivalent to a seventh or eighth school year (Fernandez-Huerta, 62.3, IQR [59.7-66.6]; INFLESZ, 57.5, IQR [55.1-62.1]). The authors found that 36.6% of English-language sites had some degree of difficulty for readers to understand their contents, whereas 23% of Spanish-language sites had some degree of difficulty (14.46; 95% confidence interval, -3.16 to 30.08).

CONCLUSIONS

Spanish- and English-language electronic health information about endodontic treatment is acceptable to read, but-particularly for English-language sites-there is an important proportion of sites scoring difficulty levels well above the recommendations.

PRACTICAL IMPLICATIONS

The internet is a useful tool for communicating with patients, but available endodontic information is difficult for laypeople to understand. Endodontists should produce relevant materials in plain language to overcome this problem.

A conceptual model of social networks and mechanisms of cancer mortality, and potential strategies to improve survival

Women with larger personal social networks have better breast cancer survival and a lower risk of mortality. However, little work has examined the mechanisms through which social networks influence breast cancer outcomes and cancer outcomes more generally, potentially limiting the development of feasible, clinically effective interventions. In fact, much of the emphasis in cancer research regarding the influence of social relationships on cancer outcomes has focused on the benefits of the provision of social support to patients, especially through peer support groups, and only more recently through patient navigation. Though critically important, there are other ways through which social relationships might influence outcomes, around which interventions might be developed. In addition to social support, these include social resources, social norms, social contagion, social roles, and social burdens and obligations. This narrative review addresses how social networks may influence cancer outcomes and discusses potential strategies for improving outcomes given these relationships. The paper (a) describes background and limitations of previous research, (b) outlines terms and provides a conceptual model that describes interrelationships between social networks and relevant variables and their hypothesized influence on cancer outcomes, (c) clarifies social and psychosocial mechanisms through which social networks affect downstream factors, (d) describes downstream behavioral, treatment, and physiological factors through which these subsequently influence recurrence and mortality, and (e) describes needed research and potential opportunities to enhance translation. Though most literature in this area pertains to breast cancer, this review has substantial relevance for cancer outcomes generally. Further clarification and research regarding potential mechanisms are needed to translate epidemiological findings on social networks into clinical and community strategies to improve cancer outcomes.

Health-Related Internet Use Among Otolaryngology Patients

Objective:

The association between online health resources use in specific otolaryngology patients is poorly understood. To better understand health-related Internet use by otolaryngology patients, we surveyed first-visit patients at academic and private practice clinics in Iowa.

Methods:

Data on socioeconomic status, access, and utilization of online resources were collected. Age distributions were compared by t test, and categorical variables were compared by chi-square analysis. Multivariate logistic regression was used to estimate odds ratios for association between independent variables (age, sex, educational attainment, otolaryngology subspecialty, etc).

Results:

Data showed that 8.7% lacked Internet access; an additional 5.4% reported access only in a public place or at work. Younger, more educated, and more urban patients reported higher rates of Internet access. Among university patients, patients seeing head and neck oncologists were most likely to report no Internet access (10.9%). Just over one-third of patients used the Internet to research their health condition prior to their appointment.

Conclusions:

Internet access was far from universal among this large cohort of otolaryngology outpatients. Head and neck cancer (HNC) patients report the least online access among all otolaryngology subspecialties. Providers should consider nonelectronic patient resources for older, more rural, less educated, and HNC patient populations as online/electronic methods of communication may not be accessible to these groups.

Evaluation of Information Sources in Plastic Surgery Decision-making

Background

Today, patients can access a myriad of information sources regarding plastic surgery procedures prior to meeting with a surgeon. Despite their widespread use, the role of these sources in a patient’s decision-making remains undefined. We hypothesized that the physician remains the key information source for patients making surgical decisions in plastic surgery, but that other sources may deliver important insights and prove helpful to varying degrees. We also explored motivations for this outside information search and any differences in perceived value among patients.

Methods

We administered a survey regarding various information sources to our breast reconstruction, reduction, and abdominoplasty patients. Responses were compared between surgery groups and demographic groups. Ordinal logistic regression analysis was used to determine the impact of patient characteristics on helpfulness rank of different sources.

Results

Survey results were obtained from 58 patients, of whom 10 (17.2%) had abdominoplasty, 35 (60.3%) breast reconstruction, and 13 (22.4%) breast reduction. The most popular information sources prior to the first surgical appointment were Internet searches (56.9%) and family/friends/other patients (39.7%). After the initial appointment, the most useful sources were plastic surgeons (84.5%), and the Internet (36.2%). Most patients (73.5%) still sought outside information after their appointment.

On a Likert-type scale of helpfulness, plastic surgeons ranked 4.28/5, followed by the web-based patient education platform, 3.73 and the Internet, 3.6. A total of 63% of participants listed plastic surgeons as their single most important source of information.

In ordinal logistic regression analysis, non-white race was significantly associated with higher rank of surgeon helpfulness (p < 0.05). Relative to low-income patients, income $50-100k (p < 0.05) and $100k+ (p < 0.05) were associated with lower rank of surgeon helpfulness.

Conclusions

Most patients seek outside information prior to visiting with a surgeon from the Internet, social media, or family and friends. Patients consider plastic surgeons their most valuable information source overall, though still in need of supplementation for varying reasons. Additionally, certain demographic differences affect patient perception of information sources, and this is an important factor for surgeons to consider as they approach educating patients.

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.

Consulting Dr. Google: Quality of Online Resources About Tympanostomy Tube Placement

OBJECTIVE

Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement.

STUDY DESIGN

Cross-sectional descriptive design.

METHODS

We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed.

RESULTS

Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6-15th). All sites were understandable (mean understandability 81.9%, range 73%-92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0-80). Shared decision-making centrality was high (mean 5, range 4-6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1-4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02).

CONCLUSION

Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.

LEVEL OF EVIDENCE

NA. Laryngoscope, 128:496-501, 2018.

The Role of Web-Based Health Information in Help-Seeking Behavior Prior to a Diagnosis of Lung Cancer: A Mixed-Methods Study

BACKGROUND

Delays to diagnosis in lung cancer can lead to reduced chance of survival, and patients often wait for several months before presenting symptoms. The time between first symptom recognition until diagnosis has been theorized into three intervals: symptom appraisal, help-seeking, and diagnostic interval (here: "pathway to diagnosis"). Interventions are needed to reduce delays to diagnosis in lung cancer. The Web has become an important lay health information source and could potentially play a role in this pathway to diagnosis.

OBJECTIVE

Our overall aim was to gain a preliminary insight into whether Web-based information plays a role in the pathway to diagnosis in lung cancer in order to assess whether it may be possible to leverage this information source to reduce delays to diagnosis.

METHODS

Patients diagnosed with lung cancer in the 6 months before study entry completed a survey about whether (and how, if yes) they had used the Web to appraise their condition prior to diagnosis. Based on survey responses, we purposively sampled patients and their next-of-kin for semistructured interviews (24 interviews; 33 participants). Interview data were analyzed qualitatively using Framework Analysis in the context of the pathway to diagnosis model.

RESULTS

A total of 113 patients completed the survey (age: mean 67.0, SD 8.8 years). In all, 20.4% (23/113) reported they or next-of-kin had researched their condition online before the diagnosis. The majority of searches (20/23, 87.0%) were conducted by or with the help of next-of-kin. Interview results suggest that patients and next-of-kin perceived an impact of the information found online on all three intervals in the time to diagnosis. In the appraisal interval, participants used online information to evaluate symptoms and possible causes. In the help-seeking interval, the Web was used to inform the decision of whether to present to health services. In the diagnostic interval, it was used to evaluate health care professionals' advice, to support requests for further investigation of symptoms, and to understand medical jargon. Within this interval, we identified two distinct subintervals (before/after relevant diagnostic tests were initiated), in which the Web reportedly played different roles.

CONCLUSIONS

Because only 20.4% of the sample reported prediagnosis Web searches, it seems the role of the Web before diagnosis of lung cancer is at present still limited, but this proportion is likely to increase in the future, when barriers such as unfamiliarity with technology and unwillingness to be informed about one's own health are likely to decrease. Participants' perceptions suggest that the Web can have an impact on all three intervals in the pathway to diagnosis. Thus, the Web may hold the potential to reduce delays in the diagnostic process, and this should be explored in future research and interventions. Our results also suggest a division of the diagnostic interval into two subintervals may be useful.

Thoracic Surgery Information on the Internet: A Multilingual Quality Assessment

BACKGROUND

Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery.

OBJECTIVE

The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment.

METHODS

Health On the Net (HON) principles may be applied to websites using an automated toolbar function. We used the English, French, Spanish, and German Google search engines to identify 12,000 websites using keywords related to thoracic conditions and procedures. The first 150 websites returned by each keyword in each language were examined. We compared website quality to assess for tertile (is the quality better in first, second, or third 50 websites returned) and language differences. A further analysis of the English site types was undertaken performing a comparative analysis of website provider types.

RESULTS

Overall, there are a considerable number of websites devoted to thoracic surgery: "lung cancer" returned over 150 million websites. About 7.85% (940/11,967) of websites are HON-accredited with differences by search term (P<.001) and tertiles (P<.001) of the first 150 websites, but not between languages. Oncological keywords regarding conditions and procedures were found to return a higher percentage of HON-accreditation. The percentage of HON-accredited sites was similar across all four languages (P=.77). In general, the first tertile contained a higher percentage of HON-accredited sites for every keyword.

CONCLUSIONS

Clinicians should appreciate the lack of validation of the majority of thoracic websites, with discrepancies in quality and number of websites across conditions and procedures. These differences appear similar regardless of language. An opportunity exists for clinicians to participate in the development of informative, ethical, and reliable health websites on the Internet and direct patients to them.

Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer

OBJECTIVES

To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style.

METHODS

This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences.

RESULTS

Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100).

CONCLUSIONS

Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret.

Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS)

OBJECTIVES

Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal pain and inflammatory conditions. A better understanding of patient information seeking behavior can help bridge the gap between patient knowledge and health care resources. This study examines the primary sources of NSAID risk information and the associations with patient socio-demographic factors.

METHODS

A cross-sectional survey analysis of patients on prescription NSAIDs (n=220) seen by primary care physicians in Alabama. Bivariate and multivariable, multinomial logistic regression analyses were conducted to evaluate the associations among primary NSAID risk information sources used with patient socio-demographic factors.

RESULTS

The primary patient source of information on NSAID risks was physician (57.3%), followed by internet (16.8%), pharmacist (16.4%), and other sources, such as nurses and family/friends (9.6%). Compared to people who use the internet as a primary source of NSAID risk information, patients who were Black/African-American (p=0.002) and 65 years of age or older (p=0.009) were more likely to use a physician. Older patients were also more likely to use a pharmacist (p=0.008) than the internet. In contrast, females (p=0.032) were less likely to use the pharmacist compared to the internet (p=0.032).

CONCLUSIONS

Patients obtain information from a variety of sources, but primarily from health care providers. While the internet is a fast growing source of health information, socio-demographic disparities in internet use for seeking information exist. Health care providers should be aware of their patient preferences for information sources on medication risks to meet the age, race, and gender need differences of all patients.

Effect of internet on Chinese patients undergoing elective laparoscopic cholecystectomy

BACKGROUND

It is a growing trend that patients seek health information on the internet to self-educate and self-diagnose, which impacts their health decisions.

OBJECTIVE

The aim of the study was to investigate how Chinese patients undergoing elective laparoscopic cholecystectomy (LC) sought information about their disease and treatment, how they preferred the information to be presented, and how it influenced them.

METHODS

A descriptive, cross-sectional-designed questionnaire was employed to obtain information from 248 Chinese patients undergoing elective LC in Peking Union Medical College Hospital.

RESULTS

A total of 223 patients (89.9 %) sought health information from the internet. Patients searching the internet for information about LC were younger than those who did not. It varied with employment status, educational level, and household average income. Among patients searching the internet for LC information, 35.4 % felt more worried and 37.2 % felt more assured; 15.2 % went to visit other doctors and 8.5 % considered changing their treatment because of internet use.

CONCLUSIONS

A significant proportion of patients used the internet to obtain information about their disease. Age, employment status, educational level, and household average monthly income had an effect on internet usage for LC information. The use of the internet could cause mixed emotional outcomes among patients. Physicians should guide Chinese patients to professional websites of high quality and take time to discuss the information with patients during their visits and consultations.