Probing, impelling, but not offending doctors: the role of the internet as an information source for patients' interactions with doctors

Physician Perspectives on Internet-Informed Patients: Systematic Review

BACKGROUND

The internet has become a prevalent source of health information for patients. However, its accuracy and relevance are often questionable. While patients seek physicians' expertise in interpreting internet health information, physicians' perspectives on patients' information-seeking behavior are less explored.

OBJECTIVE

This review aims to understand physicians' perceptions of patients' internet health information-seeking behavior as well as their communication strategies and the challenges and needs they face with internet-informed patients.

METHODS

An initial search in PubMed, Scopus, CINAHL, Communication and Mass Media Complete, and PsycINFO was conducted to collect studies published from January 1990 to August 1, 2022. A subsequent search on December 24, 2023, targeted recent studies published after the initial search cutoff date. Two reviewers independently performed title, abstract, and full-text screening, adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. Thematic analysis was then used to identify key themes and systematically categorize evidence from both qualitative and quantitative studies under these themes.

RESULTS

A total of 22 qualifying articles were identified after the search and screening process. Physicians were found to hold diverse views on patients' internet searches, which can be viewed as a continuous spectrum of opinions ranging from positive to negative. While some physicians leaned distinctly toward either positive or negative perspectives, a significant number expressed more balanced views. These physicians recognized both the benefits, such as increased patient health knowledge and informed decision-making, and the potential harms, including misinformation and the triggering of negative emotions, such as patient anxiety or confusion, associated with patients' internet health information seeking. Two communicative strategies were identified: the participative and defensive approaches. While the former seeks to guide internet-informed patients to use internet information with physicians' expertise, the latter aims to discourage patients from using the internet to seek health information. Physicians' perceptions were linked to their strategies: those holding positive views tended to adopt a participative approach, while those with negative views favored a defensive strategy. Some physicians claimed to shift between the 2 approaches depending on their interaction with a certain patient. We also identified several challenges and needs of physicians in dealing with internet-informed patients, including the time pressure to address internet-informed patient demands, a lack of structured training, and being uninformed about trustworthy internet sites that can be recommended to internet-informed patients.

CONCLUSIONS

This review highlights the diverse perceptions that physicians hold toward internet-informed patients, as well as the interplay between their perceptions, communication strategies, and their interactions with individual patients. Incorporating elements into the medical teaching curriculum that introduce physicians to reliable internet health resources for patient guidance, coupled with providing updates on technological advancements, could be instrumental in equipping physicians to more effectively manage internet-informed patients.

TRIAL REGISTRATION

PROSPERO CRD42022356317; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=356317.

Are They Important? Patients' Communication Barriers to Discussing Online Health Information During Consultations

A minority of the patients who search for online health information report discussing or having an intention to discuss this information with their healthcare provider. Not discussing online health information inhibits the provision of patient-centered care and limits the healthcare provider's possibility to tackle misinformation. Within the confines of the linguistic model of patient participation, we first provide an overview of barriers to discussing online health information during consultations. Second, we pinpoint which of these barriers indicate a need for improvement. Participants from the Netherlands (N = 300) completed a survey that measured the communication barriers (N = 15) as identified based on previous literature and interviews. Using the QUality Of Care Through the patient's Eyes (QUOTE) approach, we measured the extent to which a specific factor was a barrier ("importance") and assessed whether the barrier would withhold patients from discussing online health information ("performance"). Scores on importance and performance were multiplied to identify which barriers show the most significant room for improvement. Especially "preferring to discuss other matters" often occurred. Nine barriers showed a moderate need for improvement. We discuss the implications of these findings for healthcare providers in consultations. Future research should include observational data to analyze communication barriers to discussing online health information in consultations.

Open AI meets open notes: surveillance capitalism, patient privacy and online record access

Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated.

Current Situations and Challenges in the Development of Health Information Literacy

Health information literacy (HIL) is a significant concept that has gradually become known to the broader public in recent years. Although the definitions of HIL and health literacy seem to overlap, as an independent subconcept, HIL still shows a unique influence on improvements in people's health and health education. Remarkable evidence indicates that online health information (OHI) can effectively enrich people's knowledge and encourage patients to actively join the medical process, which is also accompanied by the emergence of various assessment tools. Although the current assessment tools, to a certain extent, can help people identify their shortcomings and improve their HIL, many studies have indicated that the deficiencies of the scales induce incomplete or unreal results of their HIL. In addition, continuing research has revealed an increasing number of influencing factors that have great effects on HIL and even regulate the different trends in doctor-patient relationships. Simultaneously, most of the uncensored OHI broadcasts have also affected the improvement in HIL in various ways. Thus, this review aims to summarize the assessment tools, influencing factors and current situations and challenges related to HIL. Further studies are required to provide more trusted and deeper references for the development of HIL.

Validation of the transactional eHealth literacy instrument with cancer caregivers

Objective

Family members are important sources of support for patients with cancer. They access, evaluate, and engage with online information and discuss it with a cancer clinician. This study validates the 4-dimensions, 18-item Transactional eHealth Literacy Instrument (TeHLI) and proposed to include Clinical eHealth Literacy as a 5th dimension.

Methods

The Leukemia & Lymphoma Society (LLS) disseminated an online survey to 121 family member caregivers between March-June 2020. We conducted confirmatory factor analyses (1) to examine model fit for the 4-factor TeHLI in the cancer caregiver population, and (2) to examine the model fit when adding the 5th factor.

Results

The 4-dimension model yielded acceptable model fit (RMSEA = 0.09; 90% CI = 0.08-0.11; CFI = 0.98; TLI = 0.98; SRMR = 0.07). The 5-dimension model also yielded acceptable model fit (RMSEA = 0.08; 90% CI = 0.07-0.10; CFI = 0.97; TLI = 0.97; SRMR = 0.08), supporting the expansion of the TeHLI within this population.

Conclusion

The five-dimension TeHLI is a valid and reliable measure of eHealth literacy among blood cancer caregiver populations.

Innovation

The TeHLI can be used as an outcome measure for communication skills training for caregivers, patients, and clinicians.

The Effect of Online Health Information Seeking on Physician-Patient Relationships: Systematic Review

BACKGROUND

The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has been found that OHI can affect the physician-patient relationship by influencing patient behaviors.

OBJECTIVE

This study aims to systematically investigate the impact of OHI-seeking behavior on the physician-patient relationship.

METHODS

Literature retrieval was conducted on 4 databases (Web of Science, PubMed, China National Knowledge Infrastructure, SinoMed), and the time limit for literature publication was before August 1, 2021.

RESULTS

We selected 53 target papers (42 [79%] English papers and 11 [21%] Chinese papers) that met the inclusion criteria. Of these, 31 (58%) papers believe that patients' OHI behavior can enable them to participate in their own medical care, improve patient compliance, and improve the physician-patient relationship. In addition, 14 (26%) papers maintain a neutral attitude, some believing that OHI behavior has no significant effect on doctors and patients and others believing that due to changes in the factors affecting OHI behavior, they will have a negative or a positive impact. Furthermore, 8 (15%) papers believe that OHI search behavior has a negative impact on doctors and patients, while 6 (11%) papers show that OHI reduces Chinese patients' trust in doctors.

CONCLUSIONS

Our main findings showed that (1) OHI-seeking behavior has an impact on patients' psychology, behavior, and evaluation of doctors; (2) whether patients choose to discuss OHI with doctors has different effects on the physician-patient relationship; and (3) the negative impact of OHI on China's internet users is worthy of attention. Due to the low quality of OHI, poor health information literacy, short physician-patient communication time, and various types of negative news, patients' trust in doctors has declined, thus affecting the physician-patient relationship. Improvement of people's health information literacy and the quality of OHI are important factors that promote the positive impact of OHI on the physician-patient relationship.

A critical analysis of the social media policies in Ontario's healthcare system

Purpose

Social media has made a revolutionary change in the relationship between the customers and business or service providers by enabling customers to publish and share feedback and views about product or service quality. This revolutionary change has not been echoed in some healthcare systems. This study analyses the social media policies of healthcare regulatory authorities in Ontario and explores how these policies encourage or discourage healthcare professionals' use of social media for collecting patient stories and understanding patient experience.

Design/methodology/approach

The study used qualitative content analysis to analyse the policy documents, focusing on the manifest themes in these documents. It used convenient sampling to select 12 organizations, including regulating and licensing bodies and health service delivery organizations in Ontario. The authors collected 24 documents from these organizations, including policies, practice standards and social media learning materials.

Findings

In Ontario's healthcare system, social media is perceived as a source of risks to the healthcare professions and professionals. Healthcare regulators emphasize that the codes of conduct and professional standards extend to social media. The study found no systematic recognition of patient stories on social media as a source of information on healthcare quality that can be useful for healthcare professionals.

Originality/value

The study identifies potential unintended consequences of social media policies in the healthcare system and calls for policy and cultural changes to enable the development of safe social media platforms that can facilitate interaction between healthcare providers and patients, when necessary, without the fear of legal consequences or privacy breaches.

Cancer Survivors: What Are Their Information Seeking Behaviours?

This study aims to examine the information seeking behaviours and experiences of cancer survivors at various stages of the cancer survivorship trajectory in Singapore. Data was collected via a self-administered questionnaire from survivors diagnosed with the top 6 cancers in Singapore seen at the National Cancer Centre Singapore (NCCS). Cancer survivorship stages were categorized as newly diagnosed and on treatment (NT), completed treatment or cancer-free ≥ 5 years (CT) and had recurrence or second cancer (RS). Out of the 998 cancer survivors, 676 (68%) had searched for cancer information since their diagnosis. About 57% of the searchers did their most recent search in the past 6 months prior to the survey, with most of these survivors from the NT and RS groups. Around half of the searchers (55%) obtained cancer information from the internet. The most preferred source for cancer information was the internet (38%), followed by healthcare professionals (HCPs) (23%). About half (49%) obtained cancer information from their preferred source. Some information searchers (24%) did not do so, out of which about half used the internet to obtain information that they would have preferred to obtain from HCPs. The top 3 most commonly sought information was related to treatment, cancer and diet/nutrition. Half of the searchers were concerned with the quality of the information that they found. These information seeking behaviours and experiences were similar across cancer survivorship stages. Our study reveals that information seeking is prevalent across all survivorship stages. Patterns of information-seeking revealed a discrepancy between preferred and actual source.

Web-Based Health Information Seeking Among African American and Hispanic Men Living With Chronic Conditions: Cross-sectional Survey Study

Background

Previous research has identified disparities in seeking and using web-based health information to inform health-related behaviors. Relatively few studies however have examined the correlations between web-based health information seeking and use based on race, gender, age, and the presence of chronic health conditions.

Objective

In this study, we identify factors associated with seeking and using web-based health information among a uniquely vulnerable and intersectional population—middle-aged and older (40 years and older) African American and Hispanic men living with one or more chronic conditions.

Methods

Survey responses were collected from a purposive sample of African American and Hispanic men using Qualtrics web-based survey management software. To qualify for inclusion in the study, respondents had to identify as African American or Hispanic men, report having at least one chronic condition, and be aged 40 years and older. A series of binary logistic regression models was created using backward elimination. Statistical significance was determined at P<.05 for all analyses.

Results

Web-based health information seeking among African American and Hispanic men is a function of education, the presence of multiple chronic conditions, frustration with health care providers, internet use, and the perceived reliability of web-based health information. The use of web-based health information to inform interactions with health care providers was more common among African American and Hispanic men, who rated their health as relatively good, perceived barriers to care, used technology regularly, and took more daily medications.

Conclusions

Understanding the factors that influence African American and Hispanic men seeking web-based health information may help improve the care and treatment of chronic conditions. African American and Hispanic men seek web-based health information as a substitute for routine care and to inform their discussions with health care providers.

Modes of Interaction in Naturally Occurring Medical Encounters With General Practitioners: The "One in a Million" Study

In this article, we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes, to develop a classification of these modes, and to uncover how modes emerge and shift both within and between consultations. Deploying an interactional perspective and a thematic and narrative analysis of consultation transcripts, we identified five distinctive interactional modes: question and answer (Q&A) mode, lecture mode, probabilistic mode, competition mode, and narrative mode. Most modes are GP-led. Mode shifts within consultations generally map on to the chronology of the medical encounter. Patient-led narrative modes are initiated by patients themselves, which demonstrates agency. Our classification of modes derives from complete naturally occurring consultations, covering a wide range of symptoms, and may have general applicability.

Linking health information seeking to patient-centered communication and healthy lifestyles: an exploratory study in China

The existing research routinely measures the influence of health information-seeking behavior (HISB) as a whole, which does not capture the complexity and diversity of media channel usage in HISB. The influence of HISB on patient's lifestyle behaviors and the mediation process through patient-centered communication (PCC) in medical encounters has been understudied in previous literature. Drawing from Street's three-stage model, this study conducted a secondary analysis of the Health Information National Trends Survey in China to investigate the influences of HISB across five different media outlets (e.g. information-oriented media, entertainment-oriented media, search engines, social media and mobile health applications) on two types of healthy lifestyles (e.g. physical activity, fruit and vegetable consumption), by the mediation of PCC. PROCESS path-analysis with bootstrapping estimation was used to test the hypothesized relationships. The results revealed that HISB is positively related to PCC, and PCC positively predicts frequent engagement in healthy lifestyles. Moreover, PCC partially mediates the effect of information-oriented media HISB on healthy lifestyles and fully mediates the effect of HISB through the other four media sources. This study highlights the essential stage of PCC transferring HISB to engagement in healthy lifestyles and draws attention to the varying influences of media channels carrying different characteristics.

Trust Me, I Am a Doctor: Discourse of Trustworthiness by Chinese Doctors in Online Medical Consultation

As a key notion in medical consultation, trustworthiness has been the attention of an array of research, focusing on its significance for the patient-doctor alliance as well as the success of communication in between. Despite its importance, scant effort has been made previously about the actual discourse through which trustworthiness is achieved, in particular for online medical consultation in Chinese. The aim of this research is to investigate the linguistic structures of Chinese doctors' narratives for trustworthiness construction in online medical consultation. We use the Internet-based dataset collected from 120 ask.com. It is found that doctors' trustworthiness discourse can be categorized into two types: authoritative discourse and attitudinal discourse, with the former specifically realized by expertise-oriented discourse through medical jargon and experience-oriented discourse with the help of individual experience and collective experience, and the latter by including affection-oriented discourse through doctors' respect for patients, behavior-oriented discourse by means of doctors' avoidance of imposition on patients and cognition-oriented discourse with the aid of doctors' disagreements. Meanwhile, detailed linguistic and para-linguistic means to realize these discourses are analyzed to offer some insights into the appropriate discourses of trustworthiness for the doctors both online and offline in Chinese medical consultation scenario.

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.

Exploring the role of online health information and social media in the illness experience of arthritis-related fatigue: A focus group study

PURPOSE

Online health information (OHI) and social media have become prominent health resources for people with arthritis-related fatigue. More research is needed to understand how OHI and online social support may influence illness experiences and patient-practitioner relationships in people with arthritis-related fatigue. The present study aimed to explore how OHI and social media shape these experiences by using an inductive qualitative analysis.

METHOD

Seven focus groups were conducted with 21 participants aged 28-77 diagnosed with a range of rheumatic diseases. Within the focus groups, participants were asked questions about OHI, online social support and the role of OHI in their health care. The focus groups were recorded, transcribed and analysed using a combination of interpretative phenomenological analysis (IPA) and thematic analysis.

RESULTS

The analysis resulted in three themes: (a) how online social support changes illness experiences, (b) communicating fatigue to health professionals using OHI and (c) health care experiences online. These themes provide insight into the ways people with arthritis-related fatigue benefit from online social support, use OHI to support communication with health professionals and how they share health care for arthritis in online spaces.

CONCLUSION

This research expanded on previous literature addressing the role of OHI and social media in the illness experience of arthritis-related fatigue. As technology use is increasing, particularly in the current extraordinary environment of social distancing, it is critical to address the role of OHI and social media in health care. In this study, OHI and social media played a prevalent role in the health care of many participants.

Investigating the Association Between Internet Health Information Use and Patient Willingness to Communicate with Health Care Providers

Communication between health professionals and patients is an intergroup phenomenon where the health professional has the most power and status. Over the past few decades, there has been a steady increase in the availability to patients of information about healthcare and specific diseases on the Internet. In this paper, we ask whether the use of Internet health information assists patients to manage their consultations with health professionals better and whether it alters the intergroup dynamic by providing a more equal status for patients. In this study 370 participants from Australia and Canada completed a survey that included a 'willingness to communicate with health professionals' scale. They also commented on their use and trust of Internet health information. Thematic analysis suggests that patients' use of Internet health information serves as a broker between patients and their health provider in health consultations. We discuss the implications of these findings for health practitioners as they address how easier Internet access influences patient interactions with health professionals. We consider future research directions these finding provide in explaining communication behaviour in this context.

The extent to which cancer patients trust in cancer-related online information: a systematic review

Background

The use of the internet to satisfy information needs is widespread among cancer patients. Patients’ decisions regarding whether to act upon the information they find strongly depend on the trustworthiness of the information and the medium. Patients who are younger, more highly educated and female are more likely to trust online information. The objectives of this systematic review were to examine the extent to which cancer patients trust in cancer-related online information, internet websites as a source of cancer-related information or the internet as a medium of cancer information.

Methods

A systematic review was conducted using five databases (PROSPERO registration number: CRD42017070190). Studies of any kind were included if they measured cancer patients’ trust in online health information. Study quality was assessed using the Research Triangle Institute (RTI) item bank. A narrative synthesis was undertaken to examine the included studies.

Results

Of the 7,314 citations obtained by the search, seven cross-sectional studies were included in the synthesis. A total of 1,054 patients reported having some or a great deal of trust in online cancer information; 154 patients reported moderately trusting such information; and 833 patients reported having no or little trust in online cancer information, internet websites as a source of cancer-related information or the internet as a medium of cancer-related information. Two of the seven studies reported between group comparisons for the above-stated patient characteristics. The methodological quality of the included studies was diverse.

Conclusion

The results of the included studies indicates that approximately half of cancer patients appear to trust cancer-specific online information, internet websites as a source of cancer-related information or the internet as an information medium. However, the small number of included studies, high heterogeneity of participants, methods and outcomes calls for further systematic research. It is important to understand that cancer patients do and will increasingly use trusted cancer information websites to search for information concerning their disease. Therefore, physicians and other health care providers should provide more support and advice to these patients.

Searching for Health: Doctor Google and the Shifting Dynamics of the Middle-Aged and Older Adult Patient-Physician Relationship and Interaction

Objectives: While online health information (OHI) has become ubiquitous, little is known about its use by middle-aged and older adults. This contribution examines the role of OHI and its influence on the patient-physician relationship. Method: This qualitative study reports the thematic analysis of 40 semistructured, in-depth interviews with Flemish middle-aged and older adults between the ages of 50 and 80 years. Results: Middle-aged and older adults obtain OHI pre- and post-consultation, albeit with different motivations and in search of different types of information. Patients strategically and carefully introduce OHI in the clinical encounter. "Doctor Google" expands the traditional patient-physician dyad into an information triangle. Discussion: The findings have implications for policy guidance and clinical practice. Public campaigns against "Googling" for health information might have to be amended to be successful. Importantly, physicians are increasingly expected to refer to and appraise OHI and put it into the individual patient context.

The Internet as a Source of Health Information and Services

The Internet is increasingly used for health-related purposes and evolves with the ever-changing needs of patients. The aim of this study was to assess the level of reliance on the Internet as a health information source, to examine which online communication activities are the most common for health purposes, and to determine the attitudes and needs of patients in this area and the factors affecting its use. A total of 1000 adults were selected from the Polish population by random sampling. The survey was administered by the Computer-Assisted Telephone Interview (CATI). The study concluded that 76.9% of the participants used the Internet for health purposes, among whom 72.6% of active and 27.4% of passive users were distinguished. The role of the Internet as a source of health information has increased, which corresponds to a growing interest in online health services. The majority of individuals searching for health information in the Internet lived in urban areas, had a high level of education, and was professionally active. We conclude that the increased interest in the use of the Internet related to health determines the direction in which e-health should be developed in the future.

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.

Online Health Searches and Their Perceived Effects on Patients and Patient-Clinician Relationships: ASystematic Review

Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from January 1, 1990 to January 29, 2016 for studies in which patients searched online for any aspect of health care and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, although the nature of the effect could depend on the clinician's response to patient queries about the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship and commonly raised concerns about the accuracy of online content. Significant methodologic heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking.

Protocol paper for the 'Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)' study: a mixed qualitative methods study

INTRODUCTION

Many patients now turn to the internet as a resource for healthcare information and advice. However, patients' use of the internet to manage their health has been positioned as a potential source of strain on the doctor-patient relationship in primary care. The current evidence about what happens when internet-derived health information is introduced during consultations has relied on qualitative data derived from interview or questionnaire studies. The 'Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)' study combines questionnaire, interview and video-recorded consultation data to address this issue more fully.

METHODS AND ANALYSIS

Three data collection methods are employed: preconsultation patient questionnaires, video-recorded consultations between general practitioners (GP) and patients, and semistructured interviews with GPs and patients. We seek to recruit 10 GPs practising in Southeast England. We aim to collect up to 30 patient questionnaires and video-recorded consultations per GP, yielding up to 300. Up to 30 patients (approximately three per participating GP) will be selected for interviews sampled for a wide range of sociodemographic characteristics, and a variety of ways the use of, or information from, the internet was present or absent during their consultation. We will interview all 10 participating GPs about their views of online health information, reflecting on their own usage of online information during consultations and their patients' references to online health information. Descriptive, conversation and thematic analysis will be used respectively for the patient questionnaires, video-recorded consultations and interviews.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the London-Camden & Kings Cross Research Ethics Committee. Alongside journal publications, dissemination activities include the creation of a toolkit to be shared with patients and doctors, to guide discussions of material from the internet in consultations.

Is doctor-patient relationship influenced by health online information?

SUMMARY OBJECTIVES To analyse the opinions and attitudes reported by medical specialists regarding online health information and their interference in the doctor-patient relationship. Methods A cross-sectional study developed between 2016 and 2017 in Recife-Pernambuco-Brazil, which used a questionnaire in person in a population of 183 specialists from the Instituto de Medicina Integral Prof. Fernando Figueira. The results were analysed through the Statistical Package for the Social Sciences. Obtained approval of the Ethics Committee under the voucher number 121004/2016. Results In the opinion of 85.2% of physicians, online health information has both positive and negative impacts on the physician-patient relationship. Faced with a questioning patient who claims to have researched information on the internet, 98.9% of the physicians said they would try to explain the reasons for their diagnosis and treatment. 59% already had a patient who modified the treatment recommended after seeing health information on the Internet. 73.8% agreed that online health information has positive effects for the general public, but 89.1% feel that most patients do not know which online health information is reliable CONCLUSION The physicians surveyed view online health information in a positive way, but realize that it is necessary to be cautious as to their repercussions on the treatment of patients. There is concern about the accuracy of online health information, and it is incumbent upon the physician and health institutions to instruct patients about the sources of quality and that they are able to understand, as its known the patients have an active voice through the guarantee of the ethical principle of autonomy.

How Experts' Use of Medical Technical Jargon in Different Types of Online Health Forums Affects Perceived Information Credibility: Randomized Experiment With Laypersons

Background

Online health forums are widely used, but the quality of advice differs as much as the knowledge backgrounds of the audience members who receive the advice. It is important to understand how people judge the information given online. In line with the communication accommodation theory (CAT), online forums represent specific social contexts of communication which can present either accommodative or nonaccommodative language to an audience. Accordingly, use of accommodative or nonaccommodative language might affect people’s perceived trust in the communicator.

Objective

The objective of this study was to investigate how experts who use accommodative (vs nonaccommodative) language are evaluated by passive users of an online forum.

Methods

Participants (n=98) took part in an online experiment and read experts’ posts about 10 nutrition myths. Following a 2 x 2 mixed design, experts’ posts were written using either low or high amounts of medical technical jargon (MTJ) (within factor) and were directed at different audiences (mainly other medical experts [in a professional forum] vs a user group mainly comprising laypersons [in an advisory forum]) (between factor). Accommodation occurred where experts used high amounts of MTJ to address other medical experts in the professional forum; it also occurred when experts used low amounts of MTJ to address laypersons in the advisory forum. Conversely, nonaccommodation occurred when experts used high amounts of MTJ in the advisory forum and low amounts of MTJ in the professional forum. In each condition, participants evaluated the credibility of the information, the trustworthiness of the experts, and the accommodation by the experts.

Results

Overall, participants judged the credibility of information to be higher when experts used MTJ that was accommodative to the designated audience, F_1,95=3.10, P=.04, η_p²=.031. In addition, participants judged the experts in professional forums to be more trustworthy than experts in advisory forums (all F_1,96≥3.54, P ≤.03, η_p²≥.036). Moreover, participants rated experts who used high amounts of MTJ to have higher competence (F_1,96=37.54, P<.001, η_p²=.28], lower integrity (F_1,96=10.77, P=.001, η_p²=.101), and lower benevolence (F_1,96=9.75, P=.002, η_p²=.092), as well as to have lower perceived accommodation to the audience (all F_1,96≥72.17, P<.001, η_p²≥.43) compared with experts who used low MTJ.

Conclusions

To provide health information online that is perceived as credible, experts should consider using similar language as the language used by the addressed audience. As it is often impossible to determine the exact makeup of an online audience, further research might investigate whether having experts explicitly declare which audience they intend to address can help people to more reliably assess an expert’s trustworthiness. Furthermore, as people assess information differently depending on the context of online communication, it would be valuable for research to consider other aspects of the context beyond those of the audience.

What Is Trust? Ethics and Risk Governance in Precision Medicine and Predictive Analytics

Trust is a ubiquitous term used in emerging technology (e.g., Big Data, precision medicine), innovation policy, and governance literatures in particular. But what exactly is trust? Even though trust is considered a critical requirement for the successful deployment of precision medicine initiatives, nonetheless, there is a need for further conceptualization with regard to what qualifies as trust, and what factors might establish and sustain trust in precision medicine, predictive analytics, and large-scale biology. These new fields of 21st century medicine and health often deal with the "futures" and hence, trust gains a temporal and ever-present quality for both the present and the futures anticipated by new technologies and predictive analytics. We address these conceptual gaps that have important practical implications in the way we govern risk and unknowns associated with emerging technologies in biology, medicine, and health broadly. We provide an in-depth conceptual analysis and an operative definition of trust dynamics in precision medicine. In addition, we identify three main types of "trust facilitators": (1) technical, (2) ethical, and (3) institutional. This three-dimensional framework on trust is necessary to building and maintaining trust in 21st century knowledge-based innovations that governments and publics invest for progressive societal change, development, and sustainable prosperity. Importantly, we analyze, identify, and deliberate on the dimensions of precision medicine and large-scale biology that have carved out trust as a pertinent tool to its success. Moving forward, we propose a "points to consider" on how best to enhance trust in precision medicine and predictive analytics.

"That Should Be Left to Doctors, That's What They are There For!"-Exploring the Reflexivity and Trust of Young Adults When Seeking Health Information

This paper explores the health information-seeking practices of healthy young adults and how they assess and rank sources of information through a qualitative study. The findings show that participants (a) are strongly committed to searching for information about health and lifestyle, especially via the Internet; (b) healthcare professionals were perceived as the most reliable source of health information and advice; (c) online health information, although frequently accessed and experienced as empowering, is seen as a potentially unreliable source. Findings evidence how becoming better informed about health-related topics plays a pivotal role in individuals' lives, most notably by using the Internet. Participants were able to reflect about what it means to know about health. The construction of trust regarding health information involved a heuristic process vis-à-vis source reliability and perceived credibility that places doctors as the most trustworthy medium of medical advice and health information. We conclude that participants' trust toward professionals suggests the preference and need for more personalized care; and it is a response to the ambiguity and uncertainty that permeates the health information landscape, particularly that which is web-based.

Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population.

Objective

The objective of this study was to describe where, what, and when people search online for topics related to ADHD.

Methods

Data were collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods.

Results

Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis.

Conclusions

The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD.

Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

BACKGROUND

With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients' Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship.

OBJECTIVE

Our objective was to systematically review existing research on patients' Internet health information seeking and its influence on the patient-physician relationship.

METHODS

We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients' discussion of online findings during consultations and implications for the patient-physician relationship.

RESULTS

We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients' disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients' relationship with their physicians.

CONCLUSIONS

Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic.

Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

Background

With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship.

Objective

Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship.

Methods

We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship.

Results

We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians.

Conclusions

Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic.

Factors Influencing Health-Related Internet Activities and Their Outcomes

This study explores why people participate in health-related Internet activities and what the potential impacts of such activities are. Specifically, this study examines how trust in health information (i.e., from a physician and from the Internet) determines individuals' health-related Internet activities and whether this use subsequently improves outcomes such as discussion with doctors about online health information and satisfaction with health care. Findings from a Web-based survey in South Korea indicated that trust in health information from doctors decreased communication activities, whereas trust in online health information increased both communication and information activities. Both communication and information activities increased discussions with doctors about online health information, which subsequently led to satisfaction with health care.

Patterns of Reasons for Taiwanese Adults' Health Information-Seeking Efforts: A Latent Class Analysis Approach

The aims of this study were to use latent class analysis (LCA) to identify subgroups of adults in Taiwan based on their reasons for seeking health information and to explore predictors of subgroup membership. A questionnaire survey of 752 adults from 25 communities in Taiwan was conducted. LCA was used to identify distinct classes of participants; latent class regression was performed to identify factors predicting latent class membership. Three classes emerged through LCA. The Health-Improving Group (50.40%) reported high probabilities of reasons relevant to improving their or someone else's health but low probabilities of reasons relevant to patient-provider interaction. The Active Group (32.98%) showed high probabilities of almost all of the reasons for seeking health information. The Passive Group (16.62%) showed low probabilities across all of the reasons. Compared to the Health-Improving Group, the Active Group was significantly more likely to have higher education and perceive higher information-seeking self-efficacy. The individuals in the Passive Group were significantly more likely to be male, be younger, have lower health literacy, and have fewer years of education than those in the Health-Improving Group. This LCA approach can provide important information on how communication strategies should be applied to different population subgroups.

Exploring eHealth Ethics and Multi-Morbidity: Protocol for an Interview and Focus Group Study of Patient and Health Care Provider Views and Experiences of Using Digital Media for Health Purposes

BACKGROUND

eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to medical consultations (telemedicine) and multiple forms of health education, support, and tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has the potential to accelerate the shift from traditional "passive patient" to an informed, engaged, and empowered "patient as partner," equipped to take part in shared decision-making, and take personal responsibility for self-managing their illness.

OBJECTIVE

The objective of our study is to examine how people with chronic illness use eHealth in their daily lives, how it affects patient-provider relationships, and the ethical and practical ramifications for patients, providers, and service delivery.

METHODS

This two-phase qualitative study is ongoing. We will purposively sample 60-70 participants in British Columbia, Canada. To be eligible, patient participants have to have arthritis and at least one other chronic health condition; health care providers (HCPs) need a caseload of patients with multi-morbidity (>25%). To date we have recruited 36 participants (18 patients, 18 HCPs). The participants attended 7 focus groups (FGs), 4 with patients and 3 with rehabilitation professionals and physicians. We interviewed 4 HCPs who were unable to attend a FG. In phase 2, we will build on FG findings and conduct 20-24 interviews with equal numbers of patients and HCPs (rehabilitation professionals and physicians). As in the FGs conducted in phase I, the interviews will use a semistructured, but flexible, discussion guide. All discussions are being audiotaped and transcribed verbatim. Constant comparisons and a narrative approach guides the analyses. A relational ethics conceptual lens is being applied to the data to identify emergent ethical issues.

RESULTS

This study explores ethical issues in eHealth. Our goal is to identify the role of eHealth in the lives of people with multiple chronic health conditions and to explore how eHealth impacts the patient role, self-managing, and the patient-HCP relationship. The ethical lens facilitates a systematic critical analysis of emergent ethical issues for further investigation and pinpoints areas of practice that require interventions as eHealth develops and use increases both within and outside of the clinical setting.

CONCLUSIONS

The potential benefits and burdens of eHealth need to be identified before an ethical framework can be devised.

Patient-provider discussion of online health information: results from the 2007 Health Information National Trends Survey (HINTS)

Increasing numbers of people have turned to the Internet for health information. Little has been done beyond speculation to empirically investigate patients' discussion of online health information with health care professionals (HCPs) and patients' perception of HCPs' reactions to such discussion. The author analyzed data from the 2007 Health Information National Trends Survey (HINTS) to identify the characteristics of patients (a) who search for health information on the Internet, (b) who discuss the information found on the Internet with HCPs, and (c) who positively assess HCPs' reaction to the online information. Findings show that men were more likely than were women to have a conversation on online information with HCPs. It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs. Reactions of HCPs to online information were perceived as particularly negative by certain groups of patients, such as those who experienced poor health and those who had more concerns about the quality of their searched information. Results are discussed for their implications for patient empowerment and patient-HCP relationships.

Communication online with fellow cancer patients: writing to be remembered, gain strength, and find survivors

This qualitative research explored how cancer patients' writing and reading on the Internet play a role in their illness experience. Focus-group interviews were conducted, with 34 cancer patients participating. A grounded qualitative analysis method was applied to analyze the interview transcripts. The results show that by writing personal blogs, cancer patients reconstructed their life story, expressed their closure of life, and expected to be remembered after death. Reading fellow cancer patients' stories online significantly influenced cancer patients' perceptions and expectations of their own illness prognosis, and that influence was sometimes greater than that of the doctors' influence.