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

The emotional side of taking part in a cancer clinical trial

BACKGROUND

Taking part in a cancer clinical trial often represents a source of psychological distress and emotional activation among patients and their caregivers. Nowadays, social media platforms provide a space for these groups to freely express and share their emotional experiences.

AIMS

We aimed to reveal the most prevalent basic and complex emotions and sentiments in the posts of the patients and caregivers contemplating clinical trials on Reddit. Additionally, we aimed to categorize the types of users and posts.

METHODS

With the use of keywords referring to clinical trials, we searched for public posts on the subreddit 'cancer'. R studio v. 4.1.2 (2021-11-01) and NRC Emotion Lexicon was used for analysis. Following the theoretical framework of Plutchik's wheel of emotions, the analysis included: 8 basic emotions (anger, fear, anticipation, trust, surprise, sadness, joy, and disgust) and 4 types of complex emotions (primary, secondary, tertiary, and opposite dyads). We utilized the package 'PyPlutchik' to visualize the emotion wheels in Python 3.10.5.

RESULTS

A total of 241 posts were included in the final database. User types (129 patients, 112 caregivers) and post types (142 expressed shared experience, 77 expressed advice, and 85 conveyed both) were identified. Both positive (N = 2557, M = .68) and negative (N = 2154, M = .57) sentiments were high. The most prevalent basic emotions were: fear (N = 1702, M = .45), sadness (N = 1494, M = .40), trust (N = 1470, M = .44), and anticipation (N = 1376, M = .37). The prevalence of complex/dyadic emotions and their interpretation is further discussed.

CONCLUSION

In this contribution, we identified and discussed prevalent emotions such as fear, sadness, optimism, hope, despair, and outrage that mirror the psychological state of users and affect the medical choices they make. The insights gained in our study contribute to the understanding of the barriers and reinforcers to participation in trials and can improve the ability of healthcare professionals to assist patients when confronted with this choice.

Social Media and Social Support: A Framework for Patient Satisfaction in Healthcare

Social media has been a powerful source of social support for health consumers. In the healthcare sector, social media has thrived, building on various dynamic platforms supporting the connection between social relationships, health, and wellbeing. While prior research has shown that social support exerts a positive impact on health outcomes, there is scant literature examining the implications of social support for patient satisfaction, which suggests that there is a profound gap in the extant literature. The objective of this study is to develop and test a theoretical model for understanding the relationship between different dimensions of social support and patient empowerment. The study further investigates the debated relationship between patient empowerment and patient satisfaction. The measurement model indicated an acceptable fit (χ2 = 260.226; df, 107, χ2/df = 2.432, RMSEA = 0.07, GFI = 0.90, IFI = 0.95, TLI = 0.94, and CFI = 0.95). Findings indicate that emotional support (p < 0.001), information support (p < 0.05), and network support (p < 0.001) positively influence the notion of patient empowerment. In turn, patient empowerment positively influences patient satisfaction (p < 0.001). The proposed framework contributes to the health communication literature by introducing a novel framework for patient satisfaction in the social media context, which provides important inputs for healthcare service providers in developing patient empowerment strategies.

Digital haemophilia: Insights into the use of social media for haemophilia care, research and advocacy

INTRODUCTION

The haemophilia community on Twitter is diverse, consisting of advocacy groups, patients, physicians, researchers and other users. However, the scope of this community is uncharacterized, and limited data is available regarding effective participation in this community.

AIM

To assess the types of users active in the haemophilia community on Twitter, as well as major themes present in haemophilia-related tweets.

METHODS

Forty-nine thousand five hundred and twelve tweets between September 2019 and September 2021 were classified using regular expressions. A subset of the classified tweets was manually analysed to identify prevalent discussion themes.

RESULTS

Among the top 250 users by post count, the largest categories of users were support and advocacy groups, people with bleeding disorders and healthcare providers. The largest thematic categories of tweets were gene therapy, contaminated haemophilia blood products, haemophilia research, clinical management of haemophilia and COVID-19. While misinformation was rare, negative and incorrect perceptions of haemophilia were present among the general public.

CONCLUSION

Our results demonstrate patterns of effective Twitter usage for patient care, research and advocacy purposes among the haemophilia community.

Analysis of Information About Medicines Available on Facebook

There are many anxieties have been shown and perceived by the experts for SMP of medicines. This procedure of DTCA can be reciprocated, and one of the reason is the platform is uncontrolled; the advantages of the medicines could be exaggerated compared to the disadvantages. Also, patients can share their own experience of using medicine on social networking sites. There is a high probability for the patients to be exposed to ambiguous, contradicting, and confusing information about medicines on social media. Our focal point is to inspect how drug pages in social media influencing the overall population or web-based media clients. We tried to investigate the data available on Facebook pages of popular drugs. Many social media users often go through the content posted on social networking sites. Patients and their family members are likely to be exposed to drug product claims while looking for information about medicines of a specific disease on social media.

Impact of Medical Blog Reading and Information Presentation on Readers' Preventative Health Intentions: Mixed Methods, Multistudy Investigation

Background

Medical blogs have become valuable information sources for patients and caregivers. Most research has focused on patients’ creation of blogs as therapy. But we know less about how these blogs affect their readers and what format of information influences readers to take preventative health actions.

Objective

This study aimed to identify how reading patient medical blogs influences readers’ perceived health risk and their intentions to engage in preventative health actions. Further, we aimed to examine the format of the medical blog and the reader’s response.

Methods

We surveyed 99 university participants and a general-population, online panel of 167 participants. Both studies randomly assigned participants to conditions and measured blog evaluation, intentions for preventative health action, and evaluation of health risk and beliefs, and allowed open-ended comments. The second study used a different sample and added a control condition. A third study used a convenience sample of blog readers to evaluate the link between reading medical blogs and taking preventative health action.

Results

Across 3 studies, participants indicated a desire to take future preventative health action after reading patient blogs. Studies 1 and 2 used experimental scenario-based designs, while Study 3 employed a qualitative design with real blog readers. The 2 experimental studies showed that the type of blog impacted intentions to engage in future preventative health actions (Study 1: F_2,96=6.08, P=.003; Study 2: F_3,166=2.59, P=.06), with a statistical blog being most effective in both studies and a personal narrative blog showing similar effectiveness in Study 2, contrary to some prior research. The readers’ perceptions of their own health risk did not impact the relationship between the blog type and health intentions. In contrast, in one study, participants’ judgments about the barriers they might face to accessing care improved the fit of the model (F_2,95=13.57, P<.001). In Study 3’s sample of medical blog readers, 53% (24/45) reported taking preventative health action after reading a health blog, including performing a self-check, asking a doctor about their health risk, or requesting a screening test. Additionally, these readers expressed that they read the blogs to follow the author (patient) and to learn general health information. All studies demonstrated the blogs were somewhat sad and emotional but also informative and well-written. They noted that the blogs made them appreciate life more and motivated them to consider taking some action regarding their health. 

Conclusions

Reading patient blogs influences intentions to take future health actions. However, blog formats show different efficacy, and the readers’ disease risk perceptions do not. Physicians, medical practitioners, and health organizations may find it useful to curate or promote selected medical blogs to influence patient behavior.

Mapping the online social network of cancer bloggers

While social media has the ability to quickly disseminate information and reach large audiences, cancer blogs as a communication platform have not yet been well studied. A social network analysis was conducted on 89 active cancer blogs. Results demonstrated the overall cancer-blog-network was widely distributed and decentralized, with blogs clustered by cancer type, and that breast cancer blogs were the most significant and highly linked blogs. Efforts to disseminate cancer-related information may focus on identifying key breast cancer bloggers or linking key bloggers of various cancers to create a more interconnected network and expand its reach within this online community.

The use of digital storytelling of patients' stories as an approach to translating knowledge: a scoping review

BACKGROUND

A growing interest has centered on digital storytelling in health research, described as a multi-media presentation of a story using technology. The use of digital storytelling in knowledge translation (KT) is emerging as technology advances in healthcare to address the challenging tasks of disseminating and transferring knowledge to key stakeholders. We conducted a scoping review of the literature available on the use of patient digital storytelling as a tool in KT interventions.

METHODS

We followed by Arksey and O'Malley (Int J Soc Res Methodol 8(1):19-32, 2005), and Levac et al. (Implement Sci 5(1):69, 2010) recommended steps for scoping reviews. Search strategies were conducted for electronic databases (Medline, CINAHL, Web of Science, ProQuest dissertations and theses global, Clinicaltrials.gov and Psychinfo). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was used to report the review process.

RESULTS

Of 4656 citations retrieved, 114 full texts were reviewed, and twenty-one articles included in the review. Included studies were from nine countries and focused on an array of physical and mental health conditions. A broad range of interpretations of digital storytelling and a variety of KT interventions were identified. Digital storytelling was predominately defined as a story in multi-media form, presented as a video, for selective or public viewing and used as educational material for healthcare professionals, patients and families.

CONCLUSION

Using digital storytelling as a tool in KT interventions can contribute to shared decision-making in healthcare and increase awareness in patients' health related experiences. Concerns centered on the accuracy and reliability of some of the information available online and the impact of digital storytelling on knowledge action and implementation.

Lay participation with medical expertise in online self-care practices: Social knowledge (co)production in the Running Mania injury forum

Recent literature on the public understanding of science has focused on replacing the deficit model of public communication in which experts disseminate information with one that encourages public participation and dialogue. Situated within this call for increased participation, this study looks at self-care practices in which medical expertise is not passively consumed by the layperson, but shared and (re)produced through arenas of lay practice. This collective knowledge production is facilitated by the online environment, which provides access to mediated medical knowledge and the ability to form communities in which users can negotiate this expertise and share their experiences. The laypersons examined here are members of the Canadian online collective, Running Mania, highlighting how this negotiation of expertise occurs in a "wellness" community. Drawing from member interviews and website observations of the site's injury forum, the study examines collective injury management using two dominant theoretical discourses surrounding lay knowledge and participation in medical expertise: the lay expert whose knowledge arises from experience and the expert patient whose knowledge base parallels dominant biomedical discourse. Using the coproduction model and the related concepts of tinkering and logic of care from material semiotics, the research examines how these knowledge forms articulate to produce an intermediary discourse unique to this collective's articulation of running and caring practices, a discourse that is enacted in individuals' embodied negotiation of these multiple forms of medical expertise. It suggests that the logic of care has the potential to bridge the expert/lay boundary since the need for persistent, attentive tinkering applies across epistemological divides: in "good" care practices, multiple expertises are needed, both expert and lay, to hold the body together.

Perception of peer advice in online health communities: Access to lay expertise

When seeking advice online about health concerns, forums dedicated to medical themes are increasingly becoming an appreciated source of information for many individuals. In online health communities, patients can ask questions or otherwise seek advice that is particularly relevant to them. While they may find some of the advice useful, other advice may be perceived as less valuable. By studying the advice-seeking, advice-giving, and advice-evaluation behaviours in one of the largest online health communities in Europe, this paper looks at what determines which advice is perceived as helpful, and why. Drawing on network theory, we analysed the interaction data of 108,569 users over twelve consecutive years based on all publicly available information of an established Q&A online health community. Utilising zero-inflated negative binominal modelling, our results show that advice received from others, who have similar predominant interests, is valued more when reaching out for lay expertise. If this advice is given by peers, who can also draw on expertise from other health areas, allowing for a combination of diverse "lay" expertise, the advice is valued even more. Advice provided by those who are quick to obtain the latest knowledge available in the larger community further reinforces these effects. Our findings offer an original view to understand the influence of lay expertise exchanged via online health communities and hold implications for both policy-makers and medical practitioners regarding their approach to patient-initiated use of social media for health-related reasons.

Investigating How Bowel Cancer Survivors Discuss Exercise and Physical Activity Within Web-Based Discussion Forums: Qualitative Analysis

Background

Online cancer support group discussions enable patients to share their illness experience with others. The sharing of technical and emotional support information and the ability to ask for advice are some of the primary discussions shared online. People with bowel cancer can also use these forums to support each other by sharing information based on personal experiences. This type of support provides newly diagnosed patients with advice about several topics, including exercise from those who have been there. Information gathered from online discussion boards may complement the advice received by health professionals.

Objective

This study aimed to explore the nature of information related to exercise and physical activity exchanged online for cancer survivors.

Methods

A public open access bowel cancer discussion board was searched for threads containing information related to physical activity or exercise. Keywords such as exercise, physical activity, moving, walking, lifting, weights training, and resistance were used to search for threads (online conversations) related to exercise or physical activity. Only threads initiated by bowel cancer patients or survivors were included. From more than 6000 posts, the inclusion criteria yielded 75 threads for analysis. Inductive thematic analysis was conducted across all included threads.

Results

Analysis yielded 3 main themes: level of exercise competence, beneficial dimensions of exercise, and faith in the knowledge. Level of exercise competence illustrated the varying definitions of exercise that members of the forum discussed in the forum. Beneficial dimensions of exercise revealed that forum members shared both the spiritual benefits associated with exercise as well as the physical benefits or goodness that they feel exercise or physical activity provides them. Faith in the knowledge of exercise demonstrated that forum members were aware of the general benefits of exercise but felt disappointed that it did not keep the cancer at bay. However, members also had faith that exercise would keep them healthy after diagnosis and treatment.

Conclusions

The analysis revealed that people with bowel cancer discuss exercise and physical activity online and that they view exercise as having a mostly positive influence on their cancer journey. However, personal definitions of exercise became a source of conflict within the group. People with bowel cancer seeking information about exercise may benefit from participating in online support groups as it appears that there are many similar others willing to share their personal experiences with exercise. In addition, health care professionals responsible for caring for people with bowel cancer may use these findings to discuss exercise with their patients while being mindful of how they may view exercise.

Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients

PURPOSE

The purpose of this study was to examine and compare pre- to post-diagnosis change patterns of physical activity (PA) among breast, prostate, and colorectal cancer patients. Moreover, the study aimed to investigate sociodemographic and medical determinants of post-diagnosis PA and to identify patient subgroups at increased risk of inactivity.

METHODS

A total of 912 cancer patients (457 breast, 241 prostate, 214 colorectal cancer) completed a questionnaire assessing their pre- and post-diagnosis PA behavior, and sociodemographic and medical variables. Age-adjusted regression and classification tree analyses were used to investigate PA determinants and detect subgroups that were most likely to meet or not meet PA guidelines.

RESULTS

Across cancer types, we found that PA yet decreased from pre- to post-diagnosis, but that 54.1% of participants still reported to be meeting PA guidelines after the diagnosis. While post-diagnosis PA was strongly affected by previous PA behavior among individuals of all patient groups, other sociodemographic and medical determinants played different roles depending on cancer type. The results yielded that previously active, longer diagnosed patients with higher education levels were most likely to be meeting PA guidelines post-diagnosis, whereas specifically previously inactive prostate cancer patients had an increased likelihood of insufficient activity.

CONCLUSIONS

An encouragingly high number of cancer patients indicated sufficient PA levels. For those having difficulties to maintain or adopt PA post-diagnosis, interventions should be tailored to the specific characteristics of each cancer type, as different factors are associated with PA for each patient group.

Role of Social Media Promotion of Prescription Drugs on Patient Belief-system and Behaviour

In the current scenario, extremely little information exists on the uses, benefits, and limitations of social media for health communication among the patients and health professionals. Further, how it is affecting the patient belief system and behavior is even less studied, but it is emerging on the research horizon due to its growing significance in this digital age. This is a review article using a systematic approach. We performed a systematic literature search for papers that address social media–related challenges and opportunities for pharmaceutical drugs. It identifies the needs that propel patients to take recourse to SMPs; the benefits they derive from these and their limitations. This review article confirms that healthcare information provided by the social media sites has been found to be beneficial in many ways for the stakeholders and that it complements existing patient-physician interaction. However, it has limitations that need to be explored and understood to avoid ill consequences.

Consumer perceptions of using social media for health purposes: Benefits and drawbacks

Consumers are increasingly using social media to interact with other consumers about health conditions and treatment options. This study aimed to investigate the advantages and disadvantages of using social media for health-related purposes from the consumers' perspectives. Five focus groups with 36 Australian adults with a chronic condition and on medication were conducted, audio-recorded, transcribed verbatim, and thematically analysed. Consumers reported that social media was very convenient, for accessing health-related information and for peer engagement; user-friendly; improved their health knowledge; empowered them; and provided social and emotional support. The disadvantages included information overload, wasting time; negative feelings; doubts about online information credibility; and issues related to online interactions. Despite some disadvantages, health-related use of social media led consumers to feel supported, knowledgeable, and empowered. Consumers' motivation to keep accessing social media for health-related purposes opens up avenues for the delivery of services via social media.

How patients' use of social media impacts their interactions with healthcare professionals

INTRODUCTION

Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients' use of SM impacted their interactions with healthcare professionals (HCPs).

METHODS

Focus groups (n=5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 60-90min, were audio-recorded, transcribed verbatim, and thematically analysed.

RESULTS

Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patient-HCP relationship due to increased knowledge, better communication, and empowerment. Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition.

CONCLUSION

Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making.

PRACTICE IMPLICATIONS

HCPs should be aware of patients' activities and expectations, and support them in their online activities.

Consumer Health-Related Activities on Social Media: Exploratory Study

BACKGROUND

Although a number of studies have investigated how consumers use social media for health-related purposes, there is a paucity of studies in the Australian context.

OBJECTIVE

This study aimed to explore how Australian consumers used social media for health-related purposes, specifically how they identified social media platforms, which were used, and which health-related activities commonly took place.

METHODS

A total of 5 focus groups (n=36 participants), each lasting 60 to 90 minutes, were conducted in the Sydney metropolitan area. The group discussions were audiorecorded and transcribed verbatim. The transcripts were coded line-by-line and thematically analyzed.

RESULTS

Participants used general search engines to locate health-related social media platforms. They accessed a wide range of social media on a daily basis, using several electronic devices (in particular, mobile phones). Although privacy was a concern, it did not prevent consumers from fully engaging in social media for health-related purposes. Blogs were used to learn from other people's experiences with the same condition. Facebook allowed consumers to follow health-related pages and to participate in disease-specific group discussions. Wikipedia was used for factual information about diseases and treatments. YouTube was accessed to learn about medical procedures such as surgery. No participant reported editing or contributing to Wikipedia or posting YouTube videos related to health topics. Twitter was rarely used for health-related purposes. Social media allowed consumers to obtain and provide disease and treatment-related information and social and emotional support for those living with the same condition. Most considered their participation as observational, but some also contributed (eg, responded to people's questions).

CONCLUSIONS

Participants used a wide range of social media for health-related purposes. Medical information exchange (eg, disease and treatment) and social and emotional support were the cornerstones of their online activities. Social media appears to be used as a key tool to support disease self-management.

Blogs and the Art of Dying: Blogging With, and About, Severe Cancer in Late Modern Swedish Society

In recent years, the common and mundane dying has begun to take place in the public space of the Internet. Among the blogs about food, fashion, travel, and other joyful aspects of life, blogs about severe disease and dying have appeared. The aim of this article is to describe some characteristic features of a sample of cancer blogs and to discuss them in the light of Zygmunt Bauman's theory of the rationalization of death in modernity and theories about networked media, especially the theories about "affective labor" and "ambient intimacy" by McCosker, Darcy, and Pfister. It will then be argued that an affective communication is performed in and through these cancer blogs, where not only language but also the deficiencies of language-and what is called shared ineffability-might be valuable and meaningful (although not unproblematic) as part of a late modern approach to death, and in the practicing of the art of dying.

Social media use in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals

Background

Since the emergence of social media in 2004, a growing percentage of patients use this technology for health related reasons. To reflect on the alleged beneficial and potentially harmful effects of social media use by patients, the aim of this paper is to provide an overview of the extant literature on the effects of social media use for health related reasons on patients and their relationship with healthcare professionals.

Methods

We conducted a systematic literature review on empirical research regarding the effects of social media use by patients for health related reasons. The papers we included met the following selection criteria: (1) published in a peer-reviewed journal, (2) written in English, (3) full text available to the researcher, (4) contain primary empirical data, (5) the users of social media are patients, (6) the effects of patients using social media are clearly stated, (7) satisfy established quality criteria.

Results

Initially, a total of 1,743 articles were identified from which 22 were included in the study. From these articles six categories of patients’ use of social media were identified, namely: emotional, information, esteem, network support, social comparison and emotional expression. The types of use were found to lead to seven identified types of effects on patients, namely improved self-management and control, enhanced psychological well-being, and enhanced subjective well-being, diminished subjective well-being, addiction to social media, loss of privacy, and being targeted for promotion. Social media use by patients was found to affect the healthcare professional and patient relationship, by leading to more equal communication between the patient and healthcare professional, increased switching of doctors, harmonious relationships, and suboptimal interaction between the patient and healthcare professional.

Conclusions

Our review provides insights into the emerging utilization of social media in healthcare. In particular, it identifies types of use by patients as well as the effects of such use, which may differ between patients and doctors. Accordingly, our results framework and propositions can serve to guide future research, and they also have practical implications for healthcare providers and policy makers.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1691-0) contains supplementary material, which is available to authorized users.

Social Media Use in Chronic Disease: A Systematic Review and Novel Taxonomy

PURPOSE

The purpose of this study is to evaluate clinical outcomes from applications of contemporary social media in chronic disease; to develop a conceptual taxonomy to categorize, summarize, and then analyze the current evidence base; and to suggest a framework for future studies on this topic.

METHODS

We performed a systematic review of MEDLINE via PubMed (January 2000 to January 2015) of studies reporting clinical outcomes on leading contemporary social media (ie, Facebook, Twitter, Wikipedia, YouTube) use in 10 chronic diseases. Two reviewers independently performed data extraction and quality assessment; characterization of study outcomes as positive, negative, neutral, or undefined impact; and inductive, thematic analysis to develop our taxonomy.

RESULTS

Of 378 citations identified, 42 studies examining the use of Facebook (n = 16), blogs (n = 13), Twitter (n = 8), wikis (n = 5), and YouTube (n = 4) on outcomes in cancer (n = 14), depression (n = 13), obesity (n = 9), diabetes (n = 4), heart disease (n = 3), stroke (n = 2), and chronic lower respiratory tract infection (n = 1) were included. Studies were classified as support (n = 16), patient education (n = 10), disease modification (n = 6), disease management (n = 5), and diagnosis (n = 5) within our taxonomy. The overall impact of social media on chronic disease was variable, with 48% of studies indicating benefit, 45% neutral or undefined, and 7% suggesting harm. Among studies that showed benefit, 85% used either Facebook or blogs, and 40% were based within the domain of support.

CONCLUSIONS

Using social media to provide social, emotional, or experiential support in chronic disease, especially with Facebook and blogs, appears most likely to improve patient care.

Positive Thinking and Social Perceptions of a Male vs. Female Peer's Cancer Experience

Positive thinking (PT; i.e., sustaining positive thoughts and suppressing negative thoughts to "fight" cancer) is often equated with direct control over one's cancer trajectory. It was determined whether PT exposure enhanced the effort, control, and responsibility attributions ascribed to a peer for his/her cancer trajectory, and whether those ascriptions varied as a function of the peer's or participant's gender. Within a hypothetical online blog, a peer described a personal experience with bone cancer. Undergraduate participants (N = 630) were randomly administered one of 12 experimental conditions that varied in terms of the peer's gender, PT exposure, and cancer outcome. MANCOVA results indicated that PT exposure enhanced the effort, control, and responsibility attributions assigned to the peer for an unsuccessful cancer outcome, regardless of the peer's or participant's gender. Moreover, the male peer was perceived as more accountable for still having cancer but the female peer received more "credit" for being cancer-free. The notion of PT may contribute to overestimating cancer patients' personal influence over their disease trajectory and social perceptions of successful or unsuccessful cancer outcomes vary as a function of the patient's gender.

The emerging diabetes online community

BACKGROUND

Diabetes self-management is complex and demanding, and isolation and burnout are common experiences. The Internet provides opportunities for people with diabetes to connect with one another to address these challenges. The aims of this paper are to introduce readers to the platforms on which Diabetes Online Community (DOC) participants interact, to discuss reasons for and risks associated with diabetes-related online activity, and to review research related to the potential impact of DOC participation on diabetes outcomes.

METHODS

Research and online content related to diabetes online activity is reviewed, and DOC writing excerpts are used to illustrate key themes. Guidelines for meaningful participation in DOC activities for people with diabetes, families, health care providers, and industry are provided.

RESULTS

Common themes around DOC participation include peer support, advocacy, self-expression, seeking and sharing diabetes information, improving approaches to diabetes data management, and humor. Potential risks include access to misinformation and threats to individuals' privacy, though there are limited data on negative outcomes resulting from such activities. Likewise, few data are available regarding the impact of DOC involvement on glycemic outcomes, but initial research suggests a positive impact on emotional experiences, attitudes toward diabetes, and engagement in diabetes management behaviors.

CONCLUSION

The range of DOC participants, activities, and platforms is growing rapidly. The Internet provides opportunities to strengthen communication and support among individuals with diabetes, their families, health care providers, the health care industry, policy makers, and the general public. Research is needed to investigate the impact of DOC participation on self-management, quality of life, and glycemic control, and to design and evaluate strategies to maximize its positive impact.

Use and taxonomy of social media in cancer-related research: a systematic review

Little is known about how social media are used in cancer care. We conducted a systematic review of the use and taxonomy of social media in cancer-related studies, in PubMed, Web of Knowledge, CINAHL, and Google Scholar. We located 1350 articles published through October 2013; 69 met study inclusion criteria. Early research (1996-2007) was predominantly descriptive studies of online forums. Later, researchers began analyzing blogs, videos shared on YouTube, and social networking sites. Most studies (n = 62) were descriptive, and only 7 reported intervention studies published since 2010. Future research should include more intervention studies to determine how social media can influence behavior, and more empirical research is needed on how social media may be used to reduce health disparities.

Start, stop, and continue: Preliminary insight into the appeal of self-injury e-communities

Nonsuicidal self-injury e-communication has gained heightened empirical and public interest. This is the first study to examine possible motives for nonsuicidal self-injury e-communication. A total of 68 nonsuicidal self-injury e-community members responded to open-ended questions concerning reasons for starting, temporarily stopping, and continuing nonsuicidal self-injury e-communication. Results from a thematic analysis indicated that being motivated to obtain support, get nonsuicidal self-injury help, help others, and better understand nonsuicidal self-injury represented motives for starting nonsuicidal self-injury e-communication. For some, negative interactions and accessing triggering material contributed to e-communication stoppage; these individuals continued e-communication to get support and help. Implications for research and e-outreach are discussed.

Designing and evaluating the acceptability of Realshare: An online support community for teenagers and young adults with cancer

A participatory action approach was used to design and evaluate the acceptability of the Realshare online community. Pre and post-intervention focus groups were conducted and participants were asked to test out Realshare during two intervention periods: when a facilitator was present and when one was not. Focus group data and forum messages were thematically analysed. The themes identified related to participants’ website design requirements, how they used the community and the evaluation of Realshare after having used it. Amendments were made to Realshare throughout the project. Realshare is available to young oncology patients in the South West of England.

Visible ink: A flexible and individually tailored writing intervention for cancer patients

OBJECTIVES

Subjective reports on the effectiveness of and satisfaction with writing interventions in medical populations have indicated that they can have a profound impact on patients. Further, past research on these programs has demonstrated that they can lead to a number of different positive outcomes depending on the personal characteristics of the participating patients and the type of writing with which they are tasked. For this reason, a flexible and individually tailored writing intervention may be particularly effective for patients, molding its approach to their desires and backgrounds. This paper examines Visible Ink, a writing program for cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) that follows this model.

METHODS

At Visible Ink's First Fall Writing Festival in November 2012, an optional survey was provided to all program participants in attendance, capturing both quantitative and qualitative information on patient experiences in the program. Twenty-nine surveys were completed.

RESULTS

The program appears to have a variety of positive effects, including fostering personal growth and providing a positive distraction. Respondents reported that they write in a number of different genres on topics both related and not related to their illnesses, which supports the flexible model of the program. All respondents indicated that they would recommend the program to others, and satisfaction with the program's general approach (i.e., individualized work with a writing coach) was unanimous. A few areas for potential improvement were also identified, most of which involved expanding the services and events offered by the program.

SIGNIFICANCE OF RESULTS

Despite the limitations of this survey (e.g., small sample size and low response rate), its results support the promise of the Visible Ink model and demonstrate participants' satisfaction with the program. Future research can more thoroughly examine Visible Ink's effectiveness, and additional resources could enable the program to expand.