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Lu Q, Schulz PJ. Physician Perspectives on Internet-Informed Patients: Systematic Review. J Med Internet Res 2024; 26:e47620. [PMID: 38842920 PMCID: PMC11190621 DOI: 10.2196/47620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/01/2023] [Accepted: 02/27/2024] [Indexed: 06/07/2024] Open
Abstract
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.
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Affiliation(s)
- Qianfeng Lu
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
| | - Peter Johannes Schulz
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
- Department of Communication & Media, Ewha Womans University, Seoul, Republic of Korea
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
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Lu Q, Schulz PJ. How Physicians Tackle Internet-Misinformed Patients: Going Beyond Traditional Patient-Centered Communication - A Study Protocol. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:983-988. [PMID: 37701424 PMCID: PMC10493147 DOI: 10.2147/amep.s425434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
Background The proliferation of misleading and irrelevant health information on the Internet has become a significant public concern. Inappropriate use of online materials can cause harm to patients' health and quality of life. While close attention has been paid to health campaigns and education programs that aim to disseminate accurate health knowledge, the role of physicians, who directly communicate with patients in medical encounters and provide personalized information, has been overlooked. Therefore, this study focuses on physicians and their communication strategies with internet-misinformed patients (IMPs). Objective This study aims to understand the communicative strategies physicians use to tackle IMPs and explore connections between physicians' communicative strategies and patient-centered communication. Methods Approximately 10 to 15 physicians from diverse cultural backgrounds, including Ticino (an Italian-speaking region in Switzerland), Milan and China will be interviewed. Interviews will be conducted in-person or online through video conferencing software programs. Physicians will be asked about their experiences with IMPs, communicative strategies for addressing patients' misconceptions, balancing patient preferences, decision-making obstacles, and envisioning an ideal relationship with them. A thematic analysis will be utilized to analyze data, employing a general inductive approach. Discussion The results will provide valuable insights into effective clinical communication strategies that address patients' misuse of internet materials and inform policymakers and healthcare providers about the limitations and applicability of patient-centered communication in the current digital era.
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Affiliation(s)
- Qianfeng Lu
- Faculty of Communication, Culture and Society, Università della Svizzera italiana (USI), Lugano, Switzerland
| | - Peter J Schulz
- Faculty of Communication, Culture and Society, Università della Svizzera italiana (USI), Lugano, Switzerland
- Department of Communication & Media, Ewha Womans University, Seoul, South Korea
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Vicente MA, Fernández C, Guilabert M, Carrillo I, Martín-Delgado J, Mira JJ. Patient Engagement Using Telemedicine in Primary Care during COVID-19 Pandemic: A Trial Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14682. [PMID: 36429402 PMCID: PMC9690471 DOI: 10.3390/ijerph192214682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
The correct treatment of most non-transmissible diseases requires, in addition to adequate medication, adherence to physical activity and diet guidelines, as well as health data monitoring and patient motivation. The restrictions caused by the COVID-19 pandemic made telemedicine tools and mobile apps the best choice for monitoring patient compliance. The objective of this study was to analyze the benefits of an m-Health solution designed specifically for chronic patients during the COVID-19 pandemic. A pragmatic clinical trial with pre-post measurements of a single group was carried out with 70 patients (aged 40+) with one or more chronic conditions. Patients were provided with an ad hoc mobile app and health data measuring devices according to their diseases. The health status of the patients was monitored remotely by health professionals who could also modify the patient's objectives according to their evolution. The results obtained show an average fulfillment of objectives of 77%. Higher fulfillment values: medication adherence (98%) and oxygen saturation (82%); lower fulfillment values: weight (48%), glucose (57%), and distance walked (57%). Globally, the ad hoc app was rated 8.72 points out of 10 (standard deviation 1.10). Concerning the pre-post analysis, there were significant improvements vs. prior apps used by the participants in the following items: improved physical activation and better control of blood pressure, diet, weight, glucose, and oxygen saturation. In conclusion, the telemedicine tool developed was useful in increasing patient engagement and adherence to treatment.
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Affiliation(s)
| | - César Fernández
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Jimmy Martín-Delgado
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 0313 Alicante, Spain
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil 090603, Ecuador
| | - José Joaquín Mira
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 0313 Alicante, Spain
- Alicante-Sant Joan d’Alacant Health Department, 03013 Alicante, Spain
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Shachar L. "You become a slightly better doctor": Doctors adopting integrated medical expertise through interactions with E-patients. Soc Sci Med 2022; 305:115038. [PMID: 35598443 DOI: 10.1016/j.socscimed.2022.115038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
The accessibility of information via the internet has radically altered the doctor-patient relationship. By means of in-depth interviews with Israeli physicians from four different specialties, this study explored how physicians cope with internet-informed patients, referred to as e-patients, and examined how they make sense of their new professional roles. Findings show that three types of boundaries in the doctor-patient relationship have been blurred by the emergence of the e-patient: the boundaries between doctors' and patients' knowledge, between doctors' authority and patients' autonomy, and between positivistic knowledge and humanistic knowledge. Each of these is a boundary between liberal and non-liberal values. Only the combination of all these components produces, according to the participants, a good doctor. I call this new phenomenon integrated medical expertise and explain how it diverges from previous notions of 'good doctoring'.
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Affiliation(s)
- Leeor Shachar
- The Department of Sociology and Anthropology, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel.
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Thompson CM, Rhidenour KB, Blackburn KG, Barrett AK, Babu S. Using crowdsourced medicine to manage uncertainty on Reddit: The case of COVID-19 long-haulers. PATIENT EDUCATION AND COUNSELING 2022; 105:322-330. [PMID: 34281723 PMCID: PMC8805953 DOI: 10.1016/j.pec.2021.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Causes of and treatments for long-COVID syndrome remain unknown. Drawing on uncertainty management theory (UMT), this study elucidates the communicative nature of crowdsourced medicine as a means by which COVID "long-haulers" respond to their poorly understood illness. METHODS 31,892 posts on the long-haulers subreddit (r/covidlonghaulers) were analyzed, starting with its creation date, July 24th, 2020, until January 7, 2021. The Meaning Extraction Method was used to identify clusters of words that mathematically group together across the text observations. RESULTS Analyses yielded 16 distinct factors of words, which we thematized based on their composition, the data, and UMT. The 16 themes encompassed symptoms (e.g., pain, respiratory, sensory), diagnostic concerns (testing, diagnosis), broad health concerns (immunity, physical activity, diet), chronicity, support, identity, and anxiety. CONCLUSION Findings provide a succinct, yet robust set of themes reflecting the information-seeking (i.e., "This is happening to me") and support-seeking functions of long-haulers' talk (i.e., "Is this happening to you?"). Findings have implications for collective uncertainty management, online crowdsourcing, and patient advocacy. PRACTICE IMPLICATIONS We recommend that health care providers employ sensitivity when addressing the anxiety that long-haulers are experiencing while also validating that their physical symptoms are real. Online communities help long-haulers manage their uncertainty.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois, Urbana-Champaign, IL, USA.
| | | | - Kate G Blackburn
- Department of Psychology, University of Texas at Austin, TX, USA
| | | | - Sara Babu
- Department of Communication, University of Illinois, Urbana-Champaign, IL, USA
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Guraya SS, Guraya SY, Yusoff MSB. Preserving professional identities, behaviors, and values in digital professionalism using social networking sites; a systematic review. BMC MEDICAL EDUCATION 2021; 21:381. [PMID: 34247617 PMCID: PMC8273947 DOI: 10.1186/s12909-021-02802-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 06/24/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Despite a rapid rise of use of social media in medical disciplines, uncertainty prevails among healthcare professionals for providing medical content on social media. There are also growing concerns about unprofessional behaviors and blurring of professional identities that are undermining digital professionalism. This review tapped the literature to determine the impact of social media on medical professionalism and how can professional identities and values be maintained in digital era. METHODS We searched the databases of PubMed, ProQuest, ScienceDirect, Web of Science, and EBSCO host using (professionalism AND (professionalism OR (professional identity) OR (professional behaviors) OR (professional values) OR (professional ethics))) AND ((social media) AND ((social media) OR (social networking sites) OR Twitter OR Facebook)) AND (health professionals). The research questions were based on sample (health professionals), phenomenon of interest (digital professionalism), design, evaluation and research type. We screened initial yield of titles using pre-determined inclusion and exclusion criteria and selected a group of articles for qualitative analysis. We used the Biblioshiny® software package for the generation of popular concepts as clustered keywords. RESULTS Our search yielded 44 articles with four leading themes; marked rise in the use of social media by healthcare professionals and students, negative impact of social media on digital professionalism, blurring of medical professional values, behaviors, and identity in the digital era, and limited evidence for teaching and assessing digital professionalism. A high occurrence of violation of patient privacy, professional integrity and cyberbullying were identified. Our search revealed a paucity of existing guidelines and policies for digital professionalism that can safeguard healthcare professionals, students and patients. CONCLUSIONS Our systematic review reports a significant rise of unprofessional behaviors in social media among healthcare professionals. We could not identify the desired professional behaviors and values essential for digital identity formation. The boundaries between personal and professional practices are mystified in digital professionalism. These findings call for potential educational ramifications to resurrect professional virtues, behaviors and identities of healthcare professionals and students.
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Affiliation(s)
- Shaista Salman Guraya
- Royal College of Surgeons Ireland, RCSI - MUB, Busaiteen, Bahrain
- Department of Medical Education, School of Medical Sciences, University Sains Malaysia, Health campus, Kelantan Kota Bahru, Malaysia
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Muhamad Saiful Bahri Yusoff
- Department of Medical Education, School of Medical Sciences, University Sains Malaysia, Health campus, Kelantan Kota Bahru, Malaysia
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Masters K, Loda T, Al-Abri R, Johannink J, Herrmann-Werner A. Surgical patients' use of, and attitudes towards, the internet for e-patient activities in Germany and Oman. Ann Med Surg (Lond) 2020; 55:287-293. [PMID: 32551100 PMCID: PMC7287187 DOI: 10.1016/j.amsu.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/16/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction E-patient activities are known to impact upon the patient-doctor relationship and on surgical outcomes. In Oman, there is no published information about the e-patient. The aim of this study, conducted at two surgical sites, was to investigate surgical e-patients’ use of, and attitudes towards, the Internet, and the possible impact on the delivery of healthcare. Materials and methods A convenience sample of 83 German and 93 Omani patients at the two surgical sites were given an in-house paper-based questionnaire, based on e-patient activities described in the literature. Descriptive statistics like means, standard deviations and frequencies were calculated. Results There were many similarities in usage and attitudes. Omani patients showed much greater knowledge and usage of sites and apps, used the Internet more for health-related activities (26.9% vs. 12.0%), and had a greater proportion of their physician encounters through email (10.0% vs. 4.0%) and social media (15.2% vs. 1.8%). More Omani patients brought information from the Internet than German patients (13.5% vs. 6.0%). Patients from both countries were generally positive about bringing material from the Internet to the consultation. Discussion and conclusion Both sites indicated typical e-patient activity and attitudes as described in the literature. Age and type of condition (chronic vs. acute) may explain the differences to some extent, but this was not consistent. Socio-cultural differences between the two countries may have a great influence on the usage. Although both sites indicated typical e-patient activity and attitudes, the Omanis had greater use than the Germans. This was evident in overall Internet use for health-related activities and for social media interaction with their surgeons. All were positive about bringing Internet material to consultations, potentially impacting on doctor-patient relationships.
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Affiliation(s)
- Ken Masters
- Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Teresa Loda
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Corresponding author. Department of Psychosomatic medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany.
| | - Rashid Al-Abri
- Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Jonas Johannink
- Department of Surgery and Transplantation, University Hospital Tübingen, Tübingen, Germany
| | - Anne Herrmann-Werner
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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