Patient decision making in the face of conflicting medication information

A comparison of adult-child and spousal cancer caregivers' participation in medical decisions

BACKGROUND

Family caregivers often play a key role in medical decision-making for patients with cancer. Adult-children account for nearly half of caregivers, but often have less experience with serious illness care and decision-making and face unique relational challenges as the patient's child. Yet little research explores the potentially distinctive decision-making, involvement in decisions, and support needs of adult-child caregivers.

METHODS

Analysis of survey data of U.S. cancer caregivers conducted by CancerCare® in 2021. Chi-square tests and multivariable regression models assessed whether adult-child and spousal caregivers differed on the type of medical decisions they participated in (e.g., treatment planning, medication management), who made the decision (e.g., caregiver or joint decision), and the resources that informed decisions (e.g., friends and family, education materials).

RESULTS

Adult-children (N = 892) were less likely than spouses (N = 314) to participate in treatment planning (beta = -0.41; 95%CI = -0.81,-0.01), but more likely to be involved in decisions about whether to challenge medical authority (e.g., seeking alternative treatment, second opinion) (beta = 0.50; 95%CI = 0.22,0.78). Compared to spouses, adult-children made joint decisions with patients less often (-13.2-percentage points; 95%CI = -19.64,-6.67) and acted as primary decision-maker more frequently (5.60-percentage points; 95%CI = 0.01,10.43). More adult-children than spouses sought help and information regarding decisions from the oncology team (8.42-percentage points; 95%CI = 1.98,14.87) and friends and family (7.91-percentage points; 95%CI = 1.34,14.48).

CONCLUSIONS

How cancer caregivers and patients are related to each other shapes caregivers' medical decision-making. Adult-children's and spouses' probabilities of participating in and influencing decisions differed for certain types of decisions while adult-children were more likely to seek information and social support regarding decisions. These findings highlight the importance of the patient's and caregiver's relationship type in medical decision-making, suggesting that decision support programs may be more effective if they tailor programs by relationship type.

Patient listening on social media for patient-focused drug development: a synthesis of considerations from patients, industry and regulators

Patients, life science industry and regulatory authorities are united in their goal to reduce the disease burden of patients by closing remaining unmet needs. Patients have, however, not always been systematically and consistently involved in the drug development process. Recognizing this gap, regulatory bodies worldwide have initiated patient-focused drug development (PFDD) initiatives to foster a more systematic involvement of patients in the drug development process and to ensure that outcomes measured in clinical trials are truly relevant to patients and represent significant improvements to their quality of life. As a source of real-world evidence (RWE), social media has been consistently shown to capture the first-hand, spontaneous and unfiltered disease and treatment experience of patients and is acknowledged as a valid method for generating patient experience data by the Food and Drug Administration (FDA). While social media listening (SML) methods are increasingly applied to many diseases and use cases, a significant piece of uncertainty remains on how evidence derived from social media can be used in the drug development process and how it can impact regulatory decision making, including legal and ethical aspects. In this policy paper, we review the perspectives of three key stakeholder groups on the role of SML in drug development, namely patients, life science companies and regulators. We also carry out a systematic review of current practices and use cases for SML and, in particular, highlight benefits and drawbacks for the use of SML as a way to identify unmet needs of patients. While we find that the stakeholders are strongly aligned regarding the potential of social media for PFDD, we identify key areas in which regulatory guidance is needed to reduce uncertainty regarding the impact of SML as a source of patient experience data that has impact on regulatory decision making.

How do patients with high cardiovascular risk evaluate online health information? A qualitative study

BACKGROUND

People are exposed to variable health information from the Internet, potentially influencing their health decision-making and behaviour. It remains a challenge for people to discern between good- and poor-quality online health information (OHI). This study explored how patients evaluate and determine trust in statin-related OHI in patients with high cardiovascular risk.

METHODS

This qualitative study used vignettes and think-aloud methods. We recruited patients from a primary care clinic who were at least 18 years old, had high cardiovascular risk and had previously sought OHI. Participants were given two statin-related vignettes: Vignette 1 (low-quality information) and Vignette 2 (high-quality information). Participants voiced their thoughts aloud when reading the vignettes and determined the trust level for each vignette using a 5-point Likert scale. This was followed by a semi-structured interview which was audio-recorded and transcribed verbatim. The transcripts were coded and analysed using thematic analysis.

RESULTS

A total of 20 participants were recruited, with age ranging from 38-74 years. Among all the high cardiovascular-risk participants, eight had pre-existing cardiovascular diseases. For Vignette 1 (low-quality information), five participants trusted it while nine participants were unsure of their trust. 17 participants (85%) trusted Vignette 2 (high-quality information). Five themes emerged from the analysis of how patients evaluated OHI: (1) logical content, (2) neutral stance and tone of OHI content, (3) credibility of the information source, (4) consistent with prior knowledge and experience, and (5) corroboration with information from other sources.

CONCLUSION

Patients with high cardiovascular risks focused on the content, source credibility and information consistency when evaluating and determining their trust in statin-related OHI. Doctors should adopt a more personalised approach when discussing statin-related online misinformation with patients by considering their prior knowledge, beliefs and experience of statin use.

Is Coffee the Cause or the Cure? Conflicting Nutrition Messages in Two Decades of Online New York Times' Nutrition News Coverage

Two-thirds of US adults report hearing news stories about diet and health relationships daily or a few times a week. These stories have often been labeled as conflicting. While public opinion suggests conflicting nutrition messages are widespread, there has been limited empirical research to support this belief. This study examined the prevalence of conflicting information in online New York Times' news articles discussing published nutrition research between 1996-2016. It also examined the contextual differences that existed between conflicting studies. The final sample included 375 news articles discussing 416 diet and health relationships (228 distinct relationships). The most popular dietary items discussed were alcoholic beverages (n = 51), vitamin D (n = 26), and B vitamins (n = 23). Over the 20-year study period, 12.7% of the 228 diet and health relationships had conflicting reports. Just under three-fourths of the conflicting reports involved changes in study design, 79% involved changes in study population, and 31% involved changes in industry funding. Conflicting nutrition messages can have negative cognitive and behavioral consequences for individuals. To help effectively address conflicting nutrition news coverage, a multi-pronged approach involving journalists, researchers, and news audiences is needed.

“Negotiating a new normality” - a longitudinal qualitative exploration of the meaning of living with an open surgical wound

Purpose

Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds.

Methods

A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines.

Results

We found that the meaning of living with open surgical wounds is shaped by five subthemes: “enduring healing”, “life disruption”, “adapting to a new reality”, “striving for healing” and “returning to normal life;” all under an overarching theme of “negotiating a new normality”.

Conclusion

Participants’ well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical “chronicity” trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals’ experience of living with open surgical wounds.

Vitamin D in the news: A call for clear public health messaging during Covid-19

Background: The public are increasingly reliant on the internet and media to access healthcare related information during the Covid-19 pandemic. Vitamin D is essential for musculoskeletal and immune health, with daily supplementation advised by public health bodies. Several studies assessing a possible link between vitamin D and Covid-19 severity have arrived at conflicting results and news articles have been rapidly disseminating such research to the public. There has been little focus on studying the quality of information available. Aim: To identify if online search interest in vitamin D increased with pandemic burden and analyse the accuracy of public health messaging relating to vitamin D in online news articles. Methods: Online search interest data for vitamin D was correlated with pandemic burden, defined as the number of Covid-19 deaths. Online news articles discussing vitamin D and Covid-19 were analysed using qualitative coding. Results: Online search interest for vitamin D increased as pandemic burden increased (p < 0.0001, Spearman's rank). Of the 72 articles identified, most (50%) offered a mixed opinion on the benefit of vitamin D in Covid-19. From articles making a recommendation for vitamin D supplementation, 23% of articles gave mixed messaging or advised against supplementation. 16% of articles recommended a dose which exceeded the safe limit of 4000 IU/day, risking toxicity. Conclusion: A significant number of articles provided mixed messaging or incorrectly advised supratherapeutic doses. This study highlights an opportunity for public health bodies to utilise the increased interest in vitamin D during the pandemic to raise awareness with accurate information.

Attitudes of Australians with inflammatory arthritis to biologic therapy and biosimilars

OBJECTIVES

To investigate the knowledge and beliefs of Australian patients with inflammatory arthritis regarding biologic/targeted synthetic DMARDs (b/tsDMARDs) and biosimilars and their sources of information.

METHODS

Participants enrolled in the Australian Rheumatology Association Database (ARAD) with RA, PsA and axial SpA were sent an online survey. They were asked about information sources for b/tsDMARDs and how positive or negative this information was. The Beliefs about Medicine Questionnaire (BMQ) was used to measure beliefs about b/tsDMARDs with scores ranging from 1 (strongly disagree) to 5 (strongly agree). Participants were asked about their knowledge of biosimilars and willingness to switch to biosimilar.

RESULTS

There was a response rate of 66% (994/1498; 67% female, median age 62 years). Participants currently taking b/tsDMARDs (n = 794) had a high b/tsDMARD-specific BMQ 'necessity' score {median 4.2 [interquartile range (IQR) 3.6-4.8]}, with a lower specific 'concerns' score [median 2.4 (IQR 2.0- 3.0)]. Participants consulted multiple information sources [median 3 (IQR 2-5)]. Positive sources were rheumatologists and educational websites and negative were chat rooms and social media. Only 18% were familiar with biosimilars, with half knowing of availability in Australia. Following a short paragraph describing biosimilars, 75% (744) of participants indicated they would consider switching if recommended by their rheumatologist, with nearly half identifying safety and efficacy of biosimilars as an important concern.

CONCLUSION

Australian patients have positive attitudes towards b/tsDMARDs overall, although little knowledge of biosimilars specifically. They have a high degree of trust in their rheumatologist regarding treatment decisions, even if they are unfamiliar with the medication recommended.

Patients' perceptions of conflicting information on chronic medications: a prospective survey in Switzerland

OBJECTIVE

The number of patients with chronic diseases and subsequent visits to various healthcare professionals has been rising over the past decades, exposing patients to potential risks of receiving conflicting medication information. This study aims to investigate the prevalence of conflicting information on medications perceived by chronic patients in Switzerland and to understand its impact on patients' medication self-management and navigation in the healthcare system.

PARTICIPANTS

This cross-sectional study included adult patients taking at least one prescribed medication for at least 6 months, who had visited at least two physicians in the past 3 months.

MAIN OUTCOME MEASURES

Data on patients' perceptions of conflicting information were collected in person through a 17-item questionnaire available on paper and electronically with four domains: (1) whether the patient had perceived any conflicting information, (2) categories of conflicting information, (3) impact and (4) sources involved in the conflicting information.

RESULTS

Of the 405 included patients, 47% perceived conflicting information related to one or more medication topics including indication, schedule, dosage, risk, severity or duration of side effects. Patients who perceived conflicting information were prescribed more drugs than those perceiving no conflicting information (p&lt;0.01). Consequently, 65% of the participants modified their navigation of the healthcare system and 34% reported medication non-adherence. General practitioners (82%), specialist physicians (74%) and pharmacists (49%) were the healthcare professionals most often involved in conflicting information. Experience with the medication, its package insert and significant others were more frequently involved in conflicting information than internet or social media.

CONCLUSION

Nearly half the patients in our study perceived conflicting information in the outpatient healthcare system, which can decrease medication effectiveness and pose safety issues. This issue is widely overlooked and unaddressed. Consistency of information among healthcare providers in partnership with patients should be reinforced through guidelines and new models of interprofessional care.

A systematic integrative review of cognitive biases in consumer health information seeking: emerging perspective of behavioral information research

Purpose

With the growing interest in behavioral health and medical decision-making, this systematic integrative review aims to understand research on cognitive biases in the context of consumer health information seeking and where future research opportunities may reside.

Design/methodology/approach

Following a systematic review protocol, 40 empirical research articles, out of 1,127 journal research papers from 12 academic databases, from 1995 to 2019, are included for review.

Findings

The study of cognitive biases in consumer health information seeking is a nascent and fast-growing phenomenon, with variety in publication venues and research methods. Among the 16 biases investigated, optimistic bias and confirmation bias have attracted most attention (46.9%). Researchers are most interested in specific disease/illness (35%) and the health factors of consumer products (17.5%). For theoretical presence, about one-third of the reviewed articles have cited behavioral economist Daniel Kahneman, although most of the references are the early works of Kahneman.

Research limitations/implications

As an emerging research area, there exists plenty of cognitive biases to be investigated in the context of health information seeking. In the meantime, the adoption of more recent theoretical insights such as nudge for debiasing may enrich this research area. Health communication scientists may find incorporating the behavioral decision research framework enriches the disciplinary inquiry of health information seeking, while information scientists could use it to commence the cognitive turn of information science evolution.

Originality/value

Through evidence-based understanding, this review shows the potential research directions that health communication scientists and information scientists could contribute to optimize health decisions through the adoption of behavioral decision research framework.

Patients' Online Information-Seeking Behavior Throughout Treatment: The Impact on Medication Beliefs and Medication Adherence

Research on the longitudinal impact of using the internet as an information source on patients' beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients' online information seeking behavior is particular relevant in affecting patients' beliefs and medication adherence.

Characteristics of self-management among patients with complex health needs: a thematic analysis review

OBJECTIVE

There is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs.

DESIGN

Thematic analysis review of the literature.

METHODS

We developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000-October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al.

RESULTS

Twenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills.

CONCLUSIONS

This review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.

Investigating the Role of Communication for Information Seekers' Trust-Related Evaluations of Health Videos on the Web: Content Analysis, Survey Data, and Experiment

Background

According to the language expectancy theory and the communication accommodation theory, health information seekers’ trust evaluations of Web-based videos are determined by interplays between content and seekers’ expectations on vloggers’ appropriate language use in specific contexts of Web-based communication.

Objectives

Two investigations focused on differences both between vloggers’ language styles and between users’ general trust in specific Web-based platforms to investigate how the context of Web-based communication can be characterized (research question, RQ1). Thereafter, we investigated whether information uncertainty, vloggers’ language style, and context of Web-based communication affect seekers’ trust evaluations of videos (RQ2).

Methods

With a content analysis of 36 health videos from YouTube and Vimeo, we examined the extent of trust-related linguistic characteristics (ie, first-person and second-person pronouns). Additionally, we surveyed participants (n=151) on their trust in YouTube and Moodle (academic Web-based platform; RQ1). In an experiment, further participants (n=124) watched a video about nutrition myths and were asked to evaluate the information credibility, vloggers’ trustworthiness, and accommodation of language by vloggers (RQ2). Following a 3 × 2 × 2 mixed design, vloggers’ explanations contained unambiguous (confirming or disconfirming) or ambiguous (neither confirming nor disconfirming) evidence on the myths (within factor). Furthermore, vloggers used YouTube-typical language (many first-person pronouns) or formal language (no first-person pronouns), and videos were presented on YouTube or Moodle (between factors).

Results

The content analysis revealed that videos on YouTube contained more first-person pronouns than on Vimeo (F_1,35=4.64; P=.04; η_p²=0.12), but no more second-person pronouns (F_1,35=1.23; P=.23). Furthermore, when asked about their trust in YouTube or Moodle, participants trusted YouTube more than Moodle (t₁₅₀≤−9.63; all P ≤.001). In the experiment, participants evaluated information to be more credible when information contained unambiguous rather than ambiguous evidence (F_2,116=9.109; P<.001; η_p²=0.14). Unexpectedly, information credibility did not depend on vloggers’ language style or the video platform (F_1,117≤2.40; P ≥.06). Likewise, video’s platform did not affect participants’ evaluations of vloggers’trustworthiness (F_1,117<0.18; P>.34). However, participants judged vloggers who used a YouTube-typical language as being more benevolent, and their language use as being more appropriate in both video platforms (F_1,117≥3.41; P ≤.03; η_p²≥0.028). Moreover, participants rated the YouTube-typical (vs formal) language as more appropriate for Moodle, but they did not rate one or the other language style as more appropriate for YouTube (F_1,117=5.40; P=.01; η_p²=0.04).

Conclusions

This study shows that among specific Web-based contexts, users’ typical language use can differ, as can their trust-related evaluations. In addition, health information seekers seem to be affected by providers’ language styles in ways that depend on the Web-based communication context. Accordingly, further investigations that would identify concrete interplays between language style and communication context might help providers to understand whether additional information would help or hurt seekers’ ability to accurately evaluate information.

Conflicting health information: a critical research need

Conflicting health information is increasing in amount and visibility, as evidenced most recently by the controversy surrounding the risks and benefits of childhood vaccinations. The mechanisms through which conflicting information affects individuals are poorly understood; thus, we are unprepared to help people process conflicting information when making important health decisions. In this viewpoint article, we describe this problem, summarize insights from the existing literature on the prevalence and effects of conflicting health information, and identify important knowledge gaps. We propose a working definition of conflicting health information and describe a conceptual typology to guide future research in this area. The typology classifies conflicting information according to four fundamental dimensions: the substantive issue under conflict, the number of conflicting sources (multiplicity), the degree of evidence heterogeneity and the degree of temporal inconsistency.

The relationship between partner information-seeking, information-sharing, and patient medication adherence

OBJECTIVES

We describe the medication information-seeking behaviors of arthritis patients' partners and explore whether partner medication information-seeking and information-sharing are associated with patient medication adherence.

METHODS

Arthritis patients and their partners (n = 87 dyads) completed an on-line questionnaire. Partners indicated how often they obtained medication information from 14 sources, how much they trusted these sources, and whether they shared medication information with the patient. Patients reported their medication adherence. Bivariate associations were calculated to explore the relationships between partner information-seeking, information-sharing, and patient medication adherence.

RESULTS

Partners sought little information about the patient's medications. Partners sought more information if the patient's medication regimen was more complex (r = 0.33, p = 0.002). Most partners (∼ 98%) shared medication information with the patient; older partners shared more information with the patient (r = 0.25, p = 0.03). Neither partner information-seeking (r = 0.21, p = 0.06) nor partner information-sharing (r = 0.12, p = 0.31) were significantly associated with patient medication adherence.

CONCLUSIONS

Although partners of arthritis patients do not seek large amounts of medication information, the vast majority share this information with the patient.

PRACTICE IMPLICATIONS

Involving partners in medical consultations can help them better understand the patient's medications, have questions answered by providers, and engage in more informed discussions with patients about their medications.

Outcomes of HIV-infected patients receiving care at multiple clinics

Receiving care at multiple clinics may compromise the therapeutic patient-provider alliance and adversely affect the treatment of people living with HIV. We evaluated 12,759 HIV-infected adults in Philadelphia, PA between 2008 and 2010 to determine the effects of using multiple clinics for primary HIV care. Using generalized estimating equations with logistic regression, we examined the relationship between receiving care at multiple clinics (≥ 1 visit to two or more clinics during a calendar year) and two outcomes: (1) use of ART and (2) HIV viral load ≤ 200 copies/mL for patients on ART. Overall, 986 patients (8 %) received care at multiple clinics. The likelihood of attending multiple clinics was greater for younger patients, women, blacks, persons with public insurance, and for individuals in their first year of care. Adjusting for sociodemographic factors, patients receiving care at multiple clinics were less likely to use ART (AOR = 0.62, 95 % CI 0.55-0.71) and achieve HIV viral suppression (AOR = 0.78, 95 % CI 0.66-0.94) than individuals using one clinic. Qualitative data are needed to understand the reasons for visiting multiple clinics.

Barriers to health information seeking in Iranian patients with cardiovascular disease: a qualitative study

OBJECTIVE

Providing patients with health care information is a critical component of the process of cardiovascular disease (CVD) management. The purpose of this study was to explore obstacles to seeking health care information among cardiovascular patients from the perspectives of patients, their family caregivers, and health care providers.

METHODS

This study was conducted with a qualitative approach using conventional qualitative content analysis. The study included 31 Iranian participants including 16 cardiovascular patients, 5 family members, and 10 health care providers (multidisciplinary). Data were collected with semi-structured interviews and continued to the point of data saturation. Analysis of the data was performed continually and concurrently with data collection of using a comparative method.

RESULTS

Five themes emerged including 'poor quality of information provision,' 'mutual ambiguity,' 'beliefs, faith, and expectations,' 'from routine life to obtaining information,' and 'conditions governing information seekers.' Seven sub-themes indicated participants' experiences and understandings of obstacles in health care information seeking.

CONCLUSION

Health care information seeking in cardiovascular patients and their family members occurs as a result of the influence of beliefs, interaction with numerous information sources, and in the context and structure that the care and information are provided. Understanding the nature of obstacles to health information seeking will help health care policy makers to provide evidence-based, reliable, and patient-centered information to encourage cardiovascular patients' involvement in treatment decisions.

Conflicting medication information: prevalence, sources, and relationship to medication adherence

Conflicting medication information has been defined as contradictory information about a medication topic from two or more sources. The objective of this study was to determine whether arthritis patients are exposed to conflicting medication information, to document sources of conflicting information, and to explore whether conflicting information is associated with sociodemographic factors, clinical characteristics, and medication adherence. Using an online survey, arthritis patients (N = 328) reported how often they received conflicting information about 12 medication topics as well as sources of conflicting information, demographic/clinical characteristics, and medication adherence. A linear regression model, which controlled for various demographic/clinical factors, determined whether conflicting information was associated with medication adherence. The majority of patients (80.1%) received conflicting information and were most likely to receive conflicting information about medication risks. Physicians, media sources, and the Internet were the most common sources of conflicting information. Less conflicting information (B =-0.13, p < .05), more information source use (B = 0.22, p < .01), and lower perceived regimen complexity (B =-0.17, p < .05) were associated with better medication adherence. In conclusion, conflicting medication information is pervasive, comes from a variety of sources, and may negatively affect patient health outcomes. To potentially decrease exposure to conflicting information, providers should direct patients to high-quality medication information sources.

Patient decision making in the face of conflicting medication information

When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources.