Information needs and sources of information for patients during cancer follow-up

The role of diet in cancer: the potential of shaping public policy and clinical outcomes in the UK

Cancer universally represents one of the largest public health concerns, substantially contributing to global disease burden and mortality. The multifaceted interplay of environmental and genetic factors in the disease aetiology and progression has required comprehensive research to elucidate modifiable elements which can reduce the risk of incidence and improve prognosis. Among these factors, diet and nutrition have emerged as the most fundamental with a significant potential for influence and effect. Nutrition is not only an essential part of human survival, but also a vital determinant of overall health. Certain dietary requirements are necessary to support normal physiology. This includes individualised levels of macronutrients (proteins, carbohydrates and fats) and specific micronutrients (vitamins and minerals). Extensive research has demonstrated that diet plays a role in cancer pathogenesis at the genetic, epigenetic and cellular level. Therefore, its potential as a modifiable determinant of cancer pathogenesis for the purpose of prevention and improving management of disease must be further explored and implemented. The ability to influence cancer incidence and outcomes through dietary changes is underutilised in clinical practice and insufficiently recognised among the general public, healthcare professionals and policy-makers. Dietary changes offer the opportunity for autonomy and control over individuals health outcomes. Research has revealed that particular dietary components, as well as cultural behaviours and epidemiological patterns may act as causative or protective factors in cancer development. This review aims to comprehensively synthesise this research to further explore how to best utilise this knowledge within the community and clinical environment for more effective cancer prevention and therapeutic strategies. The identified key areas for improvement include the development of more specific, widely accepted guidelines, promoting increased involvement of dieticians within cancer multidisciplinary teams, enhancing nutritional education for healthcare professionals and exploring the potential implementation of personalised nutrition tools. A greater understanding of the complex interactions between diet and cancer will facilitate informed clinical interventions and public health policies to reduce global cancer burden and improve care for cancer patients and survivors.

Assessment of the Quality of Patient-Oriented Internet Information on Fluorescence Imaging in Surgery

BACKGROUND

In the digital age, patients are increasingly turning to the Internet to seek medical information to aid in their decision-making process before undergoing medical treatments. Fluorescence imaging is an emerging technological tool that holds promise in enhancing intra-operative decision-making during surgical procedures. This study aims to evaluate the quality of patient information available online regarding fluorescence imaging in surgery and assesses whether it adequately supports informed decision-making.

METHOD

The term "patient information on fluorescence imaging in surgery" was searched on Google. The websites that fulfilled the inclusion criteria were assessed using 2 scoring instruments. DISCERN was used to evaluate the reliability of consumer health information. QUEST was used to assess authorship, tone, conflict of interest and complementarity.

RESULTS

Out of the 50 websites identified from the initial search, 10 fulfilled the inclusion criteria. Only two of these websites were updated in the last two years. The definition of fluorescence imaging was stated in only 50% of the websites. Although all websites mentioned the benefits of fluorescence imaging, none mentioned potential risks. Assessment by DISCERN showed that 30% of the websites were rated low and 70% were rated moderate. With QUEST, the websites demonstrated an average score of 62.5%.

CONCLUSION

This study highlights the importance of providing patients with accurate and balanced information about medical technologies and procedures they may undergo. Fluorescence imaging in surgery is a promising technology that can potentially improve surgical outcomes. However, patients need to be well-informed about its benefits and limitations in order to make informed decisions about their healthcare.

Comparative analysis of treatment decision-making in patients with localized prostate and cervical cancer: what influences receiving surgery or radiotherapy?

PURPOSE

This study focused on identifying the factors influencing the decision-making process in patients with localized prostate and cervical cancer in Japan and specifically examining the choice between surgery and radiotherapy.

METHODS

Patients with specific cancer stages registered with a healthcare research company for whom radical surgery or radiotherapy was equally effective and recommended participated in this cross-sectional online survey.

RESULTS

The responses of 206 and 231 patients with prostate and cervical cancer, respectively, revealed that both groups relied heavily on the physicians' recommendations (prostate: odds ratio (OR) = 40.3, p < 0.001; cervical: OR = 5.59, p < 0.001) and their impression of radiotherapy (prostate: OR = 9.22, p < 0.001; cervical: OR = 2.31, p < 0.001). Factors such as hypertension (OR = 6.48, p < 0.05), diabetes mellitus (OR = 9.68, p < 0.05), employment status (OR = 0.08, p < 0.01), and impressions of surgery (OR = 0.14, p < 0.01) also played a significant role in patients with prostate cancer. In contrast, the specialty of the physician (OR = 4.55, p < 0.05) proposing the treatment influenced the decision-making process of patients with cervical cancer. Information sources varied between the two groups: patients with prostate cancer were more inclined towards printed materials, whereas patients with cervical cancer were more inclined towards interpersonal relationships.

CONCLUSION

Although several limitations, such as the sample and recall bias, were noted, this study emphasizes the role of psychosocial factors in the decision-making process and the requirement for tailored information sources.

Ostomy Information on the Internet-Is It Good Enough?

PURPOSE

The aim of this study was to determine which internet search engines and keywords patients with ostomies utilize, to identify the common websites using these terms, to determine what aspects of information they wanted, and to perform a quality and readability assessment for these websites.

DESIGN

A cross-sectional survey of persons with ostomies to identify search engines and terms, followed by a structured assessment of the quality and readability of the identified web pages.

SUBJECT AND SETTINGS

The sample comprised 20 hospitalized patients with ostomies cared for on a colorectal surgical ward of a tertiary care hospital located in Melbourne, Australia. There were 15 (75%) adult males and 5 (25%) adult females; their mean age was 52.2 years. Participants were surveyed between August and December 2020.

METHODS

Patients with newly formed ostomies were surveyed about which search engines and keywords they would use to look for information and for which questions regarding ostomies they wanted answers. In addition, 2 researchers then performed independent searches using the search terms identified by patient participants. These searches were conducted in August 2021, with the geographical location set to Australia. The quality of the websites was graded using the DISCERN, Ensuring Quality Information for Patients, and Quality Evaluation Scoring Tool scoring assessments, and their readability was graded using the Flesch Reading Ease Score tool.

RESULTS

Participants used Google as their primary search engine. Four keywords/phrases were identified: stoma for bowel surgery, ileostomy, colostomy, and caring for stoma. Multiple web pages were identified, 8 (21%) originated from Australia, 7 (18%) were from the United Kingdom, and 23 (61%) were from the United States. Most web pages lacked recent updates; only 18% had been undated within the last 12 months. The overall quality of the online information on ostomies was moderate with an average level of readability, deemed suitable for patient educational purposes.

CONCLUSIONS

Information for persons living with an ostomy can be obtained from multiple web pages, and many sites have reasonable quality and are written at a suitable level. Unfortunately, these websites are rarely up-to-date and may contain advice that may not be applicable to individual patients.

Patient evaluation of gynaecological information provision and preferences

AIM

To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access.

DESIGN

A descriptive cross-sectional survey design was used.

METHODS

A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data.

RESULTS

Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information.

CONCLUSION

Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information.

IMPACT

This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions.

REPORTING METHOD

The STROBE reporting method was used in the preparation of the manuscript.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Assessment of the quality of online patient-oriented information on robotic colorectal surgery

With advances in modern medicine, there is a constant need for accurate and up-to-date readily available information online to ensure patients are well-equipped for informed decision making. This study sets out to analyze websites that provide patient-centered information on robotic colorectal surgery. Three search engines (Google, Yahoo and Firefox) were used with search terms 'robotic colorectal surgery' and the first 20 results on each platform assessed. After screening sites using predetermined criteria, further analysis was performed with the DISCERN questionnaire and Cohen Kappa analysis. Out of the 60 websites identified from the initial search, only 14 websites contained patient information on robotic colorectal surgery. Of these, only three (21%) sites had been updated in the past year and one site was last updated 10 years ago. Ten (71%) websites were affiliated with hospitals and the majority (12, 86%) were based in the United States of America (USA). Approximately half of the websites explored alternative surgical techniques, only three (21%) discussed the risks, a similar number had details on post-operative experience, and none mentioned cost implications, ongoing research or the waiting list involved. Overall, no website had a perfect score of 5 to be classified as good or excellent. There was at least a fair level of agreement (reliability score of > 0.2) in 12 DISCERN criteria (80%), 4 of which were statistically significant. Despite the huge volume of generic information on colorectal surgery, there is still a paucity of comprehensive patient-centered information on robotics as a modality of treatment.

Predictors of information needs among women with breast cancer receiving adjuvant therapy at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia: a cross-sectional study

BACKGROUND

Women undergoing adjuvant therapy for breast cancer have diverse information needs that remain unfulfilled. Extensive research has shown that access to relevant information about their condition can significantly enhance the quality of life for these women, making it an essential part of cancer care. However, various clinical and socioeconomic factors influence the information needs of these women. Hence, the primary aim of this study is to identify predictors of the information needs of women undergoing adjuvant therapy for breast cancer. In addition, this study will also describe the preferred sources of information and the optimal timing for its acquisition.

METHODS

A facility-based cross-sectional study was undertaken at Tikur Anbessa Specialty Hospital, enlisting a cohort comprising 121 women undergoing adjuvant therapy for breast cancer. Trained interviewers administered an Amharic-translated Toronto information needs questionnaire specifically designed for breast cancer to assess the information needs of the study participants Statistical analysis was executed using the sophisticated software SPSS (version 25). Descriptive statistics were employed to summarize the variables of the study. A linear regression analyses was then carried out to identify notable predictors that significantly influenced the information needs of the women.

RESULTS

The total mean score for overall information needs in the current study was 194.30 (± 28.01), with a range scale of 142-260 and a standardized mean score of 3.74 (± 0.54). The disease and treatment domains had the highest information needs, with standardized mean scores (standard deviation) of 4.00 (± 0.54) and 3.77 (± 0.59), respectively. 95% of the participants sought information from healthcare professionals, and 67.7% of the women needed the information before beginning the treatments. Predictors of information needs were following a single treatment option (β = 12.68; 95% CI (0.68, 24.68); P = 0.039) and joining higher education and above (β = 17.1; 95% CI (1.47, 34.14); P = 0.033).

CONCLUSION

The women exhibited a substantial demand for information. Healthcare professionals need to consider the women's educational background and treatment status while delivering the needed information.

Profiling Cancer Patients Based on Their Motives for Seeking Informational and Emotional Support Online

Understanding why patients seek informational and/or emotional support online is fundamental to providing patients with accurate and reliable support that is tailored to their needs, preferences, and personal situation. Based on the stress and coping theory and uses and gratifications theory (UGT), this study aimed to identify theoretically-founded profiles of cancer patients differing in their motives for seeking informational and/or emotional support online, and to compare the profiles in terms of patients' psychological and background characteristics, and perception of health care services. Hierarchical cluster analysis was conducted, using questionnaire data from patients visiting a large Dutch health website (N = 181). This revealed three distinctive profiles, i.e., overall seekers (n = 83, 46.0%), occasional information seekers (n = 83, 46.0%), and contact exchangers (n = 15, 8.0%). Patients across these profiles differed in their eHealth literacy, with the contact exchangers being more eHealth literate than the overall seekers and occasional information seekers. The results can be used to create awareness among health care providers, web designers, and patient organizations on different types of cancer patients with different motives for seeking informational and/or emotional support online, and help them to tailor recommendations to and development of (online) sources that fit patients' needs. Future research could further investigate the integration of stress and coping theory with UGT by acknowledging the interplay of different coping strategies and different gratifications.

The health information technology preferences and perceptions of newly diagnosed patients with cancer

BACKGROUND & GOALS

Patients with new cancer diagnoses have unique needs. In this study, we explored the technological needs and preferences of new cancer patients and the challenges to technology use among these patients.

METHODS

We used qualitative data from semi-structured interviews to identify the new cancer patients' technology preferences. Interviews were recorded and then transcribed verbatim. A thematic analysis was conducted to identify the technology perceptions of new cancer patients, their technology needs, and the challenges of technology.

RESULTS

Most of the patients preferred mhealth technologies over other types of technologies to be used in their care management. The primary needs related to potential features in these technologies include access to information just in time, convenience, access to home care, self-management, privacy, interaction, and personalization. Patients also reported challenges of current technologies they utilized, including usability, impersonality, interoperability, and cost-effectiveness.

CONCLUSION

Addressing patients' needs to increase uptake and efficient use of technologies in cancer care is critical. Growing clinical and consumer informatics technologies can potentially help cancer management if designed by employing user-centered approaches.

Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study

PURPOSE

This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1).

METHODS

This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients.

RESULTS

A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004).

CONCLUSION

The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.

Needs and preferences of breast cancer survivors regarding outcome-based shared decision-making about personalised post-treatment surveillance

PURPOSE

In this study, we explored how patients experience current information provision and decision-making about post-treatment surveillance after breast cancer. Furthermore, we assessed patients' perspectives regarding less intensive surveillance in case of a low risk of recurrence.

METHODS

We conducted semi-structured interviews with 22 women in the post-treatment surveillance trajectory in seven Dutch teaching hospitals.

RESULTS

Although the majority of participants indicated a desire for shared decision-making (SDM) about post-treatment surveillance, participants experienced no SDM. Information provision was often suboptimal and unstructured. Participants were open for using risk information in decision-making, but hesitant towards less intensive surveillance. Perceived advantages of less intensive surveillance were: less distressing moments, leaving the patient role behind, and lower burden. Disadvantages were: fewer moments for reassurance, fear of missing recurrences, and a higher threshold for aftercare for side effects.

CONCLUSIONS

SDM about post-treatment surveillance is desirable. Although women are hesitant about less intensive surveillance, they are open to the use of personalised risk assessment for recurrences in decision-making about surveillance.

IMPLICATIONS FOR CANCER SURVIVORS

To facilitate SDM about post-treatment surveillance, the timing and content of information provision should be improved. Risk information should be provided in an accessible and understandable way. Moreover, fear of cancer recurrence and other personal considerations should be addressed in the process of SDM.

A nurse versus a chatbot ‒ the effect of an empowerment program on chemotherapy-related side effects and the self-care behaviors of women living with breast Cancer: a randomized controlled trial

BACKGROUND

The high levels of unmet needs in relation to provision of self-care information reported by women living with breast cancer suggests that pre-chemotherapy education is suboptimal. Chatbots are emerging as a promising platform to provide education to patients helping them self-manage their symptoms at home. However, evidence from empirical studies on the effect of chatbots education on women living with breast cancer self-care behaviors and symptoms management are scarce.

METHODS

This three-arm randomized controlled trial was performed in a chemotherapy day care center within an oncology center in Egypt. A total of 150 women living with breast cancer were randomly selected and randomized into three groups: the ChemoFreeBot group (n = 50), the nurse-led education group (n = 50), and the routine care group (n = 50). In the ChemoFreeBot group, women were given a link to interact with ChemoFreeBot and ask questions about their symptoms and self-care interventions by typing questions or keywords at any time. On the same day as their first day of chemotherapy, the nurse-led education group received face to face teaching sessions from the researcher (nurse) about side effects and self-care interventions. The routine care group received general knowledge during their chemotherapy session about self-care interventions. The self-care behaviors effectiveness and the frequency, severity and distress of chemotherapy side effects were measured at baseline and postintervention for the three groups. The ChemoFreeBot's usability was assessed.

RESULTS

The mixed design repeated measures ANOVA analyses revealed a statistically significant both group effect and interaction effect of group*time, indicating a significant difference between the three groups in terms of the physical symptoms frequency (F = 76.075, p < .001, F = 147, p < .001, respectively), severity (F = 96.440, p < .001, F = 220.462, p < .001), and distress (F = 77.171, p < .001, F = 189.680, p < .001); the psychological symptoms frequency (F = 63.198, p < .001, F = 137.908, p < .001), severity (F = 62.137, p < .001), (F = 136.740, p < .001), and distress (F = 43.003, p < .001, F = 168.057, p < .001), and the effectiveness of self-care behaviors (F = 20.134, p < .001, F = 24.252, p < .001, respectively). The Post hoc analysis with Bonferroni adjustment in showed that women in the ChemoFreeBot group experienced a statistically significant less frequent, less severe and less distressing physical and psychological symptoms and higher effective self-care behaviors than those in the nurse-led education and routine care groups (p > .001).

CONCLUSION

ChemoFreeBot was a useful and cost-effective tool to improve increase self-care behavior and reduce chemotherapy side effects in women living with breast cancer through the provision of personalized education and the improvement of the accessibility to real-time and high-quality information compared to "one size fits all" approach used by nurses to provide the information. ChemoFreeBot can be an empowering tool to assist nurses to educate women with breast cancer and allow women to take an active role in managing their symptom.

TRIAL REGISTRATION

This study was retrospectively registered in the University hospital Medical Information Network (UMIN) Center, Clinical Trials Registry on 26/09/2022; Registration No:R000055389,Trial ID:UMIN000048955.

Evaluation of quality, readability, suitability, and usefulness of online resources available to cancer survivors

PURPOSE

The aim of this study was to evaluate the quality, readability, suitability, and usefulness of resources publicly available to adult cancer survivors (aged 18 +) who have completed primary treatment.

METHODS

Resources were identified in July 2021 through Google. Search completeness was verified using Yahoo, Bing, and MedlinePlus. Retrieved resources were assessed for quality using the DISCERN, readability, suitability using the Suitability Assessment Measure (SAM), and usefulness based on a list of unmet needs and self-management skills derived from the literature. Descriptive analyses were conducted, and a cluster analysis identified the highest-scoring resources.

RESULTS

Forty-five resources were included. The mean DISCERN score was fair at 63.3% (SD 13.7%) with low-rated items being sources, publication date, and risks and mechanisms of treatment. The mean reading grade level was 11.19 (SD 1.61, range 8-16) with only one resource scoring an 8. The mean SAM score was in the adequate range at 48.2% (SD 10.6%), with graphics being the lowest-rated section. On average, included resources addressed 57.7% (SD 27.3%) of the unmet needs and 48.4% (SD 20.9%) of the self-management skills, the least addressed being problem-solving.

CONCLUSION

Quality and suitability were fair, whereas readability exceeded recommended levels. Only one resource had a superior score in both quality and suitability.

IMPLICATIONS FOR CANCER SURVIVORS

The most pressing need is to develop resources for cancer survivors that address their unmet needs and are accessible in terms of literacy. Study findings outline the highest-scoring resources currently available to survivors, families, and clinicians.

Barriers and Facilitators to the Choice of Active Surveillance for Low-Risk Papillary Thyroid Cancer in China: A Qualitative Study Examining Patient Perspectives

Background: Internationally, several clinical practice guidelines recommend active surveillance as a nonsurgical management strategy for select patients with low-risk papillary thyroid carcinoma. However, patient's decision making when choosing active surveillance as a management approach is not well understood. Thus, our aim was to examine the barriers and facilitators to selecting active surveillance among patients with low-risk papillary thyroid carcinoma in China. Methods: Thirty-nine participants diagnosed with low-risk papillary thyroid carcinoma were purposively recruited between July and November 2021 for semistructured interviews; 24 of whom rejected and 15 patients chose "active surveillance" as a management approach in our sample. Inductive content analysis illustrated emerging themes. Audit trails, member checks, and thematic discussions were used to assert rigor. Results: Barriers and facilitators were classified as patient-related, disease-related, and external factors. Patient-related factors included patient's knowledge, attitudes, and emotions. Disease-related factors included the response to having cancer, the constant state of being diseased, and perceived value of the thyroid gland. External factors included the residual effects of surgery, the active surveillance protocol, and physicians' recommendations. Conclusions: Patient's acceptability of the active surveillance as a management approach are complex with many influencing factors. The public acceptance of active surveillance as a disease management approach needs to be improved, through the presentation of active surveillance as an evidence-based and optimized dynamic management strategy. Clinicians must address their patients' psychological struggles when patients choose active surveillance and patients require more attention and supportive intervention.

Health information seeking behaviour and decision making by patients undergoing breast cancer surgery: A qualitative study

BACKGROUND

Information is critical for patients having to decide about the best treatment option, and an in-depth understanding of their information behaviour can help health and information services to improve and facilitate their access to reliable information.

OBJECTIVE

To investigate the health information-seeking behaviour and information sources and their roles in decision making among breast cancer patients in Romania in the context of the surgical treatment.

METHODS

Semi-structured interviews were conducted with 34 patients who were treated surgically for breast cancer at the Bucharest Oncology Institute.

RESULTS

Most participants searched for information independently, before and after the operation, and their information needs evolved during the progression of their disease. The surgeon was regarded as the most trusted source of information. Most patients adopted a paternalistic or a shared approach for decision making.

DISCUSSION

Besides findings consistent with research from other countries, our study also revealed findings in contrast to previous research. None of the interviewed patients made any reference to the library as a source of information even if books were mentioned.

CONCLUSIONS

Health information specialists should develop a detailed guide and online information services to help physicians and other health professionals to provide relevant and reliable health care information to surgical inpatients from Romania.

Assessing the Quality of Online Health Information and Trend Data for Colorectal Malignancies

INTRODUCTION

Patients often refer to the internet to learn about different health conditions. This study aims to assess the landscape of online health information on malignant colorectal conditions, focusing on the popularity, quantity, and quality of internet resources pertaining to these conditions. This information can be used as a guide for surgeons to supplement patient information at the time of surgical evaluation and to help design optimal online health information.

METHODS

The terms "colon cancer," "rectal cancer," "anal cancer," and "colorectal cancer" were searched using the Google search engine. The number of search results or "hits" obtained per search term was recorded and the first 50 websites for each search term were reviewed. Included websites did not have a password requirement, were in English, and were free. Quality assessments were performed using the DISCERN instrument, and mean DISCERN scores were compared using analysis of variance. The popularity of each search term was determined using Google Trends, which generates a relative search volume score.

RESULTS

A total of 431 million hits were obtained for the term "colon cancer," 72.5 million for "rectal cancer," 244 million for "anal cancer," and 194 million for "colorectal cancer." Mean DISCERN scores for reviewed websites ranged between 39.7 and 40.6, and were thus within the "fair" category. There were no significant differences in mean DISCERN scores across search terms (P = 0.5). Colon cancer had the highest relative search volume score (61.8), followed by colorectal cancer (43.4/100), rectal cancer (42.5/100), and anal cancer (41.7/100).

CONCLUSIONS

Although there is a large amount of online information on malignant colorectal conditions, the quality of the available information is inadequate. Clinician guidance to resources aimed at higher quality from guidance of the DISCERN tool may be of value for patient education.

Informational Needs of Surgical Oncology Patients: A Cross-Sectional Patient Survey

INTRODUCTION

Patients newly diagnosed with cancer often seek information prior to being seen by a specialist. Little is known about the type of information desired and the sources used. We asked how patients find information about their new cancer diagnoses to improve information provision.

METHODS

An anonymous seven-question survey was provided to new patients in the surgical and medical oncology clinics at a comprehensive cancer center from February 2021 to June 2021.

RESULTS

Of 503 consecutive patients, 405 (81%) returned surveys; 49% female, 57% aged 51-75 y, and 71% Caucasian. Many (74%) sought information before their visit. Most (57%) relied on prior medical providers and 77% reported them as a trusted source. Nearly 80% of patients used at least one nonvalidated resource; 21% friends and relatives, 20% nongovernment or hospital resources, and 12% social media. Importantly, 23% found conflicting information. Respondents desired information on cancer treatment (58%), alternative therapies (35%), and nutrition and supplements (31%).

CONCLUSIONS

Patients with cancer trust information from medical providers but seek information from a variety of sources that can provide conflicting information. These data support encouraging patients to use validated sources, providing robust organization-based resources, and engaging patients on topics such as alternative therapies and nutrition.

Understanding the Pathway of Cancer Information Seeking: Cancer Information Services as a Supplement to Information from Other Sources

Cancer information services (CISs) can play an important role within the pathway of cancer information seeking, but so far, this role is not well understood. Callers (n = 6,255) who contacted the largest provider of cancer information in Germany participated in a survey in which they reported their information sources, information level, and needs leading to the call. Persons with prior information from a physician (n = 1,507) were compared to people with prior online information (n = 901) and people with prior information from both sources (n = 2,776). Nearly all callers (96.7%) stated prior sources, while physicians and the Internet were the most frequently reported sources. People, who only talked to a doctor before, are more likely to be a patient and in the disease stages during/after the first treatment or with recurrence than prior Internet users. The two groups do not differ in their prior information level but did differ in their information needs. CISs are an important supplement to other sources, while the information repertoire depends on patients' stages during the cancer journey. Specific characteristics and needs of callers with different prior information sources help to individualize the service of CISs and similar providers.

Digital Trends, Digital Literacy, and E-Health Engagement Predictors of Breast and Colorectal Cancer Survivors: A Population-Based Cross-Sectional Survey

Introduction: Advances in information and communication technology (ICT) and post-COVID-19 tectonic changes in healthcare delivery have made it possible for cancer survivors to obtain disease-related information for remote management online rather than through healthcare providers. To comprehend and evaluate health information, digital literacy is crucial. Objectives: This study examined cancer survivors’ information-seeking behaviour, information sources, digital health literacy, and digital trends, as well as potential determinants of e-health information receptivity and online resource use. Methods: A national 30-item cross-sectional survey using a representative random sample of cancer survivors from Jordan’s cancer registry was conducted. Chi-square tests established categorical variable relationships. Using the mean and standard deviation, we calculated the Likert scale’s ordinal data average. A p-value < 0.05 was statistically significant. Logistic regression identified predictors of interest in late-trajectory information acquisition and use of e-health platforms (apps, portals) for cancer self-management. Results: Lower digital literacy and electronic searching were associated with older age and lower income, education, and employment status (p ≤ 0.001). Digital literacy independently predicted m-health app use for remote management and interest in cancer supportive care information. Digitally literate survivors preferred the use of digital platforms (p ≤ 0.001). Information acquisition barriers included “reliability” (26%, n = 25) and “health information trustworthiness” (16.2%, n = 25). Following treatment completion, Internet-seeking behaviour decreased significantly when compared to the early cancer trajectory. Conclusion: Our findings imply that Jordanian cancer survivors’ low digital literacy may hinder information acquisition and technology-enabled cancer care. Digital interventions for cancer survivors should be adaptable to varying levels of digital health literacy. Healthcare policymakers should recognise digital inequities and devise focused initiatives to bridge the digital divide while responding to the urgent need to digitalise cancer care delivery.

Perceived needs and health-related quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study

OBJECTIVES

Women with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL.

DESIGN

Cross-sectional design.

SETTING

Two tertiary level hospitals in Shaanxi Province, China.

PARTICIPANTS

Women newly diagnosed with breast cancer were recruited.

OUTCOME MEASURES

The Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL.

RESULTS

A total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=-0.067, p=0.024) and mental component summary (MCS) (b=-0.185, p&lt;0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c'=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c'=0.194, p&lt;0.001) and perceived needs importance (a=0.458, p&lt;0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=-0.031; 95% CI -0.058 to -0.004) and the relationship between perceived needs satisfaction and MCS (a*b=-0.085; 95% CI -0.138 to -0.043).

CONCLUSION

For women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.

Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women

Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI_95%: 0.336-0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.

The usefulness of YouTube videos on lung cancer

BACKGROUND

The use of social media as a source of health information is increasing, and the usefulness of the content may vary depending on the specific disease. Thus, this study was designed to assess the content, viewer engagement and usefulness of the most viewed YouTube videos on lung cancer.

METHODS

167 videos were reviewed, and 143 met the eligibility criteria. Two authors evaluated the videos separately, and data on views, likes, dislikes and comments were extracted, and data on the source of uploader, duration and content quality were recorded.

RESULTS

89 videos (62%) were classified as useful, 8 (6%) as misleading and 46 (32%) as neither. The misleading videos were significantly more popular in terms of views and likes compared with the useful videos: 845 643 versus 81 700, P = 0.003 and 12 170 versus 415, P < 0.001, respectively.

CONCLUSIONS

This study shows that YouTube videos on lung cancer are popular and that around two-thirds of the videos are useful in terms of patient education. However, the misleading videos are currently attracting higher viewer interaction and might compose a future challenge in terms of the spread of misinformation as the algorithms will prioritize popular videos rather than videos with evidence-based information.

Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study

BACKGROUND

Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied.

OBJECTIVE

The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information-seeking.

METHODS

We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5-derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information-seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods.

RESULTS

A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information-seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use.

CONCLUSIONS

Increased frequency of patient portal use was associated with higher PCC, and an individual's health information-seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.

Internet Information on Oral Cancer Drugs: a Critical Comparison between Website Providers

Cancer patients need access to high-quality information, when making decisions about oral cancer drugs. The internet is often used as a source of information published by highly heterogeneous providers. The objective was to evaluate the quality of website providers supplying online information about oral cancer drugs. One hundred websites were analyzed using content-related and formal criteria, selected from three existing evaluation methods used for cancer websites, for medical information (defined by the German Agency for Quality in Medicine), and for the "fact box" tool. A web search by a patient was simulated to identify websites to evaluate. ANOVA was used to assess information provided by non-profit organizations (governmental and non-governmental), online newspapers, for-profit organizations, and private/unknown providers. Content-related quality differences were found between online newspapers and all other categories, with online newspapers ranking significantly lower than for-profit and non-profit websites. As for formal criteria, for-profit providers scored significantly lower than non-profit providers and online newspapers for the aspect of transparency. Internet information on oral cancer drugs published by non-profit organizations constitutes the best available web-based source of information for cancer patients. Health literacy and e-health literacy should be promoted in the public domain to allow patients to reliably apply web-based information. Certification should be required by law to ensure fulfillment of requirements for data reliability and transparency (authorship and funding) before health professionals recommend websites to cancer patients.

How can we improve information for people affected by cancer? A national survey exploring gaps in current information provision, and challenges with accessing cancer information online

OBJECTIVE

Despite improved recognition regarding the importance and association between provision of high quality information for people affected by cancer and improved outcomes and experiences; gaps and unmet needs are still reported. As oncology health information provision increasingly moves online, understanding how service users experience and manage misinformation is important. Determining patient and carer preferences regarding cancer provision is needed to address outstanding gaps.

METHODS

This study utilised a purpose-built national cross-sectional survey distributed via social media to assess perspectives regarding cancer information in Australia. Quantitative and qualitative (open text) items assessed respondents' perspectives regarding current inforation preferences and gaps, and experiences with accessing information online.

RESULTS

A total of 491 people affected by cancer completed the survey. Respondents highlighted a preference for information that better addresses the diversity of cancer experience, and is more timely and responsive to personal situation and care context. Despite increasing attention to health literacy standards, complex medical jargon and terminology remains prevalent. Many respondents have concerns about misinformation, and seek improved mechanisms or skills to assist with determining the trustworthiness and relevance of information found online.

CONCLUSIONS

Survey responses identified current gaps in information provision for people affected by cancer. Personalised information in formats which are more flexible, accessible, and responsive to user needs are required.

PRACTICE IMPLICATIONS

Education and resources to target and improve digital health literacy and combat health misinformation are needed. Novel solutions co-designed by people affected by cancer will ensure that information is provided in a manner that is relevant, timely, and personalised.

eHealth Literacy in German Skin Cancer Patients

The global incidence of skin cancer has steadily increased in recent years, and malignant melanoma still has one of the fastest-growing incidence rates among all malignant tumors in the western world. Thus, newly diagnosed patients have an increased need for health information concerning their disease. Using a standardized questionnaire, our study aims to investigate our patients’ primary sources of health-related information as well as their self-proclaimed eHealth literacy. We received 714 questionnaires. Regardless of age, the primary source of information was the treating dermato-oncologist, followed by the treating general practitioner and the Internet. However, with increasing age, the usage of the Internet decreased. Hence, younger participants were better equipped to find health-related information while using the Internet. Additionally, comprehending health-related information and gaining medical knowledge was significantly increased in better-educated participants. Overall, our study shows that with increased use of eHealth services, accessing web-based information increased, correlating with a better eHealth literacy of our patients. eHealth technologies are increasingly becoming more prevalent as a primary source of information in our modern health care system. Thus, it is crucial to educate cancer patients in eHealth literacy to make autonomous, informed decisions and gain more confidence in dealing with their disease.

Informational needs and predictors of Jordanian breast and colorectal cancer survivors: a national cross-sectional study

PURPOSE

To investigate the informational gap and predictors of information-seeking behaviour amongst survivors to inform survivorship planning and supportive cancer services for the population.

METHODS

A national cross-sectional survey of breast and colorectal cancer survivors was conducted in 2020 using a representative sample of those diagnosed in 2015/2016 as recruited from Jordan's Cancer Registry (JCR). Participants responded to a 3-domain questionnaire: background information (9 items); information typologies (13 items) measured on a 5-point Likert scale (from very interested to extremely not interested); timing of developing the information needs (13 items) (ranging from immediately after diagnosis to after recurrence). Logistic regression was used to determine the independent association between demographics and information-seeking behaviour amongst survivors. The chi-square test was employed to examine the association between categorical variables. ANOVA was used to compare the means of interest in cancer-related information between more than two groups.

RESULTS

Results show a relatively high overall information needs amongst survivors (3.68 ± 1.53). The most prevalent typologies were cancer staging (3.77 ± 1.593), treatment options (3.76 ± 1.55), and doctors' communications (3.73 ± 1.62). ANOVA revealed no statistically significant differences between cancer types. 55.8% of patients desired information immediately after diagnosis and 23.3% developed their needs within 2 months. There was a statistically significant difference across all information typologies and educational attainment, age groups, monthly income, and employment (P < 0.05). Age was the only independent predictor of high information requirements amongst cancer survivors.

CONCLUSION

Survivors reported high cancer information needs, suggesting that they may have been under-informed. Effective health communication programmes should be implemented to meet the informational needs.

Filling the gaps of patient information needs and information perception in chronic myeloid leukemia with the patient-physician co-produced web-based platform CMyLife

BACKGROUND

For patients with chronic myeloid leukemia, a web-based platform CMyLife was developed. Its aim is to enhance patient empowerment, by adequate information provision, among others. Before evaluating its effect, information provision and needs in current care were assessed.

OBJECTIVE

To assess patients' evaluation of received information and information needs before CMyLife utilization and whether this information source is used correspondingly. Additionally, we explored predicting patient factors in information perception.

PATIENT INVOLVEMENT

CMyLife platform was developed with active patient participation.

METHODS

We conducted a cross-sectional survey among 203 CML patients before launch of the CMyLife platform, using validated questionnaires on information provision and predictive factors. We focused on website utilization during the first 3 years, using Google Analytics. Regression analyses were performed to determine influence of patient factors on information perception.

RESULTS

Global perceived information provision was scored 42.8 (0-100). Information on other services such as rehabilitation and psychological support, and effects of treatment on sexuality showed room for improvement. One out of 3 knew where to find useful health information online. But more information was desired by 36% of them. Age ≥65 years, time since diagnosis and low education were positively associated with this need. Pages on medication and side effects were visited the most.

DISCUSSION

To fill the gap in perceived provision and needs, information should be adjusted more to the individual in content, manner and timing. Age, time since diagnosis, and educational level are of influence in perceived information, and specific needs within these groups should be further explored.

PRACTICAL VALUE

CMyLife provides reliable and up-to-date information for low eHealth literacy skilled patients concerning multiple topics indicated by patients.

Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country

There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.

Clinical characteristics and prognostic factors of 70 patients with Sézary syndrome: a single-institutional experience at Moffitt cancer center

Sézary syndrome (SS) is a rare and aggressive leukemic variant of cutaneous T-cell lymphoma, with a median overall survival (OS) rate of 2-4 years. Few studies have described the clinical outcome of SS patients since 2012. We retrospectively analyzed 70 patients diagnosed with SS treated at a high-volume tertiary cancer center between 2000 and 2018. Overall survival at 1 and 5 years was 84.1% and 50.7%, respectively. Univariate analyses identified older age (>65 years) and male sex as poor prognostic factors. Five patients presented with circulating large granular lymphocytic proliferation and had a favorable prognosis. Targeted therapies were effective in treating refractory/relapsed SS patients with a durable response. Therapeutic advancements and the comprehensive treatments used in a multidisciplinary clinic improved OS rates.

Telemedicine Readiness Across Medical Conditions in a US National Representative Sample of Older Adults

Telemedicine has provided older adults the ability to seek care remotely during the coronavirus disease (COVID-19) pandemic. However, it is unclear how diverse medical conditions play a role in telemedicine uptake. A total of 3379 participants (≥65 years) were interviewed in 2018 as part of the National Health and Aging Trends Study. We assessed telemedicine readiness across multiple medical conditions. Most chronic medical conditions and mood symptoms were significantly associated with telemedicine unreadiness, for physical or technical reasons or both, while cancer, hypertension, and arthritis were significantly associated with telemedicine readiness. Our findings suggest that multiple medical conditions play a substantial role in telemedicine uptake among older adults in the US. Therefore, comorbidities should be taken into consideration when promoting and adopting telemedicine technologies among older adults.

Cancer Survivors: What Are Their Information Seeking Behaviours?

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

Correlates of Information Seeking Behaviors and Experiences Among Adult Cancer Survivors in the USA

Understanding information seeking behaviors and experiences is essential for designing educational and supportive interventions to promote survivor's self-management post treatment. This study examined health and cancer information seeking, use of internet to find cancer information, and information seeking experiences among breast, colorectal, and prostate cancer survivors. Nationally representative data collected in 2017-2018 from 2 cycles of the Health Information National Trends Survey (HINTS 5, cycles 1 and 2 were merged with combined replicate weights using the jackknife replication method (n = 373). Regression analysis for three information seeking behaviors (i.e., health information, cancer information, and internet for cancer information) were modeled, including sociodemographic and clinical factors as predictors. In addition, separate regression analysis predicted three experiences of information seeking (effort, quality, and hard to understand) with sociodemographic and clinical factors. A majority of survivors (84.7%) sought health information. Factors significantly associated with seeking health information were gender (p = 0.024), education (p = 0.0021), and income (p = 0.018). Only 38% of survivors used the internet to seek cancer-related information. The only factor significantly associated with using the internet to seek cancer-related information was time since diagnosis (p = 0.0002). The factor significantly associated with difficulty understanding information was annual household income (p = 0.026). This study fills an important gap by identifying sociodemographic and cancer-related factors associated with information seeking behaviors and experiences. These findings highlight a need to tailor information for low socioeconomic status survivors to account for the lack of skills, resources, and motivation to seek information about health and cancer related topics independently.

Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review

PURPOSE

Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period.

METHODS

We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information.

RESULTS

Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care.

CONCLUSIONS

Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.

A qualitative study of online information-seeking preferences among cancer survivors

Purpose

As the cancer survivor population increases, diminished health care provider capacity will place more responsibility on survivors to obtain health information. Many survivors search for cancer information online, yet there is a dearth of research on how survivors obtain and engage with this information. This study examined cancer survivors’ information-seeking behaviors and perceptions during a self-guided online search task.

Methods

Ten adult cancer survivors (largely breast and thyroid) completed a task in which they searched for online cancer-related information of their choice. Participants were asked to verbally narrate the procedural aspects of the task and provide real-time responses to the search results and experiences related to the task. Transcripts were analyzed using a qualitative descriptive approach, and codes and themes were examined and interpreted.

Results

Participants searched primarily for information specific to their cancer type and stage, seeking personalized information about risk factors, prognosis, and treatments. Additionally, participants reported having to engage in excessive navigation to find relevant cancer information, citing aesthetic, usability, and credibility features of the websites that they considered barriers to obtaining this information.

Conclusions

Survivors’ online health information needs require streamlined cancer information resources that are disaggregated by cancer type, stage, and treatment course and located on websites with aesthetic and usability features that facilitate expedient searches for personally relevant cancer information.

Implications for Cancer Survivors

This study provides useful perspectives of cancer survivors that may inform the development of online cancer resources to better serve this population.

Effect of question prompt lists for cancer patients on communication and mental health outcomes-A systematic review

OBJECTIVE

To provide a systematic review on the effects of question prompt lists (QPL) in oncological settings.

METHODS

A systematic literature search was conducted in Medline, PsycINFO and the Cochrane Collaboration. Randomized controlled studies (RCTs) that evaluated QPL-only interventions were included. Risk of bias of included studies was evaluated using the Cochrane RoB 2 tool. Data concerning effects on communicative processes in patient-physician relationship and psychological outcomes were analyzed.

RESULTS

10 RCTs met the inclusion criteria. Results suggest that QPLs lead to a shift of topics discussed. There were weak indications that QPL interventions increase anxiety shortly before and after consultations, but may decline anxiety during follow-up. Patients consistently perceive QPLs as more helpful than usual information sheets. QPL-only interventions show limited impact on communicative processes and psychological outcomes. They help not to forget or discuss important questions.

CONCLUSION

With a better integration in patient-physician communication QPLs may become a useful tool for patients and physicians. Future research is needed to investigate if there is greater benefit from QPL interventions in specific settings.

PRACTICE IMPLICATIONS

QPLs are an inexpensive tool to influence communicative processes positively in oncological consultations.

Gastrointestinal Disease-Specific Survivorship Care: A New Personalized Model Integrating Onco-Wellness

Although the number of gastrointestinal (GI) cancer survivors is projected to increase in the coming years, there are currently no survivorship care models that address the specific and growing needs of this population. Current survivorship care models were evaluated to assess their suitability for GI cancer survivors. A survivorship care model based on foundational wellness principles is under development to address the specific needs of GI cancer survivors. This model delivers a cohesive and collaborative care continuum for survivors of different GI malignancies. Oncology providers in GI departments and internal medicine providers in survivorship programs are positioned to provide a comprehensive approach for the care of patients treated with curative intent. Survivorship care is introduced at the conclusion of active treatment in the form of an Onco-wellness consultation, an in-person or telemedicine comprehensive care plan creation and review by our Survivorship Program. Personalized care plan including long term and late effects of treatment, nutrition, physical activity and rehabilitation recommendations, prevention of secondary malignancies and psychosocial needs are reviewed. As patients transition from active treatment to survivorship within the GI Program, the GI Advance Practice Professionals (APPs) are well-positioned to deliver comprehensive survivorship care specific to the GI patient’s needs while integrating recommendations and principles from the Onco-wellness consultation. With projected shortages of both oncology and primary care physicians, such an APP-based model has the potential to bridge gaps in the survivorship care continuum and mutually benefit patients and physicians.

Is a Brief Online Booklet Sufficient to Reduce Fear of Cancer Recurrence or Progression in Women With Ovarian Cancer?

Background: Fear of cancer recurrence or progression (FCR/P) is a common challenge experienced by people living with and beyond cancer and is frequently endorsed as the highest unmet psychosocial need amongst survivors. This has prompted many cancer organizations to develop self-help resources for survivors to better manage these fears through psychoeducation, but little is known about whether they help reduce FCR/P.

Method: We recruited 62 women with ovarian cancer. Women reported on their medical history and demographic characteristics and completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF). They then read a booklet on FCR specifically created for Ovarian Cancer Australia by two of the authors (ABS and PB). One week after reading the booklet, 50/62 women (81%) completed the FoP-Q-SF and answered questions about their satisfaction with the booklet.

Results: More than half of the women (35/62; 56.5%) scored in the clinical range for FCR/P at baseline. Of the completers, 93% said that they would recommend the booklet to other women. Satisfaction with the booklet was relatively high (75.3/100) and more than two-thirds of women rated it as moderately helpful or better. However, FCR/P did not change significantly over the week following reading the booklet [t₍₄₉₎ = 1.71, p = 0.09]. There was also no difference in change in FCR/P between women in the clinical vs. non-clinical range on the FoP-Q. Women high in FCR/P rated the booklet as less helpful in managing FCR/P (r = −0.316, p = 0.03), but overall satisfaction with the booklet was not associated with degree of FCR/P (r = −0.24, p = 0.10).

Conclusions: These results suggest that a simple online FCR booklet is acceptable to women with ovarian cancer and they are satisfied with the booklet, but, it was insufficient to change in FCR/P levels. These results suggest that such resources are valued by women with ovarian cancer, but more potent interventions are necessary to reduce FCR in this population.

Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States

Background

In response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends.

Methods

We used Google Trends to query search terms related to cancer types for short-term (September 2019–September 2020) and long-term (September 2016–September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation.

Results

General search interest declined for all cancer types beginning in March 2020, with changes in search interest for “Breast cancer,” “Colorectal cancer,” and “Melanoma” of − 30.6%, − 28.2%, and − 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for “Telemedicine” has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020.

Conclusion

We observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10552-021-01409-1.

Odds of Meeting Cancer Prevention Behavior Recommendations by Health Information Seeking Behavior: a Cross-Sectional HINTS Analysis

People who seek health information frequently may be more likely to meet health behavior goals; however, people use many different information sources. The purpose of this paper is to assess how different sources of health information influence likelihood of meeting cancer prevention behavior guidelines. Logistic regression of cross-sectional data from 6 years of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included first source of health information, gender, age, race, education level, income, cancer history, general health, and data year; dependent variables were fruit and vegetable intake, exercise, smoking, mammography, Pap test, and colon cancer screening. Those who seek health information from doctors, the internet, or publications had higher odds of meeting more cancer prevention guidelines than those who do not seek health information. Those who used healthcare providers as an initial information source had higher odds of meeting diet, cervical, and colon cancer screening recommendations, while using the internet as an initial source of health information was associated with higher odds of meeting diet, smoking, and colon cancer screening recommendations. No health information source was associated with meeting either exercise or mammography recommendations. People should be encouraged to seek health information to help them meet their behavior goals, especially from sources that are more likely to be accurate and encourage cancer prevention behavior. Future research is needed to understand the accuracy of health information and what kinds of health information have positive influences on cancer prevention behavior.

Persistent digital divide in health-related internet use among cancer survivors: findings from the Health Information National Trends Survey, 2003-2018

PURPOSE

Prior research on the use of the internet among cancer survivors indicates a digital divide. The online landscape and patterns of information consumption, however, have notably changed over the past decade necessitating an updated examination of health-related internet use (HRIU) among cancer survivors.

METHODS

Using survey data from 2003, 2005, 2007, 2011, 2013, 2017, and 2018 Health Information National Trends Survey (HINTS) iterations, the objectives of this study were to report prevalence, trends, and user profiles in HRIU in terms of emailing doctors, buying medicine online, and support group participation. Descriptive analyses and weighted multivariate logistic regression analyses were performed.

RESULTS

Cancer survivors who reported not using the internet were more likely to be older, belong to ethnic minorities, be less educated, and reside in rural areas as compared with those who reported using the internet. Except for participation in online support groups, all other types of HRIU increased in prevalence across the years.

CONCLUSIONS

Consistent with the increased penetration of the internet and the altered online health communication landscape, we found increased prevalence of HRIU among cancer survivors. However, the digital divide persists in terms of internet access. These findings can inform initiatives to bridge the gap among survivors of varying profiles in using the internet for their health needs.

IMPLICATIONS FOR CANCER SURVIVORS

There is increased reliance on online platforms to obtain and communicate health-related information. The risk with this approach is potential oversight of ensuring equity in terms of internet access and technology literacy among survivors.

Irish cancer patients and survivors have a positive view of the role of nutritional care in cancer management from diagnosis through survivorship

BACKGROUND

Nutrition is an important aspect of care in the management of cancer at all stages from diagnosis to survivorship. There is currently little data available on the views of those with cancer regarding the importance of nutrition throughout the cancer journey.

AIM

To identify the views of those with cancer regarding the importance of nutrition in ten different situations or cancer stages.

METHODS

A questionnaire containing demographic information and one question utilising a 5-point Likert scale around the importance of nutrition in relation to ten different cancer stages or patient types was circulated through the oncology day wards and outpatient departments in two hospitals in the North West of Ireland. We received 197 complete responses.

RESULTS

Nutritional care was viewed positively with 88.8 to 98.5% agreeing or strongly agreeing that nutritional care is important for everyone independent of their weight or cancer treatment; when you are receiving any form of active treatment for cancer; when you require surgery for cancer; when you require chemotherapy for cancer; when you require radiotherapy for cancer; when you are in the advanced stages of cancer; when you are a cancer survivor; when you have a low body weight; when you have a normal body weight; and when you are overweight.

DISCUSSION

Irish cancer patients and survivors have a positive view of the role of nutritional care in cancer from diagnosis through cancer survivorship. It is important that services are put in place to provide this nutritional care at all stages of cancer.

Information Needs of Breast Cancer Patients Attending Care at Tikur Anbessa Specialized Hospital: A Descriptive Study

PURPOSE

The purpose of this study was to assess the information needs of women with breast cancer attending care at a major hospital in Ethiopia. It also aimed at describing the association of information needs with sociodemographic and clinical variables, preferred sources of information, and time to have it.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted on 375 women with breast cancer at Tikur Anbessa Specialized Hospital. Data were collected by interview and Toronto information needs questionnaire for breast cancer which contains 52 items categorized under five domains was pretested, adopted, and used to address the information needs of patients. One way ANOVA was done to get an association of sociodemographic and clinical variables with information needs. All statistical analysis was performed using STATA (Version 14), and statistical significance was set at P ≤ 0.05.

RESULTS

The total mean score for overall information needs among breast cancer patients was 238.7 (22.5) with a range scale of 156-260. Among the five subscales information on disease and information on treatment were the most highly needed areas with a mean percentage of 94.8 and 93.7, respectively; and 254 (67%) of them preferred the information to come from health professionals. Diagnosing as stage IV (p=0.0005) and urban residence (0.02) was associated with less and high information needs, respectively.

CONCLUSION

The information needs of breast cancer patients were high. Determining what the patient's needs are an important aspect of providing health care especially in cancer care. The healthcare system should include a way of information provision system for breast cancer patients based on their needs.

Nutritional challenges of gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study

PURPOSE

This study aims to explore the perceptions of gastric cancer patients, their family caregivers, physicians, and nurses of nutritional challenges.

METHODS

Using a descriptive qualitative method, this study was conducted in 2019-2020. Twenty participants (6 patients, 6 family caregivers, 3 physicians, and 5 nurses) were selected through purposive sampling. Data was collected through in-depth semi-structured interviews and examined using qualitative content analysis.

RESULTS

Data analysis revealed three categories, each with two subcategories: eating, an unpleasant experience that contains "a feeling like hyperemesis gravidarum" and "childish food excuses"; flexibility while adhering to a proper diet, which consists of "dietary dos and don'ts" and "nutritional leniency"; and nutrition with distress that contains "patient's sense of being an extra burden" and "provision of nutrition with suffering in caregivers."

CONCLUSION

Because of the significant physical and psychological impact of nutritional problems on patients and their caregivers, the need to provide care and education to these patients and their families using a multidisciplinary team is becoming more important.

Development and Validation of the Hospital Outpatients' Information Needs Questionnaire (HOINQ)

PURPOSE

The main objective was to develop and validate a "Hospital Outpatients' Information Needs Questionnaire" (HOINQ). Secondly, to identify patients' preferred sources of information. Finally, to establish differences depending on the disease, as well as between sociodemographic and clinical variables.

PATIENTS AND METHODS

This is a transversal study based on a questionnaire. All adult hospital outpatients' who collected their medication at the Pharmacy Service were consecutively recruited, regardless of their diagnosis time, treatment or disease. The Spanish version of the internationally validated European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC QLQ-25) aimed at oncology patients was used as the starting point. In order to be applicable on new target population, it was crucial to make several changes and ensure that it complies with the validity, viability and reliability criteria. The questionnaire prepared for validation was then obtained by a literature review (face validity), submitting the EORTC QLQ-25 to an expert committee (content validity), by piloting (viability) and Cronbach's alpha statistical analysis (reliability). Once the questionnaire was completed, Cronbach's alpha of the final study (reliability) and factor analysis (construct validity) were performed. Then, pertinent modifications were applied to obtain the HOINQ.

RESULTS

A total of 153 outpatients filled the questionnaire, which was widely accepted and required 5-10 min to complete. Cronbach's alpha coefficients met criteria >0.7. Three factors were established by factor analysis: aspects about the disease, pharmacological and no-pharmacological treatment and satisfaction and perception of the information received. Participants felt satisfied (41-52%) with the information amount, quality and usefulness, although 1 out of 3 stated wanting to know more about the different information areas. Younger patients (P-value <0.05) and those who had been attending the Pharmacy Service for a longer time span (P-value <0.01) reported receiving more information. On a 0 to 7 scale, medical specialists (mean = 6.28, SD = 1.38) followed by the rest of health care professionals (mean = 4.23-4.63, SD = 2.25-2.29) were selected as the preferred sources of information. HIV patients reported being more informed, while those with rheumatoid arthritis felt less informed (P-value <0.05).

CONCLUSION

The HOINQ was developed. It is a self-completed questionnaire, composed of three blocks: the 16-item information needs questionnaire, demographic and clinical variables, and patients' preferred sources of information. It is an easy tool to use and replicate, both for patients and professionals.

Assessing how health information needs of individuals with colorectal cancer are met across the care continuum: an international cross-sectional survey

BACKGROUND

Studies evaluating health information needs in colorectal cancer (CRC) lack specificity in terms of study samples involving patients. We assessed how health information needs of individuals with CRC are met across the care continuum.

METHODS

We administered an international, online based survey. Participants were eligible for the study if they: 1) were 18 years of age or older; 2) received a diagnosis of CRC; and 3) were able to complete the online health survey in English, French, Spanish, or Mandarin. We grouped participants according to treatment status. The survey comprised sections: 1) demographic and cancer characteristics; 2) health information needs; and 3) health status and quality of life. We used multivariable regression models to identify factors associated with having health information needs met and evaluated impacts on health-related outcomes.

RESULTS

We analyzed survey responses from 1041 participants including 258 who were currently undergoing treatment and 783 who had completed treatment. Findings suggest that information needs regarding CRC treatments were largely met. However, we found unmet information needs regarding psychosocial impacts of CRC. This includes work/employment, mental health, sexual activity, and nutrition and diet. We did not identify significant predictors of having met health information needs, however, among participants undergoing treatment, those with colon cancer were more likely to have met health information needs regarding their treatments as compared to those with rectal cancer (0.125, 95% CI, 0.00 to 0.25, p-value = 0.051).

CONCLUSIONS

Our study provides a comprehensive assessment of health information needs among individuals with CRC across the care continuum.

Patients' Convergence of Mass and Interpersonal Communication on an Online Forum: Hybrid Methods Analysis

Background

Patients are increasingly taking an active role in their health. In doing so, they combine both mass and interpersonal media to gratify their cognitive and affective needs (ie, convergence). Owing to methodological challenges when studying convergence, a detailed view of how patients are using different types of media for needs fulfillment is lacking.

Objective

The aim of this study was to obtain insight into the frequency of reported convergence, how convergence affects what posters write online, motives for posting, and the needs posters are trying to fulfill.

Methods

Using a hybrid method of content analysis and supervised machine learning, this study used naturally available data to fill this research gap. We analyzed opening posts (N=1708) of an online forum targeting cancer patients and their relatives (Kanker.nl).

Results

Nearly one-third of the forum opening posts contained signs of convergence in mass or interpersonal media. Posts containing mass media references disclosed less personal information and were more geared toward community enhancement and sharing experiences compared to posts without convergence. Furthermore, compared to posts without signs of convergence, posts that included interpersonal media references disclosed more personal information, and posters were more likely to ask for the experiences of fellow users to fulfill their needs. Within posts containing signs of convergence, posts including interpersonal media references reported fewer shortages of information, disclosed more information about the disease, and were more active in seeking other posters’ experiences compared to posts containing mass media references.

Conclusions

The current study highlights the intertwining of media platforms for patients. The insights of this study can be used to adapt the health care system toward a new type of health information–seeking behavior in which one medium is not trusted to fulfill all needs. Instead, providers should incorporate the intertwinement of sources by providing patients with reliable websites and forums through which they can fulfill their needs.