International medical tourism of US cancer patients for alternative cancer treatments: Financial, demographic, and clinical profiles of online crowdfunding campaigns

BACKGROUND

Previous research has found that individuals may travel outside their home countries in pursuit of alternative cancer therapies (ACT). The goal of this study is to compare individuals in the United States who propose plans for travel abroad for ACT, compared with individuals who seek ACT domestically.

METHODS

Clinical and treatment data were extracted from campaign descriptions of 615 GoFundMe® campaigns fundraising for individuals in the United States seeking ACT between 2011 and 2019. We examined treatment modalities, treatment location, fundraising metrics, and online engagement within campaign profiles. Clinical and demographic differences between those who proposed international travel and those who sought ACT domestically were examined using two-sided Fisher's exact tests. Differences in financial and social engagement data were examined using two-sided Mann-Whitney tests.

RESULTS

Of the total 615 campaigns, 237 (38.5%) mentioned plans to travel internationally for ACT, with the majority (81.9%) pursuing travel to Mexico. Campaigns that proposed international treatment requested more money ($35,000 vs. $22,650, p < 0.001), raised more money ($7833 vs. $5035, p < 0.001), had more donors (57 vs. 45, p = 0.02), and were shared more times (377 vs. 290.5, p = 0.008) compared to campaigns that did not. The median financial shortfall was greater for campaigns pursuing treatments internationally (-$22,640 vs. -$13,436, p < 0.003).

CONCLUSIONS

Campaigns proposing international travel for ACT requested and received more money, were shared more online, and had more donors. However, there was significantly more unmet financial need among this group, highlighting potential financial toxicity on patients and families.

Overcoming Challenges of Online Research: Measures to Ensure Enrollment of Eligible Participants

BACKGROUND

Internet-based surveys are increasingly used for health research because they offer several advantages including greater geographic reach, increased participant anonymity, and reduced financial/time burden. However, there is also a need to address inherent challenges, such as the likelihood of fraudulent responses and greater difficulty in determining eligibility.

METHODS

We conducted an online nationwide survey of 18-29 year olds living with HIV in the United States, to assess willingness to participate in HIV cure research. To ensure that respondents met age and HIV serostatus inclusion criteria, we instituted screening procedures to identify ineligible respondents using tools that were built into the survey platform (eg, reCAPTCHA, geolocation) and required documentation of age and serostatus before providing access to the incentivized study survey.

RESULTS

Of 1308 eligibility surveys, 569 were incomplete or ineligible because of reported age or serostatus. Of the remaining 739 potentially eligible respondents, we determined that 413 were from fraudulent, bot, or ineligible respondents. We sent individual study survey links to 326 participants (25% of all eligibility survey respondents) whose eligibility was reviewed and confirmed by our study team.

CONCLUSION

Our multicomponent strategy was effective for identifying ineligible and fraudulent responses to our eligibility survey, allowing us to send the study survey link only to those whose eligibility we were able to confirm. Our findings suggest that proactive fraud prevention can be built into the screening phase of the study to prevent wasted resources related to data cleaning and unretrievable study incentives and ultimately improve the quality of data.

Challenging encounters in clinical dentistry: a qualitative study investigating online reviews of patient satisfaction with Norwegian dentists

OBJECTIVE

Mapping key themes that characterize challenging and positive encounters in dental practice using online reviews of patient satisfaction.

MATERIALS AND METHODS

11,764 online patient reviews of dental encounters, consisting of an overall satisfaction rating (1-5 stars) and a free-text response, were collected from the web-site Legelisten.no. The reviews were split into two sets: reviews from patients with low satisfaction (1-2 stars) representing challenging encounters vs. patients with high satisfaction (4-5 stars) representing positive encounters. A qualitative thematic analysis was used to analyse the text materials in the datasets.

RESULTS

Five key themes to both challenging and positive patient encounters were identified: (1) Interpersonal factors, (2) Patient factors, (3) Dentist factors, (4) Situational factors, and (5) Consequences. These themes are discussed in light of their role in challenging and positive patient encounters, as well as previous studies of online reviews and patient satisfaction.

CONCLUSIONS

Based on the patients' experiences with dental encounters, challenging encounters seem to arise when dentists' personality traits and communication skills fail to match the patients' expectations or preferences. It appears central to patient satisfaction that dentists are able to shift between different communication styles in order to adapt to the personality and preferences of the patients.

AIM against survey fraud

Objectives

Although there exists a variety of anonymous survey software, this study aimed to develop an improved system that incentivizes responses and proactively detects fraud attempts while maintaining anonymity.

Materials and Methods

The Anonymous Incentive Method (AIM) was designed to utilize a Secure Hash Algorithm, which deterministically assigned anonymous identifiers to respondents. An anonymous raffle system was established to randomly select participants for a reward. Since the system provided participants with their unique identifiers and passwords upon survey completion, participants were able to return to the survey website, input their passwords, and receive their rewards at a later date. As a case study, the validity of this novel approach was assessed in an ongoing study on vaping in high school friendship networks.

Results

AIM successfully assigned irreversible, deterministic identifiers to survey respondents. Additionally, the particular case study used to assess the efficacy of AIM verified the deterministic aspect of the identifiers.

Discussion

Potential limitations, such as scammers changing the entry used to create the identifier, are acknowledged and given practical mitigation protocols. Although AIM exhibits particular usefulness for network studies, it is compatible with a wide range of applications to help preempt survey fraud and expedite study approval.

Conclusion

The improvements introduced by AIM are 2-fold: (1) duplicate responses can be filtered out while maintaining anonymity and (2) the requirement for the participant to keep their identifier and password for some time before returning to the survey website to claim a reward ensures that rewards only go to actual respondents.

Incentivizing a target population to complete a survey can be at odds with maintaining privacy. Anonymous survey software typically either collects some form of personal information (eg, emails) to send rewards to participants or upholds respondents’ privacy by providing rewards without requiring personally identifiable information but risks being exploited by scammers. To address this gap, the Anonymous Incentive Method (AIM) was designed to only reimburse actual participants and allow for the detection of scammers without storing personal information of any kind. AIM can be adapted for a wide variety of commercial and research surveys. Despite not completely eradicating survey fraud, AIM can be bolstered by additional safeguards depending on the specific survey. AIM can not only increase the response rate by ensuring anonymity and making potential respondents more comfortable but also help qualify studies as exempt from full review to expedite approval by an Institutional Review Board.

Expressions of Individualization on the Internet and Social Media: Multigenerational Focus Group Study

Background

Growing individualization within the past decades has been described as a fundamental shift in society. Studies have reported how the digital age promotes new forms of individualism with self-tracking technologies and self-presentation in social networks. Potential harmful effects on the mental health of young adults have already been at the forefront of research. However, 2 questions that remain unanswered are how emotional experiences and expressions of self-relatedness differ among generations in their usage of the internet and social media, and if an increasing individualism can be observed by this.

Objective

The aim of this study is to examine whether the use of the internet and social media has led people to be more concerned about themselves than former generations. The potential consequences of mental and emotional distress among different age groups are analyzed.

Methods

A focus-group approach was chosen to study the following age groups: Baby Boomers (those born in 1950-1965), Generation X (those born in 1966-1980), and Digital Natives (those born in 1981-2000). We organized 6 focus groups with 36 participants who discussed their private usage of the internet and social media, different devices, platforms and functions, communication behavior, and self-tracking. We applied inductive category formation and followed the Standards for Reporting Qualitative Research (SRQR) checklist.

Results

We found differences in the 3 studied generations regarding the reasons for their use of the internet and social media, the effects of this use, personal feelings and experiences, expressions of self-relatedness, and social relationships. The Baby Boomers voiced a wish to stay autonomous while being in contact with their personal network. Generation X included enthusiastic members who appreciate self-tracking for curiosity and fascination, as well as people who felt fears about data surveillance. The Digital Natives reported a wish to optimize their own body by self-tracking while being faced with norms and expectations that were communicated via the internet and social media.

Conclusions

All generations expressed self-relatedness, yet by different means. The Baby Boomers expressed less individualism than Generation X and the Digital Natives, who felt the highest strain due to social comparisons. However, all generations reported specific, potentially problematic consequences for their mental health. Age-specific coping strategies are necessary to promote a mentally healthy way of using the internet and social media.

Online accounts of gene expression profiling in early-stage breast cancer: Interpreting genomic testing for chemotherapy decision making

Background

Genomic techniques are being developed within oncology and beginning to be experienced within routine cancer care. Little is known about how these tools feature in patients’ experiences of treatment decision making.

Objective

This research explores the ways in which women interpret and discuss gene expression profiling for breast cancer treatment decision making, as articulated within online accounts.

Design

This study used a qualitative approach to analyse written exchanges focusing on gene expression profiling in the UK (Oncotype DX test). Accounts are taken from online forums hosted by two UK cancer charity websites, comprising 132 discussion threads from a total of seven forums. Authors qualitatively analysed the data and developed key themes drawing on existing literature from medical sociology.

Findings

Women used online spaces to share and discuss results of gene expression profiling. Women interpreted results in the context of indirect experience of cancer treatment, and sociocultural depictions of cancer and chemotherapy. Users largely represented the test positively, emphasizing its ability to “personalize” treatment pathways, though many also pointed to inherent uncertainties with regards the possibility of cancer recurrence.

Discussion and Conclusions

We highlight the complex contexts in which genomic techniques are experienced, with these shaped by personal biographies, online environments and pervasive cultural narratives of cancer and its treatment. We highlight tensions between the claims of genomic testing to aid treatment decision making and patient reflections on the capability of these techniques to resolve uncertainties surrounding treatment decisions.

Gone in sixty (milli)seconds: Disentangling the effects of location context on attention bias

Attention bias is associated with a broad range of emotional disorders. Because of its transportability, attention bias modification (ABM) training can be administered outside of the laboratory; however, some evidence suggests that ABM training may be less effective when conducted in the individual's natural environment. The aim of this study was to examine factors that might account for the attenuated effects of attentional bias (AB) when assessed remotely. One hundred fifty-eight undergraduate psychology students completed the Emotional Stroop Task on two occasions - once in the laboratory and once remotely. To help disentangle the influences of emotional state and location on attention bias, participants were randomized to view either an emotionally provocative clip or an emotionally neutral clip prior to completing the emotional Stroop task. Results showed evidence of an attentional bias only in the laboratory, among participants in the neutral emotion condition (b = -19.67, P = .008, 95% CI [-34.18, -5.15]). Exploratory analyses revealed that emotion provocation was associated with attentional bias among individuals with greater symptoms of depression, but only remotely (b = -15.70, P = 0.046, 95% CI [-31.15, -0.25]). These findings suggest that caution should be used when conducting attention bias research remotely. Limitations and future directions are discussed.

Identity, community and care in online accounts of hereditary colorectal cancer syndrome

Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically "at risk" are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers' accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.

Ethical Considerations in Research Participation Virality

This article seeks to commence and encourage discussion around the upcoming ethical challenges of virality in network structures. When the call for participation in a research project on lupus in Ireland went from an advertisement in a newsletter to a meme (unit of transmissible information) on a closed Facebook page, the ethical considerations of virality were raised. The article analyzes the Association of Internet Researchers guidelines, Facebook policies, and the context of privacy in relation to virality. Virality creates the leverage for methodological pluralism. The nature of the inquiry can determine the method rather than the other way around. Viral ethical considerations are evolving due to the cyber world becoming the primary meme of communication, with flexibility in the researcher's protocol providing opportunities for efficient, cost-effective, and diverse recruitment.

Munchausen by Proxy: A Qualitative Investigation into Online Perceptions of Medical Child Abuse

In Munchausen by proxy (MBP) maltreatment, increasingly termed "medical child abuse" (MCA), a caregiver fabricates or induces illness in another. The perpetrator's goal for the behavior is to meet personal emotional needs by forcing unnecessary or misguided medical or psychological treatment. Generally, a mother is the perpetrator and her child is the victim. There is a serious lack of research into most aspects of MCA, and this study is the first to utilize the anonymity of an Internet forum to investigate victims' first-hand experiences of, and the public's opinions about, suspected and confirmed MCA. Three-hundred and fifty-six posts by 348 members were explored and coded using formal qualitative content analysis. By accessing an open-thought online forum, this paper acquired information regarding social perceptions about the nonperpetrating partners who are unaware of the maltreatment; the disturbing and counterintuitive phenomenon of MCA itself; and the resistance often faced by those who attempt to report it.

The multiple sclerosis rating scale, revised (MSRS-R): development, refinement, and psychometric validation using an online community

BACKGROUND

In developing the PatientsLikeMe online platform for patients with Multiple Sclerosis (MS), we required a patient-reported assessment of functional status that was easy to complete and identified disability in domains other than walking. Existing measures of functional status were inadequate, clinician-reported, focused on walking, and burdensome to complete. In response, we developed the Multiple Sclerosis Rating Scale (MSRS).

METHODS

We adapted a clinician-rated measure, the Guy's Neurological Disability Scale, to a self-report scale and deployed it to an online community. As part of our validation process we reviewed discussions between patients, conducted patient cognitive debriefing, and made minor improvements to form a revised scale (MSRS-R) before deploying a cross-sectional survey to patients with relapsing-remitting MS (RRMS) on the PatientsLikeMe platform. The survey included MSRS-R and comparator measures: MSIS-29, PDDS, NARCOMS Performance Scales, PRIMUS, and MSWS-12.

RESULTS

In total, 816 RRMS patients responded (19% response rate). The MSRS-R exhibited high internal consistency (Cronbach's alpha = .86). The MSRS-R walking item was highly correlated with alternative walking measures (PDDS, ρ = .84; MSWS-12, ρ = .83; NARCOMS mobility question, ρ = .86). MSRS-R correlated well with comparison instruments and differentiated between known groups by PDDS disease stage and relapse burden in the past two years. Factor analysis suggested a single factor accounting for 51.5% of variance.

CONCLUSIONS

The MSRS-R is a concise measure of MS-related functional disability, and may have advantages for disease measurement over longer and more burdensome instruments that are restricted to a smaller number of domains or measure quality of life. Studies are underway describing the use of the instrument in contexts outside our online platform such as clinical practice or trials. The MSRS-R is released for use under creative commons license.