Substantial utilization of Facebook, Twitter, YouTube, and Instagram in the prostate cancer community

Codesign and Launch of 'On the Ball': An Inclusive Community-Based 'Testicular Awareness' Campaign

INTRODUCTION

Increased awareness of testicular diseases can lead to early diagnosis. Evidence suggests that men's awareness of testicular diseases is low, with many expressing their willingness to delay help-seeking for symptoms of concern. The risk of testicular diseases is higher in gender and sexual minority groups. In this study, we discuss the codesign, refinement and launch of 'On the Ball', an inclusive community-based 'testicular awareness' campaign.

METHODS

The World Café participatory research methodology was used. Individuals from Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, policymakers, media/marketing experts and graphic designers were recruited. Participants were handed a brief for 'On the Ball', which was designed based on feedback from a previous World Café workshop. They were assigned to three tables. Participants rotated tables at random for three 20-min rounds of conversations. Each table had a facilitator who focussed on one element of the campaign brief. Data were collected using audio recorders and in writing and were analysed thematically.

RESULTS

Thirteen individuals participated in the workshop. The following themes emerged from the data: (i) campaign identity, (ii) campaign delivery and (iii) campaign impact. Participants recommended enhancements to the campaign logo, slogan, social media posts and poster. They suggested delivering the campaign online via social media and offline using various print and broadcast media. Participants recommended targeting areas with a large number of men such as workplaces. To help measure the impact of the campaign, participants proposed capturing social media analytics and tracking statistics relating to testicular diseases. Recommendations were used to refine the 'On the Ball' campaign and launch it in a university. In total, 411 students engaged with the various elements of the campaign during the soft launch.

CONCLUSIONS

'On the Ball' campaign visuals ought to be inclusive. Online and offline campaign delivery is warranted to reach out to a wider cohort. Campaign impact can be captured using social media analytics as well as measuring clinical outcomes relating to testicular diseases. Future research is needed to implement the campaign online and offline, explore its impact and evaluate its feasibility, acceptability, cost and effect on promoting testicular awareness.

PATIENT OR PUBLIC CONTRIBUTION

The 'On the Ball' campaign was codesigned and refined with members of Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, health policymakers, media and marketing experts and graphic designers using the World Café participatory research methodology.

Overview and characterization of penile cancer content across social media platforms

Background

Social media platforms (SMP) are an emerging resource that allows physicians, patients, and families to converse on cancer prevention, diagnosis, and treatment. We aimed to characterize penile cancer (PC) content shared on SMP.

Methods

We searched PC posts on Twitter, Facebook, and Instagram from July 1st, 2021, through June 30th, 2022. Two independent, blinded reviewers analyzed the hashtags: #PenileCancer, #PenileCancerAwareness, and #PenileNeoplasm. Descriptive statistics were used for posts characterization, Pearson´s correlation coefficient for associations, and Cohen's weighted kappa coefficient for inter-rater agreement rate.

Results

A total of 791 posts were analyzed, with Twitter accounting for 52%, Facebook for 12.2%, and Instagram for 35.5%, and. Most posts originated from high-income countries, such as the United Kingdom (48.8%). We found no correlation between the number of posts with PC incidence (p = 0.64) or users on SMP (p = 0.27). Most accounts were classified as "support and awareness communities" (43.6%) and "physicians and clinical researchers" (38.2%). Urology was the most common medical specialty to post (60.9%), followed by oncology (11.3%). Most posts were classified as "prevention and awareness for users" (45.1%). Global inter-reviewer agreement rate was almost perfect (k=0.95; p ≤ 0.01). On Twitter, "physicians and clinical researchers" shared more content on "treatment updates and medical papers published in medical journals," while on Facebook and Instagram, "support and awareness communities" focused on "personal and support comments."

Conclusion

Overall, the number of PC posts was low compared to other neoplasms across the SMP evaluated in this study. "Physicians and clinical researchers" shared more content on Twitter, while "support and awareness communities" on Facebook and Instagram. Encouraging the use of a common SMP among the medical community and general users could lead to a more effective communication between physicians, patients, and support groups, and to increased awareness of PC.

Evaluation of the Quality and Comprehensiveness of YouTube Videos Discussing Pancreatic Cancer

Pancreatic cancer is one of the most lethal diseases worldwide and incidence continues to rise, resulting in increased deaths each year. In the modern era, patients often turn to online sources like YouTube for information regarding their disease, which may be subject to a high degree of bias and misinformation; previous analyses have demonstrated low quality of other cancer-related YouTube videos. Thus, we sought to determine if patients can rely on educational YouTube videos for accurate and comprehensive information about pancreatic cancer diagnosis and treatment. We designed a search query and inclusion/exclusion criteria based on published studies evaluating YouTube user tendencies, which were used to identify videos most likely watched by patients. Videos were evaluated based on two well-known criteria, the DISCERN and JAMA tools, as well as a tool published by Sahin et al. to evaluate the comprehensiveness of YouTube videos. Statistical analyses were performed using Chi-square analysis to compare categorical variables. We used linear regression to assess for correlations between quantitative variables. Kruskal-Wallis and independent samples t-test were used to compare means between groups. We assessed inter-rater reliability using Cronbach's alpha. After the initial search query, 39 videos were retrieved that met inclusion criteria. The comprehensiveness and quality of these materials was generally low to moderate, with only 7 videos being considered comprehensive. Pearson's R demonstrated strong correlations between video length and both comprehensiveness and quality. Higher-quality videos also tended to be newer. YouTube videos regarding pancreatic cancer are generally of low to moderate quality and lack comprehensiveness, which could affect patients' perceptions of their disease or understanding of treatment options. These videos, which have collectively been viewed over 6 million times, should be subject to some form of expert review before upload, and producers of this content should consider citing the sources used in the video.

Examining Public Communication About Surgical Cancer Care on Twitter

INTRODUCTION

Social media platforms like Twitter are highly utilized for communicating about cancer care. Although surgery is the primary curative treatment for solid malignancies, little is known about online communication behaviors regarding this treatment modality. This study tracked online discussions and characterized participants to better characterize the content of public communication about surgical cancer care.

METHODS

Tweets referencing cancer surgery were collected from 2018 to 2021 using Twitter's Application Programming Interface. Metadata (e.g., profile biography, follower count) was used to predict user demographic information. Natural language processing was performed using Latent Dirichlet Allocation to identify common themes of conversation and mentioned cancer sites.

RESULTS

There were 442,840 tweets about cancer surgery by 262,168 users, including individuals (65%), influencers (1.5%), surgeons (1%), and oncologists (0.5%). Following the onset of the COVID-19 pandemic, tweets mentioning delays in care increased by 21.7% (1971-57,846 tweets). Individuals commonly mentioned surgical costs (20.3%) and postoperative recovery (21.6%). Surgeons and oncologists frequently mentioned research (52.7%), but infrequently mentioned community support (7.8%) or survivorship (9.3%). Relative to their prevalence, neurologic cancers were most discussed (231 tweets per 1000 operations) while thoracic (29 tweets per 1000 operations) and urologic cancers were least discussed (12 tweets per 1000 operations).

CONCLUSIONS

Twitter was utilized by patients to discuss real-time issues such as COVID-19-related surgical delays and the financial burden of cancer surgery. Further efforts to improve community outreach may be optimized by targeting greater discussion of undermentioned cancer types and encouraging clinicians to participate in discussions about community-centered themes.

Prostate cancer, online health information and communication technology - Bibliometric analysis of field with research frontiers

OBJECTIVES

The purpose of this study is to conduct the first bibliometric analysis which examines eHealth communication technologies in prostate cancer care, and the utilization of internet-based health information and communication technology by men with prostate cancer.

METHODS

Original articles were extracted from the Science Citation Index Expanded (SCI-E) on Web of Science (WOS) and analyzed concerning their distributions. Quantitative guidance directed investigation of findings from previous studies and trending issues within the field. The WOS, VOSViewer and CiteSpace IV were used for information analysis.

RESULTS

302 articles were included in the final analysis. There has been a 165 % increase in productivity over the past decade. The leading country by publication was the USA (145 articles = 48.02 %). Journals which published the highest number of original articles were the Journal of Medical Internet Research (6.95 %), and Patient Education and Counseling (4.64 %).

DISCUSSION AND PRACTICE IMPLICATIONS

The field of research which examines utilization and impacts of internet-based health information on men with prostate cancer is growing and diverse. Research frontiers are 'Information quality and diversity', 'eHealth literacy', 'decision making', and 'survivorship and advanced disease'. Clinicians should be aware of several significant limitations which exist within the current field of research.

Longitudinal analysis of YouTube videos discussing post-prostatectomy erectile dysfunction

BACKGROUND

YouTube is heavily utilized by patients as an educational resource, but this content can be fraught with misinformation. We sought to characterize the quality of videos on YouTube discussing postprostatectomy erectile dysfunction and to evaluate metrics associated with retaining a top position in search results over time.

METHODS

In October 2019, we watched the first 100 YouTube videos using the search query "radical prostatectomy erectile dysfunction." Videos not relevant to the topic were excluded. Video metrics were collected, and content quality was evaluated using the DISCERN instrument. In June 2022, the search was repeated and video metrics were updated. Video characteristics were associated with search rank and the ability to remain in the top 100 spots using the Pearson correlation coefficient (r) and logistic regression, respectively.

RESULTS

We included 81 videos which amassed 529,428 views in 2019. The median total DISCERN score was 29 (IQR 21-42), which is interpreted as a poor quality video. Self-promotion or commercial bias was present in 42 videos (51.9%); false claims were present in 16 (19.8%). There was no correlation between DISCERN score and search rank (r = 0.08, p = 0.49). In 2022, 15 videos remained in the top 100 search results and had a higher median DISCERN score than videos no longer in the top 100 (46 vs. 28.5, p = 0.01). Each additional DISCERN point was associated with a 7% higher odds of remaining in the top 100 (OR 1.07, 95% CI 1.01-1.11, p = 0.003).

CONCLUSIONS

The quality of the top 100 YouTube videos discussing postprostatectomy erectile dysfunction is low. Higher quality videos had a higher odds of remaining in the top 100 search results over time but do not correlate with the order in which they are ranked.

Digitalization and Urological Diseases: Severity of Cyberchondria and Level of Health Anxiety in Patients Visiting Outpatient Urology Clinics

This study aimed to evaluate the cyberchondria levels of patients who applied to the urology outpatient clinic. The second goal of this study was to evaluate the relationship between cyberchondria severity and health anxiety in these patients. The present prospective observational study was conducted at the urology outpatient clinic of two tertiary centers in our city between September and December 2021. Eligible patients were the adult patients (>18 and ≤60 years) who used the Internet for health purposes and had no self-reported psychological or mental disease. The patients were divided into following groups according to their complaints: general urology, uro-oncology, andrology, functional urology, and endourology (stone disease). The level of cyberchondria and health anxiety was evaluated for these patients by using the Short Health Anxiety Inventory (SHAI) and a short-form version of the Cyberchondria Severity Scale (CSS-12). This study enrolled 578 patients (190 female, 388 male). The mean age of patients was 43.4 ± 13.3 years (18-60 years). The mean CSS-12 was 28.1 ± 12.1, and the mean value of SHAI was 18.9 ± 13.6. The patients had andrological symptoms, is uniquely related to higher CSS and health anxiety, and followed by uro-oncological diseases. However, the least relationship was observed in patients with functional urological diseases (analysis of variance [ANOVA], p < 0.001 for CSS-12; p < 0.001 for SHAI). In addition, a positive correlation was observed between the CSS and SHAI (Pearson's correlation = 0.782). The increased level of cyberchondria causes increased health anxiety and an increased disease burden in these patients. Therefore, physicians should consider this increased treatment burden during the treatment of patients.

Does the urologist keep a central place in the medical information delivered to patients?

INTRODUCTION

Although urologists play an essential role in informing patients, with the ever-increasing use of modern media, a wealth of information sources is now available. The aim of this study was to identify the different sources of information available to urology patients, assess the scale of use of the internet and social networks in this group, and establish the profile of patients for whom a high level of information is crucial.

MATERIALS

A questionnaire was given to 500 patients consulting the urology department of a university hospital.

RESULTS

Out of the 500 questionnaires, 372 were analysable; the average age of respondents was 62.9years; 73% were men; 66.9% said they used the internet; 57% had received an explanatory document such as an French Urology Association information leaflet, 32.5% had received information from the paramedical team, 28.2% from their regular doctor, 28.2% from health-related websites and 5.9% from the website developed by the French Urology Association. Although 80.3% of patients thought that information received from the urologist was satisfactory, 53.2% of patients would like to receive more information. We did not identify any factors allowing us to determine the typical profile of patients seeking more information.

CONCLUSION

Urologists seem to retain their central role in informing patients, but almost half of patients were still seeking additional information after their urology consultation. The increasing use of the internet should encourage urologists to use these new media resources to optimise the information supplied to patients.

LEVEL OF EVIDENCE: 4

New Data Resources, Linkages, and Infrastructure for Cancer Health Economics Research: Main Topics From a Panel Discussion

Although a broad range of data resources have played a key role in the substantial achievements of cancer health economics research, there are now needs for more comprehensive data that represent a fuller picture of the cancer care experience. In particular, researchers need information that represents more diverse populations; includes more clinical details; and provides greater context on individual- and neighborhood-level factors that can affect cancer prevention, screening, treatment, and survivorship, including measures of financial health or toxicity, health-related social needs, and social determinants of health. This article highlights 3 critical topics for cancer health economics research: the future of the National Cancer Institute's Surveillance, Epidemiology, and End Results-Centers for Medicare & Medicaid Services-linked data resources; use of social media data for cancer outcomes research; and multi-site-linked electronic health record data networks. These 3 topics represent different approaches to enhance data resources, linkages, and infrastructures and are complementary strategies to provide more complete information on activities involved in and factors affecting the cancer control continuum. These and other data resources will assist researchers in examining the complex and nuanced questions now at the forefront of cancer health economics research.

The construction of rare disease discourse on YouTube: highlighting a disparity between policy rhetoric and patient practices around public engagement

Background: Policy rhetoric around the 6,000-8,000 rare diseases affecting 300 million people worldwide often focuses on public engagement. Meanwhile, medical authorities tend either to treat patients with rare diseases as pre-categorised data sources, proffer to them notions of technological self-care as empowerment, or recruit them as advocacy allies. Conversely, people living with rare diseases often mobilise and engage with one another in self-organised communities via social media to share discussion, information, and resources. How rare disease discourse forms on specific social media platforms, the role of different actors (including medical authorities and algorithms), and its relation to public engagement policy are poorly understood. Methods: This paper examines data on YouTube video watching/sharing (gathered from YouTube’s API via DMI’s ‘Data Tools for YouTube’) through social network analysis (read through a controversy analysis lens). Results: The paper identifies eight patterns – each revolving around different levels of: focus on rare disease content; engagement between content and viewers, i.e. through likes, dislikes, and surrounding particular videos; permeability of videos between categories; and repetition in viewers watching the same video. Across six of the patterns, the paper finds a rare disease issue-network forming, where discourse is constructed through three distinct communication strategies, each garnering a different form of engagement. Conclusions: Overall, the paper highlights a disconnect between how rare disease discourse is enacted on YouTube and policy promises of public engagement, with potential spaces for dialogue often closed off by medical authorities. To close, the paper provides recommendations for how policymakers might engage with and facilitate more inclusive forms of social media interaction between specific rare disease related communities and clinicians to develop more meaningful forms of knowledge exchange.

Instagram and prostate cancer: using validated instruments to assess the quality of information on social media

BACKGROUND

The quality of prostate cancer (PCa) content on Instagram is unknown.

METHODS

We examined 62 still-images and 64 video Instagram posts using #prostatecancer on 5/18/20. Results were assessed with validated tools.

RESULTS

Most content focused on raising awareness or sharing patient stories (46%); only 9% was created by physicians. 90% of content was low-to-moderate quality and most was understandable, but actionability was 0%. Of the 30% of content including objective information, 40% contained significant misinformation. Most posts had comments offering social support.

CONCLUSIONS

Instagram is a source of understandable PCa content and social support; however, information was poorly actionable and had some misinformation.

#ColonCancer: Social Media Discussions About Colorectal Cancer During the COVID-19 Pandemic

PURPOSE

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide. Social media platforms such as Twitter are extensively used to communicate about cancer care, yet little is known about the role of these online platforms in promoting early detection or sharing the lived experiences of patients with CRC. This study tracked Twitter discussions about CRC and characterized participating users to better understand public communication and perceptions of CRC during the COVID-19 pandemic.

METHODS

Tweets containing references to CRC were collected from January 2020 to April 2021 using Twitter's Application Programming Interface. Account metadata was used to predict user demographic information and classify users as either organizations, individuals, clinicians, or influencers. We compared the number of impressions across users and analyzed the content of tweets using natural language processing models to identify prominent topics of discussion.

RESULTS

There were 72,229 unique CRC-related tweets by 31,170 users. Most users were male (66%) and older than 40 years (57%). Individuals accounted for most users (44%); organizations (35%); clinicians (19%); and influencers (2%). Influencers made the most median impressions (35,853). Organizations made the most overall impressions (1,067,189,613). Tweets contained the following topics: bereavement (20%), appeals for early detection (20%), research (17%), National Colorectal Cancer Awareness Month (15%), screening access (14%), and risk factors (14%).

CONCLUSION

Discussions about CRC largely focused on bereavement and early detection. Online coverage of National Colorectal Cancer Awareness Month and personal experiences with CRC effectively stimulated goal-oriented tweets about early detection. Our findings suggest that although Twitter is commonly used for communicating about CRC, partnering with influencers may be an effective strategy for improving communication of future public health recommendations related to CRC.

Oncofertility and Fertility Preservation in Cancer Patients Across the Twitterverse

PURPOSE

Infertility is a major problem affecting children, adolescents, and young adults (AYAs) with cancer, either due to the disease itself or because of oncologic treatment. Oncofertility (OF) focuses on counseling cancer patients about fertility risks and preservation options. However, OF and fertility preservation (FP) conversations on Twitter and their impact are unknown. We aim to characterize the users and type of content of these conversations.

MATERIALS AND METHODS

This observational study analyzed tweets with the hashtags "#Oncofertility" and "#FertilityPreservation" over eight months. We classified Twitter accounts by user type and country. Tweets were categorized by content type, and retweets and likes were quantified. Descriptive statistics were used for analysis.

RESULTS

A total of 399 tweets from 223 different accounts were evaluated. Twitter accounts comprised 22 countries and stemmed from high, upper-middle, and lower-middle-income countries in 86.5%, 5.4%, and 6.3%, respectively; no accounts from low-income countries were found. Accounts were mostly from physicians (37%) and healthcare centers (20%); we did not find any patient accounts. The most common content category was informative tweets directed to patients (30.8%), followed by discussion/sharing of medical papers (25.6%). Only 14.5% of tweets contained information about children and adolescents. Still, only 4.5% were aimed at children. Retweets were absent in 16.5% of the tweets, and 80.7% did not have comments.

CONCLUSION

OF and FP discussions on Twitter were limited to interactions among medical professionals. Also, advocacy groups showed limited activity on social media. Even though a significant proportion of tweets directed to patients were found, no active involvement of patients was observed. Finally, limited number of tweets (4.5%) were directed to children and adolescents. There is a need to raise awareness about the effects of cancer on fertility in this group. Currently, Twitter is not a resource of information for children and AYAs with cancer who need OF counseling and fertility preservation. Our results open a debate on how to promote the use of social media in the future to improve the quality of OF information available, awareness, and care since there is an unmet need for fertility preservation access in young cancer patients.

[Acceptance and status of digitalization in clinics and practices : Current assessment in German urology]

BACKGROUND

Digitalization of patient documentation and introduction of the electronic patient record (ePA) pose challenges to everyday clinical practice.

OBJECTIVES

We investigated the acceptance and status of the digitalization of patient data and the introduction of the ePA among German urologists.

MATERIALS AND METHODS

A questionnaire with 30 questions about the acceptance and status of digitalization of patient documentation and ePA was sent out via the newsletter of the German Society of Urology.

RESULTS

A total of 80 urologists participated in the survey (response rate 2%). Digital platforms such as Urotube or Researchgate are used by 63% of participants. The complete implementation of digital patient documentation was reported by 72% of respondents working in medical practice and by 54% of those working in the hospital (p = 0.042). While 76% see the digitalization process as reasonable, 34% expressed partial or strong concerns about the complete digitalization of patient documentation. Only 14% of the participants offer video consultations. Advantages for ePA include better networking of the healthcare system (73%), improved diagnosis, indication (41%) and treatment quality (48%), and avoidance of medication errors (70%).

CONCLUSION

German urologists are open to the digitalization process and ePA. Especially younger urologists are using digital media. The advantages of digitalization are, in particular, an improvement in treatment processes. For a smooth introduction, a cross-departmental establishment and, if necessary, an adaptation of the treatment processes are necessary.

Exploring predictors of and barriers to online prostate cancer community use: A cross-sectional survey of users and non-users

OBJECTIVE

Prostate cancer survivors are increasingly turning to online communities for support. This study explored predictors of and barriers to use.

METHODS

A prospective survey of 141 Australian prostate cancer survivors assessed sociodemographic, clinical, psychosocial, and attitudinal characteristics associated with intention to use, and subsequent use of online communities.

RESULTS

The sample was divided into current, past, and non-user groups. Current users reported more intent to use online communities and had higher levels of social support. Current and past users, and their close contacts, held a more positive attitude towards use. Non-users experienced more barriers to use, fewer life impacts due to health changes, and were more likely to live in rural or remote regions. According to current users online prostate cancer communities are too informal, to past users they are too time intensive, and non-users believe they are too shallow. The most critical barriers to use were finding a suitable community, time to use them, and being capable of talking about or articulating their illness on the Internet. While these forums allow men to share experiences, gain recognition and understanding, and receive information, they may lead men to becoming too preoccupied with their illness and feeling more concerned about the consequences of their disease.

CONCLUSION

Improving attitudes towards online communities and reducing barriers to use may help better encourage men with unmet supportive care needs to seek help from these groups. Future research exploring supporter attitudes towards use and explicating how men are supported online is needed.

The construction of rare disease discourse on YouTube: highlighting a disparity between policy rhetoric and patient practices around public engagement

Background: Policy rhetoric around the 6,000-8,000 rare diseases affecting 300 million people worldwide often focuses on public engagement. Meanwhile, medical authorities tend either to treat patients with rare diseases as pre-categorised data sources, proffer to them notions of technological self-care as empowerment, or recruit them as advocacy allies. Conversely, people living with rare diseases often mobilise and engage with one another in self-organised communities via social media to share discussion, information, and resources. How rare disease discourse forms on specific social media platforms, the role of different actors (including medical authorities and algorithms), and its relation to public engagement policy are poorly understood. Methods: This paper examines data on YouTube video watching/sharing (gathered from YouTube’s API via DMI’s ‘Data Tools for YouTube’) through social network analysis (read through a controversy analysis lens). Results: The paper identifies eight patterns – each revolving around different levels of: focus on rare disease content; engagement between content and viewers, i.e. through likes, dislikes, and surrounding particular videos; permeability of videos between categories; and repetition in viewers watching the same video. Across six of the patterns, the paper finds a rare disease issue-network forming, where discourse is constructed through three distinct communication strategies, each garnering a different form of engagement. Conclusions: Overall, the paper highlights a disconnect between how rare disease discourse is enacted on YouTube and policy promises of public engagement, with potential spaces for dialogue often closed off by medical authorities. To close, the paper provides recommendations for how policymakers might engage with and facilitate more inclusive forms of social media interaction between specific rare disease related communities and clinicians to develop more meaningful forms of knowledge exchange.

Using Instagram to Enhance a Hematology and Oncology Teaching Module During the COVID-19 Pandemic: Cross-sectional Study

BACKGROUND

The COVID-19 pandemic necessitated the rapid expansion of novel tools for digital medical education. At our university medical center, an Instagram account was developed as a tool for medical education and used for the first time as a supplement to the hematology and medical oncology teaching module of 2020/2021.

OBJECTIVE

We aimed to evaluate the acceptance and role of Instagram as a novel teaching format in the education of medical students in hematology and medical oncology in the German medical curriculum.

METHODS

To investigate the role of Instagram in student education of hematology and medical oncology, an Instagram account was developed as a tie-in for the teaching module of 2020/21. The account was launched at the beginning of the teaching module, and 43 posts were added over the 47 days of the teaching module (at least 1 post per day). Five categories for the post content were established: (1) engagement, (2) self-awareness, (3) everyday clinical life combined with teaching aids, (4) teaching aids, and (5) scientific resources. Student interaction with the posts was measured based on overall subscription, "likes," comments, and polls. Approval to conduct this retrospective study was obtained from the local ethics commission of the University Medical Center Goettingen.

RESULTS

Of 164 medical students, 119 (72.6%) subscribed to the Instagram account, showing high acceptance and interest in the use of Instagram for medical education. The 43 posts generated 325 interactions. The highest number of interactions was observed for the category of engagement (mean 15.17 interactions, SD 5.01), followed by self-awareness (mean 14 interactions, SD 7.79). With an average of 7.3 likes per post, overall interaction was relatively low. However, although the category of scientific resources garnered the fewest likes (mean 1.86, SD 1.81), 66% (27/41) of the student participants who answered the related Instagram poll question were interested in studies and reviews, suggesting that although likes aid the estimation of a general trend of interest, there are facets to interest that cannot be represented by likes. Interaction significantly differed between posting categories (P<.001, Welch analysis of variance). Comparing the first category (engagement) with categories 3 to 5 showed a significant difference (Student t test with the Welch correction; category 1 vs 3, P=.01; category 1 vs 4, P=.01; category 1 vs 5, P=.001).

CONCLUSIONS

Instagram showed high acceptance among medical students participating in the hematology and oncology teaching curriculum. Students were most interested in posts on routine clinical life, self-care topics, and memory aids. More studies need to be conducted to comprehend the use of Instagram in medical education and to define the role Instagram will play in the future. Furthermore, evaluation guidelines and tools need to be developed.

Re-evaluating standards of human subjects protection for sensitive health data in social media networks

This study addresses ethical questions about conducting health science research using network data from social media platforms. We provide examples of ethically problematic areas related to participant consent, expectation of privacy, and social media networks. Further, to illustrate how researchers can maintain ethical integrity while leveraging social media networks, we describe a study that demonstrates the ability to use social media to identify individuals affected by cancer. We discuss best practices and ethical guidelines for studying social media network data, including data collection, analysis, and reporting.

Whose cancer? Visualising the distribution of mentions to cancer sites on instagram

This article presents a quantitative analysis of mentions to cancer on Instagram. Using thousands of images with cancer-related hashtags, we build several visualisations to capture their distribution. Source images are clustered by their visual traits and by the incidence, prevalence, and mortality of the cancer site they refer to. Our goal is three-fold: to provide a quantitative basis for future research on the representation of cancer online; to offer an interpretation of the sources of the imbalanced representation of the different cancer sites; and to motivate a debate on how that representation may affect patients and families.

A Proposed Approach for Conducting Studies That Use Data From Social Media Platforms

The prominence of social media in contemporary society has extended significantly into the health care arena, where both patients and health care providers have used social media platforms to gather, communicate, learn, and share medical content and personal experience in real time. The medical literature has also seen an exponential increase in the number of studies that use data derived from social media coverage of various medical issues and topics. In this guide, we present a step-by-step framework for health care professionals and researchers to conduct studies that use data from social media platforms. We present 6 overarching steps: focus on framing a question that is appropriate for social media evaluation, identification of social media outlet and selection criteria of content, systematic data extraction, assessment of quality of content and sources of bias, analysis of data, and interpretation of study findings. Each step is illustrated with published examples.

Guidelines for optimal utilization of social media for brain tumor stakeholders

OBJECTIVE

Effective use of social media (SM) by medical professionals is vital for better connections with patients and dissemination of evidence-based information. A study of SM utilization by different stakeholders in the brain tumor community may help determine guidelines for optimal use.

METHODS

Facebook, Twitter, and YouTube were searched by using the term "Brain Tumor." Platform-specific metrics were determined, including audience size, as a measure of popularity, and mean annual increase in audience size, as a measure of performance on SM. Accounts were categorized on the basis of apparent ownership and content, with as many as two qualitative themes assigned to each account. Correlations of content themes and posting behavior with popularity and performance metrics were assessed by using the Pearson's test.

RESULTS

Facebook (67 pages and 304,581 likes) was predominantly used by organizations (64% of pages). Top themes on Facebook, Twitter, and YouTube were charity and fundraising (67% of pages), education and research (72% of accounts), and experience sharing and support seeking (48% of videos, 60% of views, and 82% of user engagement), respectively. On Facebook, only the presence of other concurrent platforms influenced a page's performance (rho = 0.59) and popularity (rho = 0.61) (p < 0.05). On Twitter, the number of monthly tweets (rho = 0.66) and media utilization (rho = 0.78) were significantly correlated with increased popularity and performance (both p < 0.05). Personal YouTube videos (30% of videos and 61% of views) with the theme of experience sharing and support seeking had the highest level of engagement (60% of views, 70% of comments, and 87% of likes).

CONCLUSIONS

Popularity and prevalence of qualitative themes differ among SM platforms. Thus, optimal audience engagement on each platform can be achieved with thematic considerations. Such considerations, along with optimal SM behavior such as media utilization and multiplatform presence, may help increase content popularity and thus increase community access to neurooncology content provided by medical professionals.

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exist among Black men in this country. The primary objective of this systematic review is to describe the reported disparities in screening, diagnostics, and treatments as well as efforts to alleviate these disparities through community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, subanalyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal-access care environments have shown similar outcomes regardless of race. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials, and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. IMPLICATIONS FOR PRACTICE: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher prostate-specific antigen, and other adverse factors, but outcomes can be attenuated in trials or in equal-access care environments. Recent data have shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts, and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities.

YouTube and Men's Health: A Review of the Current Literature

INTRODUCTION

YouTube is the most used social media website, and there is a growing body of literature examining the reliability of healthcare information on this platform. Patients seeking men's health information may be more likely to use YouTube owing to the sensitivity of these issues.

OBJECTIVES

The objective of this study is to review the literature for studies related to the reliability of YouTube videos about men's health topics.

METHODS

A literature review was conducted using PubMed and Google Scholar for publications related to the reliability of YouTube videos about men's health as of July 1, 2020.

RESULTS

There were 17 studies related to YouTube and Men's Health. Most videos were found to be unreliable, and videos uploaded by physicians or healthcare organizations were usually more reliable. However, there were no studies in which more reliable videos had higher metrics of user engagement (views, likes, comments) than unreliable videos and there were several studies where unreliable videos had higher metrics of user engagement. In addition, the methods used to evaluate YouTube videos are not uniform across studies including the way that terms are searched (filtering by relevance vs view count) and the way in which reliability is assessed. For example, some studies create custom evaluation forms based on clinical guidelines, whereas others use validated questionnaires. The only validated questionnaire used across multiple studies was the DISCERN score criterion.

CONCLUSIONS

Most information on YouTube about men's health is unreliable. Videos created by physicians and healthcare organizations are more reliable, and videos that are advertisements are less reliable. Physicians and healthcare systems should continue to upload educational YouTube videos but work to increase their views and user engagement. It may benefit patients if physician organizations could work with YouTube to create verified videos disseminating healthcare information that are favored in the search algorithm. Warren CJ, Sawhney R, Shah T, et al. YouTube and Men's Health: A Review of the Current Literature. Sex Med Rev 2021;9:280-288.

A scoping review of the characteristics and benefits of online prostate cancer communities

OBJECTIVE

Online prostate cancer communities (OPCaCs) have emerged as a new source of support, not bounded by geographic barriers, for men living with prostate cancer. This scoping review mapped the existing literature to explore the characteristics and benefits of OPCaCs, identify knowledge gaps, and direct future research.

METHODS

A six-step methodological framework for scoping reviews was followed. Four electronic databases were searched for relevant studies. Two authors independently screened titles and abstracts, and full texts, against predefined criteria: empirical research, post 1990, in English-language peer-reviewed journals; participants included prostate cancer survivors; and research explored online peer support. Data were extracted from the studies and quality assessed.

RESULTS

The search yielded 905 studies, with 21 selected for synthesis. Despite significant increases in online forum membership, in the last decade, nearly half of the research was conducted over a decade ago. Three studies were rated high quality, the rest moderate. All but one of the studies were observational and cross-sectional. Men reported that sharing information helped them deal with their diagnosis and treatment side effects. They also gained a sense of camaraderie with men who shared similar experiences. Due to divergent methodologies and reporting standards, assessment regarding OPCaC efficacy is not possible.

CONCLUSION

OPCaCs may be a cost-effective and accessible resource for delivering peer support to men living with prostate cancer. While self-reported evidence as to the benefits of OPCaCs exists, more longitudinal comparative studies, utilising consistent measurement approaches, are needed to support the claims.

Look who's talking now: Cancer in primary care on Twitter. An observational study

Background

Twitter is a microblogging platform that helps share information. It is a dynamic tool that has been embraced by many user types including consumers and healthcare professionals (HCPs). Currently, there are no data on how cancer in primary care features on Twitter.

Aim

To explore the type of users and information shared about cancer in primary care on Twitter.

Design & setting

A descriptive exploratory study took place of publicly available Twitter data.

Method

Tweets were searched between July 2015 and June 2017 for ‘GP’, ‘general practice’, ‘primary care’, or ‘general practitioner’ in conjunction with ‘cancer’. A 20% random sample was coded for geographic location, user type, type of tweet, and theme. Tweet sentiment was analysed using R package sentimentr. Content that gained traction was compared by combining original tweets, retweets, favourites, and duration.

Results

There were a total of 3413 tweets from 1611 users in 44 countries. Consumers were the largest user group followed by health organisations, healthcare professionals, and the media. The most common theme across user types was diagnostic delay. Other themes that emerged included cancer screening, symptom awareness, and early diagnosis. Consumers published more negative tweets, particularly in relation to diagnostic delay. Health organisations focused on symptom awareness and screening. Over half of media tweets were stories that featured delayed diagnosis or screening.

Conclusion

A broad range of users engage with Twitter to share information about cancer in primary care. Content is different between user groups, but diagnostic delay and symptom awareness are common themes. Healthcare and professional organisations may need to consider approaches to counter negative messages about diagnostic delay.

Head and Neck Cancer and Social Media: The Patient Experience and Cancer Survivorship

OBJECTIVES/HYPOTHESIS

To characterize the head and neck cancer patients' lived experiences with survivorship through Instagram and examine opportunities for health professionals to provide support and outreach specifically targeting these needs.

STUDY DESIGN

Descriptive observational study.

METHODS

We analyzed key head and neck cancer-related hashtags by querying medical and layman terminology. The top English-language posts for #headandneckcancer underwent further content examination using thematic analysis based in grounded theory for categorization for user engagement (determined by "likes" and comments), type of content, and category of the account that created the post. Of the survivorship posts by patients, the content of posts in top user accounts was further analyzed.

RESULTS

There were 11,600 Instagram posts on #headandneckcancer, 1,300 posts on #headandneckcancerawareness, 1,100 posts on #headandneckcancersurvivor, and several thousand posts for additional layman terms. The majority of posts were from patients (65%), with few from head and neck surgeons or medical organizations (26%). User engagement was primarily by nonmedical accounts (95%). Posts by patients discussed medical appointments and treatments (81%), managing treatment effects and symptoms (66%), and cancer screening and prevention (23%). Specific concerns included fatigue (53%), postsurgical cosmetic appearance (27%), and weight and nutrition (34%).

CONCLUSIONS

Our study suggests that Instagram accounts can be intimate records of the patient experience, and gaining a better understanding of the daily experience of survivorship may be critical for head and neck surgeons and other oncology providers to provide truly comprehensive cancer care.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E1214-E1219, 2021.

Examining Public Communication About Kidney Cancer on Twitter

PURPOSE

Several studies have described the content of Twitter conversations about lung, breast, and prostate cancer, but little is known about how the public uses Twitter to discuss kidney cancer. We sought to characterize the content of conversations on Twitter about kidney cancer and the participants engaged in these dialogues.

METHODS

This qualitative study analyzed the content of 2,097 tweets that contained the key words kidney cancer from August 1 to 22, 2017. Tweets were categorized by content domain of conversations related to kidney cancer on Twitter and user types of participants in these dialogues.

RESULTS

Among the 2,097 kidney cancer-related tweets analyzed, 858 (41.4%) were authored by individuals, 865 (41.2%) by organizations, and 364 (17.4%) by media sites. The most common content discussed was support (29.3%) and treatment (26.5%). Among the 2,097 tweets, 825 were unique tweets, and 1,272 were retweets. The most common unique tweets were about clinical trials (23.9%), most often authored by media sites. The most common retweets were about treatment (38.5%), most often authored by organizations.

CONCLUSION

Twitter dialogues about kidney cancer are most commonly related to support and treatment. Our findings provide insights that may inform the design of new interventions that use social media as a tool to improve communication of kidney cancer information. Additional efforts are needed to improve our understanding of the value and direct utility of social media in improving kidney cancer care.

[Internet use after prostate cancer : Search for information and trust in disease-related information in long-term survivors]

BACKGROUND AND OBJECTIVE

The internet provides numerous sources of information about prostate cancer (PCa). The present study investigated internet use among long-term PCa survivors, trust in online PCa-related information, and associated factors.

MATERIALS AND METHODS

Based on the German national research project Familial Prostate Cancer long-term PCa survivors were asked about their internet use in 2017. Associations with sociodemographic (age at survey, children, intimate relationship, education) and disease-related parameters (time since diagnosis, PCa family history, progress) were analyzed using multivariable logistic regression.

RESULTS

In all, 4636 long-term PCa survivors were included in the analysis (mean age 76.9 years; standard deviation 6.6 years). Mean follow-up was 14.0 years. Of long-term PCa survivors, 62.1% were using the internet. Among non-users 23.5% expressed strong concerns, among users only 2.8%. Furthermore, 47.2% of internet users sought information about PCa, 18.0% of them indicated difficulties while searching for information. More than half of the users found the online information inappropriate. Lower age, shorter time since diagnosis, progress, and a more frequent internet use were associated with search for information. Only one-third fully trusted online information. Trust in online information was associated with high age, higher educational level, and frequent search for online information. Many survivors stressed that they were primarily trusting their treating urologist.

CONCLUSIONS

Two-thirds of long-term PCa survivors are using the internet. A significant proportion expressed difficulties finding proper and reliable information. Urologists should be familiar with online resources on PCa in order to offer advice to patients and to recommend adequate information on the internet.

Using Facebook for Qualitative Research: A Brief Primer

As Facebook continues to grow its number of active users, the potential to harness data generated by Facebook users also grows. As much of Facebook users’ activity consists of creating (and commenting on) written posts, the potential use of text data for research is enormous. However, conducting a content analysis of text from Facebook users requires adaptation of research methods used for more traditional sources of qualitative data. Furthermore, best practice guidelines to assist researchers interested in conducting qualitative studies using data derived from Facebook are lacking. The purpose of this primer was to identify opportunities, as well as potential pitfalls, of conducting qualitative research with Facebook users and their activity on Facebook and provide potential options to address each of these issues. We begin with an overview of information obtained from a literature review of 23 studies published between 2011 and 2018 and our own research experience to summarize current approaches to conducting qualitative health research using data obtained from Facebook users. We then identify potential strategies to address limitations related to current approaches and propose 5 key considerations for the collection, organization, and analysis of text data from Facebook. Finally, we consider ethical issues around the use and protection of Facebook data obtained from research participants. In this primer, we have identified several key considerations that should aid health researchers in the planning and execution of qualitative studies involving content analysis of text data from Facebook users.

Does YouTube include high-quality resources for training on laparoscopic and robotic radical prostatectomy?

PURPOSE

Our aim was to assess the educational quality of the YouTube video content related to laparoscopic and robotic radical prostatectomy (RP).

METHODS

An objective scoring tool named as Prostatectomy Assessment and Competency Evaluation (PACE) score was used to measure and quantify seven critical steps in RP including bladder drop, preparation of the prostate, bladder neck dissection, posterior/seminal vesicle dissection, neurovascular bundle preservation, apical dissection, and urethro-vesical anastomosis. A five-point scale was used for grading the seven steps, where a score of 1 and 5 represented the lowest and ideal performance, respectively. Additionally, descriptive statistics including the upload time, video length, view count, number of comments, likes, and dislikes were all recorded.

RESULTS

Of the 1688 videos (551 from laparoscopic RP, 567 from robotic RP, and 570 from robot-assisted RP), 226 videos were analyzed after excluding duplicate and irrelevant videos. Robotic/robot-assisted RP videos were found to be statistically longer than laparoscopic RP videos (p = 0.016). The PACE score of urethro-vesical anastomosis step in robotic RP videos was statistically higher than laparoscopic RP videos (p = 0.021). A weak but significant positive correlation between the video length and total PACE score (rho: 0.51; p = 0.04 for laparoscopic RP and rho: 0.43; p = 0.03 for robotic/robot-assisted RP) was found. A weak but positive correlation was also determined between number of likes and total PACE score (rho: 0.39; p = 0.02) for robotic/robot-assisted RP videos.

CONCLUSIONS

Although YouTube website includes high-quality videos for both laparoscopic and robotic/robot-assisted RP, there is no objective parameter to predict the educational quality of the videos.