Navigating cancer using online communities: a grounded theory of survivor and family experiences

Navigating Disagreements on Health Information: How Patients With Cancer Perceive Health Care Providers' Approaches to Discussing Patient-Identified Information

PURPOSE

Although publicly available cancer-related information online and offline could help patients make informed decisions, it also poses challenges due to prevalent misinformation. Patients need proper provider guidance to ensure they use valid and relevant information in decisions. We identify effective communication approaches for providers when (1) discussing patient-identified information and (2) disagreeing with it.

METHODS

From June to August 2023, people living with cancer were reached via online communities and asked first about their actual experiences discussing patient-identified information with their providers. Respondents were then randomly assigned into an experiment with three hypothetical scenarios where providers disagreed with patient-identified information. Provider responses included (1) dismissal, (2) explanation, and (3) explanation with relationship-building elements. Pearson correlation and multivariable analysis of variance were used to evaluate differences in patient perceptions.

RESULTS

One hundred seventy-five respondents completed the survey. Mean age: 53 years; 45% female; and 88% White, 10% Black, and 2% others. Forty-six percent held Bachelor's degrees or higher, 11% lived rurally, 36% reported financial difficulties, and 46% rated their health as good/excellent. Between 31% and 37% of respondents reported their provider used communication approaches that negatively correlated with discussion outcomes. The approaches included avoidance of such conversations due to limited time, discouragement of future information searches, or judgmental comments. In the experiment, respondents randomly assigned to receive relationship-building elements were significantly more comfortable sharing information, felt more satisfied, respected, and trusted their provider's opinion more than those receiving the dismissal scenario. The explanation scenario was not perceived differently compared with the dismissal scenario.

CONCLUSION

More than a third of respondents reported negative communication when sharing patient-identified information with their provider. Provider prioritization of relationship-building alongside explanations could foster trust and facilitate open information exchange, supporting informed decisions.

[Chat-based cancer counseling in Switzerland: A reflexive thematic analysis of chat protocols focused on cancer survivors' needs]

Chat-based cancer counseling in Switzerland: A reflexive thematic analysis of chat protocols focused on cancer survivors' needs Abstract: Background: The number of people diagnosed with cancer and continue to live as cancer survivors is growing. Together with their relatives, they have information and counseling needs during the illness trajectory. With Cancerline, the Swiss Cancer League offers a chat-based counseling service for cancer survivors. Research question/objective: For the first time, the qualitative study investigated which needs cancer survivors express in Cancerline to gain insights for the further development and quality assurance of chat-based cancer counseling. Methods: Based on the principles of Interpretive Description, 669 chat counseling transcripts were analyzed using Braun et al. (2018) reflexive thematic analysis in an iterative process in six analysis steps. Results: Cancer survivorship needs in Cancerline are multifaceted, and we have identified nine themes: need anonymous chat to communicate, get informed, weigh ethical dilemmas and make decisions, seek meaning and hope, find ways to manage burdensome emotions, resolve social conflict and not burden others, feel understood and give space to own needs, clarify role as significant other acting correctly and seeking security. Conclusions: Chat-based counseling may contribute to supporting cancer survivors with information needs about cancer in a flexible way that is close to everyday life. Professionals can sensitize survivors to chat-based counseling, which makes low-threshold counseling accessible.

A text analytics approach for mining public discussions in online cancer forum: Analysis of multi-intent lung cancer treatment dataset

BACKGROUND

Online cancer forums (OCF) are increasingly popular platforms for patients and caregivers to discuss, seek information on, and share opinions about diseases and treatments. This interaction generates a substantial amount of unstructured text data, necessitating deeper exploration. Using time series data, our study exploits topic modeling in the novel domain of online cancer forums (OCFs) to identify meaningful topics and changing dynamics of online discussion across different lung cancer treatment intent groups.

METHODS

For this purpose, a dataset comprising 27,998 forum posts about lung cancer was collected from three OCFs: lungcancer.net, lungevity.org, and reddit.com, spanning the years 2016 to 2018.

RESULTS

The analysis reflects the public discussion on multi-intent lung cancer treatment over time, taking into account seasonal variations. Discussions on cancer symptoms and prevention garnered the most attention, dominating both curative and palliative care discussions. There were distinct seasonal peaks: curative care topics surged from winter to late spring, while palliative care topics peaked from late summer to mid-autumn. Keyword analysis highlighted that lung cancer diagnosis and treatment were primary topics, whereas cancer prevention and treatment outcomes were predominant across multi-care contexts. For the study period, curative care discussions predominantly revolved around informational support and disease syndromes. In contrast, social support and cancer prevention prevailed in the palliative care context. Notably, topics such as cancer screening and cancer treatment exhibit pronounced seasonal variations in curative care, peaking in frequency during the summers (May to August) of the study period. Meanwhile, the topic of tumor control within palliative care showed significant seasonal influence during the winters and summers of 2017 and 2018.

CONCLUSION

Our text analysis approach using OCF data shows potential for computational methods in this novel domain to gain insights into trends in public cancer communication and seasonal variations for a better understanding of improving personalized care, decision support, treatment outcomes, and quality of life.

"Living with Loss": A qualitative exploration of existential fears among people with advanced lung cancer in online lung cancer support groups

OBJECTIVES

With targeted therapies, people are surviving longer with advanced lung cancer and engaging in online lung cancer support communities. While these groups provide a sense of community, witnessing the death of peers can lead to emotional distress. This qualitative study aims to (1) explore the experience of witnessing death in online cancer support groups; (2) identify factors that contribute to the emotional struggles of witnessing the death of peers; and (3) identify strategies/options for dealing with losses in the cancer community.

METHODS

We conducted a cross-sectional analysis of qualitative interviews exploring existential concerns with participants (n = 25) from oncogene-specific online lung cancer support groups. The principal investigator conducted study interviews between August 2018 and March 2019 where participants were asked about their cancer experiences and existential concerns. We used thematic analysis and NVIVO 11 software to examine and store the de-identified interview data.

RESULTS

Participants indicated that they had often witnessed their peers die and felt the pain of the loss. Factors that played a part in their struggle with witnessing others' death included the closeness of the relationship with the person, the age of the person who died, seeing oneself in the experience of the other dying, disparities in care, and losing touch in the final stages. Participants used varied coping strategies such as celebrating the life of the individual who died, engaging in advocacy efforts, not focusing on the loss, participating in therapy, and bringing self-preserving thoughts.

SIGNIFICANCE OF RESULTS

Our study highlights the importance of addressing existential fears in online lung cancer support groups and incorporating conversations about death in spaces that deal with cancer.

Patient and families' perspectives on telepalliative care: A systematic integrative review

BACKGROUND

Telepalliative care is increasingly used in palliative care, but has yet to be examined from a patient and family perspective. A synthesis of evidence may provide knowledge on how to plan and provide telepalliative care that caters specifically to patients and families' needs.

OBJECTIVE

To synthesise evidence on patients and families' perspectives on telepalliative care.

DESIGN

A systematic integrative review (PROSPERO #CRD42022301206) reported in accordance with PRISMA 2020 guidelines. Inclusion criteria; primary peer-reviewed studies published 2011-2022, patient and family perspective, >18 years, telepalliative care and English/Danish language. Quality was appraised using the mixed-methods appraisal tool, version 2020. Guided by Toronto and Remington, data were extracted, thematically analysed and synthesised.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO and CINAHL were searched in March 2022 and updated in February 2023.

RESULTS

Forty-four studies were included. Analysis revealed five themes; the effect of the Covid-19 pandemic on telepalliative care, adding value for patients and families, synchronous and asynchronous telepalliative care, the integration of telepalliative care with other services and the tailoring and timing of telepalliative care.

CONCLUSION

Enhanced access to care and convenience, as attributes of telepalliative care, are highly valued. Patients and families have varying needs during the illness trajectory that may be addressed by early integration of telepalliative care based on models of care that are flexible and combine synchronous and asynchronous solutions. Further research should examine telepalliative care in a post-pandemic context, use of models of care and identify meaningful outcome measures from patient and family perspectives for evaluation of telepalliative care.

Self-help management of patients undergoing chemotherapy: analysis of the online forum of the women's self-help association against cancer

PURPOSE

The aim of this study was to examine threads on chemotherapy in the largest German self-help forum regarding content and emotions.

METHODS

All threads on the subject of chemotherapy that were published by February 6th, 2022 were included in the category "drug therapy". A total of 50 threads were analyzed. A quantitative analysis was carried out with regard to content, emotions, number of replies, number of hits, duration of the conversation, duration of access in days, number density of replies, and hits per day.

RESULTS

16 threads are about side effects and in 18 threads, the emotion is fear. Threads in which the emotion fear was expressed have the highest number of replies at 3367. Shared therapy successes are posted with pleasure and achieved a higher mean value for the duration of conversation with 1374.25 days.

CONCLUSION

An online self-help forum is a very important source of psychosocial support for patients undergoing chemotherapy.

Advertising Alternative Cancer Treatments and Approaches on Meta Social Media Platforms: Content Analysis

BACKGROUND

Alternative cancer treatment is associated with a greater risk of death than cancer patients undergoing conventional treatments. Anecdotal evidence suggests cancer patients view paid advertisements promoting alternative cancer treatment on social media, but the extent and nature of this advertising remain unknown. This context suggests an urgent need to investigate alternative cancer treatment advertising on social media.

OBJECTIVE

This study aimed to systematically analyze the advertising activities of prominent alternative cancer treatment practitioners on Meta platforms, including Facebook, Instagram, Messenger, and Audience Network. We specifically sought to determine (1) whether paid advertising for alternative cancer treatment occurs on Meta social media platforms, (2) the strategies and messages of alternative cancer providers to reach and appeal to prospective patients, and (3) how the efficacy of alternative treatments is portrayed.

METHODS

Between December 6, 2021, and December 12, 2021, we collected active advertisements from alternative cancer clinics using the Meta Ad Library. The information collected included identification number, URL, active/inactive status, dates launched/ran, advertiser page name, and a screenshot (image) or recording (video) of the advertisement. We then conducted a content analysis to determine how alternative cancer providers communicate the claimed benefits of their services and evaluated how they portrayed alternative cancer treatment efficacy.

RESULTS

We identified 310 paid advertisements from 11 alternative cancer clinics on Meta (Facebook, Instagram, or Messenger) marketing alternative treatment approaches, care, and interventions. Alternative cancer providers appealed to prospective patients through eight strategies: (1) advertiser representation as a legitimate medical provider (n=289, 93.2%); (2) appealing to persons with limited treatments options (n=203, 65.5%); (3) client testimonials (n=168, 54.2%); (4) promoting holistic approaches (n=121, 39%); (5) promoting messages of care (n=81, 26.1%); (6) rhetoric related to science and research (n=72, 23.2%); (7) rhetoric pertaining to the latest technology (n=63, 20.3%); and (8) focusing treatment on cancer origins and cause (n=43, 13.9%). Overall, 25.8% (n=80) of advertisements included a direct statement claiming provider treatment can cure cancer or prolong life.

CONCLUSIONS

Our results provide evidence alternative cancer providers are using Meta advertising products to market scientifically unsupported cancer treatments. Advertisements regularly referenced "alternative" and "natural" treatment approaches to cancer. Imagery and text content that emulated evidence-based medical providers created the impression that the offered treatments were effective medical options for cancer. Advertisements exploited the hope of patients with terminal and poor prognoses by sharing testimonials of past patients who allegedly were cured or had their lives prolonged. We recommend that Meta introduce a mandatory, human-led authorization process that is not reliant upon artificial intelligence for medical-related advertisers before giving advertising permissions. Further research should focus on the conflict of interest between social media platforms advertising products and public health.

Acceptability and Appropriateness of Digital PrEP Interventions for Black and Latina Cisgender Women: Perspectives From Service Providers in Los Angeles County

BACKGROUND

Black and Latina cisgender women (BLCW) experience disproportionately high rates of HIV infection compared with White women. BLCW also experience disparities in uptake of pre-exposure prophylaxis (PrEP), a highly effective HIV prevention strategy. Digital technology interventions may help to improve PrEP accessibility among BLCW and address barriers to receiving PrEP services in clinical settings.

METHODS

We conducted a formative implementation research project with service providers to explore the use of digital technology interventions to improve PrEP care continuum outcomes among priority populations in Los Angeles County. A thematic analysis approach was then used to assess the perceived acceptability and appropriateness of digital PrEP interventions for BLCW.

RESULTS

Of the five technology products presented, service providers viewed the stand-alone telemedicine platforms as the most acceptable intervention type for BLCW. Service providers also noted perceived benefits and barriers that BLCW may experience in using stand-alone telemedicine platforms, and offered recommendations for tailoring the products to meet the individual needs of BLCW.

CONCLUSIONS

Digital PrEP interventions may help address barriers BLCW experience in accessing PrEP in clinical settings. We offer suggestions of implementation strategies to optimize the use of digital PrEP interventions among BLCW.

Transitional self-disappear: the journey of cancer survivors to self re-coherence in a Middle East society

Purpose

People who experience cancer often face serious and unpleasant challenges in understanding their past, present, and future. They think they have lost their lifetime, agency, and interpersonal relationships, and no longer know their bodies. These experiences can change survivors’ perceptions of themselves. Therefore, the present study aimed to develop a deep theoretical understanding of the change of self in cancer survivors.

Methods

Semi-structured interviews were used to collect data. Interviews were conducted with 17 cancer survivors, 2 oncologists, and 2 family members of survivors. In this study, grounded theory methodology was used to explore the process of understanding and experiencing “self” in cancer survivors.

Results

The present study generated a model about the change of self, with the main concept called “transitional self-disappear,” which is understandable based on the concepts of self-disruption (temporal disruption, highlighted body, interference in the agency, individual-self disruption, over-differentiation, relational self-disruption, and painful emotional experiences), self-reconstruction strategy, and quality of self-coherence, and occurs in the context of the cancer-based socio-cultural experiences and individual-environmental preparedness.

Conclusion

This model illuminated the complex paths and roads of the survivors’ journey from self-disappear to self reconstruction/re-coherence. A healthier experience of this journey can be facilitated by the transcendence of the “self” conceptualized in the past, and the promotion of specific (cancer-based socio-cultural experiences) and general (individual-environmental preparedness) conditions.

Integrating online community support into outpatient breast cancer care: Mayo Clinic Connect online platform

Introduction

Mayo Clinic Connect is an online community of over 100,000 members who support each other through sharing lived experience when facing and managing new diagnoses. The community is moderated by Mayo Clinic staff and volunteer patient mentors.

Methods

Mayo Clinic breast clinic patients undergoing evaluation received a binder of support resources including a brochure about Mayo Clinic Connect at visits between January and May of 2019. Surveys were distributed at subsequent visits between May and December of 2019 to assess patient awareness about the online resource, participation frequency, purpose of use, and benefits for members, as well as reasons for not joining (non-members). The primary aim was to assess patient resilience, coping, and self-management after joining the online community.

Results

Nine hundred surveys were distributed, and 102 participants completed surveys between May and December 2019. Forty-five percent (n = 46) had heard about Mayo Clinic Connect; 34% (n = 15) through a brochure. The remainder heard about the community from a Mayo Clinic provider (43%; n = 19) or other resources (22%, n = 10; no response n = 2). Twenty percent (n = 20) of survey participants registered as Breast Cancer group members, and most of this subgroup (55%; n = 11) reported understanding diagnosis, treatment plans, and finding peer support as reasons for joining. Seventy-five percent of Mayo Clinic Connect participants (n = 15) reported the community met or exceeded expectations.

Conclusion

This pilot study reveals the potential positive impact of introducing an online peer support group into clinical care plans for patients coping with a new and anxiety-provoking cancer diagnosis.

Voice Analysis of Cancer Experiences Among Patients With Breast Cancer: VOICE-BC

Patient experience literature in early-stage breast cancer (eBC) is limited. This study used a mixed-methods approach to examine patient conversations from public online forums to identify and evaluate eBC-related themes. Among 60,000 eBC-related posts published September 2014–2019, text from a random subset of 15,000 posts was extracted and grouped into linguistically similar, mutually exclusive clusters using an advanced natural language processing (NLP) algorithm. Clusters were characterized using four quantitative metrics: betweenness centrality (linguistic similarity to other areas of the cluster network), sentiment (general attitude toward a topic), recency (average date of posts), and volume (total number of posts). This analysis represented 3906 unique users (67% and 33% obtained from cancer–specific and general health/nonhealth forums, respectively). Of the 27 clusters identified, most important were “discussing recurrence & progression,” “understanding diagnosis & prognosis,” and “understanding cancer, biomarkers, and treatments.” Several major themes related to recurrence risk, diagnosis, monitoring, and treatment were identified. Additional emphasis on communicating the disease recurrence risk and shared decision-making could strengthen patient-clinician partnerships.

External support factors utilized by patients in coping with cancer: a European perspective

PURPOSE

The article presents the results of research on psychosocial aspects of living with cancer in the Slovak Republic focusing on hospitalized and outpatient cancer patients in treatment during the curative stage of the disease. Assessing cancer patient's interest in receiving help from individual members of a multidisciplinary team was a part of the research.

METHODS

The research was done through a questionnaire designed to focus on individual psychosocial aspects of cancer treatment. The research sample included 67 hospitalized patients and 61 outpatients. Execution of research was conducted in the individual clinical workplaces.

RESULTS

When calculating the interest of cancer patients in spiritual counseling during oncological treatment, hospitalized patients indicated significant interest (p = .014). Similarly, hospitalized patients indicated more interest in using psychological counseling (p = .040) as well as in consultation with the social worker with a significant difference of (p = .017). Interest in the aid of a physical therapist was exhibited more significantly with hospitalized patients (p = .000). Significant interest in hospitalized patients using additional members of the multidisciplinary team was statistically significant (p = .017). Outpatient cancer patients indicated significant interest in finding information about medical conditions on the Internet (p = .000). For items addressing an interest in meeting people with cancer in self-help groups, there was no significant difference between outpatient and hospital patients (p = .298) as with talking to other patients who had cancer (p = .207).

CONCLUSION

External support factors are important in helping patients cope with cancer. Health professionals can help patients mitigate the various difficulties associated with cancer.

Web-Based Peer Support Interventions for Adults Living With Chronic Conditions: Scoping Review

BACKGROUND

Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common.

OBJECTIVE

The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions.

METHODS

This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results.

RESULTS

After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual's chronic condition, access to information, and empowerment.

CONCLUSIONS

There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support-emotional, informational, and appraisal support-were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.

Online Communities as a Driver for Patient Empowerment: Systematic Review

BACKGROUND

The use of online resources has changed how people manage health care processes. Patients seek information about health conditions, guidance in treatment, and support from peers online, complementary to traditional health care trajectories. Online communities have the potential to contribute to the quality of care by increasing patient empowerment; however, there is a gap in research regarding in what way online communities contribute to patient empowerment.

OBJECTIVE

We synthesized research regarding how online communities contribute to patient empowerment to address the research question "In what ways can participation in online communities support patient empowerment?" by studying how patient empowerment is operationalized in different studies. The definition of patient empowerment used in this paper is enablement for people to develop mastery over actions and control over decisions that influence their lives. The mastery is both through processes and outcomes of the development.

METHODS

A systematic review was conducted by searching in the following databases: Scopus, ACM Digital Library, EBSCO (CINAHL and MEDLINE), PubMed, and Web of Science. In total, there were 1187 papers after excluding duplicates, and through selection processes using an analytical framework with definitions of patient empowerment and related concepts, 33 peer-reviewed papers were included.

RESULTS

Findings indicated that online communities support patient empowerment both as a process and as outcomes of these processes. Additionally, it was seen as a complement to traditional health care and encouragement for health care professionals to have a more positive attitude toward patients' usage. There was a mix between deductive (19/33, 58%), inductive (11/33, 33%), and a mixed approach (3/33, 9%) of studying patient empowerment in various forms. The online communities in most papers (21/33, 64%) were well-established and represented patients' initiatives.

CONCLUSIONS

There is a need to include professionals' perspectives regarding how health care can embrace patient empowerment through online communities. This systematic review's main contribution is the proposal of a new framework and conceptualization of how patient empowerment in online communities can be understood from different hierarchical levels.

How patients experience endocrine therapy for breast cancer: an online survey of side effects, adherence, and medical team support

PURPOSE

Many patients with hormone receptor-positive (HR+) breast cancer do not adhere to endocrine therapy (ET), and treatment-related side effects are often discussed by participants in online breast cancer forums. Our aim was to survey this unique group of patients about their ET-related experiences.

METHODS

We partnered with patients active in breast cancer social media communities to develop a survey assessing ET-related side effects and medical team communication. Patients with a history of HR+ breast cancer who had received a recommendation to take ET were eligible to participate in the anonymous, online survey.

RESULTS

Respondents included 2353 women and 54 men. Aromatase inhibitors were the most commonly used medication. Side effects were reported by 91.2%, were more often experienced by women than men (p < 0.001), and were primarily related to medication type. Approximately one-third of respondents discontinued therapy early. While most felt supported by their medical team, 31.5% reported that their side effects were dismissed or minimized. Survey respondents most frequently reported that a healthy diet and exercise, yoga/acupuncture, and vitamins/supplements were helpful in managing ET-related side effects.

CONCLUSIONS

ET-related side effects are very common, and one-third discontinued treatment early. Lifestyle changes and complementary therapies can be important tools for side effect management. One-third of patients did not feel that their side effects were taken seriously.

IMPLICATIONS FOR CANCER SURVIVORS

This is the largest survey of ET use by participants in online breast cancer communities. Further research is needed to identify strategies to improve treatment adherence and to better manage ET-related side effects.

Humanistic burden of living with anaplastic lymphoma kinase-positive non-small-cell lung cancer: findings from the ALKConnect patient insight network and research platform

Aim:

Evaluate real-world patient preferences, experiences and outcomes (health-related quality of life [HRQoL]) from patients with anaplastic lymphoma kinase-positive (ALK+) non-small-cell lung cancer (NSCLC) utilizing the ALKConnect Patient Insight Network.

Patients & methods:

Demographics, disease history/status/treatment, patient preferences and HRQoL (MD Anderson Symptom Inventory lung cancer module, reported as symptom severity and interference) were evaluated for US adults with ALK+ NSCLC.

Results:

Among 104 patients (median age: 53.0 years, 67.3% female, 40.0% employed), HRQoL and 3-month delay in disease progression were important treatment attributes. Burdensome symptoms included fatigue and disturbed sleep. Symptoms interfered most with work and day-to-day activity. Higher HRQoL was associated with ALK tyrosine kinase inhibitor (TKI) treatment and employment.

Conclusion:

ALKConnect demonstrated that disease progression, HRQoL, fatigue/sleep, ALK TKIs and employment matter in ALK+ NSCLC.

Risk reduction and harm prevention in technology use. •

This commentary paper draws on Swanton et al.'s (2020) paper "Problematic risk-taking involving emerging technologies: A stakeholder framework to minimize harms" to discuss issues pertaining to the challenges and possible risks emerging technologies may pose for the users. It acknowledges technology use is not problematic per se, but for some users, it can be associated with preventable harms. Corporate social responsibility is called for to protect consumers. It is argued that there exists a collective responsibility to ensure technology can be used in a healthy and beneficial way, risk is reduced and harm is prevented.

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.

A History of #BCSM and Insights for Patient-Centered Online Interaction and Engagement

Purpose

Participation in cancer support groups can provide a sense of community and may better prepare patients for interactions with their health care team. Online interactions may overcome some barriers to in-person support group participation. #BCSM (breast cancer social media), the first cancer support community established on Twitter, was founded in 2011 by two breast cancer survivors. The aims of this study are to describe the growth and changes in this community and to discuss future directions and lessons that may apply to other online support communities.

Methods

Symplur Signals was used to obtain all #BCSM Twitter data from January 1, 2011, to January 1, 2020 (00:00:00 Coordinated Universal Time for both). Hashtag use by selected stakeholder groups, user locations, weekly tweet chat activity, and topics were determined.

Results

From year 1 (2011) to year 9 (2019), tweets using the #BCSM hashtag increased by 424%. Tweets by patient advocates increased by 226%, with a peak in 2016. Impressions, a measure of potential tweet views, by patient advocates increased by 517%. Tweets by doctors and nonphysician health care professionals increased by 693%. Weekly #BCSM tweet chat activity peaked in 2013, increasing by 58.1% from 2011. Chat topics have included survivorship, metastatic breast cancer, death and dying, advocacy, and highlights from national breast cancer meetings.

Conclusions

#BCSM has experienced tremendous growth since 2011, although there are challenges to community sustainability. The weekly chats, as well as discussions utilizing the hashtag but occurring outside of scheduled chat times, serve as an important resource for patients and offer physicians an opportunity to both support and learn from patients.

Factors affecting online health community participation behavior in patients with thyroid cancer

Globally, cancer patients obtain much of their disease information online. Online health communities allow patients to share questions and information about diseases. However, there have been few studies on the factors affecting online health community participation behavior in cancer patients. Online social networking is associated with mental health problems, and patients with thyroid cancer experience high levels of distress, anxiety and depression. The purpose of this study was to investigate factors associated with use of online health communities by patients with thyroid cancer to understand the characteristics of patients participating in such online communities. A questionnaire survey was completed by 114 thyroid cancer patients admitted for surgery at a general hospital in Seoul, Korea. General characteristics, clinical characteristics, attitude toward cancer, distress, and anxiety and depression scores of patients who joined an online health community (user group) and patients who did not (non-user group) were compared. The factors affecting online health community participation were education (p = 0.049), tumor size (p = 0.010), attitude toward cancer (p = 0.022), and anxiety and depression (p = 0.021). The average score of satisfaction with the online health community was 4.25 of 5. The user group had larger tumors, a high awareness of the risk of thyroid cancer, and high levels of anxiety and depression. Patients who actively used the online health community have relatively larger cancer size and had higher levels of mental stress. As such patients are often very anxious and depend heavily on the gathered information, the quality of this information is important. Healthcare professionals need to develop appropriate interventions for patients participating in the online health community.

Improving cancer survivors' e-health literacy via online health communities (OHCs): a social support perspective

PURPOSE

Cancer survivors should have adequate e-health literacy to help them better use online health information. Online health communities (OHCs) can offer cancer survivors different types of social support that can represent another resource to improve health outcomes. However, there is little knowledge of how these OHC are directly related to a cancer survivors' e-health literacy. This study explores how different types of social support in OHCs are associated with cancer survivors' e-health literacy.

METHODS

A questionnaire was developed to collect data from two Chinese OHCs used by cancer survivors. The questionnaire is composed of two parts: six sociodemographic variables (i.e., gender, age, city, education, tenure, and prior Internet experience), two scales for informational support behaviors (i.e., health knowledge seeking and provision of health knowledge), a measure of emotional support within such a setting, and a measure of e-health literacy. Based on 162 complete samples, we determined the measurement properties of the scales used, provided descriptive statistics on major sociodemographic variables and conducted bivariate and multivariable hierarchical regression.

RESULTS

For cancer survivors, females demonstrate higher levels of e-health literacy. Higher education level was related to higher e-health literacy. Health knowledge seeking, contributing to health knowledge, and emotional support were all positively associated with e-health literacy. The interaction effect between health knowledge and emotional support is positively associated with e-health literacy.

CONCLUSIONS

Informational support and emotional support, as two major subtypes of social support within resources available in OHCs, are positively associated with e-health literacy among cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors might benefit from an active strategy for improving personal e-health literacy that includes more active informational involvement and emotional support rather than a passive lurking through e-health information and seeking and reading postings in OHCs.

Secret groups and open forums: Defining online support communities from the perspective of people affected by cancer

Objective

A quarter of people diagnosed with cancer lack social support. Online cancer communities could allow people to connect and support one another. However, the current proliferation of online support communities constitutes a range of online environments with differing communication capacities and limitations. It is unclear what is perceived as online cancer community support and how different features can help or hinder supportive group processes. This study aimed to explore how perceived support is influenced by the different features and formats of online support environments.

Methods

In-depth qualitative interviews were conducted with 23 individuals affected by a range of cancer diagnoses, including both cancer survivors and family members. Data were analysed using deductive thematic analysis guided by a constructivist epistemological perspective.

Findings

Online supportive communities were defined and differentiated by two themes. Firstly, ‘Open forums’ were identified with thematic properties which facilitated a uniquely informative environment including ‘Safety in anonymity’, ‘Perceived reliability’ and ‘Exposure and detachment’. Secondly, ‘Secret groups’ were identified with thematic properties which enhanced an emotionally supportive environment including ‘Personalised interactions’, an overt ‘Peer hierarchy’, and ‘Crossing the virtual divide’.

Conclusions

Properties of groups can engender different degrees of interpersonal relations and different supportive interactions. In particular, support community designers may want to adapt key features such as anonymity, trustworthiness of websites, and the personalised nature of conversations to influence the development of supportive environments. In personalised peer-led groups, it may be prudent to provide guidance on how to reassert a positive environment if arguments break out online.

Content shared on social media for national cancer survivors day 2018

BACKGROUND

Studies estimate that the number of cancer survivors will double by 2050 due to improvements in diagnostic accuracy and treatment efficacy. Despite the growing population of cancer survivors, there is a paucity of research regarding how these individuals experience the transition from active treatment to long-term surveillance. While research has explored this transition from more organized venues, such as support groups for cancer survivors, this paper explores the discourses surrounding cancer survivorship on social media, paying particular attention to how individuals who identify as cancer survivors represent their experience.

METHODS

We identified social media posts relating to cancer survivorship on Twitter and Instagram in early June 2018, in order to coincide with National Cancer Survivorship Day on June 3, 2018. We used nine pre-selected hashtags to identify content. For each hashtag, we manually collected the 150 most recent posts from Twitter and the 100 most recent plus the top 9 posts from Instagram. Our preliminary sample included 1172 posts; after eliminating posts from one hashtag due to irrelevance, we were left with 1063 posts. We randomly sampled 200 of these to create a subset for analysis; after review for irrelevant posts, 193 posts remained for analysis (118 from Instagram and 75 from Twitter). We utilized a grounded theory approach to analyze the posts, first open-coding a subset to develop a codebook, then applying the codebook to the rest of the sample and finally memo writing to develop themes.

RESULTS

Overall, there is substantial difference in the tone and thematic content between Instagram and Twitter posts, Instagram takes on a more narrative form that represents journeys through cancer treatment and subsequent survivorship, whereas Twitter is more factual, leaning towards advocacy, awareness and fundraising. In terms of content type, 120 posts (62%) of the sample were images, of which 42 (35%) were images of the individual posting and 28 (23%) were images of patients posted by family or friends. Of the remaining images, 14 (12%) were of support groups and 7 (6%) were of family or friends. We identified four salient themes through analysis of the social media posts from Twitter and Instagram: social support, celebrating milestones and honoring survivors, expressing identity, and renewal vs. rebirth.

DISCUSSION

We observed a marked relationship between physical appearance, functional status and survivorship. Additionally, our findings suggest the importance of social support for cancer patients and survivors as well as the role social media can pay in identity formation.

CONCLUSION

Our findings suggest that individuals who identify as survivors on social media define their identity fluidly, incorporating elements of physical, emotional and psychological health as well as autonomy.

eHealth literacy in older adults with cancer

OBJECTIVE

Recent advances in health monitoring technology have coincided with increases in the number of older adults with cancer, many of whom report difficulty using health information technology (HIT). Previous studies have identified lower electronic health (eHealth) literacy among older adults (≥65 years) compared to younger adults (<65), but studies in older adults with cancer are limited. The goal of this study was to examine age differences in eHealth literacy and use of technology devices/HIT in patients with cancer, and characterize receptivity towards using home-based HIT to communicate with the oncology care team.

MATERIALS AND METHODS

Patients (n = 198) in a Radiation Oncology clinic were offered an anonymous written questionnaire assessing demographics, eHealth literacy (eHealth Literacy Scale), current use of HIT, and interest in using home-based HIT.

RESULTS AND CONCLUSION

Compared to younger patients, older patients had significantly lower eHealth literacy (p < .01), and were less likely to feel confident evaluating health resources on the Internet (p < .01) or knowing how to use the health information found on the Internet to help them (p < .01) or answer health questions (p = .01). Older patients were also less likely than younger patients to have an email address (p = .04), own a smartphone (p < .01), or use the online patient portal (p = .03). Regardless of age, most patients were not opposed to using home-based HIT to communicate with their oncology care team. Future studies on HIT use in older adults with cancer should further evaluate barriers to using HIT and ways to maximize implementation and accessibility.

Facial skin cancer reconstructive and cosmetic outcomes: Analysis with algorithm for its management

BACKGROUND

Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome.

OBJECTIVE

The study is to share our findings with surgeons and healthcare providers. The authors provide their efforts by pooling data from multiple institutions; as reporting surgical outcomes is significantly lacking and much needed in the Middle East and North Africa region in order to meaningfully improve quality of care. This study proposes an algorithm for management that could aid a surgical decision-making for reconstruction of defects after excision of facial skin cancer.

METHODS

Retrograde simple descriptive analysis study is conducted for multicenter data about management of facial skin cancer and its cosmetic outcome. The analysis involves 159 male patients and 95 females.

RESULTS

Nonmelanoma skin cancer was reported in 250 (98.4%) of 254 cases. Reconstructive procedures were complicated in 16 cases (~6.3% of the study). Skin cancer recurrence in head and neck has happened in five cases (~1.9% of the study). Flaps used survived without major complications; however, V-Y advancement flaps showed the best aesthetic outcome.

CONCLUSION

This study reports data in order to meaningfully improve the quality of care. Disease incidence, reconstructive complications, recurrences, and aesthetic outcome of facial skin cancer are included in the study. Based on the data pooling, the study proposes a simple treatment algorithm that could aid in surgical decision-making. V-Y advancement flaps showed the best aesthetic outcome.

Information needs, communication and usage of social media by cancer patients and their relatives

PURPOSE

The aim of this study was to evaluate cancer patients' need for information, their communication and usage of social media.

METHODS

We developed a standardized questionnaire comprising sections on information needs, communication behavior and usage of social media with respect to cancer and combined this with a validated instrument on eHealth literacy for patients. This questionnaire was provided online and with the help of bloggers and leaders of social media groups, distributed in their networks.

RESULTS

The Internet was the most important information source (n = 308; 77.4%). Yet, most of the participants wanted to get information from their doctor (n = 342; 85.9%). With respect to trust in a source of information, oncologists were named most often (n = 285; 71.6%). On the one hand, many participants got in contact with others, especially peers, via social media (n = 319; 80.3%) with a growing bond to their family members on the other hand (n = 324; 81.6%). The cancer diagnosis was an impulse for starting with active participation in social media for some participants (n = 196; 49.2%).

CONCLUSIONS

With social media gaining importance as source of information for patients, improving the quality of information in these networks is an important task in health care systems.

Analyzing Empowerment Processes Among Cancer Patients in an Online Community: A Text Mining Approach

Background

Peer-to-peer online support groups and the discussion forums in these groups can help patients by providing opportunities for increasing their empowerment. Most previous research on online empowerment and online social support uses qualitative methods or questionnaires to gain insight into the dynamics of online empowerment processes.

Objective

The overall goal of this study was to analyze the presence of the empowerment processes in the online peer-to-peer communication of people affected by cancer, using text mining techniques. Use of these relatively new methods enables us to study social processes such as empowerment on a large scale and with unsolicited data.

Methods

The sample consisted of 5534 messages in 1708 threads, written by 2071 users of a forum for cancer patients and their relatives. We labeled the posts in our sample with 2 types of labels: labels referring to empowerment processes and labels denoting psychological processes. The latter were identified using the Linguistic Inquiry and Word Count (LIWC) method. Both groups of labels were automatically assigned to posts. Automatic labeling of the empowerment processes was done by text classifiers trained on a manually labeled subsample. For the automatic labeling of the LIWC categories, we used the Dutch version of the LIWC consisting of a total of 66 word categories that are assigned to text based on occurrences of words in the text. After the automatic labeling with both types of labels, we investigated (1) the relationship between empowerment processes and the intensity of online participation, (2) the relationship between empowerment processes and the LIWC categories, and (3) the differences between patients with different types of cancer.

Results

The precision of the automatic labeling was 85.6%, which we considered to be sufficient for automatically labeling the complete corpus and doing further analyses on the labeled data. Overall, 62.94% (3482/5532) of the messages contained a narrative, 23.83% (1318/5532) a question, and 27.49% (1521/5532) informational support. Emotional support and references to external sources were less frequent. Users with more posts more often referred to an external source and more often provided informational support and emotional support (Kendall τ>0.2; P<.001) and less often shared narratives (Kendall τ=−0.297; P<.001). A number of LIWC categories are significant predictors for the empowerment processes: words expressing assent (ok and yes) and emotional processes (expressions of feelings) are significant positive predictors for emotional support (P=.002). The differences between patients with different types of cancer are small.

Conclusions

Empowerment processes are associated with the intensity of online use. The relationship between linguistic analyses and empowerment processes indicates that empowerment processes can be identified from the occurrences of specific linguistic cues denoting psychological processes.

Online Communities as Sources of Peer Support for People Living With Cancer: A Commentary

Online communities are virtual spaces dedicated to hosting conversations between individuals with a common interest. Information can be shared and obtained incrementally, as users can periodically post both questions and responses to other users' questions. Although online communities have been used frequently by patients for a myriad of health issues, much remains to be learned about these resources. In this commentary, we explore the emerging role of online communities as forums for information exchange and sources of support for patients with cancer and caregivers. We discuss selected examples of online communities launched by research institutions, advocacy groups, philanthropic organizations, start-ups, and novel enterprises featuring collaborations between industry, health care professionals, and advocates. We explore the risks and benefits of online communities as perceived by oncology clinicians and provide practical recommendations for improving communication between clinicians and patients about the use of online resources.

Social Media Use in Cancer Care

OBJECTIVE

To describe the increasing professional use of social media within oncology health care practice.

DATA SOURCES

Peer-reviewed and lay publications.

CONCLUSION

Social media has changed the communication landscape over the last 15 years. An integral part of worldwide culture, oncology health care professionals can utilize social media to listen, learn, engage, and co-create to advance cancer care.

IMPLICATIONS FOR NURSING PRACTICE

Nurses must be aware of the professional uses for social media, how to use the media, and where to find evidence supporting health care social media efforts within cancer care.