Differences in information seeking among breast, prostate, and colorectal cancer patients: results from a population-based survey

Marketing cancer care: A content analysis of ethical compliance in television advertising by top-ranked U.S. cancer centers

BACKGROUND

Direct-to-consumer advertising (DTCA) in cancer care influences patient decisions but often targets vulnerable populations. Despite established ethical guidelines, adherence remains understudied. This study evaluates how well top U.S. cancer centers comply with these standards in television advertisements.

METHODS

We analyzed 31 TV ads from 2019 to 2024 produced by members of the top 20 cancer centers as ranked by U.S. News & World Report, comparing them against ethical guidelines from the American Medical Association, American Society of Clinical Oncology, and others. Two independent reviewers categorized ads as compliant, borderline, or transgressive. Transgressive ads explicitly violated guidelines, while borderline cases contained ambiguous claims with at least one problematic interpretation.

RESULTS

Of the 31 ads from 12 institutions, 16 (52 %) were either transgressive or borderline. Only 4 of 12 (33 %) institutions produced exclusively compliant ads. Common issues included unrealistic expectations (36 %), implying exclusive treatment availability (13 %), and unclear eligibility criteria (13 %). Notably, institutions ranked in the top 10 produced 71 % of the ads and were responsible for 8 of 9 transgressive cases.

CONCLUSION

The prevalence of transgressive advertising suggests that ethical guidelines alone are insufficient. Potential solutions include increasing awareness among marketing leadership and enforcing compliance, possibly as a hospital accreditation requirement. Policy Summary: As cancer care continues to advance and treatment options become more complex, ensuring advertising practices adhere to extant ethical guidelines is crucial for supporting informed patient decision-making and maintaining public trust in healthcare institutions.

Information Avoidance: Past Perspectives and Future Directions

In the present age of unprecedented access to information, it is important to understand how and why people avoid information. Multiple definitions of "information avoidance" exist, and key aspects of these definitions deserve attention, such as distinguishing information avoidance from (lack of) information seeking, considering the intentionality and temporal nature of information avoidance, and considering the personal relevance of the information. In this review, we provide a cross-disciplinary historical account of theories and empirical research on information avoidance and seeking, drawing from research in multiple fields. We provide a framework of antecedents of information avoidance, categorized into beliefs about the information (e.g., risk perceptions), beliefs about oneself (e.g., coping resources), and social and situational factors (e.g., social norms), noting that constructs across categories overlap and are intertwined. We suggest that research is needed on both positive and negative consequences of information avoidance and on interventions to reduce information avoidance (when appropriate). Research is also needed to better understand temporal dynamics of information avoidance and how it manifests in everyday life. Finally, comprehensive theoretical models are needed that differentiate avoidance from seeking. Research on information avoidance is quickly expanding, and the topic will only grow in importance.

Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study

BACKGROUND

Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making.

OBJECTIVE

This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States.

METHODS

We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors.

RESULTS

A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9% (n=2705) were health and wellness app users, while 19.1% (n=793) were nonusers. In the final adjusted model, participants with household incomes ≥US $50,000 had 49% higher adjusted odds of using these apps than those with incomes

CONCLUSIONS

Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps.

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Key Words

• United States
• adult
• barrier
• cancer information
• cancer intervention
• cancer management
• cancer screening
• cross-sectional study
• decision-making
• digital health
• digital health and wellness apps
• digital health engagement
• diversity
• engagement
• health seeking behavior
• knowledge seeking
• logistic regression
• mhealth
• mobile health
• mobile phone
• regression analysis
• telehealth
• utilization
• young adult

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MESH Headings

• Humans
• Cross-Sectional Studies
• Female
• Male
• Mobile Applications/statistics & numerical data
• Neoplasms/therapy
• Middle Aged
• Adult
• Aged
• Young Adult
• United States
• Adolescent
• Socioeconomic Factors

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Affiliation(s)

Ogochukwu Juliet Ezeigwe Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Kenechukwu Obumneme Samuel Nwosu Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Oladipo Kunle Afolayan Department of Biostatistics, The University of Texas Health Science Center, Houston, TX, United States
Akpevwe Amanda Ojaruega Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Jovita Echere Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Manali Desai Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Modupe Olajumoke Onigbogi Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Olajumoke Ope Oladoyin Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, United States
Nnenna Chioma Okoye Department of Pharmaceuticals, Gwarinpa General Hospital, Abuja, Nigeria
Pierre Fwelo Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States

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The relationship between men's health literacy levels and their health beliefs and attitudes towards prostate cancer screening: A case study in a rural area

This study aimed to examine the relationship between health literacy level and health beliefs and attitudes regarding prostate cancer screening in males aged 40-70 who lived in rural areas and had not been diagnosed with prostate cancer. The sample of the study consisted of 379 men. The data were collected between January and December 2022 using the "Participant Information Form," the "Turkey Health Literacy-32 Scale," and the "Prostate Cancer Screening Health Belief Model Scale." 58% of the participants are between the ages of 40-55. It was determined that 61.2% defined cancer as a fatal disease, only 14.2% had PSA in their blood and 21.6% had DRE. The average health literacy scale total score of the participants is 33.76 ± 11.55. The health literacy level of men was found to be limited in 14.8%. There was a negative relationship between the total scores of the health literacy scale and the susceptibility perception, seriousness perception, and barriers perception sub-dimensions of the Health Belief Model Scale of Cancer Screenings and a positive relationship between the total scores of the Health Literacy Scale and health motivation and benefits perception subdimensions (p < .001). As a result, men living in rural areas should be given individual counseling by health professionals to use screening tests for cancer symptoms and early diagnosis. In addition, men's health literacy levels should be increased by providing planned and regular health education in order to create positive attitudes and perceptions regarding cancer screenings, especially prostate cancer.

A Better Me? An Interpretative Phenomenological Analysis of the Experiences of Female Cancer Survivors' Heightened Preoccupation With 'Healthy Eating'

The end of treatment is known to be a particularly challenging time for many cancer survivors as they transition to coping with their condition independently. They may engage in health behaviours, such as implementing drastic dietary changes to manage the side effects of treatment they have undergone or as a way to assuage their anxiety. Understanding cancer survivors' heightened preoccupation with healthy eating is therefore fundamental to our understanding of the psychological phenomenology of cancer. This study explored how people who have developed a heightened preoccupation with healthy eating after a cancer diagnosis make sense of this change. Eight participants were recruited through social media. They each engaged in a semi-structured interview over Zoom concerning their changed relationship with food following cancer. Their accounts were then analysed using interpretative phenomenological analysis (IPA). The article focuses on four group experiential themes arising from the analysis: Open and Enlightened About Food, Becoming a Better Me?, Developing a New Passion for Nutrition, and Becoming Consumed by Food. The themes that arose from the analysis speak to the experience of becoming a 'better' person from having lived through cancer and developed a new relationship with food. Instead of seeing illness as a loss, several of the participants reported a positive shift linked to having developed an interest in healthy eating, something which became central to their identity. However, others experienced their new engagement with healthy eating as a preoccupation that engulfed them. These findings are discussed in light of existing theory and research, and their clinical implications are outlined. Areas for future research are also suggested.

Evaluating online health information utilisation and its psychosocial implications among breast cancer survivors: Qualitative explorations

Background

This study investigated the online information-seeking behaviours of breast cancer patients at Jordan University Hospital, focusing on their dissatisfaction with available online health resources and its impact on their well-being and anxiety levels.

Methods

Employing descriptive phenomenology and convenience sampling, we conducted five Skype-based focus groups with 4-6 breast cancer survivors each, from March to July 2020. Data analysis was performed using NVivo, following Braun and Clark's inductive thematic analysis framework.

Results

The thematic analysis revealed critical insights into survivors' interactions with online cancer resources, identifying key subthemes such as the quality of online information, cyberchondriasis, health literacy and search strategies, the distress caused by counterproductive searches, and the tendency to avoid internet searches.

Conclusion

The study underscores the challenges breast cancer survivors face in accessing online health information, especially in Arabic. It highlights the need to improve the quality and accessibility of these resources. Enhancing the cultural relevance of online materials and educating patients on effective information evaluation are crucial. These measures can significantly boost health literacy, mitigate anxiety, and provide better support for breast cancer survivors.

Information needs during cancer care: Qualitative research with locally advanced cervical cancer patients in Brazil, China, Germany, & the US

Objective

This study aimed to identify the information needs and factors for making informed treatment decisions among a diverse group of locally advanced cervical cancer (LACC) patients.

Methods

Semi-structured interviews were conducted with LACC patients of diverse demographic and socioeconomic backgrounds within two years of their cancer diagnosis. Trained moderators asked open-ended questions about patients' cancer journeys. Transcripts were analyzed using NVivo software to identify emergent themes.

Results

In 2022, 92 LACC patients in the United States (n = 26), Brazil (n = 25), China (n = 25), and Germany (n = 16) participated in the study. Physicians were valued sources of information, providing patients with details on prognosis, treatment options, and side effects. While most patients trusted their physicians, one-third sought a second opinion to validate their diagnosis or find a more trusted physician.Most patients conducted their own research on treatment options, side effects, causes of LACC, symptoms, and others' experiences. Challenges to information searches included understanding medical terms, finding relevant information, and evaluating source credibility.Overall, patients felt knowledgeable enough to participate in treatment decisions, either by accepting the recommended treatment or collaborating with their physicians. Nearly one-third of patients desired a more significant role in the decision-making process.

Conclusion

This study highlights the importance of physicians providing LACC patients comprehensive and understandable information, while involving them in the decision-making process. Understanding LACC patients' motivations to seek information and their willingness to actively engage in treatment decisions can lead to improved patient satisfaction in their cancer care.

Health information-seeking behavior among people living with the two common chronic diseases in low and middle-income countries (LMICs). A systematic review and meta-analysis

Objective

The main aim of this review was to systematically collect and summarize the available evidence on health information-seeking behavior among people living with the two common types of chronic diseases in LMICs.

Methods

For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, Google Scholar, and forward and backward citations from included studies. The preferred reporting items for Systematic Reviews and Meta-Analyses (PRISMA) procedure were followed to develop and report the review. The pooled effect size and the effect's 95% confidence interval were calculated using a random-effect model meta-analysis for each research. A sub-group analysis was done to investigate potential sources of heterogeneity. To identify publication bias, Egger-weighted regression tests were employed.

Results

A total of 4281 articles were retrieved, with ten studies meeting the eligibility criteria for qualitative synthesis and only seven studies were eligible for the meta-analysis. The pooled extent of health information-seeking behavior among chronic disease patients was 50.5% (95% CI: 35.36-65.70, p = 0.00), with high heterogeneity (I2 = 98.25). Based on the sub-group analysis, it was found that 55% (95% CI: 29.9-79.4) of cancer patients and 40% (95% CI: 36.9%-43.9%) of DM patients sought out health-related information. In studies conducted before 2015, the level of health information seeking was 49%, increasing to 52% (95% CI: 41.0%-62.2%) after 2015.

Conclusion

The overall health information seeking behavior among diabetes and cancer patients has increased over time, but remains relatively low, with only nearly half actively seeking information. The findings also emphasize that patients require health-related information on various topics.. Health educators and health professionals should consider this diversity when developing interventions and educational materials to provide patients with the most comprehensive information and education regarding their healthcare issues.

Protocol registration number

CRD42023433169.

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

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

Bridging the ICT Revolution and Communication Inequality: Lessons for Cancer Survivors

The rapid development of information and communication technologies (ICTs) offers new opportunities for providing health information to patients. In this study, we examined the contrasting effects that communication innovation through ICTs can bring in the care of patients with chronic diseases and the health promotion of medical consumers. We also discussed how disparities in information technology usage, based on socioeconomic status, affect the information gap and health inequalities among medical consumers. ICTs have democratized health information, but the information gap persists and can deepen health inequality. Communication inequality manifests in access to technology, information processing, attention to health information, information seeking, and health outcomes. Significant differences in health communication behaviors exist according to social class. Social disparities in technology access and usage contribute to the information gap, which ultimately leads to different health levels. Communication innovation through ICT has both positive and negative effects on managing chronic diseases. Positively, it democratizes information generation and consumption, enabling patients to interact with healthcare providers and peers for support and advice. Negatively, an abundance of medical information can cause cognitive overload. To maximize benefits and minimize adverse effects, efforts should focus on promoting ICTs in healthcare, enhancing patients' decision-making abilities, and addressing communication inequality. Healthcare institutions must provide consistent, high-quality information, and governments should support underserved populations' access to information, ensuring that ICTs contribute to improved health outcomes.

Czech Women's Point of Views on Immediate Breast Reconstruction after Mastectomy due to BRCA Gene Mutation or Breast Cancer

(1) Objective: Breast cancer is the most common cancer in women, and the incidence of the disease continues to increase. The issue of immediate breast reconstruction (IBR) in women with BRCA mutations and breast cancer is highly topical. This study is based on the long-term experience of our workplace with the diagnosis and treatment of breast cancer in women. We use the possibilities of oncoplastic surgery, including IBR. Our effort involves learning about women's awareness of IBR with a mastectomy at the same time. (2) Methods: The method of quantitative research of women's awareness using a structured anonymous questionnaire was chosen. Out of the total number of 84 respondents who already underwent IBR, 36.9% were due to BRCA mutations, and 63.1% were due to breast cancer. (3) Results: All of the respondents learned about the possibility of IBR before treatment or during treatment planning. The information was first obtained mainly from an oncologist. Women obtained the most information regarding IBR from a plastic surgeon. Before the mastectomy, all of the respondents already knew what IBR meant, as well as about the payment of IBR by the health insurance company. All of the respondents would choose the IBR option again. A total of 94.0% of women cited preservation of body integrity as a reason for undergoing IBR, and 88.1% of women knew about the possibility of performing IBR with their own tissues. (4) Conclusions: There are few specialized centers with a team of experts in reconstructive breast surgery in the Czech Republic, especially those that perform IBR. Research has shown that all of the patients were well informed about IBR, but the vast majority only learned about IBR before the surgical procedure was planned. All of the women wished to maintain body integrity. Our study results in the recommendations for patients and for healthcare management.

Use of Electronic Communication with Clinicians Among Cancer Survivors: Health Information National Trend Survey in 2019 and 2020

Purpose: To describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. Methods: Secondary analysis included cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the past 12 months. Bivariate analysis and logistic regression were conducted to examine factors associated with e-communication use. All analyses considered the complex survey design using the jackknife replication method. Results: The prevalence of e-communication use was 64% among cancer survivors. The overall e-communication use slightly increased after the start of the COVID-19 pandemic (63% vs. 64%, p = 0.79). Older adults (≥65 years old) were less likely to use e-communication (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.36-0.86); survivors who were white (OR = 2.30; 95% CI, 1.36-3.86), living in a metro area (OR = 2.47; 95% CI, 1.44-4.27), diagnosed with breast cancer (OR = 2.03; 95% CI, 1.06-3.88), seeking cancer-related information previously (OR = 2.89; 95% CI, 1.83-4.58), or having a regular health care provider (OR = 2.07,; 95% CI, 1.10-3.88) were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use (p = 0.053) when other variables were controlled. Conclusion: This nationally representative survey analysis has identified disparities in e-communication use among cancer survivors and revealed the potential increase in e-communication use under the impact of the COVID-19 pandemic. Additional support is clearly warranted for those older, nonwhite, living in rural areas, or without a regular provider, to promote their e-communication use for the delivery of optimal and high-quality cancer care.

The Role of Social Media in Breast Cancer Care and Survivorship: A Narrative Review

Background

Female breast cancer (BC) is the most diagnosed cancer and the leading cause of malignancy-related death worldwide. With the widespread utilisation of the Internet, social media has presented an invaluable yet underemployed tool in the context of BC medical information dissemination, support hub formation, and patient empowerment.

Summary

In this narrative review, we explore the untapped potential of social media in this context, caveats, and future directions that may aid in formulating a new era of patient led, in addition to patient-centred care.

Key Messages

Social media represents a powerful tool with significant potential to enable the seeking and sharing of BC-related information, and enhance patient education, communication, engagement, and empowerment. However, its use is associated with a number of limitations, including confidentiality and addiction issues, excessive and inaccurate information, and a possibility of jeopardising the patient-doctor relationship. Further research is needed to shed more light on this topic.

Understanding Contexts and Challenges of Information Management for Epilepsy Care

Epilepsy is a common chronic neurological disease. People with epilepsy (PWE) and their caregivers face several challenges related to their epilepsy management, including quality of care, care coordination, side effects, and stigma management. The sociotechnical issues of the information management contexts and challenges for epilepsy care may be mitigated through effective information management. We conducted 4 focus groups with 5 PWE and 7 caregivers to explore how they manage epilepsy-related information and the challenges they encountered. Primary issues include challenges of finding the right information, complexities of tracking and monitoring data, and limited information sharing. We provide a framework that encompasses three attributes - individual epilepsy symptoms and health conditions, information complexity, and circumstantial constraints. We suggest future design implications to mitigate these challenges and improve epilepsy information management and care coordination.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Breast Reconstruction Decision Aids Decrease Decisional Conflict and Improve Decisional Satisfaction: A Randomized Controlled Trial

BACKGROUND

Decision aids are useful adjuncts to clinical consultations for women considering breast reconstruction. This study compared the impact of two online decision aids, the Breast RECONstruction Decision Aid (BRECONDA) and the Alberta Health Services (AHS) decision aid, on decisional conflict, decisional satisfaction, and decisional regret.

METHODS

This randomized controlled trial included 60 women considering whether or not to undergo breast reconstruction. Two online decision aids, the AHS and the BRECONDA, were compared using randomized two-arm equal allocation. Participants responded to questionnaires at baseline, after the first and second consultations, and at 6 weeks and 6 months after deciding to, or not to, undergo reconstruction. Change in decisional conflict scores was compared between the BRECONDA and the AHS decision aid. Secondary outcomes included decisional regret and decisional satisfaction.

RESULTS

Both groups were similar in demographic, clinical, and behavioral characteristics. Women spent more time consulting the BRECONDA in comparison to women using the AHS decision aid (56.7 ± 53.8 minutes versus 28.4 ± 27.2 minutes; P < 0.05). Decisional conflict decreased (P < 0.05), and decisional satisfaction improved over time in both groups (P < 0.05). However, there were no differences based on the type of decision aid used (P > 0.05). Both decision aids had a similar reduction in decisional regret (P > 0.05).

CONCLUSIONS

Decision aids decrease decisional conflict and improve decisional satisfaction among women considering breast reconstruction. Physicians should therefore offer patients access to decision aids as an adjunct to breast reconstruction consultations to help patients make an informed decision.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, I.

What Does "Dr. Google" Show Patients Searching for Breast Reconstruction Outcomes Photographs?

Many women with breast cancer search the internet for photographs of their potential reconstruction outcomes, but little is known about the quality, variety, and relevance of images patients are viewing.

Methods

Breast reconstruction outcome photographs identified by a Google Images search were assessed based on the American Society of Plastic Surgeons/Plastic Surgery Foundation photographic guidelines. Information such as source metadata, breast reconstruction procedure information, and subject demographics was collected from the photographs. Additional analyses were conducted to assess whether nipple reconstruction or tattooing occurred and was disclosed, whether a symmetry procedure was performed and disclosed, and whether donor site scarring is visible in abdominal flap photographs.

Results

We acquired and analyzed 114 photograph sets. Although a variety of images were readily available, the majority of photograph sets did not follow photographic guidelines or provide sufficient information. Most photograph sets (60%) indicated symmetry procedures when a symmetry procedure was evident, but only 40% of photograph sets disclosed a nipple procedure when a nipple procedure was evident. Only 40% of abdominal flap photographs showed donor site scarring. Subject demographics were largely missing: 50% of photograph sets included subject age, 3% included race or ethnicity, and 12% included weight or BMI.

Conclusions

Although breast reconstruction outcome photographs shown by "Dr. Google" represent a variety of reconstruction types, they typically lack information that a patient needs to assess self-applicability. Patients may benefit from discussion with their healthcare team about the strengths and limitations of breast reconstruction outcome photographs available on the internet.

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

BACKGROUND

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

OBJECTIVE

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

PATIENT INVOLVEMENT

CMyLife platform was developed with active patient participation.

METHODS

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

RESULTS

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

DISCUSSION

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

PRACTICAL VALUE

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

Mirroring, monitoring, modelling, belonging, and distancing: Psychosocial processes in an online support group of breast cancer patients

Breast cancer patients are primary users of Internet Health Forums, virtual self-help communities where they find and share information, preoccupations, and support. Previous literature has mainly focused on analysing the contents and the outcomes of breast cancer forums' participation. In light of the Community of Practice theoretical model, our research investigated the psychosocial processes that build and shape patients' experience and participation in the forum. We conducted 16 semi-structured email interviews with breast cancer patients recruited within a well-established online community. Thematic analysis identified five processes-mirroring, monitoring, modelling, belonging, and distancing-that marked three phases of users' experience: initiation, participation, detachment. An interactive dynamic characterised the identified processes: the disease's experience was shaped by and, in turn, it crafted this virtual community. These community processes contributed to participants' empowerment at practical, informative, and emotional levels through the development of a shared repertoire of resources, stories, and ways of dealing with patients' recurring problems.

[Opinions and experiences of healthcare professionals in the nutritional management of oncology patients: the ONA study]

OBJECTIVES

an inadequate approach to prevent malnutrition in cancer patients may worsen their quality of life and reduce their response to treatment. This study aims to describe the nutritional management of cancer patients in clinical practice, as well as the opinions of the healthcare professionals (HCPs) involved.

METHODS

this was an observational, descriptive, cross-sectional study addressed to HCPs in the Spanish healthcare setting. The online questionnaire was designed based on a literature review, one focus group of patients (n = 6), and the experience of the multidisciplinary scientific committee (n = 5), and was distributed by the scientific societies endorsing the study.

RESULTS

a total of 461 HCPs answered the survey. Most of them considered that a nutrition expert (95.0 %) is essential for the nutritional management of patients. However, 22.8 % of HCPs did not have access to this expert, and only 49.0 % had received training. Nutritional screening or patient referral for screening was performed by 58.4 % of HCPs. Of the total of HCPs, 86.6 % stated that nutritional information is provided to patients and considered them moderately satisfied with the information received. In malnourished patients or in those at risk of malnutrition, a complete nutritional assessment was performed by HCPs (73.1 %). Most HCPs (87.4 %) reported prescribing or recommending nutritional support if needed, and assessing adherence (86.8 %).

CONCLUSIONS

despite malnutrition being a common problem in cancer patients, almost half of professionals do not perform any nutritional screening. In addition, patient information and assessment of nutritional adherence appear to be suboptimal.

Testing the efficacy of a couple-focused, tailored eHealth intervention for symptom self-management among men with prostate cancer and their partners: the study protocol

BACKGROUND

Men with localized prostate cancer often experience urinary, sexual, bowel, and hormonal symptoms; general distress; pain; fatigue; and sleep disturbance. For men in an intimate relationship, these symptoms disrupt couples' relationships and intimacy. The symptoms also reduce quality of life for both men and their partners, who are often their primary caregivers. Management of the negative effects of cancer and its treatment is a significantly under-addressed supportive care need for these men and their intimate partners. To address these unmet supportive care needs, our interdisciplinary team developed and pilot tested the usability and feasibility of an evidence-based, couple-focused, tailored eHealth intervention, "Prostate Cancer Education & Resources for Couples" (PERC). Based on the adapted stress and coping theoretical framework and developed with stakeholder involvement, PERC aims to improve quality of life for both men and their partners by enhancing their positive appraisals, self-efficacy, social support, and healthy behaviors for symptom management.

METHODS

We will test the efficacy of PERC using a population-based, geographically and demographically diverse cohort in a randomized controlled trial. Primary aim: Assess if patients and partners receiving PERC will report greater improvement in their cancer-related quality of life scores than those in the control group (usual care plus the National Cancer Institute prostate cancer website) at 4, 8, and 12 months post-baseline. Secondary aim: Test if patients and partners in PERC will report significantly more positive appraisals and higher levels of coping resources at follow-ups than those in the control group. Exploratory aim: Determine if patient race and ethnicity, education, type of treatment, or couples' relationship quality moderate the effects of PERC on patient and partner QOL at follow-ups.

DISCUSSION

This study will provide a novel model for self-managing chronic illness symptoms that impact couples' relationships, intimacy, and quality of life. It addresses the National Institute of Nursing Research's goal to develop and test new strategies for symptom self-management to help patients and caregivers better manage their illness and improve quality of life. It also responds to calls for programs from the Institute of Medicine and American Cancer Society to address treatment-related effects and improve survivors' QOL.

TRIAL REGISTRATION

CT.gov NCT03489057.

Preferences and Experiences of People with Chronic Illness in Using Different Sources of Health Information: Results of a Mixed-Methods Study

Background: People with chronic illness are particularly dependent on adequate health literacy (HL), but often report difficulties in accessing, understanding, appraising, and applying health information. To strengthen the HL of people with chronic illness, in-depth knowledge about how they deal with health information is crucial. Methods: To this end, quantitative data from the Second Health Literacy Survey Germany (HLS-GER 2) and qualitative data from seven focus group discussions were used to examine the interest in health information, preferred sources of information as well as experiences and challenges with information management among people with chronic illness. Results: The results show that people with chronic illness have a great interest in health information and use very different sources of health information, preferring personal information from physicians most. The results also point to several challenges in health information management that seem to be influenced by the illness duration as well as by the experiences made with the respective sources. Conclusions: Overall, the study provides important starting points for intervention development for the provision and communication of health-related information, but also to research on health information behavior and HL.

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

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

Chromosomal Rearrangements and Altered Nuclear Organization: Recent Mechanistic Models in Cancer

Simple Summary

New methodologies and technologies developed in the last few decades have highlighted the precise spatial organization of the genome into the cell nucleus, with chromatin architecture playing a central role in controlling several genome functions. Genes are expressed in a well-defined way and at a well-defined time during cell differentiation, and alterations in genome organization can lead to genetic diseases, such as cancers. Here we review how the genome is organized in the cell nucleus and the evidence of genome misorganization leading to cancer diseases.

Abstract

The last decade has seen significant progress in understanding how the genome is organized spatially within interphase nuclei. Recent analyses have confirmed earlier molecular cytogenetic studies on chromosome positioning within interphase nuclei and provided new information about the topologically associated domains (TADs). Examining the nuances of how genomes are organized within interphase nuclei will provide information fundamental to understanding gene regulation and expression in health and disease. Indeed, the radial spatial positioning of individual gene loci within nuclei has been associated with up- and down-regulation of specific genes, and disruption of normal genome organization within nuclei will result in compromised cellular health. In cancer cells, where reorganization of the nuclear architecture may occur in the presence of chromosomal rearrangements such as translocations, inversions, or deletions, gene repositioning can change their expression. To date, very few studies have focused on radial gene positioning and the correlation to gene expression in cancers. Further investigations would improve our understanding of the biological mechanisms at the basis of cancer and, in particular, in leukemia initiation and progression, especially in those cases where the molecular consequences of chromosomal rearrangements are still unclear. In this review, we summarize the main milestones in the field of genome organization in the nucleus and the alterations to this organization that can lead to cancer diseases.

Prostate cancer patients' self-reported participation in research: an examination of racial/ethnic disparities

PURPOSE

We examined prostate cancer patients' participation in research and associated factors by race/ethnicity in a multiethnic sample.

METHODS

Men with a new diagnosis of prostate cancer were identified through the California Cancer Registry. Patients completed a cross-sectional telephone interview in English, Spanish, Cantonese or Mandarin. Multivariable logistic regression models, stratified by race/ethnicity, estimated the associations of patient demographic and health characteristics with participation in (1) any research, (2) behavioral research, and (3) biological/clinical research.

RESULTS

We included 855 prostate cancer patients: African American (19%), Asian American (15%), Latino (24%), and White (42%). In the overall model of participation in any research, African American men (Odds Ratio (OR) = 2.54, 95% CI 1.63-3.94), and those with two or more comorbidities (OR = 2.20, 95% CI 1.27-3.80) were more likely to report participation. Men 65 years old and older (OR = 0.65, 95% CI 0.47-0.91), those who were married or living with a partner (OR = 0.67, 95% CI 0.45-0.98), and those who completed the interview in Spanish (OR = 0.36, 95% CI 0.15-0.85) were less likely to report participating in any research. Stratified analyses identified racial/ethnic-specific sociodemographic characteristics associated with lower research participation, including Spanish or Chinese language, older age, and lower education.

CONCLUSION

African American prostate cancer patients reported higher research participation than all other groups. However, recruitment efforts are still needed to overcome barriers to participation for Spanish and Chinese speakers, and barriers among older adults and those with lower education levels.

Provision of supportive spiritual care for hepatopancreatic cancer patients: an unmet need?

BACKGROUND

Among patients with a serious cancer diagnosis, like hepatopancreatic (HP) cancer, spiritual distress needs to be addressed, as these psychosocial-spiritual symptoms are often more burdensome than some physical symptoms. The objective of the current study was to characterize supportive spiritual care utilization among patients with HP cancers.

METHODS

Patients with HP cancer were identified from the electronic medical record at a large comprehensive cancer center; data on patients with breast/prostate cancer (non-HP) were collected for comparison. Associations between patient characteristics and receipt of supportive spiritual care were evaluated within the overall sample and end-of-life subsample.

RESULTS

Among 8,961 individuals (n_HP=1,419, n_non-HP =7,542), 51.7% of HP patients utilized supportive spiritual care versus 19.8% of non-HP patients (p<0.001). Younger age and religious identity were associated with receiving spiritual care (p<0.001). HP patients had higher odds of receiving spiritual care versus non-HP patients (OR 2.41, 95%CI: 2.10, 2.78). Within the end-of-life subsample, HP patients more frequently received spiritual care to "accept their illness" (39.5% vs. 22.5%, p<0.001), while non-HP patients needed support to "define their purpose in life" (13.1% vs. 4.5%, p=0.001).

DISCUSSION

Supportive spiritual care was important to a large subset of HP patients and should be integrated into their care.

Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study

Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE.

Palliative care knowledge, information sources, and beliefs: Results of a national survey of adults in the USA

OBJECTIVE

Despite its established benefits, palliative care (PC) is not well known among patients and family/caregivers. From a nationally representative survey, we sought to assess the following associated with PC: knowledge, knowledge sources, and beliefs.

METHODS

Data were drawn from the Health Information National Trends Study (HINTS 5 Cycle 2), a cross-sectional, survey of non-institutionalized adults aged 18+ years in the USA. Data were weighted and assessed by proportional comparison and multivariable logistic regression.

RESULTS

A total of 3504 respondents were identified, and approximately 29% knew about PC. In the adjusted model, less PC knowledge was associated with: lower age (those aged <50), male gender, lower education (<high school graduation or high school graduate), and non-internet users. A little over half (55%) of respondents accessed healthcare providers first for PC information, and 80% considered providers the most trusted source of PC information. Most of the participants strongly/somewhat agreed that the goal of PC is to help friends and family cope with a patient's illness (90.6%), offer social and emotional support (93.4%), and manage pain and other physical symptoms (95.1%). Similarly, a majority (83.3%) strongly/somewhat agreed that it is a doctor's obligation to inform all patients with cancer about the option of PC.

SIGNIFICANCE OF RESULTS

PC knowledge was generally low (1-in-3 respondents knew of PC), with significant differences according to age, gender, education, and internet use. These data provide a baseline from which PC education policies and interventions may be measured.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR CANCER SURVIVORS

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

Health Services: A Mixed Methods Assessment of Canadian Cancer Patient Education Materials Related to the 2019 Novel Coronavirus

The 2019 novel coronavirus (COVID-19) pandemic has prompted the reorganization in the scheduling and method of care for many patients, including patients diagnosed with cancer. Cancer patients, who have an immunocompromised status, may be at a higher risk of severe symptoms from infection with COVID-19. While information is rapidly evolving regarding COVID-19, Canada, both nationally and provincially, has been conveying new information to patients online. We assessed the content and readability of COVID-19-related online Canadian patient education material (PEM) for cancer patients to determine if the content of the material was written at a grade reading level that the majority of Canadians can understand. PEMs were extracted from provincial cancer agencies and the national Canadian Cancer Society, evaluated using 10 readability scales, qualitatively analyzed to identify their themes and difficult word content. Thirty-eight PEMs from both national and provincial cancers associations were, on average, written above the recommended 7th grade level. Each of the associations' average grade levels were: BC Cancer (11.00 95% confidence interval [CI] 8.27-13.38), CancerControl Alberta (10.46 95% CI 8.29-12.62), Saskatchewan Cancer Agency (11.08 95% CI 9.37-12.80), Cancer Care Manitoba (9.55 95% CI 6.02-13.01), Cancer Care Ontario (9.35 95% CI 6.80-11.90), Cancer Care Nova Scotia (10.95 95% CI 9.86-12.04), Cancer Care Eastern Health Newfoundland and Labrador (10.14 95% CI 6.87-13.41), and the Canadian Cancer Society (10.06 95% CI 8.07-12.05). Thematic analysis identified 4 themes: public health strategy, information about COVID-19, patient instructions during COVID-19, and resources. Fifty-three percent of the complex words identified were medical jargon. This represents an opportunity to improve PEM readability, to allow for greater comprehension amongst a wider target audience.

Early detection of COVID-19 in China and the USA: summary of the implementation of a digital decision-support and disease surveillance tool

OBJECTIVES

Rapid detection and surveillance of COVID-19 is essential to reducing spread of the virus. Inadequate screening capacity has hampered COVID-19 detection, while traditional infectious disease response has been delayed due to significant demands for healthcare resources, time and personnel. This study investigated whether an online health decision-support tool could supplement COVID-19 surveillance and detection in China and the USA.

SETTING

Daily website traffic to Thermia was collected from China and the USA, and cross-correlation analyses were used to assess the designated lag time between the daily time series of Thermia sessions and COVID-19 case counts from 22 January to 23 April 2020.

PARTICIPANTS

Thermia is a validated health decision-support tool that was modified to include content aimed at educating users about Centers for Disease Control and Prevention recommendations on COVID-19 symptoms. An advertising campaign was released on Microsoft Advertising to refer searches for COVID-19 symptoms to Thermia.

RESULTS

The lead times observed for Thermia sessions to COVID-19 case reports was 3 days in China and 19 days in the USA. We found negative cross-correlation between the number of Thermia sessions and rates of influenza A and B, possibly due to the decreasing prevalence of influenza and the lack of specificity of the system for identification of COVID-19.

CONCLUSION

This study suggests that early deployment of an online campaign and modified health decision-support tool may support identification of emerging infectious diseases like COVID-19. Researchers and public health officials should deploy web campaigns as early as possible in an epidemic to detect, identify and engage those potentially at risk to help prevent transmission of the disease.

Ashamed Caregivers: Self-Stigma, Information, and Coping among Dementia Patient Families

The number of people living with dementia increases almost every year, and the majority of the care system for these individuals is often made up of close family members. This study investigates the relationship between family caregivers' cross-checking of information with healthcare providers and patient health outcomes. Specifically, we examined whether this relationship was mediated by caregivers' enhanced coping efficacy. We also tested the moderation effect of family caregivers' affiliate stigma on information cross-checking, coping efficacy, and coping outcomes. Using a survey of 226 family caregivers of dementia patients in South Korea, this study tested the moderated mediation model with the PROCESS macro. Results indicate that low affiliate stigma moderates coping efficacy on the relationship between information cross-checking and dementia patients' health outcomes. Further implications for family caregiving and general dementia care are discussed.

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.

Online peer-to-peer support for persons affected by prostate cancer: A systematic review

OBJECTIVE

Little is known about online peer-to-peer support for persons affected by prostate cancer (PC) and its potential effects.

METHODS

Our systematic review of the literature followed the PRISMA statement and revealed a total of 2372 records. Finally, 24 studies about online peer-to-peer support for persons affected by PC were selected for qualitative synthesis. Due to a lack of suitable quantitative results, the intended meta-analysis was not possible.

RESULTS

Available studies were almost exclusively descriptive. Only one randomized controlled trial (RCT) included 40 PC survivors. In this study, quality of life improved in online support group (OSG) users and decreased in the control group. However, it returned to baseline in both groups after eight weeks. As a summary across all studies, OSGs play a significant role in patients' treatment decision-making and for the social environment of PC patients. Information exchange in OSGs was predominant, but emotional and supportive content also had an important function.

CONCLUSION

Due to the inconsistent methodology and the lack of reporting standards, a synthesis from the available studies is very limited.

PRACTICE IMPLICATIONS

Population-based studies should focus on the actual use of OSGs. The effectiveness of OSGs needs to be investigated in RCTs.

How individual and neighborhood characteristics relate to health topic awareness and information seeking

Structural determinants of health like neighborhood are often overlooked in the context of understanding public awareness of health topics and health information seeking behaviors. Seeking health information is particularly relevant given that some communities have higher prevalence of disease than others. Using the Structural Influence Model of Health Communication (SIMHC), this paper examines how both individual and neighborhood level characteristics contribute to health communication outcomes such as being aware of health topics like cancer, obesity, and HIV, and whether or not individual seeking health-related information or coming across information in the course of their general media use. Respondents to the Southeastern Pennsylvania Household Health Survey (SEPa HHS), a county-stratified random sample of adults ages 18-75 years old, who completed the survey in 2015, were recontacted for participation in 2017. Over one-thousand respondents (n=1,005) completed the survey, and the final sample size for this analysis was 887. Individual level correlates included demographic factors and relevant lifestyle behaviors (e.g., smoking); neighborhood level variables- determined by ZIP Code- included such socioeconomic status (SES) measures as percent unemployed, percent with a high school education, and percent living in poverty. Multilevel modeling was used to determine whether there were random effects on the health communication outcomes of interest. Analyses showed our outcomes of interest did not vary across neighborhoods, whether they were treated as random or fixed effects. Different characterizations of neighborhood (e.g., census block group) and different indicators of neighborhood media environments may be more likely to demonstrate macro level effects on health communication outcomes.

•

Neighborhood characteristics were not related to awareness of different health topics or health information seeking behavior.

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For most topics, reported awareness of health topics from the media was greater than from medical providers.

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Information scanning was more prevalent among those with a college education and who were younger and female.

Beliefs and Information Seeking in Patients With Cancer in Southwest China: Survey Study

Background

Although previous studies have reported the cancer information-seeking behaviors among patients in high-income countries, the cancer information-seeking practices of patients living in low- and middle-income areas are less known.

Objective

This study investigated the beliefs and information-seeking patterns of cancer patients in southwest China.

Methods

A questionnaire was designed, and data were collected in two hospitals (N=285) in southwest China. Statistical analyses included bivariate analyses and regressions.

Results

Patients’ attitudes towards cancer fatalism were significantly influenced by marital status (P<.001), education (P<.001), and household income (P<.001). Moreover, endorsing fatalistic belief was positively associated with age (r=0.35, P<.001). The regression model showed that younger patients (odds ratio [OR] 0.96, 95% CI 0.93-0.99) and those with higher education (OR 1.75, 95% CI 1.09-2.81) were more likely to seek information. Additionally, patients who were less confident in getting information were more likely to find information (OR 1.70, 95% CI 1.15-2.52), while fatalism belief was not significant in the regression (OR 0.65, 95% CI 0.22-1.95).

Conclusions

This study explored the information-seeking patterns of cancer patients in southwest China. It was found that many Chinese people endorsed cancer fatalism. These pessimistic beliefs about the potential to prevent and to cure cancer correlate with rather than cause cancer-related information seeking. However, self-efficacy about the confidence in finding needed cancer information was a significant predictor of information-seeking.

Sources of health information among U.S. cancer survivors: results from the health information national trends survey (HINTS)

Background

Health information is crucial for preservation of health and maintenance of healthy practices among cancer survivors. This study examines the sources and factors associated with choice of health information source among cancer survivors and those without a cancer history.

Methods

We examined health information sources utilized by cancer history between 2011–2014 and 2017–2018 using the Health Information National Trends Survey (HINTS). Factors associated with seeking health information were examined using multinomial logistic regression. Data from HINTS 4, cycles 1–4 (2011–2014) and HINTS 5, cycles 1–2 (2017–2018) were combined and used for all analyses. HINTS-FDA, cycles 1–2 (2015–2017) were excluded from this study because the question about a cancer history was not asked.

Results

Over half of cancer survivors (52.7%) and those without a cancer history (60.9%) obtained their health information through the media. Among cancer survivors, factors associated with health information seeking either through the media or interpersonal communication relative to not seeking information were age, gender, level of education, income, marital status and having a regular healthcare provider. Male survivors were 39% less likely to seek health information from the media (aOR: 0.61; 95% CI: 0.38–0.99) while those with a regular health provider had significantly higher odds of seeking health information via interpersonal communication (aOR: 1.92; 95% CI: 1.09–3.38). In addition, widowed cancer survivors had lower odds of seeking health information from either interpersonal communication (aOR: 0.28; 95% CI: 0.13–0.60) or the media (aOR: 0.30; 95% CI: 0.13–0.69). In the study population without a cancer history, compared to non-Hispanic whites, non-Hispanic blacks, Hispanics and non-Hispanic other categories were significantly less likely to seek health information from the media rather than not seek health information.

Conclusion

Socioeconomic status, marital status, gender and age are important correlates of choice of health information source among cancer survivors in the US. These factors may be useful in guiding interventions aimed at various groups of cancer surviving populations to ensure that they improve their health seeking behaviors.

Filling the gaps of patient information and comprehension

PURPOSE OF REVIEW

This review describes the gaps in cancer patient information and comprehension and provides examples of interventions aimed at filling the gaps.

RECENT FINDINGS

Despite the technologically advanced era, unmet information needs remain a challenge in current cancer care, even though the beneficial effects of adequate information provision are well described.It starts with the basics of patient-physician communication and information exchange. Barriers are described both patient and physician-specific. For patients to comprehend and recall information correctly, information provision should be tailored to the specific patient in content, as well as in readability level. Tailored content based on bidirectional and iterative information exchange (i.e., patients reported outcomes, followed by specific/personalized feedback) is of focus in the current development of interventions aimed at meeting the gaps. However, the effects of such interventions are not overwhelming and the explanation could be multifactorial.

SUMMARY

Unmet informational needs are still a gap in current cancer care. The effect of eHealth interventions is not yet well established. Key is to educate patients and (future) healthcare professionals in eHealth. Future research should focus on identifying what kind of interventions are able to fill the gaps.

Health information seeking behaviors among individuals with young-onset and average-onset colorectal cancer: an international cross-sectional survey

PURPOSE

Our objective was to evaluate health information seeking behaviors in yCRC (young onset colorectal cancer, diagnosed ≤ 50 years) and aCRC (average-age onset colorectal cancer, diagnosed ≥ 50 years).

METHODS

We administered an international, Internet-based survey to ask individuals diagnosed with CRC how they seek health information, including sources sought and utilization behaviors. We also asked participants their preferences for digital technologies.

RESULTS

In total 1125 individuals including 455 with yCRC (68.6% female) and 670 with aCRC (53.5% female) participated. There were similar frequencies of seeking among participants with yCRC and aCRC across all sources except for the Internet. Healthcare providers were the most frequently sought source with similar proportions of participants indicating their response as "always" (yCRC, 43.7% vs. aCRC, 43.2%, p = 0.91). We also observed differences in utilization behaviors with more participants with yCRC using the Internet first when seeking information (yCRC 31.6% vs. aCRC 24.3%, p < 0.05) and those with aCRC seeking healthcare providers first (aCRC 61.9% vs. yCRC 45.5%, p < 0.05). With respect to digital technologies, we found a higher proportion of yCRC participants owning smartphones and indicating use of apps related to health/wellness and cancer.

CONCLUSION

Individuals with yCRC and aCRC similarly sought the same resources for health information on CRC. However, they differed with respect to utilization behaviors, particularly a greater reliance on digital technologies among individuals with yCRC. These have implications for informing age-specific resources and information to support patients.

Arthroplasty information on the internet: quality or quantity?

AIMS

Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients' quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online.

METHODS

We identified 10,800 websites using 18 TJR-related keywords (conditions and procedures) across the Australian, French, German and Spanish Google search engines. We used the Health on the Net (HON) toolbar to evaluate the first 150 websites downloaded for every keyword in each language. The quality of information on websites was inspected, accounting for differences by language and tertiles. We also undertook an analysis of English websites to explore types of website providers.

RESULTS

'Total joint replacement' had the most results returned (150 million websites), and 9% of websites are HON-accredited. Differences in information quality were seen across search terms (p < 0.001) and tertiles (p < 0.001), but not between languages (p = 0.226). A larger proportion of HON-accredited websites were seen from keywords in the condition and arthroplasty categories. The first tertile contained the highest number of HON-accredited websites for the majority of search terms. Government/educational bodies sponsored the majority of websites.

CONCLUSION

Clinicians must consider the shortage of websites providing validated information, with disparities in both number and quality of websites for TJR conditions and procedures. As such, the challenge for clinicians is to lead the design of reliable, accurate and ethical orthopaedic websites online and direct patients to them. This stands to reward both parties greatly.

Importance of and Satisfaction with Information about Their Disease in Cancer Patients

To learn more about information needs and satisfaction with provided information among cancer patients and whether dissatisfaction with information has any association with how therapy decisions are made. An online survey was conducted during March 2015 and January 2016 by the German non-profit patient organization "Das Lebenshaus e.V." among their members with rare solid tumors. A total of 338 records was analyzed. The majority found information on their disease important and was satisfied with the provided information. The participants were less satisfied with the information concerning management of side effects than with other aspects of information (p < .001). Support groups, lectures, and the oncologist were rated as the most helpful sources of information followed by a second opinion and media. Participants who were dissatisfied with the information more often made the decision on the treatment alone by themselves (p < .001). Our results show a high satisfaction with disease-related information among our study participants. Improvements could be made by offering more information on the management of side effects and by giving more information about support groups, reliable websites, and other helpful media.

Health-Related Internet Use Among Men With Prostate Cancer in Canada: Cancer Registry Survey Study

Background

After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population.

Objective

This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website.

Methods

Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression.

Results

A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82% (n=1071) were internet users and 71% (n=910) used the internet daily. Further, 65% (n=784) used the internet as a source of prostate cancer information, and 40% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95% CI 1.0-1.1). Top features wanted in a website, reported by more than 50% of respondents, were a library of resources (n=893, 65.6%), tools to support treatment decision making (n=815, 59.8%), and tools to help navigate the prostate cancer journey (n=698, 51.2%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3%), disease progression (n=904, 66.4%), and management of side effects (n=858, 63%).

Conclusions

Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men’s confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects.

Changes in internet use and wishes of cancer survivors: A comparison between 2005 and 2017

Background

Given the major changes in internet use for health communication, the objective of the current study was to compare the internet use and wishes of cancer survivors between 2005 and 2017.

Methods

The authors drew a sample of 390 patients in 2005 and 539 patients in 2017 who were diagnosed with breast (128 patients in 2005 and 143 patients in 2017), prostate (96 patients in 2005 and 126 patients in 2017), or gynecologic (89 patients in 2005 and 188 patients in 2017) cancer or lymphoma (77 patients in 2005 and 82 patients in 2017) in 4 different hospitals for the periods 2002 through 2004 and 2014 through 2016. These patients were sent a paper‐based questionnaire that contained 45 questions regarding demographics and 4 functions of internet use: content, communication, community, and e‐health.

Results

The response in 2017 (53%) was lower than that in 2005 (75%). Survivors browsed the internet most frequently to search for information regarding cancer shortly after being diagnosed and while waiting for treatment. There was little change noted with regard to the relative importance attached to the various subjects. In 2017, significant increases were evident with regard to finances (+33%), health care insurance (+29%), and genetics and/or heritability (+27%). The wishes expressed in 2005 by patients were realized in part in 2017.

Conclusions

A significant sample of cancer survivors in the Netherlands have indicated that the internet is an important source of information regarding their illness. However, little change was evident over the past 15 years with regard to patients' priorities regarding their wishes for internet use. The wishes of users in 2005 were found to accurately reflect the internet use of the majority of patients in 2017. The results of the current study support the belief that health care professionals should expand their online services and tailor them toward the needs and wishes of their patients.

The internet wishes of patients with cancer reported in 2005 accurately reflect the internet use of the majority of patients in 2017. The current study supports the belief that health care professionals should expand their online services and tailor them toward the needs and desires of their patients.

Aromatase inhibitors: The unexpected breast cancer treatment

OBJECTIVE

Suboptimal adherence with endocrine treatment for breast cancer is influenced by a number of factors but remains poorly understood. We sought to describe the prior knowledge about and expectations of breast cancer treatments among older women retrospecting on their diagnosis and treatment.

METHODS

Thematic analysis was used to systematically analyze data obtained with face-to-face, open-ended interviews conducted with 54 women who had filled at least one prescription for an aromatase inhibitor. The average age was 71.9 (65-93) years at diagnosis.

RESULTS

Three salient themes were described: the sources of information on which preknowledge and expectations surrounding treatment were founded, and two phases of treatment, primary (surgery, chemotherapy and radiation therapy) and anti-hormonal. The main source of information was from family and friends who had been treated for cancer. These peers reported both positive and negative experiences and in many cases contributed to the women having some degree of misinformation. A foundational knowledge of primary treatments was evident (necessity, duration, intensity, side-effects) and that receiving one or more treatments was needed. Compared to primary treatments, anti-hormonal treatment (AHT) was unexpected, the women knew less about it, and felt comparatively under-prepared for this treatment.

CONCLUSIONS

The transition from primary treatments to adjuvant AHT therapy with receiving a prescription for an aromatase inhibitor caught many participants off guard. Our findings elucidate areas to enhance clinical practice, expand the research agenda to more thoroughly explore AHT information and design of an age-appropriate supportive intervention to improve continuation with AHT.

[Trends in cancer information services over 25 years : An analysis of inquiries from patients and relatives made to the Cancer Information Service of the German Cancer Research Center from 1992 to 2016]

BACKGROUND

Cancer information services (CISs) are a valuable source of evidence-based information. Previous studies in the field of CISs often investigate only short periods of time. However, there is a need for long-term analyses to identify changes in the use of CISs.

OBJECTIVES

The purpose of this study was to analyze trends in the inquiries of patients and surrogate seekers to a CIS.

METHOD

We conducted a secondary data analysis of the inquiry records of the German CIS (Krebsinformationsdienst, KID) hosted by the German Cancer Research Center from 1992 until 2016 (N = 545,070). Trends in the number of inquiries were described using the whole sample, while the description of further characteristics is based on a sample (n = 55,046) of patients, their family members, and friends.

RESULTS

The inquiries increased in the period examined (1992: 11,344 inquiries; 2016: 34,869 inquiries). Since 2005, a greater share of patients (between 52 and 60%) than surrogate seekers have been contacting the CIS. The mean age of both self-seeking and supported patients increased from under 55 years between 1992 and 2000 up to over 60 years in the year 2016. Breast cancer is at all times the most frequently inquired cancer type (patients: n = 11,319, 39%; surrogate seekers: n = 4173, 17%). Even after the implementation of e‑mail as an additional communication channel, the majority of inquirers still prefer contact by phone (between 80 and 98%).

CONCLUSIONS

Changes in the utilization of a CIS over time are discussed against the background of structural changes, such as shifts in prevalence rates, family structures, or media environments.