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Berger H, Wittman J, Smith K, Horick N, Norris K, Young A, Magana Gomez J, Ocampo KKE, Skotko BG. Health care satisfaction and medical literacy habits among caregivers of individuals with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32074. [PMID: 37946659 DOI: 10.1002/ajmg.c.32074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Patients with Down syndrome have significant specialized health care needs. Our objective was to understand the needs, satisfaction, and online habits of caregivers as they care for persons with Down syndrome. A mixed-method survey was distributed through REDCap from April 2022 to June 2022 in the United States; a Spanish-translated version was distributed through SurveyMonkey from August 2022 to March 2023 in Mexico. We received 290 completed responses from the United States and 58 from caregivers in Mexico. We found that current health care options are not meeting the needs of many individuals with DS in both the United States (39.7%) and Mexico (46.6%). Caregivers expressed frustrations with the inaccessibility and inapplicability of health care information. In particular, they often found the volume of information overwhelming, given their limited medical background. Additionally, health care recommendations were not customized and lacked practical recommendations. Most caregivers in both the United States (72.1%) and Mexico (82.8%) believe it is not easy to find answers to medical questions about their loved ones with DS. Online platforms with customized, specific health information related to DS could offer innovative solutions to these unmet needs for families and primary care providers.
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Affiliation(s)
- Heidi Berger
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | | | - Katelyn Smith
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Nora Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Norris
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Allison Young
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Javier Magana Gomez
- Nutrition Faculty, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | | | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Wall NR, Fuller RN, Morcos A, De Leon M. Pancreatic Cancer Health Disparity: Pharmacologic Anthropology. Cancers (Basel) 2023; 15:5070. [PMID: 37894437 PMCID: PMC10605341 DOI: 10.3390/cancers15205070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Pancreatic cancer (PCa) remains a formidable global health challenge, with high mortality rates and limited treatment options. While advancements in pharmacology have led to improved outcomes for various cancers, PCa continues to exhibit significant health disparities, disproportionately affecting certain populations. This paper explores the intersection of pharmacology and anthropology in understanding the health disparities associated with PCa. By considering the socio-cultural, economic, and behavioral factors that influence the development, diagnosis, treatment, and outcomes of PCa, pharmacologic anthropology provides a comprehensive framework to address these disparities and improve patient care.
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Affiliation(s)
- Nathan R. Wall
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Ryan N. Fuller
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Ann Morcos
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Marino De Leon
- Division of Physiology, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
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Garikipati SC, Grewal US, Gaddam SJ, Sheth AR, Samant H. Assessing the Educational Value of Pancreatic Cancer Videos on YouTube®. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1134-1139. [PMID: 36469199 DOI: 10.1007/s13187-022-02239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Online resources such as YouTube® can serve as the go-to resource for patients and their caregivers after a life-changing diagnosis of pancreatic cancer. There is a need to analyze the content and educational value of these videos for patients with pancreatic cancer. The top 100 most viewed videos on pancreatic cancer on YouTube® were assessed and data were collected on various variables such as views, likes, dislikes, and comments. Videos categorized as patient educational videos were further analyzed for their content, source, and educational value. Videos uploaded by patients were the most discussed (p = 0.014) and liked (p = 0.0028) videos on YouTube®. The content of the videos (personal experience, advertisement, patient education, medical professional education, alternative treatments, and increased pancreatic cancer awareness) varied depending on the uploader (patients, healthcare providers, professional societies, media) of the videos (p = 0.0007). Patient education videos were poor in being comprehensive on their education of pancreatic cancer based on our rubric (mean score of 7.67 ± 2.63 of 20 possible points). The current study shows that the educational values of YouTube® videos related to pancreatic cancer remain limited. There is significant room for healthcare providers to use the platform to develop and share comprehensive videos that can be used as more effective sources of patient education.
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Affiliation(s)
- Subhash C Garikipati
- Department of Internal Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71104, USA
| | - Udhayvir Singh Grewal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71104, USA.
| | - Shiva Jashwanth Gaddam
- Department of Internal Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71104, USA
| | - Aakash Rajendra Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71104, USA
| | - Hrishikesh Samant
- Department of Gastroenterology and Hepatology, Ochsner Clinic Foundation, New Orleans, LA, USA
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Wilson C, Flight I, Zajac IT, Turnbull D, Young GP, Olver I. Web-Based Communication Strategies Designed to Improve Intention to Minimize Risk for Colorectal Cancer: Randomized Controlled Trial. JMIR Cancer 2018; 4:e2. [PMID: 29434013 PMCID: PMC5826979 DOI: 10.2196/cancer.8250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People seek information on the Web for managing their colorectal cancer (CRC) risk but retrieve much personally irrelevant material. Targeting information pertinent to this cohort via a frequently asked question (FAQ) format could improve outcomes. OBJECTIVE We identified and prioritized colorectal cancer information for men and women aged 35 to 74 years (study 1) and built a website containing FAQs ordered by age and gender. In study 2, we conducted a randomized controlled trial (RCT) to test whether targeted FAQs were more influential on intention to act on CRC risk than the same information accessed via a generic topic list. Secondary analyses compared preference for information delivery, usability, relevance, and likelihood of recommendation of FAQ and LIST websites. METHODS Study 1 determined the colorectal cancer information needs of Australians (N=600) by sex and age group (35-49, 50-59, 60-74) through a Web-based survey. Free-text responses were categorized as FAQs: the top 5 issues within each of the 6 cohorts were identified. Study 2 (N=240) compared the impact of presentation as targeted FAQ links to information with links presented as a generic list (LIST) and a CONTROL (no information) condition. We also tested preference for presentation of access to information as FAQ or LIST by adding a CHOICE condition (a self-selected choice of FAQs or a list of information topics). RESULTS Study 1 showed considerable consistency in information priorities among all 6 cohorts with 2 main concerns: treatment of CRC and risk factors. Some differences included a focus on general risk factors, excluding diet and lifestyle, in the younger cohort, and on the existence of a test for CRC in the older cohorts. Study 2 demonstrated that, although respondents preferred information access ordered by FAQs over a list, presentation in this format had limited impact on readiness to act on colorectal cancer risk compared with the list or a no-information control (P=.06). Both FAQ and LIST were evaluated as equally usable. Those aged 35 to 49 years rated the information less relevant to them and others in their age group, and information ordered by FAQs was rated, across all age groups and both sexes, as less relevant to people outside the age group targeted within the FAQs. CONCLUSIONS FAQs are preferred over a list as a strategy for presenting access to information about CRC. They may improve intention to act on risk, although further research is required. Future research should aim to identify better the characteristics of information content and presentation that optimize perceived relevance and fully engage the target audience. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12618000137291; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=374129 (Archived by WebCite at http://www.webcitation.org/6x2Mr6rPC).
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Affiliation(s)
- Carlene Wilson
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,La Trobe University, Heidelberg, VIC, Australia.,Olivia Newton John Cancer Wellness & Research Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ian T Zajac
- Health & Biosecurity, Commonwealth Scientific & Industrial Research Organisation, Adelaide, SA, Australia
| | - Deborah Turnbull
- Freemasons Foundation Centre for Men's Health, School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ian Olver
- Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Ziebland S, Powell J, Briggs P, Jenkinson C, Wyke S, Sillence E, Harris P, Perera R, Mazanderani F, Martin A, Locock L, Kelly L, Booth M, Gann B, Newhouse N, Farmer A. Examining the role of patients’ experiences as a resource for choice and decision-making in health care: a creative, interdisciplinary mixed-method study in digital health. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04170] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundTraditional health information has been based on facts and figures and not on patient experience (PEx). Websites featuring people’s accounts of their experiences of health and illness are popular as a source of information, support and much else. However, there are concerns that experiential information on the internet might have adverse effects on health.AimsTo find out whether, when and how the NHS should incorporate PEx into online health information and elucidate the mechanisms through which PEx might influence health, develop a tool to measure the effects of online PEx, explore how PEx is used, and investigate the feasibility and acceptability of a randomised controlled trial of online PEx.MethodsMixed methods, including a conceptual literature review, qualitative secondary data analysis, the development of a new questionnaire, online ethnography, observational and experimental studies in an internet café environment, and finally feasibility trials to compare new websites based on PEx with those based on facts and figures.ResultsThe review concluded that online PEx could affect health outcomes through seven domains (information, support, affecting relationships, providing ideas on how to use health services, influencing behaviour change, learning to tell the story and visualising illness). We developed the e-Health Impact Questionnaire, which demonstrates good psychometric properties and is suitable for use across different health groups and various styles of online information. Online ethnographic studies found three types of PEx on multiple sclerosis (MS) platforms: accounts of ‘living with MS’, self-expression and creativity, and experiences of health care and treatment. Observational and laboratory-based methods included studies of how people find and use PEx to inform health choices. We developed a three-stage model (gating, the engagement loop and outcomes) which guided the development of six prototype multimedia websites featuring either experiential information (intervention) or factual information (comparator) for three exemplar health issues. We evaluated the feasibility and acceptability of a trial of the prototype PEx websites, comparing self-report and process measures with a comparator. In the three conditions we randomised 87 (smoking cessation), 148 (asthma), and 42 (caring for someone with MS) participants. At final (2-week) follow-up, retention rates were 75%, 82% and 86%, for smoking cessation, asthma and MS carers, respectively. Usage of the allocated websites was low. The median number of logins to the websites over the 2-week period was two, two and four; the median number of page views was 10, 15 and 27.5, respectively, with a median total duration on site of 9 minutes, 17 minutes and 31.5 minutes respectively. There were no reported adverse events or harms. The qualitative interviews with 30 trial participants found that the trial methods were acceptable and not burdensome and that preferences for combinations of different types of information were both idiosyncratic and dependent on timing and need.LimitationsThis programme used a pragmatic, mixed-methods approach, in which we adapted some standard approaches (e.g. realist review). The conceptual review provided a framework for the whole programme but did not draw on a single overarching theoretically informed approach. Instead, we used relevant theory and methods from the work package leads, who represented a range of disciplines.ConclusionsOnline PEx is not seen as an alternative to facts, or to care from a health professional, but is used in addition to other sources of information, support and expression. This programme of work indicates how the sharing of online PEx may benefit people, and how this can be measured. A randomised controlled trial is feasible but an allocated ‘exposure’ to a ‘dose of information’ is far from from how online experiences are shared in everyday life. Future work evaluating online health interventions which incorporate personal experiences should aim to reflect ‘natural’ use of the internet and might include online ethnography and offline interviews. Studies might explore how and why people use online sources of experience-based health information, and the effects on subsequent behaviour and health and social outcomes in different conditions. Future intervention research evaluating online health interventions should examine and explain issues of engagement and use, and seek to identify how to increase engagement.Trial registrationCurrent Controlled Trials ISRCTN29549695.FundingThis project was funded by the Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 17. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Pamela Briggs
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elizabeth Sillence
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Peter Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fadhila Mazanderani
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Angela Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Bob Gann
- Widening Digital Participation, NHS England, London, UK
| | - Nicola Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ayrian E, Kaye AD, Varner CL, Guerra C, Vadivelu N, Urman RD, Zelman V, Lumb PD, Rosa G, Bilotta F. Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy. J Clin Med Res 2015; 7:731-41. [PMID: 26345202 PMCID: PMC4554211 DOI: 10.14740/jocmr2256w] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/11/2022] Open
Abstract
Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based.
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Affiliation(s)
- Eugenia Ayrian
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Alan David Kaye
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Chelsia L Varner
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carolina Guerra
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, USA
| | - Vladimir Zelman
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Philip D Lumb
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Giovanni Rosa
- Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy ; Department of Anaesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
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Chew SW, Khoo CS. Comparison of drug information on consumer drug review sites versus authoritative health information websites. J Assoc Inf Sci Technol 2015. [DOI: 10.1002/asi.23390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Shu Wen Chew
- Wee Kim Wee School of Communication & Information; Nanyang Technological University; 31 Nanyang Link 637718 Singapore
| | - Christopher S.G. Khoo
- Wee Kim Wee School of Communication & Information; Nanyang Technological University; 31 Nanyang Link 637718 Singapore
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Thompson HS, Shelton RC, Mitchell J, Eaton T, Valera P, Katz A. Inclusion of underserved racial and ethnic groups in cancer intervention research using new media: a systematic literature review. J Natl Cancer Inst Monogr 2014; 2013:216-23. [PMID: 24395995 DOI: 10.1093/jncimonographs/lgt031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND An increasing number of behavioral and psychosocial cancer interventions incorporate new media elements that are digital, networked, and interactive. However, it is unclear to what extent new media is being leveraged to benefit underserved racial and ethnic groups who disproportionately bear the burden of cancer. This inquiry is timely in light of growing evidence that these groups are receptive to new media. A systematic literature review was conducted to assess the inclusion of these groups in research on cancer-related new media interventions and use of new media to reduce racial and ethnic cancer disparities. METHODS A systematic search of three databases was conducted for articles published between January 2000 and March 2012 that presented studies of user experience with a behavioral or psychosocial cancer-related intervention with at least one new media component. RESULTS Thirty-six articles were included in the final review. In about one-quarter of the studies, less than 20% of participants were African American, Latino, Asian American, or American Indian. In less than 10% of the studies, 80% or more of the samples were members of the aforementioned groups. Almost one-third of the studies reviewed were categorized as disparity focused but limited data were available on racial and ethnic differences in responses to new media interventions. CONCLUSIONS Findings suggest that the promise and potential of new media cancer interventions are largely unrealized among the underserved. Additional research is needed to investigate a wide range of issues related to the development and delivery of such interventions in diverse racial and ethnic groups.
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Affiliation(s)
- Hayley S Thompson
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R - MM03CB, Detroit, MI 48201.
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Capurro D, Ganzinger M, Perez-Lu J, Knaup P. Effectiveness of eHealth interventions and information needs in palliative care: a systematic literature review. J Med Internet Res 2014; 16:e72. [PMID: 24610324 PMCID: PMC3961802 DOI: 10.2196/jmir.2812] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/17/2013] [Accepted: 01/09/2014] [Indexed: 11/28/2022] Open
Abstract
Background One of the key components in palliative care is communication. eHealth technologies can be an effective way to support communications among participants in the process of palliative care. However, it is unclear to what extent information technology has been established in this field. Objective Our goal was to systematically identify studies and analyze the effectiveness of eHealth interventions in palliative care and the information needs of people involved in the palliative care process. Methods We conducted a systematic literature search using PubMed, Embase, and LILACS according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected and analyzed quantitative and qualitative data regarding effectiveness of eHealth interventions and users’ information needs in palliative care. Results Our search returned a total of 240 articles, 17 of which met our inclusion criteria. We found no randomized controlled trial studying the effects of eHealth interventions in palliative care. Studies tended to be observational, noncontrolled studies, and a few quasi-experimental studies. Overall there was great heterogeneity in the types of interventions and outcome assessments; some studies reported some improvement on quality of care, documentation effort, cost, and communications. The most frequently reported information need concerned pain management. Conclusions There is limited evidence around the effectiveness of eHealth interventions for palliative care patients, caregivers, and health care professionals. Focused research on information needs and high-quality clinical trials to assess their effectiveness are needed.
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Yli-Uotila T, Rantanen A, Suominen T. Motives of cancer patients for using the internet to seek social support. Eur J Cancer Care (Engl) 2013; 22:261-71. [DOI: 10.1111/ecc.12025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 11/30/2022]
Affiliation(s)
- T. Yli-Uotila
- Nursing Science, School of Health Sciences; University of Tampere; Tampere; Finland
| | - A. Rantanen
- Nursing Science, School of Health Sciences; University of Tampere; Tampere; Finland
| | - T. Suominen
- Nursing Science, School of Health Sciences; University of Tampere; Tampere; Finland
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Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:327036. [PMID: 23365492 PMCID: PMC3556397 DOI: 10.1155/2013/327036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/07/2012] [Accepted: 12/07/2012] [Indexed: 01/17/2023]
Abstract
Background. The dose of alcohol used in EUS-CPN is not standardized. The objective was to compare the safety of 20 mL alcohol versus 10 mL alcohol during EUS-CPN for patients with pancreatic cancer-related pain. Methods. 20 patients were selected to receive 10 mL or 20 mL of alcohol during EUS-CPN. Followup was done at baseline, 24 hours, and weekly. Health-related quality of life (HRQoL) was assessed at baseline, week 2, week 4, and every 4 weeks thereafter until pain returned. Results. There were no major complications in both groups. Minor self-limited adverse effects were seen in 6 (30%) subjects and included lightheadedness in 1 (5%), transient diarrhea in 2 (10%), and transient nausea and vomiting in 3. Pain relief was similar in both groups: 80% in the 10 mL group and 100% in the 20 mL group (P = 0.21). The mean (± SD) duration of pain relief in the 10 mL and 20 mL groups was 7.9 ± 10.8 and 8.4 ± 9.2 weeks, respectively. 30% of patients in each group had complete pain relief. Conclusions. EUS-CPN using 20 mL of alcohol is safe. Similar clinical outcomes were seen in both groups. Further investigations to confirm these findings are warranted.
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Yeo TP, Burrell SA, Sauter PK, Kennedy EP, Lavu H, Leiby BE, Yeo CJ. A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients. J Am Coll Surg 2012; 214:463-75; discussion 475-7. [PMID: 22321518 DOI: 10.1016/j.jamcollsurg.2011.12.017] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND As patients with pancreas and periampullary cancer (PPC) experience improved survival rates and longevity, the focus shifts toward living life while surviving cancer. Fatigue is the most commonly reported symptom in all cancer patients. Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients. STUDY DESIGN One hundred two patients with resected PPC consented to participate in this study and were randomized to either an intervention group (IG) or a usual care group (UCG). Subjects completed visual analog scales, the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 months after hospital discharge. RESULTS Patients in the IG and UCG were comparable with regard to demographics, comorbidities, cancer type and staging, type of resection, preoperative fatigue and pain levels, adjuvant therapy, and baseline walking distance. Patients in the IG had significantly improved scores on the FACIT-Fatigue Scale at study completion, improved fatigue and pain scores, as well as overall physical functioning and mental health composite scores. At study completion, participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared with the UCG. Using hierarchical cluster analysis, 3 mutually exclusive symptom groupings were identified in the cohort. Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG. CONCLUSIONS This is the first prospective, randomized controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients with regard to fatigue levels, physical functioning, and health-related quality of life.
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Affiliation(s)
- Theresa P Yeo
- Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Abstract
OBJECTIVES To describe the current level of utilization of informatics systems in hospice and palliative care and to discuss two projects that highlight the role of informatics applications for hospice informal caregivers. DATA SOURCES Published articles, Web resources, clinical practice, and ongoing research initiatives. CONCLUSION There are currently few informatics interventions designed specifically for palliative and hospice care. Challenges such as interoperability, user acceptance, privacy, the digital divide, and allocation of resources all affect the diffusion of informatics tools in hospice. IMPLICATIONS FOR NURSING PRACTICE Caregiver support through use of information technology is feasible and may enhance hospice care.
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Grant MS, Wiegand DL. Palliative Care Online: A Pilot Study on a Pancreatic Cancer Website. J Palliat Med 2011; 14:846-51. [DOI: 10.1089/jpm.2011.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marian S. Grant
- University of Maryland School of Nursing, Baltimore, Maryland
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Knapp C, Madden V, Marcu M, Wang H, Curtis C, Sloyer P, Shenkman E. Information seeking behaviors of parents whose children have life-threatening illnesses. Pediatr Blood Cancer 2011; 56:805-11. [PMID: 21370415 DOI: 10.1002/pbc.22674] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 05/05/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVES For children with life-threatening illnesses we sought to (1) understand the associations between parental characteristics and preferred health information sources, and (2) assess the e-health literacy of Internet-users. STUDY DESIGN Cross-sectional, telephone survey of 129 parents whose children are in a pediatric palliative care program in Florida. RESULTS Four out of five parents report that they use the Internet, and 64% of Internet-users use it daily. Parents who never use the Internet, versus parents who do use the Internet, are predominately Hispanic (50%) and have less than a high school education (64%) (P ≤ 0.023). Internet-users have high levels of e-health literacy; however, they are not confident or are unsure about the quality of information on the Internet. Not having graduated from high school was associated with a decrease in e-health literacy and using the Internet as the primary information source (vs. doctor as primary source) was associated with an increase in e-health literacy. CONCLUSION Parents of children with life-threatening illnesses have access to and use the Internet as a source of information about their children's health. More information is needed to explore how electronic-based interventions could be used to impact information seeking of parents whose children are in pediatric palliative care programs.
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Affiliation(s)
- Caprice Knapp
- Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, Florida, USA.
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Evaluation of a hospital-based cancer information and support centre. Support Care Cancer 2011; 20:287-300. [PMID: 21225290 DOI: 10.1007/s00520-010-1071-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although information seeking is encouraged by health care professionals as a positive coping strategy evidence suggests information needs of those affected by cancer are not always fully met. In response to the need for novel models of information provision and educational support for people affected by cancer, a hospital-based cancer information and support centre (CISC) was introduced into a tertiary cancer hospital. Professional support is provided by a cancer support nurse (CSN) with the clinical experience of working with cancer patients, whilst peer support is provided by volunteers. MATERIALS AND METHODS A survey was developed to ascertain the perceptions and experiences of consumers (users) of a hospital-based CISC. The aim was to understand what information and support patients and families consider important and helpful in order to develop the service to reflect the needs of its users. During a 12-month period 111 surveys were distributed to users of the centre. RESULTS Sixty-nine surveys were returned (62.1%). Nearly all visits were motivated by the need to access (58/84.0%) information, indicating an unmet or changing need. The CSN initiated referrals to support services, both internal and community based, for 21 (53.9%) participants with whom there was contact. Contact with the CISC volunteers also resulted in internal or community-based referrals for 15 (32.6%) of participants. Of note, half of the participants (35/50.7%) reported seeking additional information from the internet as a consequence of having visited the CISC and/or having contact with the CSN or volunteer, in contrast to the six (8.7%) who had reported internet use for information prior to their first visit. Participants indicated a desire for the service to provide additional support to enhance self-care capacity and to do so alongside other people affected by cancer. CONCLUSIONS Our study results support the capacity of a hospital-based CISC to provide a highly valued service that can broaden information options and meet changing information and support needs of people affected by cancer in an ongoing capacity. An experienced, qualified CSN in this setting is ideally positioned to screen for unmet information and support needs and deliver tailored education to support both inpatient and ambulatory care services. Information prescriptions have the potential to provide a 'directed information seeking approach' to those who visit a CISC. Through the use of information technology there is scope to develop information and support that expands beyond pamphlets and booklets.
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Kernisan LP, Sudore RL, Knight SJ. Information-seeking at a caregiving website: a qualitative analysis. J Med Internet Res 2010; 12:e31. [PMID: 20675292 PMCID: PMC2956334 DOI: 10.2196/jmir.1548] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 11/13/2022] Open
Abstract
Background The Internet is widely used for health information, yet little is known about the online activity of family caregivers of elders, a rapidly growing group. In order to better understand the online information-seeking activity of “e-caregivers” and other visitors at a caregiving website, we undertook a qualitative analysis of survey data from a website marketed as a comprehensive resource for adults caring for aging parents. Objective The objectives were to better understand what types of information are sought by those visiting a website focused on elder-care issues and to identify overarching themes that might inform future development of Internet resources related to caregiving and aging. Methods From March 2008 to March 2009, a 5-question pop-up survey was offered 9662 times and completed 2161 times. For 1838 respondents, included was a free text answer to the question "What were you looking for?” and 1467 offered relevant and detailed responses. The survey also asked about satisfaction with the site, gender of the respondent, and relationship to the individual being cared for. Content analysis was used to develop a coding dictionary, to code responses into information-seeking categories, and to identify overarching themes. Results Of the respondents (76% of whom were female), 50% indicated they were caring for parents, 17% for themselves only, and 31% for others. Over half (57%) reported finding what they were looking for, and 46% stated they were extremely likely to recommend the website. Frequently mentioned information-seeking categories included “health information,” “practical caregiving,” and “support.” Respondents also requested information related to housing, legal, insurance, and financial issues. Many responses referred to multiple comorbid conditions and complex caregiving situations. Overarching themes included (1) a desire for assistance with a wide range of practical skills and information and (2) help interpreting symptoms and behavior, such as knowing what life impacts to expect over the course of a health condition or treatment. Conclusion Visitors to a website targeting adults caring for aging parents reported seeking both general information on caregiving and specific assistance with the complex custodial, medical, emotional, and financial aspects of caregiving. Visitors requested both information to build caregiving skills as well as assistance in interpreting and knowing what to expect from symptoms, health conditions, and changes in behavior and relationships. Many desired communication with and support from other caregivers. Health care providers and eHealth developers should expect that many caregivers of elders are using the Internet as a resource. Further research and development is needed to fully realize the Internet’s potential for education and support of caregivers.
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Affiliation(s)
- Leslie P Kernisan
- Division of Geriatrics, University of California San Francisco, San Francisco, CA 94121, USA.
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Abstract
e-Health has the potential to improve pediatric palliative care. e-Health initiatives use the Internet or health information technology to improve quality of care and have the potential to decrease costs by reducing medical errors, reducing duplication of services, improving access to diagnostic and laboratory results, and improving communication between providers and patients, and so on. The majority of e-health initiatives are for adults and only a limited amount of evidence exists in the literature on e-health interventions in palliative care that are focused on pediatrics. To explore what role e-health could play in pediatric palliative care programs, this article aims to describe the Internet use in general in the United States and in palliative care, describe the use of health information technology in general in the United States and in palliative care, and suggest areas in pediatric palliative care that might benefit from e-health interventions.
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Affiliation(s)
- Caprice Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA.
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The role of the Internet in supporting and informing carers of people with cancer: a literature review. Support Care Cancer 2010; 18:1123-36. [PMID: 20336326 DOI: 10.1007/s00520-010-0863-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Internet is an expanding source of information and support for cancer patients and their families. Studies mostly report patient Internet use. Little is known about how carers (families/informal caregivers/friends) use the Internet and what they find useful. AIM The aim of this paper was to review the literature on the role of the Internet in supporting and informing carers of people with cancer. MATERIALS AND METHODS Findings are based on a review of published studies identified from 1996-2009 Ovid MEDLINE, CINAHL, EMBASE and 2002-2009 PsycINFO, Cochrane database and Google Scholar. Key search words used were cancer, patient, information, Internet, online, web, support, family, carer, caregiver and friend. RESULTS One hundred forty-five abstracts were reviewed. Fifty-two articles were retrieved in full text. Twenty of the 52 articles were critically appraised using the appropriate Critical Appraisal Skills Programme tool. All studies retrieved were level IV evidence. Most compared carer and patient Internet use with other cancer information sources or analysed content of postings to web sites. Some reported on patient 'indirect' Internet use through carers. Heterogeneity of results related to different study aims, diversity in study tools, varying sample sizes and differing cancer populations. Broadly, Internet use can be divided into information searching and support group activity. Carers access Internet information to problem solve; however, they report doctors as their most preferred information source. They would like to have e-mail communication with Health Care Professionals to ask questions and clarify information. Participation in online support groups provides information tailored to individual needs and peer support. IMPLICATIONS FOR PRACTICE The Internet may be a primary or secondary source of information and can be used to access services. Routine assessment of carers' Internet use, prescribing of Internet sites and e-mail communication with carers are possible areas for practice improvement. The current level of evidence is not ideal to influence policy development. CONCLUSIONS Research is required to evaluate carer Internet use in the rapidly changing world of health and technology. Interactive Internet applications developed specifically for carer use have the potential to prepare, inform and support the carer in their ever-expanding health care role. The impact of these services on carer quality of life also requires investigation.
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Polomano RC, Droog N, Purinton MCP, Cohen AS. Social Support Web-Based Resources for Patients with Chronic Pain. J Pain Palliat Care Pharmacother 2009. [DOI: 10.1080/j354v21n03_09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Social support is commonly thought to reduce negative health outcomes for patients and their family members, particularly when experiencing end-of-life issues. Although numerous people turn to hospice when dealing with end-of-life circumstances, many individuals do not have access to or may not be able to use hospice services. As an alternative to traditional hospice, individuals may seek social support in online hospice support communities. Although a large body of research focuses on individual disease/condition-specific communities, to date, online hospice support communities have remained unexplored. This investigation sought to describe how social support was provided within a publicly accessible, online hospice support community located within Yahoo! groups. A content analysis was conducted on 443 messages from 4 months of posts in an online hospice community. During the sample period, 28 community members, ranging from hospice professionals to family members of hospice patients, posted messages. As optimal matching theory may predict, it was found that emotional support interactions were far more frequent than informational support exchanges. Overall, encouragement/support themes were the most common type of emotional support, and medication/treatment themes were the most common type of informational support.
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Street AF, Swift K, Annells M, Woodruff R, Gliddon T, Oakley A, Ottman G. Developing a web-based information resource for palliative care: an action-research inspired approach. BMC Med Inform Decis Mak 2007; 7:26. [PMID: 17854509 PMCID: PMC2194759 DOI: 10.1186/1472-6947-7-26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 09/14/2007] [Indexed: 11/21/2022] Open
Abstract
Background General Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website [1]. Method The action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197) scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166). Results Involving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers). Conclusion Web developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to volunteer networks forms an integral part of such an approach.
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Affiliation(s)
- Annette F Street
- Clinical School of Nursing, La Trobe University/Austin Health, Lv 4 Austin Tower, Heidelberg VIC 3084, Australia
| | - Kathleen Swift
- Clinical School of Nursing, La Trobe University/Austin Health, Lv 4 Austin Tower, Heidelberg VIC 3084, Australia
| | - Merilyn Annells
- Nursing & Midwifery, La Trobe University, Bundoora VIC 3083, Australia
| | - Roger Woodruff
- Director of Palliative Care Austin Health, Suit 9, 210 Burgundy Street, Heidelberg VIC 3084, Australia
| | - Terry Gliddon
- Research and Development, Royal District Nursing Services, 31 Alma Rd, St. Kilda VIC 3182, Australia
| | - Anne Oakley
- CEO, Melbourne City Mission, 471 Nicholson St., North Fitzroy VIC 3068, Australia
| | - Goetz Ottman
- Clinical School of Nursing, La Trobe University/Austin Health, Lv 4 Austin Tower, Heidelberg VIC 3084, Australia
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Washington KT, Demiris G, Oliver DP, Day M. Home Internet Use among Hospice Service Recipients: Recommendations for Web-Based Interventions. J Med Syst 2007; 31:385-9. [DOI: 10.1007/s10916-007-9080-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Riehl M. Help your patient cope with pancreatic cancer. Nursing 2007; 37:54-7. [PMID: 17413370 DOI: 10.1097/01.nurse.0000266044.57534.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marie Riehl
- Ambulatory Care Department, Fox Chase Cancer Center, Philadelphia, PA, USA
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Abstract
This literature review explores the current evidence related to use of the Internet by hospice patients or families and palliative care/hospice professionals. The research questions guiding this study pertain to the current Internet-based interventions in hospice and palliative care and the evidence of their effectiveness. Six studies were identified as a result of an extensive literature review. These studies included research about web-based clinical interventions for patients, and patients', caregivers' and hospice/palliative care providers' use of the Internet. The majority of interventions involve accessing information via the Internet. Participants among the studies included patients, caregivers/family members, and health care professionals. Findings overall indicate effectiveness of Internet-based interventions. Both patients and professionals are using the Internet to find answers to healthcare questions, communicate, and/or deliver healthcare interventions.
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Affiliation(s)
- Lia Willis
- University of Missouri-Columbia, Columbia, MO 65211-2060, USA
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Nolan MT, Hodgin MB, Olsen SJ, Coleman J, Sauter PK, Baker D, Stanfield C, Emerling A, Hruban RH. Spiritual Issues of Family Members in a Pancreatic Cancer Chat Room. Oncol Nurs Forum 2007; 33:239-44. [PMID: 16518439 DOI: 10.1188/06.onf.239-244] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe spiritual issues addressed by users of a pancreatic cancer informational Web site. DESIGN Qualitative, descriptive. SETTING The patient and family chat room of Johns Hopkins Hospital's pancreatic cancer Web site. SAMPLE 600 postings on the pancreatic cancer Web site. METHODS Identification of categories and themes in Web postings using the constant comparison method of content analysis. MAIN RESEARCH VARIABLES Spirituality, relationship of the person posting a message (poster) to the person with cancer. FINDINGS Relationship of the poster to the person with pancreatic cancer was explicit in 68% (n = 410) of the 600 postings, and 83% of those 410 postings indicated that the poster was a family member. Issues of spirituality appeared in 19% (n = 114) of the 600 postings and addressed four themes: spiritual convergence, reframing suffering, hope, and acceptance of the power of God and eternal life. Six percent of postings were by family members reporting on the death of their loved ones, suggesting that the site also served a bereavement function. CONCLUSIONS Family members of patients with pancreatic cancer sought and received spiritual comfort in a variety of forms in an Internet-based cancer chat room. IMPLICATIONS FOR NURSING Nurse developers of cancer information Web sites should periodically assess how the sites are being used and apply the information to the refinement of the sites to better meet user needs. Further study is needed to develop and evaluate cancer Web sites as an evolving medium for providing spiritual support to family members of patients with life-threatening forms of cancer.
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Affiliation(s)
- Marie T Nolan
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
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Laser Literature Watch. Photomed Laser Surg 2006; 24:222-48. [PMID: 16706704 DOI: 10.1089/pho.2006.24.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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