Cancer patients' self-reported attitudes about the Internet

Effects of a pre-visit online information tool about genetic counselling for ovarian cancer patients, a randomized controlled trial

OBJECTIVE

In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients.

METHODS

Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients' satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling.

RESULTS

The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed.

CONCLUSION

Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling.

PRACTICE IMPLICATIONS

Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.

Current Status of Out-of-Hospital Management of Cancer Patients and Awareness of Internet Medical Treatment: A Questionnaire Survey

Objective: To explore the current situation of the out-of-hospital management of patients with cancer and evaluate the feasibility of Internet medical intervention outside the hospital in China.

Methods: The questionnaire was designed based on the investigators' clinical experience, literature data, and the Anderson Symptom Scale, and adopted a cross sectional survey method.

Results: Totally 1,171 qualified questionnaires were analyzed. The results showed that 92.7% of patients with cancer experienced varying degrees of out-of-hospital symptoms after treatment, and a third of them needed clinical intervention. Abnormal blood test results outside the hospital were basically consistent with the events that occurred during the hospitalization. One third of patients with cancer could not identify abnormal results. The primary approaches to solve these abnormalities were to seek guidance from the physician in charge or from nearby hospitals, but only 6.75% patients sought help online. More than half of the life or work of patients with cancer are still greatly affected under the current management model. 92% of respondents required medical help outside the hospital, and 65% ones were willing to pay for the out-of-hospital management.

Conclusions: Out-of-hospital management model needs to be improved. Most users are willing to accept Internet cancer management with fees. The survey has a positive effect on guiding future Internet cancer management practices in China to a certain extent.

Cancer Survivors' Emotional Well-being: Roles of Internet Information Seeking, Patient-centered Communication, and Social Support

Cancer survivors' emotional well-being is an integral part of their overall health and may influence their recovery and survival. The current study used the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 (N = 593) to evaluate the determinants of cancer survivors' emotional well-being. Internet cancer information seeking, social support, patient-centered communication, cancer beliefs, and self-efficacy to take care of one's health were examined as factors to be associated with cancer survivors' emotional well-being using structural equation modeling. Social support, cancer beliefs, and self-efficacy to take care of one's health were found to be significantly associated with emotional well-being among cancer survivors. Cancer beliefs mediated the associations of cancer information seeking using the Internet, social support, and patient-centered communication with cancer survivors' emotional well-being while health self-efficacy mediated the associations of social support and patient-centered communication with cancer survivors' emotional well-being. It is important for health practitioners to focus on improving social support, self-efficacy for managing health, and cancer-related beliefs in order to enhance the emotional well-being of cancer survivors.

Preferences in trust regarding the provision of cancer information among adults

BACKGROUND

Disparities associated with trust in health information exist warranting a need for research assessing this relationship among adults. Therefore, the aim of this study was to assess trust of cancer information among U.S. adults.

METHODS

A weighted sample of 237,670,167 adults from the Health Information National Trends Survey (HINTS) from 2011-2014 was used for the analyses. Dependent variables were dichotomized answers to whether individuals trusted information from family/friends, the internet, or a doctor. Independent variables included age, sex, region, race/ethnicity, and cancer diagnosis to investigate associations between demographic factors and differences in trust. Logistic regression was run using R survey package.

RESULTS

There were statistically significant differences in trust based on race/ethnicity, age, and cancer diagnosis. Minorities were less likely to trust information from a doctor, with Hispanics more likely to trust information from the internet (OR=1.8 (95% CI 1.36,2.43)), and Non-Hispanic Blacks trusting information from family and friends (OR=1.5 (95% CI 1.06, 2.13)). Adults ≥45 years of age were less likely to trust the doctor 'a lot' (45-64 years: OR=0.6 (95% CI 0.50, 0.83); 65+ years (OR=0.7 (95% CI 0.54, 0.92)), but more likely to not trust information from family and friends or the internet. Patients with cancer were more likely to trust information from a doctor 'a lot' (78%; p=0.01).

DISCUSSION

Significant differences in preferences regarding trust in cancer information occurred based on sociodemographic characteristics.

CONCLUSION

These finding suggest targeting specific population subgroups for information from sources they trust could be helpful in reducing disparities in trust.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

[A partnership to favour patient self-determination in oncology]

Today's patients wish to establish a dialogue with the health professional and aspire to become partners in their care. A dedicated tool can help patients with cancer create such a partnership. Cooperative research to improve transitions in cancer care focused on this question.

Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions

Background

Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective

The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions.

Methods

The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years.

Results

The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users.

Conclusions

Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources.

What to Consider in a Culturally Tailored Technology-Based Intervention?

The purpose of this article is to identify practical issues in implementing a culturally tailored technology-based intervention among Asian American survivors of breast cancer. In a large-scale technology-based breast cancer intervention study, research team members wrote memos on issues in implementing a culturally tailored technology-based intervention and plausible reasons for the issues. Then, the content of the research diaries was analyzed, along with written records of the research team. The practical issues found in the research process included those related to (1) technology literacy and preferences; (2) language issues; (3) cultural attitudes, beliefs, and values; (4) intervention staff competence; (5) security and confidentiality issues; and (6) time and geographical constraints. Based on the issues, several recommendations are proposed for future research using culturally tailored technology-based interventions among racial and ethnic minorities.

Demands and Needs for Psycho-Oncological eHealth Interventions in Women With Cancer: Cross-Sectional Study

Background

Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients.

Objective

This cross-sectional study aimed to explore the cancer-affected women’s needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden.

Methods

Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated.

Results

Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications.

Conclusions

Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a promising medium to improve the psychosocial care and enhance individual disease management and engagement among women with cancer.

Cancer Center Website Rankings in the USA: Expanding Benchmarks and Standards for Effective Public Outreach and Education

The 68 National Cancer Institute (NCI)-designated comprehensive and cancer centers have been tasked with leading the campaign in the fight against cancer, as well as providing education and outreach to the public. Therefore, it is important for these organizations to have an effective online presence to disseminate information and engage patients. The purpose of this study was to assess both the functionality and usability of cancer centers' websites. The 68 center web domains were evaluated using two separate but complementary approaches. First, a webcrawler was used to score each website on five dimensions: accessibility, content, marketing, technology, and usability. Rankings on each dimension and an average ranking were calculated for all 68 centers. Second, a three-reader system was used to determine a list of all functionalities present on the websites. Both webcrawler scores and functionality prevalence were compared across center type. No differences were observed in webcrawler scores between comprehensive and cancer centers. Mean scores on all dimensions ranged between 5.47 and 7.09. For the functionality assessment, 64 unique functions were determined and categorized into 12 domains, with the average center possessing less than 50 % of the functions. This census assessment of NCI centers' websites suggests the need for improvement to capitalize on new dissemination platforms available online. Progress in development of this technology can help achieve the goals of public education and outreach to a broad audience. This paper presents performance guidelines evaluated against best-demonstrated practice to facilitate social media use improvement.

PATI: Patient accessed tailored information: A pilot study to evaluate the effect on preoperative breast cancer patients of information delivered via a mobile application

OBJECTIVES

The information needs of cancer patients are highly variable. Literature suggests an improved ability to modulate personalised stress, increased patient involvement with decision making, greater satisfaction with treatment choices and reduced anxiety levels in cancer patients who have access to information. The aim of this project was to evaluate the effects of a mobile information application on anxiety levels of patients undergoing surgery for breast cancer.

MATERIALS AND METHODS

An application was developed for use with Apple iPad containing information on basic breast cancer biology, different treatments used and surgical techniques. Content and face validity studies were performed. A randomized control trial was designed, with a 1:2 allocation. Data collected include basic demographics and type of surgery. Questionnaires used included: the HADS, Mini-MAC, information technology familiarity and information satisfaction.

RESULTS

A total of 39 women participated. 13 women had access to an iPad containing additional information and 26 women acted as controls. The mean age was 54 and technology familiarity was similar among both groups. Anxiety and depression scores at seven days were significantly lower in control patients without access to the additional information provided by the mobile application (p = 0.022 and 0.029 respectively).

CONCLUSION

Anxiety and depression in breast cancer patients is both multifactorial and significant, with anxiety levels directly correlating with reduced quality of life. Intuitively, information should improve anxiety levels, however, we have demonstrated that surgical patients with less information reported significantly lower anxiety. We advise the thorough testing and auditing of information initiatives before deployment.

Health information needs and preferences in relation to survivorship care plans of long-term cancer survivors in the American Cancer Society's Study of Cancer Survivors-I

PURPOSE

Survivorship care plans (SCPs) provide cancer patients and health care providers with a treatment summary and outline of recommended medical follow-up. Few studies have investigated the information needs and preferred sources among long-term cancer survivors.

METHODS

Cancer survivors of the ten most common cancers enrolled in the longitudinal Study of Cancer Survivors-I (SCS-I) completed a survey 9 years post-diagnosis (n = 3138); at time of diagnosis of the SCS-I cohort, SCPs were not considered usual care. We assessed participants' current desire and preferred sources for information across ten SCP items and evaluated factors associated with information need 9 years after diagnosis.

RESULTS

The proportion of long-term cancer survivors endorsing a need for cancer and health information 9 years post-diagnosis ranged from 43 % (cancer screening) to 9 % (consequences of cancer on ability to work). Print media and personalized reading materials were the most preferred information sources. Younger age, higher education, race other than non-Hispanic white, later cancer stage, having breast cancer, having ≥2 comorbidities, and self-reporting poor health were associated with greater informational need (p < 0.05).

CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS

Long-term cancer survivors continue to report health information needs for most SCP items and would prefer a print format; however, level of need differs by socio-demographic and cancer characteristics. Cancer survivors who did not previously receive a SCP may still benefit from receiving SCP content, and strategies for enabling dissemination to long-term survivors warrant further investigation.

[eHealth and mHealth: current developments in 2014 and perspectives in oncology]

New information technologies and communication in health or "eHealth" is a way of improvement for management of chronic diseases. EHealth can improve patient care and care coordination especially in cancer patients who require a multidisciplinary approach. Treatments in oncology are complex and can result in new toxicities. Information of patients and of caregivers is a crucial issue. The patients require to be monitored and the caregivers need up-to-date information. The mobile component of eHealth: the mobile health or "mHealth" could provide to this need. This paper proposes to expose the principles of eHealth and its mobile component mHealth then to discuss their place in the management of cancer, for patients and caregivers.

Is nicotine replacement therapy overvalued in smoking cessation? Analysis of smokers' and quitters' communication in social media

BACKGROUND

Internet discussion forums provide new, albeit less used data sources for exploring personal experiences of illness and treatment strategies.

OBJECTIVE

To gain an understanding of how discussion forum participants value nicotine replacement therapy (NRT) in smoking cessation (SC).

SETTING

Finnish national Internet-based discussion forum, STUMPPI, supporting SC and consisting of ten free discussion areas, each with a different focus. The analysis was based on STUMPPI forum participants' postings (n = 24 481) in five discussion areas during January 2007-January 2012.

DESIGN

Inductive content analysis of the postings concerning NRT use or comparing NRT to other SC methods.

RESULTS

Three major themes related to NRT in SC emerged from the discussions. These were as follows: (I) distrust and negative attitude towards NRT; (II) neutral acceptance of NRT as a useful SC method; and (III) trust on the crucial role of NRT and other SC medicines. The negative attitude was related to following perceptions: NRT use maintains tobacco dependence, fear of NRT dependence or experience of not gaining help from NRT use. NRT was perceived to be useful particularly in the initiation of SC attempts and in dealing with physiological dependence. The most highlighted factors of successful quitting were quitters' own psychological empowerment and peer support from the discussion community.

CONCLUSIONS

The majority of STUMPPI forum participants had low or balanced expectations towards the role of NRT in SC. More research from the smokers' and quitters' perspective is needed to assess the real value of NRT compared to other methods in SC.

The utilization of oncology web-based resources in Spanish-speaking Internet users

OBJECTIVES

There currently are few web-based resources written in Spanish providing oncology-specific information. This study examines utilization of Spanish-language oncology web-based resources and evaluates oncology-related Internet browsing practices of Spanish-speaking patients.

METHODS

OncoLink (http://www.oncolink.org) is the oldest and among the largest Internet-based cancer information resources. In September 2005, OncoLink pioneered OncoLink en español (OEE) (http://es.oncolink.org), a Spanish translation of OncoLink. Internet utilization data on these sites for 2006 to 2007 were compared.

RESULTS

Visits to OncoLink rose from 4,440,843 in 2006 to 5,125,952 in 2007. OEE had 204,578 unique visitors and 240,442 visits in 2006, and 351,228 visitors and 412,153 visits in 2007. Although there was no time predilection for viewing OncoLink, less relative browsing on OEE was conducted during weekends and early morning hours. Although OncoLink readers searched for information on the most common cancers in the United States, OEE readers most often search for gastric, vaginal, osteosarcoma, leukemia, penile, cervical, and testicular malignancies. Average visit duration on OEE was shorter, and fewer readers surveyed OEE more than 15 minutes (4.5% vs. 14.9%, P < 0.001).

CONCLUSIONS

Spanish-speaking users of web-based oncology resources are increasingly using the Internet to supplement their cancer knowledge. Limited available resources written in Spanish contribute to disparities in information access and disease outcomes. Spanish-speaking oncology readers differ from English-speaking readers in day and time of Internet browsing, visit duration, Internet search patterns, and types of cancers searched. By acknowledging these differences, content of web-based oncology resources can be developed to best target the needs of Spanish-speaking viewers.

Health information needs and health-related quality of life in a diverse population of long-term cancer survivors

OBJECTIVE

To investigate health information needs and their association with health-related quality of life (HRQOL) in a diverse, population-based sample of long-term cancer survivors.

METHODS

We analyzed health information needs from 1197 cancer survivors 4-14 years post-diagnosis drawn from two cancer registries in California. Multivariable regression models were used to identify factors associated with endorsement of total number and different categories of needs. The relationship between number of needs and HRQOL and effect modification by confidence for obtaining information was examined.

RESULTS

Survivors reported a high prevalence of unmet information needs in the following categories: side effects & symptoms: 75.8%; tests & treatment: 71.5%; health promotion: 64.5%; interpersonal & emotional: 60.2%; insurance: 39.0%; and sexual functioning & fertility: 34.6%. Survivors who were younger, non-White, and did not receive but wanted a written treatment summary reported a higher number of needs. Number of information needs was inversely related to mental well-being, particularly for those with low confidence for obtaining information (P<0.05).

CONCLUSION

These patterns suggest disparities in access to important health information in long-term survivors and that affect HRQOL.

PRACTICE IMPLICATIONS

Findings suggest a need for tailored interventions to equip survivors with comprehensive health information and to bolster skills for obtaining information.

The impact of colorectal cancer and self-efficacy beliefs on work ability and employment status: a longitudinal study

We examined how colorectal cancer patients' treatment and symptom management impacted perceptions of work ability and subsequent work decisions. Fifty patients completed questionnaires at baseline (post-surgery/pretreatment), 3 months and 6 months. Questionnaires assessed fatigue, depression, quality-of-life (QoL), cancer self-efficacy, job self-efficacy (JSE) and work ability. Factors related to perceived work ability were occupation (β= 0.31, P= 0.0005) and QoL (β= 0.42, P= 0.01) at baseline, treatment type (β=-0.19, P= 0.05) at 3 months, and JSE at 3 months (β= 0.57, P= 0.0005) and 6 months (β= 0.50, P= 0.006). Factors related to being on sick leave were lower levels of JSE (OR = 2.20, 95% CI: 1.17-4.13) at baseline and being employed in a manual occupation (OR = 0.03, 95% CI: 0.00-0.86), and perceived work ability (OR = 3.05, 95% CI: 1.00-12.80) at 6 months. Along with self-assessed work ability at baseline (β= 0.67, P= 0.0005), receiving chemotherapy or a combination of treatments (β=-0.24, P= 0.05) were the strongest predictors of poorer perceptions of follow-up work ability. Self-efficacy beliefs may add to understanding and should be considered in future research.

Does increased patient awareness improve accrual into cancer-related clinical trials?

BACKGROUND

Oncology literature cites that only 2% to 4% of patients participate in research. Up to 85% of patients are unaware that clinical trials research is being conducted at their treatment facility or that they might be eligible to participate.

OBJECTIVES

It was hypothesized that patients' satisfaction with information regarding clinical trials would improve after targeted educational interventions, and accruals to clinical trials would increase in the year following those interventions.

METHODS

All new patients referred to the cancer center over a 4-month period were mailed a baseline survey to assess their knowledge of clinical research. Subsequently, educational interventions were provided, including an orientation session highlighting clinical trials, a pamphlet, and a reference to a clinical trials Web site. A postintervention survey was sent to the responders of the initial survey 3 months after the initial mailing.

RESULTS

Patient satisfaction with information significantly increased after the interventions. There was no increase in subsequent enrollment in clinical trials. Patients who indicated an inclination to participate in clinical trials tended to have greater satisfaction with the information they received.

CONCLUSIONS

A set of educational interventions designed for cancer patients significantly improved their satisfaction with information on clinical research, but did not improve clinical trial enrollment of these participants as of 1 year after the study.

IMPLICATIONS FOR PRACTICE

The development of educational interventions may be justified, but such interventions may require prolonged implementation to establish benefit. Information relating to research may be most effectively delivered by patients' primary cancer care providers.

Informational and decisional empowerment in online health support communities: initial psychometric validation of the Cyber Info-Decisional Empowerment Scale (CIDES) and preliminary data from administration of the scale

PURPOSE

This article presents initial psychometric validation of an instrument developed to measure cyber informational and decisional empowerment. The article provides preliminary insights into the extent to which cyber patients view the digital environment of peer-based information and support as a resource for informed and empowered participation in self health care management.

METHODS

Data come from cancer patients (N = 350) who participated in the Study of Virtual Health Networks for Cancer Patients of the 21st Century. Data were first analyzed using exploratory factor analysis with principle component extraction and Varimax rotation. Age-based split-sample analysis (≥ 51 and ≤ 50) was performed on a subsample, which consisted of only women (N = 255), in order to cross-validate psychometric data obtained from the full sample. A confirmatory factor analysis was conducted using AMOS 19.0. to further validate the scale.

RESULTS

The composite scale is unidimensional with excellent internal consistency reliability. The highest average scores were obtained for informational empowerment items. The lowest average was for the item that measured empowerment to seek second opinion from additional health care professionals.

CONCLUSIONS

The ability of this composite measure to provide information about the extent to which computer-connected patients view digital peer support as an empowerment tool makes it a valuable addition to the literature in health informatics, supportive cancer care, and health quality of life research.

Relationship between health service use and health information technology use among older adults: analysis of the US National Health Interview Survey

BACKGROUND

Older adults are the most frequent and heaviest users of health services in the United States; however, previous research on older adults' use of health information technology (HIT) has not examined the possible association of HIT use among older adults with their use of health services.

OBJECTIVE

This study examined the relationship between US older adults' use of health services and their use of the Internet for health-related activities, controlling for socioeconomic characteristics and aging-related limitations in sensory and cognitive function. It also examined gender differences in the pattern of association between the types of health services used and HIT use.

METHODS

The data for this study were drawn from the 2009 US National Health Interview Survey (NHIS), which was the first nationally representative household survey to collect data on HIT (Internet) use. First, the rates of lifetime and 12-month HIT use among sample adults (n = 27,731) by age group (18-29 to 85 and over) were analyzed. Second, bivariate analysis of sociodemographic characteristics, health status, and health service use by HIT use status among those aged 65 or older (n = 5294) was conducted. Finally, multivariate binary logistic regression analysis was used to test the study hypotheses with 12-month HIT use as the dependent variable and 12-month health service uses among the age group 65 or older as possible correlates.

RESULTS

The rates of HIT use were significantly lower among the age groups 65 or older compared with the younger age groups, although the age group 55 to 64 was not different from those younger. The rates of HIT use decreased from 32.2% in the age group 65 to 74 to 14.5% in the age group 75 to 84 and 4.9% in the 85 and older age group. For both genders, having seen or talked to a general practitioner increased the odds of HIT use. However, having seen or talked to a medical specialist, eye doctor, or physical therapist/occupational therapist (PT/OT) were significantly associated with HIT use only for older women, while having seen or talked to a mental health professional only marginally increased the odds of HIT use only for older men. Having visited or talked to a chiropractor and having had overnight hospitalization, surgery, and/or homecare services were not associated with the odds of HIT use for either gender.

CONCLUSIONS

Older-adult users of general health services were more likely to use HIT than nonusers of general health services, while older-adult users of specialized health services were not different from nonusers of specialized health services in their odds of HIT use. The findings have implications for narrowing the age-related and socioeconomic status-related gaps in HIT use. The access gaps among racial/ethnic minority older adults and poorly educated and/or low-income older adults are especially striking and call for concerted efforts to facilitate Internet access and HIT use among these disadvantaged older adults.

Experiences of diagnosis and treatment among people with multiple sclerosis

RATIONALE, AIMS AND OBJECTIVES

The aim of this qualitative study was to examine patients' experiences of being diagnosed with multiple sclerosis (MS), the information that they were given at this time, subsequent treatment and its impact on their lives.

METHOD

Data were collected through semi-structured interviews with 24 people with MS. The use of interviews allowed participants' experiences to be explored in depth. Participants were recruited by the MS Society through membership details and through a press release in a local newspaper. Telephone interviews lasted between 30 and 60 minutes, were tape-recorded and transcribed verbatim. Data were analysed using thematic content analysis.

RESULTS

The majority of participants were female (n = 17), with ages ranging from 35 to 72 years. Disease duration ranged from 1 to 37 years. Many participants' diagnosed before and after 2000 had experienced long delays in diagnosis. At the point of diagnosis, participants had to make sense of and understand their diagnosis often with insufficient support. Some participants expressed anger about the way they had been given their diagnosis. Many felt they had not received sufficient information about their illness at this time and had responded by conducting their own searches for information to satisfy this need.

CONCLUSION

Improving the way in which doctors communicate with patients experiencing diagnostic delay and at the point of diagnosis deserves further study, in order to avoid later adjustment problems.

Using health communication best practices to develop a web-based provider-patient communication aid: the CONNECT study

OBJECTIVE

Although there is broad consensus that careful content vetting and user testing is important in the development of technology-based educational interventions, often these steps are overlooked. This paper highlights the development of a theory-guided, web-based communication aid (CONNECT), designed to facilitate treatment decision-making among patients with advanced cancer.

METHODS

The communication aid included an on-line survey, patient skills training module and an automated physician report. Development steps included: (1) evidence-based content development; (2) usability testing; (3) pilot testing; and (4) patient utilization and satisfaction.

RESULTS

Usability testing identified some confusing directions and navigation for the on-line survey and validated the relevance of the "patient testimonials" in the skills module. Preliminary satisfaction from the implementation of the communication aid showed that 66% found the survey length reasonable and 70% found it helpful in talking with the physician. Seventy percent reported the skills module helpful and about half found it affected the consultation.

CONCLUSION

Designing patient education interventions for translation into practice requires the integration of health communication best practice including user feedback along the developmental process.

PRACTICE IMPLICATIONS

This developmental process can be translated to a broad array of community-based patient and provider educational interventions.

Cancer survivors information seeking behaviors: a comparison of survivors who do and do not seek information about cancer

OBJECTIVE

To examine the cancer information seeking behaviors and preferences of cancer survivors.

METHODS

This cross-sectional study used the National Cancer Institute's 2003 Health Information National Trends Survey data to evaluate 619 cancer survivors.

RESULTS

Two-thirds (67.5%, n = 418) of the survivors sought cancer information (InfoSeek) and 32.5% (n = 201) did not (NoInfoSeek). Significant predictors of cancer information seeking included age (less than 65), gender (female), income (>US$ 25,000/year), and having a regular health care provider (HCP).

CONCLUSION

Not all survivors actively look for cancer information. Although most survivors prefer receiving cancer information from their HCP, many turn to a variety of other sources, primarily the Internet.

PRACTICE IMPLICATIONS

HCPs should periodically assess information seeking behaviors and preferences of cancer survivors and actively refer patients to the Internet as an extension of and enhancement to their patient interactions. Credible and useful websites could be identified and recommended by the HCP as a means to address some of the barriers identified by survivors.

What do obstetricians think about media influences on their patients?

BACKGROUND

Patients are playing an increasingly active role in decision-making about their care and are becoming increasingly informed about their health. Traditionally, sources of information about pregnancy and birth were family and friends and, in more recent times, antenatal classes. Evidence suggests that the media, particularly the Internet, is an increasingly influential source of information about illness and health.

AIMS

The aim of this study was to survey Australian Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) about their perceptions of sources of patient information about pregnancy and birth, particularly the media and the Internet.

METHODS

A two-page survey with a reply paid envelope was sent to all Australian Fellows of RANZCOG. Most questions only allowed a selection of prespecified categorical options. Some questions allowed open-ended replies that were assessed using thematic analysis.

RESULTS

RANZCOG fellows thought that family and friends were the most important source of information for patients about pregnancy and birth followed by formal antenatal education, although they ranked the influence of the Internet above that of free-to-air television. Responses suggested that women in both the public and the private sectors were accessing the Internet.

CONCLUSIONS

Fellows felt that their patients are actively involved in decisions about their care during pregnancy and birth and that the media influences their knowledge and attitudes. The Internet appears to have an increasingly important role in providing women with information. Obstetricians need to be aware of what their patients are accessing on the Internet.

The Dutch cancer information helpline: more critical patients after 10 years

OBJECTIVE

This study was conducted to assess the impact and evaluation of the Dutch national cancer information helpline and to assess differences in evaluation and impact with a comparable study conducted in 1994.

METHODS

A cross-sectional survey was conducted among all callers from the target groups patients, friends/relatives and the general public who contacted the information helpline from December 2003 until March 2004 (response 59%; N=665).

RESULTS

All characteristics of the helpline (provided information, educator's communication skills, and telephone aspects) were evaluated positively by a large majority of the respondents. All groups evaluated the impact of the helpline on overall satisfaction, anxiety, and meeting expectations positively. However, the three target groups showed different predictors for the outcome measures.

CONCLUSION

It can be concluded that 10 years after the first study, callers are still very positive in their evaluation. However, the different characteristics of the helpline are nowadays slightly more negatively judged, particularly by patients. The installation of the voice response system (VRS) as well as the fact that people have more easily access to information about their disease might account for these differences in evaluation.

PRACTICE IMPLICATIONS

To maintain the positive evaluations helpline educators as well as the VRS need to attune more to the different needs and problems of the target groups and provide tailored information.

Health and the information nonseeker: a profile

Despite increased information-seeking by the public, a significant percentage of those diagnosed with a serious disease such as cancer report that they do not seek or receive health information beyond that given by health care providers. This study attempts to profile these nonseekers and study possible determinants of nonseeking behaviors. Data come from the 2003 Health Information National Trends Survey, a national survey of American adults conducted by the National Cancer Institute ( N = 6,133; Nelson et al., 2004). Individuals were categorized as nonseekers or seekers and then further classified based on cancer history to yield 4 groups: nonseeker patients, the nonseeker public, seeker patients, and the seeker public. Compared to other groups, nonseeker patients came from the lowest income and education groups, and scored lower on attention to health in the media and trust in mass media health information. Nonseekers also scored lower on preventative health behaviors.

Creating a framework for online cancer services research to facilitate timely and interdisciplinary applications

Researchers from a wide array of disciplines have conducted engaging and informative studies in recent years concerning the use of the Internet for cancer-related services. Typically, these publications provide key data related to utilization statistics, how online information can be used, what users want or expect from the Internet, outcomes or impacts, and quality and credibility of websites. These are important themes for understanding online cancer issues. However, this special issue of the Journal of Medical Internet Research seeks to recast these themes in a way that will facilitate pragmatic and applied means of employing data in prescriptive and interdisciplinary ways. This issue includes 14 papers that exemplify applications for the research framework recommended in this paper. This framework includes an expanded focus on the development and design of online cancer services, online consumer behavior/communication, behavior change, and living with cancer.