Use of the Internet and Ratings for Information Sources for Medical Decisions: Results from the DECISIONS Survey

Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan 48106, USA.
Medical Decision Making (Impact Factor: 3.24). 09/2010; 30(5 Suppl):106S-114S. DOI: 10.1177/0272989X10377661
Source: PubMed


The rise in Internet use for seeking health information raises questions about the role the Internet may play in how patients make medical decisions.
To examine Internet use and perceived importance of different sources of information by patients making 9 specific medical decisions covering prescription medication initiation, cancer screening, and elective surgery.
National sample of US adults identified by random-digit dialing.
Cross-sectional survey conducted between November 2006 and May 2007.
The final sample comprised 2575 English-speaking US adults aged 40 y and older who had either undergone 1 of 9 medical procedures or tests or talked with a health care provider about doing so during the previous 2 y.
Participants indicated if they or other family members used the Internet to seek information related to each of the specific medical decisions and rated how important the health care provider, the Internet (if used), family and friends, and the media (newspapers, magazines, and television) were in providing information to help make the medical decision.
Use of the Internet for information related to specific decisions among adults 40 y and older was generally low (28%) but varied across decisions, from 17% for breast cancer screening to 48% for hip/knee replacement. Internet use was higher at younger ages, rising from 14% among those aged 70 y and older to 38% for those aged 40 to 49 y. Internet users consistently rated health care providers as the most influential source of information for medical decisions, followed by the Internet, family and friends, and media.
Telephone surveys are limited by coverage and nonresponse. The authors excluded health-related Internet use not associated with the 9 target decisions.
A minority of patients reported using the Internet to make specific common medical decisions, but use varied widely by type of decision. Perhaps reflecting perceived risk and uncertainty, use was lowest for screening decisions and highest for surgical decisions.

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    • "These are summarized in Table 3. Of the remaining 24 studies that reported on interventions using a mixture of literacy-directed strategies, only one reported on a health literacy intervention in a PtDA context [30]. While this pre-post study of a prostate cancer PtDA reported improved knowledge among individuals in all health literacy subgroups (adequate literacy: + 1.27 points on a 10-point scale, adjusted p < 0.01; inadequate literacy +2.05 points, adjusted p < 0.01; p for interaction not reported), it did not describe its literacy-directed strategies in sufficient detail to allow recommendations to be derived. "
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    ABSTRACT: Effective use of a patient decision aid (PtDA) can be affected by the user's health literacy and the PtDA's characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed. Lower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.
    BMC Medical Informatics and Decision Making 11/2013; 13 Suppl 2(Suppl 2):S10. DOI:10.1186/1472-6947-13-S2-S10 · 1.83 Impact Factor
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    • "Second, empirical studies are needed that specifically assess the need for, and the effectiveness of, Internet-delivery of PtDAs. Since the IPDAS quality criteria were first published [1,2], Internet usage studies have reported continued increase in health information-seeking on the Internet [22-28], but have not specifically assessed the usage rates for PtDAs. Online libraries of PtDAs provide access to an increasing number of PtDAs [29], but few PtDAs have been developed using health technology research methods (such as user experience design, human computer interaction, etc.) or have been evaluated for effectiveness as used on the Internet. "
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    BMC Medical Informatics and Decision Making 11/2013; 13 Suppl 2:S13. DOI:10.1186/1472-6947-13-S2-S13 · 1.83 Impact Factor
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    • "Second, only three national newspapers were chosen and other media such as Internet and television sources were not included. More and more people are relying on the Internet as their source of health information and medical decision (40). Third, we did not include the tone of the media, which may have more impact on the public and policymakers. "
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