Article

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

ABSTRACT

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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    • "Even though individuals with one or more chronic diseases were less likely than their healthy peers to have Internet access, 62% were able to access online information (Fox, 2011). However, while more Americans are going online to find health and medical information, healthcare providers are consistently recognized as the most influential source of information for medical decisions (Fox & Duggan, 2013; Couper et al., 2010). Healthcare providers have responded to their patients' use of IT by going online themselves; responding to patients' questions posted on the Internet in forums such as blogs, chat rooms, or via email with their patients; and by communication via secure patient portals. "
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    ABSTRACT: In the current era of medical education and curriculum reform, medical schools across the United States are launching innovative approaches to teaching students in order to improve patient outcomes and increase patient safety. One such innovation is the use information technology (IT) that can be used to disseminate health information, especially for patients with limited access to care. Strategies for using health IT to enhance communication between providers and patients in low-income communities can be incorporated into undergraduate medical education (UME) curriculum.METHODS: A pilot study was conducted to determine if IT could serve as an effective means of communication with patients at a free clinic where 100% of the patients are uninsured; the clinic is located in an urban setting and primarily serves Latinos, the working poor, and the homeless. An anonymous survey was administered to patients to assess rates of IT ownership, general IT use, and IT use for health and medical information.RESULTS: The majority of study participants owned a cell phone (92%); one-third used their cell phone to access health or medical information (38%). Most study participants reported using the Internet (72%), and two-thirds had used the Internet to obtain health and medical information (64%). CONCLUSION: Given the difficulties faced by low income and medically underserved communities in accessing healthcare services, the use of IT tools may improve their’ access to health information in ways that could enhance patient knowledge and self-management, and perhaps positively impact health outcomes. Therefore, it is essential to incorporate use of IT tools in training for medical students and residents to enhance communication with patients in underserved communities.
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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.
    Full-text · Article · Nov 2013 · BMC Medical Informatics and Decision Making
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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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    ABSTRACT: In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension-the delivery of patient decision aids on the Internet-is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies.
    Full-text · Article · Nov 2013 · BMC Medical Informatics and Decision Making
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