BETHESDA, MD—Health information on the Internet isn't about to upstage physicians, according to data reported at a National Cancer Institute news briefing here on cancer control.
The Internet was supposed to empower cancer patients to learn more about their disease and participate more rationally in medical decisions about their care, but instead the glut of online information is causing growing confusion for patients while increasing their trust in physicians as a source of accurate health information, said Bradford W. Hesse, PhD, Chief of NCI's Health Communications and Informatics Research Branch of the Behavioral Research Program.
“There is a glut of information of uneven quality and readability, leading to ‘caveat clicktor.’ Confusion is actually rising.”
He cited data showing that when patients have a strong need to get information about cancer, 50% say they prefer their health providers, while 34% turn to the Internet, 4% turn to their family, 5% turn to the library, 3% turn to print media, and 4% seek other sources.
However, even though patients prefer their physicians as a source for health information, 49% actually go to the Internet first when seeking information on cancer, which may be a reflection of its convenience. “I worry sometimes that the Internet is going to be a surrogate for meeting with providers,” Dr. Hesse said.
Asked by OT why cancer patients' confusion is increasing when they use the Internet for health information, Dr. Hesse said there is a proliferation of websites and patients cannot pick up on “credibility cues”—signs that differentiate trustworthy sites from those that are not. Thus sometimes patients might give equal weight to, for example, the American Cancer Society site and the site of a celebrity touting an herbal treatment for cancer.
“Is the public's understanding improving?” asked Dr. Hesse. No, because “we do see ‘data smog’ currently.” Patients engulfed in data smog have difficulty interpreting the results of clinical trials and treatment recommendations, and sometimes do not even appreciate the fact that there are risk factors for cancer other than smoking.
“A lot of the public is not even aware that obesity is a risk factor for cancer,” noted Robert Croyle, PhD, Director of NCI's Division of Cancer Control and Population Sciences, the moderator of the news briefing.
Dr. Hesse cited data from surveys of physicians and electronic health information drawn from the Health Information National Trends Survey (HINTS) published as part of the correspondence section of the New England Journal of Medicine (2010;362:859-860), showing that despite 10 years of available online health information, trust in Internet information during the period 2002–2008 declined, while trust in physicians remained strong and even increased. The HINTS data show that when patients access health information online it not only doesn't decrease their trust in physicians, as some observers have feared, but rather it increases their trust in physicians as patients turn to their care providers for help in interpreting complex, technical and sometimes conflicting information, said Dr. Hesse.
Data Smog; Digital Divide
Despite “data smog” caused by the glut of information on the Internet, said Dr. Hesse, the Internet can be a valuable tool for gaining health information about cancer if used wisely. Thus he said he worries about the “digital divide” that favors patients with higher incomes (and, by inference, higher education levels) over patients with lower education levels in accessing online health information.
HINTS data show that in 2008, slightly more than 80% of patients with incomes of $75,000 a year used the Internet for medical information for themselves, compared with slightly under 40% among those with annual incomes of less than $25,000. The digital divide also exists, he said, for age, with fewer patients over 65 using the Internet for health information compared with younger patients, and for ethnicity, with fewer black patients using the Internet for health information compared with whites.
As the nation invests in e-health tools to help improve patients' control over their health and the efficiency of medical care delivery, policy makers need to think about how best to include such tools in the practice of medicine, said Dr. Hesse.
“Will e-health tools help? We think so, but strategies for integrating them into health care reform are needed.”
Adoption of e-health tools remains variable and spotty. For example, while some managed care organizations and large group systems successfully foster e-mail communication between physician and patient in closed, secure networks, the percentage remains low, he said. The HINTS data show that in 2008, less than 15% of patients used e-mail to communicate with their physicians.