Oncologists Disagree on Impact of Patient Internet Use


Figure  .

US oncologists differ in their views on Internet cancer information.

Several large surveys of the general public have documented the growing use of the Internet as a source of health information and the generally positive attitude among the public regarding the impact of that information.

One study of Canadian oncologists and their patients discussed in CA: A Cancer Journal for Clinicians (2002;52:63–64) reported that patients were three times as likely as oncologists to report that Internet information helped them cope with their disease.

A recent study, published in the Journal of Clinical Oncology (2003;21:942–947), found considerable diversity among US oncologists as to their views on Internet cancer information. Paul R. Helft, MD, and colleagues from the Indiana University School of Medicine and the University of Chicago surveyed a sample of medical oncology members of the American Society of Clinical Oncology, and analyzed the 266 responses. Among the findings:

  • • The median estimate of the proportion of patients who brought Internet information to their oncologists was 30 percent. The estimate was higher among academic oncologists.

  • • Ninety eight percent felt that the time they spent discussing Internet information with their patients had increased during the past five years. They reported that such discussions typically added 10 minutes to encounters with patients who brought Internet information with them.

  • • Thirteen percent felt that Internet information made their patients feel less hopeful, while 29 percent reported that it did not change their patients' impressions of their prognosis. Among the 57 percent who felt this information made their patients more hopeful, half saw that as a good thing and half thought it was not.

  • • Thirty eight percent reported that they sometimes found it difficult to discuss Internet information, and six percent said they had difficulty always or most of the time.

  • • Approximately 75 percent felt that the Internet increased their patients' understanding of their disease, but only 36 percent reported that the overall impact on their patients (and the physician/patient relationship) was positive.

The survey also provided an opportunity for written comments by the oncologists. Fifty four percent of the written responses reflected an overall negative view of Internet information, and 36 percent indicated a positive view.

Concerns addressed in the negative com-ments included “unrealistic hopes and needless anxieties generated by inaccurate information regarding alternative therapies and by infor-mation that is accurate but inappropriate to a particular patient's medical condition.”

On the positive side, several oncologists commented that discussions of Internet information strengthened the physician/patient relationship, and that some of their patients found relevant clinical trials, of which they had not been aware, on the Internet.

Two quotes from different oncologists seemed to best summarize opposing views of the Internet as a source of health information: “A little knowledge is a dangerous thing,” and “The more you know about your enemy the better you can fight.”

The latter view is a guiding principle of American Cancer Society patient information efforts, according to Alan G. Thorson, MD, chair of the ACS volunteer committee responsible for oversight of the Society's patient information activities. Dr. Thorson, who is also clinical associate professor of surgery at the University of Nebraska College of Medicine and Creighton University School of Medicine in Omaha, NE, noted that the same types of inaccurate and irrelevant information are available from non-Internet sources, such as books, newspapers, TV, or friends. The age of electronic information merely makes it possible for greater numbers of people to access it.

“This just puts a higher degree of responsibility on physicians, nurses, and other health care professionals to help patients sort through the maze,” Thorson said. “This includes providing patients with directives to reliable Web sites, such as those of the American Cancer Society, the National Cancer Institute, the Food and Drug Administration, and the American Society of Clinical Oncology, for example. And it means helping to ensure that these and other Web sites of stature remain reliable.”

Throughout history, every advance in communications has led to concerns that new information will not be handled well by those to whom it is newly available, said Thorson. However, he points out, history has made it clear that the benefits derived from information delivery have always ultimately outweighed the disadvantages. How does Thorson handle his Web-savvy patients? “I am not troubled by the information my patients bring to me from the Internet,” he said. “Mostly, it provides a basis for sound and meaningful discussion. Whether my recommendations prevail or not, I can take comfort in the fact that the patient made a decision based on a broader level of understanding than he or she otherwise may have had without the Internet.”