Assessment of the information needs and use of information resources on complementary and alternative medicine by Alberta family physicians

BACKGROUND: The public's increasing use of complementary and alternative medicine (CAM) poses unique challenges for primary care physicians in knowledge and patient communication. The objective of our study was to assess Alberta family physicians' interest in CAM information and the type of information sources they currently use. METHODS: A cross-sectional survey was designed and mailed to a random sample of family physicians registered with the College of Physicians and Surgeons of Alberta. Main outcomes were physicians' self-reported knowledge of CAM, interest in CAM information and frequency of use of various medical information sources. RESULTS: Response rate was 34% (n = 346). Physicians indicated having limited knowledge of CAM, but were interested in evidence-based CAM information such as randomized controlled trials and systematic reviews on acupuncture, herbal medicine, massage, chiropractic treatment and meditation. Most respondents did not make use of reliable information sources that are available on the Internet. CONCLUSION: Education strategies are needed to help physicians access and use Internet sources of evidence-based CAM information more effectively.     

Quality of healthcare information on the Internet: caveat emptor still rules

The Internet is a burgeoning source of healthcare information for consumers and medical professionals, providing a wealth of data on diseases and chronic conditions, treatment options and patient safety. However, numerous studies have documented substantial variation in both the completeness and accuracy of this information. Although there are promising signs of improvement and new self-policing efforts, Internet users must still proceed with caution when seeking healthcare information online, as incomplete, inaccurate and even dangerous information still abounds in cyberspace. Constituencies concerned with healthcare and the Internet can take action to improve the quality of information online.     

Oncology nurses' use of the Internet for continuing education: a survey of Oncology Nursing Society Congress attendees

A publication and continuing education company conducted a survey at the 23rd Annual Oncology Nursing Society Congress to determine whether nurses are using the Internet and, if so, for what purposes. Survey results revealed that oncology nurses are using the Internet for a variety of educational purposes, which include drug information, literature searches, academic information, continuing education, and patient education. Continuing education providers should continue to pursue the Internet as a means of meeting the needs of oncology nurses for quick, up-to-date information in their field. There is a need for further documentation on the use of the Internet by nurses for continuing education, including topics and program formats that would be most beneficial.     

The role of the Internet in supporting and informing carers of people with cancer: a literature review

Background

The Internet is an expanding source of information and support for cancer patients and their families. Studies mostly report patient Internet use. Little is known about how carers (families/informal caregivers/friends) use the Internet and what they find useful.

Aim

The aim of this paper was to review the literature on the role of the Internet in supporting and informing carers of people with cancer.

Materials and methods

Findings are based on a review of published studies identified from 1996–2009 Ovid MEDLINE, CINAHL, EMBASE and 2002–2009 PsycINFO, Cochrane database and Google Scholar. Key search words used were cancer, patient, information, Internet, online, web, support, family, carer, caregiver and friend.

Results

One hundred forty-five abstracts were reviewed. Fifty-two articles were retrieved in full text. Twenty of the 52 articles were critically appraised using the appropriate Critical Appraisal Skills Programme tool. All studies retrieved were level IV evidence. Most compared carer and patient Internet use with other cancer information sources or analysed content of postings to web sites. Some reported on patient ‘indirect’ Internet use through carers. Heterogeneity of results related to different study aims, diversity in study tools, varying sample sizes and differing cancer populations. Broadly, Internet use can be divided into information searching and support group activity. Carers access Internet information to problem solve; however, they report doctors as their most preferred information source. They would like to have e-mail communication with Health Care Professionals to ask questions and clarify information. Participation in online support groups provides information tailored to individual needs and peer support.

Implications for practice

The Internet may be a primary or secondary source of information and can be used to access services. Routine assessment of carers’ Internet use, prescribing of Internet sites and e-mail communication with carers are possible areas for practice improvement. The current level of evidence is not ideal to influence policy development.

Conclusions

Research is required to evaluate carer Internet use in the rapidly changing world of health and technology. Interactive Internet applications developed specifically for carer use have the potential to prepare, inform and support the carer in their ever-expanding health care role. The impact of these services on carer quality of life also requires investigation.     

Patients,health information,and guidelines: A focus-group study

Background. Evidence-based clinical guidelines could support shared decision-making and help patients to participate actively in their care. However, it is not well known how patients view guidelines as a source of health information. This qualitative study aimed to assess what patients know about guidelines, and what they think of their presentation formats. Research question. What is the role of guidelines as health information for patients and how could the implementation of evidence-based information for patients be improved? Methods. A qualitative study with focus groups that were built around a semi-structured topic guide. Focus groups were audiotaped and transcribed and analysed using a phenomenographic approach. Results. Five focus groups were carried out in 2012 with a total of 23 participants. Patients searched for health information from the Internet or consulted health professionals or their personal networks. The concepts of guidelines included instructions or standards for health professionals, information given by a health professional to the patient, and material to protect and promote the interests of patients. Some patients did not have a concept for guidelines. Patients felt that health information was abundant and its quality sometimes difficult to assess. They respected conciseness, clarity, clear structure, and specialists or well-known organizations as authors of health information. Patients would like health professionals to deliver and clarify written materials to them or point out to them the relevant Internet sites. Conclusions. The concept of guidelines was not well known among our interviewees; however, they expressed an interest in having more communication on health information, both written information and clarifications with their health professionals.     

Evidence-based practice guidelines--one way to enhance clinical practice

Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.     

Internet resources for evidence-based practice in nursing.

There are many Web sites where nurses can find valuable information on evidence-based practice. This brief article reviews some of those Web sites and includes Internet resources for learning about evidence-based nursing and finding evidence to guide nursing practice.     

Implementing and sustaining evidence-based clinical practice in Australia: the Evidence Based Clinical Practice Research Initiative

Evidence-based medicine is a process by which clinicians translate clinical information needs into answerable questions, track down answers to those needs as efficiently and effectively as possible using the best evidence available, apply the information to patients and evaluate their performance. Implementing evidence-based medicine is fragmented and variable. The National Health and Medical Research Council of Australia has implemented a research program to determine successful strategies for implementation and sustaining of evidence-based clinical practice. In addition this research program will help to answer whether evidence-based practice improves patient outcomes. This paper describes this program and other strategies that improve the application of evidence-based practice in clinical settings.     

Evaluation of patient satisfaction with tailored online patient education information

Patients are using the Internet for access to standardized health information in ever-growing numbers. Although increased access to health information can be helpful, the quality of information varies widely. All too often, the information retrieved is incomplete, inaccurate, or inappropriate. An interdisciplinary team of clinicians, librarians, software engineers, and multimedia designers developed an online patient education system that enables clinicians to "prescribe" tailored, evidence-based health information. The system provides access to text and video that patients can adapt for language, vision, and hearing preferences. Usability testing was conducted with eight patients in a usability laboratory using the "think-aloud" method, surveys, and interviews. Results indicated that patients were highly satisfied and that the site has the potential to become a valuable resource in disease management. Patients made several recommendations regarding system appearance, function, and content that will have application for other groups developing online patient education systems.     

Do gynaecology outpatients use the Internet to seek health information? A questionnaire survey

Background The Internet is a rich source of medical information and the general opinion among doctors is that the number of patients attending clinics with information from a web search is increasing. The purpose of this study was to assess the demographics of those who access the Internet and their attitudes towards the quality and usefulness of information provided by the Internet. This study also looked at the various sources of health information and the satisfaction rates. Design Cross‐sectional observational study. The study group consisted of a cohort of women attending the gynaecology outpatient clinic at a district general hospital in the United Kingdom. In total, 484 patients attending the gynaecology outpatient clinic completed a questionnaire which included 13 structured questions regarding access to and attitudes towards the Internet and other health sources of information. Setting Questionnaires were distributed to 564 women attending gynaecology outpatient clinics for 3 months from 1 June 2005. Results A total of 484 patients (85.6%) completed the questionnaire. Age range was 41–65 years and the median education level was completion of General Certificate of Secondary Education (GCSE). In total, 360/484 (74%) had sought health information about their condition from a variety of sources before attending the outpatient clinic. In total, 399/484 (82.4%) respondents had access to the Internet. Of 399 with access, 107 (26.8%) of the patients used the Internet to find information about their condition before their appointment. General practitioners remain as the primary source of health information, mainly to improve the knowledge of the condition. A total of 78/107 (73.3%) who had used the Internet before their appointment would like to continue using the Internet as a health information resource. Conclusion A significant proportion of patients had access to the Internet to find health information. The widespread availability and increased usage of medical websites by patients raises important issues regarding the need for quality control and impacts on the doctor–patient relationship.     

Impact de l’information disponible sur Internet chez les patients douloureux chroniques

Aims

Practitioners are increasingly faced with patients who have previously seeked medical information on the Internet. However, although these websites related to pain therapy are more and more known by doctors, the impact of those informations on patients and on the doctorpatient relationship is much less known and taken into account. The objective of this study was to determine the population using this type of research and assesses the impact on their therapeutic management.

Material and methods

260 questionnaires were handed out to patients attending a University pain center in Marseille and Nice (France) from May to July 2011.The response rate was 94%.

Results

Two thirds of the respondents were using Internet seeking medical information. The age was directly associated to the web use. Internet represented the first source of information before the doctor. Primary motivation lay in the rapid answers to the patient’s quest. Thus, allowing to avoid a medical consultation. Patients judged the information provided as being fair to good quality. A majority changed their own attitude and conduct to their approach as to pain therapy after Internet research. Only 35% of patients informed their physician. In return, doctors kept a certain distance with it. Patients’ approach has a neutral to positive impact on the relationship with their doctor.

Discussion and conclusion

Internet influences the behavior of patients and participates in their education in health issues. It modifies the dynamics of the patient-physician relationship. Pain physicians have to acknowledge this new source of information and thus discuss it with their patients. This attitude will help to dispel misunderstandings and strengthen the therapeutic alliance with the patient.     

Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice

Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.     

Using the Internet for patient education

The Internet, especially the World Wide Web, has a wealth of health-related information easily accessible to patients and families. Commercial health-related Internet sites offer the "3 C's: content, commerce, and connectivity. Many are quickly adding the 4th "C": communication. A growing concern among health care professionals is the quality and the seemingly overabundance of patient education information available on the Internet. Certainly it is possible for nurses to use the Internet for patient education, but new skills and knowledge are needed by nurses who incorporate this technology into their practice. This article will briefly review the evolution of patient education on the Internet, provide a brief review of the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) Patient and Family Education Standards, and offer guidelines for nurses who choose to enhance their patient education efforts by using resources readily available on the Internet.     

Applied informatics for quality assessment and improvement

In our hospital, transition planning for order entry and clinical documentation has presented an opportunity for process changes and the ability to capture quality initiatives into data warehouses, where they can be utilized for building evidence-based practice. For example, the order entry and clinical documentation system allows for data retrieval of performance measures set by organizations including the Joint Commission on Accreditation of Healthcare Organizations, Centers for Medicare & Medicaid Services, and National Quality Forum. These data will reside in one system where they can be mined and extracted for reporting. Details of this magnitude are crucial when developing a CPR that will serve as the primary data source of clinical information. As we continue to seek IT solutions to improve patient safety and provide quality care, the use of informatics as a foundation in quality programs will provide the structure and database needed to support evidence-based practice at the point-of-care and reduce potential for error.     

Dual diagnosis,as described by those who experience the disorder: Using the Internet as a source of data

The complexity of providing treatment for people with dual diagnosis is well recognized. For the purpose of this paper, the World Health Organization definition of dual diagnosis was used; that is, a person diagnosed with an alcohol or drug use problem in addition to mental illness. This research explored the personal narratives of those who experience dual diagnosis using the Internet as a data source. An important consideration in using the Internet as a data source was that Web forums can offer a sense of anonymity, allowing people to share very detailed and personal information, and providing a rich source of qualitative data. The results produced five emergent themes: spiralling out of control – again!, getting help and giving support, treating both the addiction and mental illness, having meaning and being active, and being honest with self and others. The results indicate that individuals who experience dual diagnosis are often left to navigate their personal treatment requirements across two diverse systems, and were generally not satisfied with the conflictual advice received across these two systems (i.e. alcohol and other drug and mental health services). This study has produced valuable insights related to consumer‐perceived service barriers and enablers.     

The information requirements of people with cancer: where to go after the "patient information leaflet"?

Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.     

Usage of the Internet pharmacology resources among European pharmacologists: a preliminary investigation

The Internet is becoming an ever more important source of information in pharmacology and medicine. Little is known, however, about which Internet pharmacology resources are actually used by the pharmacologists - and to what extent - and how they estimate the Internet information quality and evaluation. This pilot study used an anonymous questionnaire, distributed among 250 mostly European (220/250) pharmacologists from 30 European countries attending The 2nd European Congress of Pharmacology, held in Budapest, Hungary, in 1999. According to study results, 93% of all participants use the Internet pharmacology resources: 56%, 35% and 9% of them on a daily, weekly and monthly basis, respectively. Among 56 pharmacological/medical free online databases offered, the general scientific databases were found to greatly prevail (Pub Med 60%, Evaluated MEDLINE 37%, Internet Grateful Med 29%, etc.), while drug monographs or toxicological databases were less used [e.g. ECDIN, RxList, National Toxicology Programme (NTP) < 10%]. Some 80% of the participants estimated the quality of the pharmacological information on the Internet as good or very good, while 20% thought the quality should be improved. Also, 35% of participants felt the need for improvement of the Internet pharmacological information evaluation, which should be the goal of pharmacology professional.     

Nurses and Internet health information: a questionnaire survey

AIM: This paper is a report of a study to identify the extent of postgraduate nursing students' information literacy skills in relation to electronic media and health information and barriers to accessing this information. BACKGROUND: The Internet is a key source of information for a significant group of patients. However, there is evidence of quality issues with some Internet health information sites. Nurses need to be aware of the range and quality of online health information so as to assist patients and families to locate and evaluate relevant and current information. METHOD: A questionnaire designed to collect quantitative and qualitative data was posted to a convenience sample of all students enrolled in a postgraduate nursing programme in December 2005. The response rate was 55.1% or 123 responses. RESULTS: Most respondents had Internet access at home and work and believed that access to online health information resources had improved their practice. However, some had difficulties in accessing computers at work and insufficient time to search for online health information. Concern was expressed about the quality of online information, but the majority of respondents did not assess patient use. Frequent users of online resources were more likely to assess patient use. CONCLUSION: The development of nursing competencies in accessing and using online resources is a key precursor to supporting patients and families' use of the medium. Access to Internet resources at work, along with training and time for searching, is necessary for the development of skills enabling effective use of information technology.