Patient behavior and the benefits of artificial intelligence: The perils of “dangerous” literacy and illusory patient empowerment

Objective

Artificial intelligence can provide important support of patient health. However, limits to realized benefits can arise as patients assume an active role in their health decisions.

Methods

Distinguishing the concepts of health literacy and patient empowerment, we analyze conditions that bias patient use of the Internet and limit access to and impact of artificial intelligence.

Results

Improving health literacy in the face of the Internet requires significant guidance. Patients must be directed toward the appropriate tools and also provided with key background knowledge enabling them to use the tools and capitalize on the artificial intelligence technology.

Conclusion

Benefits of tools employing artificial intelligence to promote health cannot be realized without recognizing and addressing the patients’ desires, expectations, and limitations that impact their Internet behavior. In order to benefit from artificial intelligence, patients need a substantial level of background knowledge and skill in information use—i.e., health literacy.

Practice implications

It is critical that health professionals respond to patient search for information on the Internet, first by guiding their search to relevant, authoritative, and responsive sources, and second by educating patients about how to interpret the information they are likely to encounter.     

The effect of web-based preoperative information on parents of children who are going through elective ambulatory surgery: A systematic review and meta-analysis

ObjectiveTo evaluate the effect of preoperative web-based information to parents of children undergoing elective ambulatory surgery performed with anesthesia. Outcome measures were parental anxiety, knowledge, and satisfaction.MethodThe review followed the PRISMA statement. A systematic search of six databases was conducted. Randomized controlled trials, cluster-randomized trials and quasi-randomized controlled trials were eligible for inclusion.ResultEight studies were included. An effect in favour of web-based information compared to standard information was observed for parental anxiety measured before separation from child (SMD=?0.66, 95% CI=?0.92 to ?0.40) and after surgery (SMD=?0.55, 95% CI=?0.95 to ?0.16), for parental knowledge measured in-hospital (SMD=1.10, Cl 95%=0.37–1.82), and parental satisfaction after discharge (SMD=1.03, 95% Cl=0.41–1.65). No effect was observed for anxiety at separation, and for satisfaction in-hospital. The certainty of the evidence varied from very low to moderate.ConclusionDepending on the timing of assessment, web-based information before pediatric surgery may reduce the level of parental anxiety and increase the level of parental knowledge and satisfaction more than standard care.Practice implicationsWeb-based routines can be used to convey pre-operative information to parents before paediatric ambulatory surgery. Still, standardized research that enables further comparison across studies is needed.     

An investigation into the empowerment effects of using online support groups and how this affects health professional/patient communication

Objective

The current research investigates the potential of online support groups (OSGs) to foster empowerment and how membership might affect the patient/health professional relationship.

Methods

246 participants across 33 OSGs completed an online questionnaire.

Results

All empowerment processes and outcomes identified by van Uden-Kraan et al. [1] were found to be present. All empowerment outcomes were adequately predicted by empowerment processes. The majority (82.2%) of participants had discussed information found online with their health professional and most (74.2%) were satisfied with the response. Around 60% of participants felt membership of an OSG had affected the relationship with their health professional and from qualitative responses the effects were mostly positive.

Conclusion

OSGs have the potential to produce empowerment outcomes for those who choose to use them. Furthermore, users report a positive reaction to information found online from their health professionals.

Practice implications

Although not all patients will benefit from using OSGs, health professionals suggesting their use could ensure that they reach the maximum receptive audience. Furthermore, this research could be used to encourage a more ‘net friendly’ attitude amongst health professionals.     

Evaluation of the web-based Diabetes Interactive Education Programme (DIEP) for patients with type 2 diabetes

Objective

The objective in this study was to evaluate a web-based type 2 diabetes self-management education programme aimed at improving knowledge, encouraging active patient participation and providing supportive self-management tools.

Methods

(1) An effect evaluation was conducted using a randomized controlled trial with a pre-test and post-test design (n = 99) and a knowledge questionnaire. (2) A user evaluation was conducted using an online questionnaire (n = 564) and one-on-one interviews (n = 11) to examine the perceived quality, use of functionalities and use of the programme as a supportive tool in education.

Results

The effect evaluation showed a significant intervention effect (p < 0.01) on knowledge. The user evaluation showed high satisfaction with the programme's content, credibility and user-friendliness. However, functionalities and self-management tools were used by less than half of the participants.

Conclusion

The programme can improve knowledge, but it is not fully used as intended. A more optimal use of the programme is necessary for higher efficacy.

Practice implications

The use of mostly spoken text instead of written text was highly appreciated and could be used more often for educational websites. Furthermore, health care practitioners need support in implementing new educational programmes during consultations.     

The use of video for patient information and education: A scoping review of the variability and effectiveness of interventions

ObjectiveTo provide an overview of video interventions used for patient information and education, and of the tools used to evaluate their effectiveness, in order to consider the feasibility of developing generic guidelines and appraisal tools for the use of video in patient care.MethodsA scoping review was carried out to describe and synthesise emerging knowledge, using thematic analysis of data. Studies focussed upon videos for health professional education were excluded, as were those which consider the impact of videos available via social media.ResultsA narrative overview of 65 identified papers provides insight into the range and scope of studies. Common themes emerge, notably the aim of reducing anxiety and the variety of instruments designed to measure this. The use of self-report questionnaires was common, but their design is variable.ConclusionTargeted video-based intervention can improve patient experience and outcomes. High utility guidelines and appraisal tools, transferable between contexts, are needed to facilitate deployments at scale for sustainable outcomes.Practice implicationsVideo production guidelines and appraisal tools will be of value to those engaged in video development and deployment. Guidance should be based upon emerging evidence of effectiveness and incorporate an emphasis on reusability.     

The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review

Objective

To summarize the literature on the impact of video-based educational interventions on patient outcomes in inpatient settings as compared to standard education techniques.

Educational benefits of Internet and computer-based programmes for prostate cancer patients: A systematic review

Objective

This study aims to review systematically the available literature on Internet and computer-based patient education programmes, assess the quality of these studies and analyze the benefit of these programmes for prostate cancer patients.

Methods

Complete databases were searched. Studies were included if they concerned patient education of prostate cancer patients, were qualitative or quantitative and examined Internet or interactive CD-ROM use.

Results

Eighteen studies met the inclusion criteria. The majority of the studies reported a significant increase in the knowledge of the disease, satisfaction with treatment options and support for men. The benefit of the programmes was that the patients felt more empowered and obtained a heightened sense of control over their disease.

Conclusion

The Internet or computer-based programmes had a positive impact on prostate cancer patient education. Most papers reported that the programmes were beneficial, but few presented data from studies with rigorous research methodologies to support these claims.

Practice implications

Internet and computer-based programmes can be useful tools in prostate cancer patient education. In order to improve the benefits of the programmes, more Internet and computer-based programmes need to be developed and studied.     

Opportunities for patients to engage in postoperative recovery following cardiac surgery: A systematic narrative review

ObjectiveTo compare patient booklets with clinical guidelines and care pathways to assess: gaps in content and depth of information delivered, opportunities for patients participation and to review the trajectory of care to inform recovery.MethodsA systematic review of the grey literature was conducted using Google search engine and a variety of terms related to cardiac surgery, patient outcomes and recovery pathways. Patient books and care pathways were obtained from major hospitals in Melbourne. Resources were included if they were published between January 2013-August 2018 and written in English.ResultsA total of 31 resources were included in the review, (n = 14 patient booklets, n = 17 clinician guides). Twenty-one topics of recovery were identified. Patient booklets provided information on more topics of recovery than clinician guides (50 % and 24 % respectively). Clinician guides provided more depth on information on topics of recovery than patient booklets (85 % and 73 % respectively). The majority of patient booklets outlined patient participation was in five topics of recovery.ConclusionsGaps in the type and depth of information exist between patient and clinician guidelines. Clearer guidelines on how patients can participate in care are needed.Practice implicationsNurses are key drivers in facilitating patient participation in postoperative recovery.     

Patient education interventions for colorectal cancer patients with stoma: A systematic review

ObjectivesTo describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills.MethodsA systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills.ResultsThirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate.ConclusionsPatient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding.Practice implicationFurther education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.     

Knowing the ABCs: a comparative effectiveness study of two methods of diabetes education

Objective

To test an active-learning, empowerment approach to teaching patients about the “diabetes ABCs” (hemoglobin A₁C, systolic blood pressure, and low density lipoprotein cholesterol).

Methods

84 (97%) diabetic patients who participated in a randomized effectiveness trial of two clinic-based group educational methods and completed a post-intervention assessment. The empowerment arm participated in a group session that incorporated two educational innovations (a conceptual metaphor to foster understanding, and team-based learning methods to foster active learning). The traditional diabetes education arm received a didactic group session focused on self-management and educational materials about the diabetes ABCs. Participants in both arms received individual review of their current ABC values.

Results

A questionnaire evaluated knowledge, understanding, and recall of the diabetes ABCs was administered three months after enrollment in the study. At three months, participants in the empowerment group demonstrated greater understanding of the diabetes ABCs (P < 0.0001), greater knowledge of their own values (P < 0.0001), and greater knowledge of guideline-derived target goals for the ABCs compared with participants in the traditional arm (P < 0.0001).

Conclusion

An active-learning, empowerment-based approach applied to diabetes education can lead to greater understanding and knowledge retention.

Practice implications

An empowerment approach to education can facilitate informed, activated patients and increase performance of self-management behaviors.     

Effectiveness of multimedia interventions in the provision of patient education on anticoagulation therapy: A review

ObjectiveA literature review was conducted to identify available evidence on the use of multimedia patient educational interventions on anticoagulation therapy.MethodsA literature search was conducted on 9/4/2020 via six research databases. Publications that evaluated the effects of these interventions on anticoagulation therapy were included.ResultsThe review included ten original research studies (five randomized controlled trials, four observational studies and a pre- and post-interventional study), a systematic review and meta-analysis, three systematic reviews, a scoping review, and a literature review.Multimedia interventions significantly improved knowledge after education, but no significant differences found when compared to traditional methods. There was insufficient evidence to conclude whether knowledge retained over time. Patients were equally satisfied with both methods. Multimedia interventions significantly reduced healthcare professional’s time required for education. Heterogeneity in intervention, methodology and results limited comparison and combination of findings across studies.ConclusionMultimedia patient educational interventions on anticoagulation therapy have similar outcomes to traditional methods in knowledge improvement and satisfaction, but they save health personnel time.Practice implicationsThere is lack of evidence to support the effectiveness of multimedia interventions in educating patients on anticoagulation therapy. Larger randomized studies evaluating their benefits in health outcomes and clinical practice are warranted.     

A web-based patient education system and self-help group in Persian language for inflammatory bowel disease patients

BACKGROUND AND AIMS: To study the use patterns of a Persian web-based patient education system for inflammatory bowel disease (IBD) patients in Iran. METHODS: A web-based patient education system was developed with Persian content in three sections: general, ulcerative colitis (UC), and Crohn's disease (CD). The website included a forum for patients to communicate as a self-help group. A customized web tracking system recorded web use statistics. Polls at the bottom of each page collected the visitors' opinion on the extent of helpfulness and readability of page contents. Web use data were analyzed for an 18-month period from October 2004 to April 2006. RESULTS: Having excluded page visits from search engine robots, the website's homepage was visited 4452 times (mean of monthly visits: 234, range: 102-330). The web pages titled Anatomy of gastrointestinal system, Nutrition in IBD, Diagnostic tests, How to cope with IBD, and IBD in women were the most favorite in general section. The web page titled IBD treatment was the most visited in both CD and UC sections followed by the web pages on cause of disease, diagnostic procedures and complications in CD section; and those titled symptoms, cause of disease and risk factors in the UC section. Overall, the content evaluation polls received 294 hits (from 186 unique visitors) of which, 196 (67%) were from patients, 30 (10%) from patients' relatives/friends, 21 (7%) from doctors, and 47 (16%) from other groups. During the 18-month period, 47 patients registered in the self-help forum, 24 threads were opened, and 97 posts (33 in CD and 64 in UC section) were sent. CONCLUSIONS: Considering the increasing trend of Internet use in developing countries like Iran, and the consequent increase in the proportion of Internet-using patients, and finally the time constraints gastroenterologists face answering patients' questions; similar websites seem to be effective ways of patient education in close future.     

Effects of patient education and therapeutic suggestions on cataract surgery patients: A randomized controlled clinical trial

Objective

This paper describes a randomized controlled single blind study testing the effects of a patient education intervention combined with positive therapeutic suggestions on anxiety for cataract surgery patients.

Methods

84 patients participated in the study. Physiological and behavioral indicators of anxiety were compared between a regularly treated control and an intervention group receiving an audio CD containing information, relaxation, and positive imagery.

Results

We found that the intervention group was calmer throughout the four measurement points of the study (p = .004; d = 0.71) and they were more cooperative (p = .01; d = 0.60) during the operation. The groups did not differ in sleep quality before the day of the operation, heart rate during the procedure, and subjective Well-being.

Conclusion

Findings indicate that preoperative information combined with positive suggestions and anxiety management techniques might reduce patient anxiety in the perioperative period of cataract surgery, but further research is needed to investigate the benefits of such interventions and to uncover the underlying mechanisms.

Practice implications

Patient education interventions providing additional anxiety management techniques are recommended for use prior to cataract surgery.     

Entertainment education for breast cancer surgery decisions: A randomized trial among patients with low health literacy

Objective

To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients.

Methods

Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted.

Results

Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group.

Conclusions

Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options.

Practice Implications

Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers).     

肾上腺腺瘤患者采用后腹腔镜手术与开放手术临床效果的定量对比研究

目的：定量对比肾上腺腺瘤患者行开放手术与后腹腔镜手术治疗的临床效果。方法：选取本院2009年5月至2014年5月收治的肾上腺腺瘤患者113例,根据其手术方案差异将其分为对照组44例与观察组69例,对照组患者采用传统开放手术,观察组患者给予后腹腔镜手术。结果：观察组患者手术时间、术中出血量、术后引流量、引流管拔除时间、镇痛药物应用剂量、肛门排气时间、下床活动时间、住院时间以及术后并发症发生率均显著好于对照组,具有统计学意义(P<0.05)。结论：后腹腔镜手术治疗肾上腺疾病可良好改善患者围术期状况,抑制术后疼痛与并发症发生率,促进预后恢复速度。     

Assessing the quality and contents of asthma-related information on the Korean internet as an educational material for patients

Despite the substantial amount of asthma-related information available on the internet, little is known about the quality of such information. We assessed asthma-related information on the Korean internet intended as an educational material for asthma patients. By entering the key word, 'asthma', into 4 popular search engines, 32 web sites were identified and categorized with respect to authorship. The core asthma educational concepts and Health On the Net Code of Conduct principles were used to evaluate informational value and justifiability of unreliable information. Eight of 32 web sites were categorized as western physician, seventeen as oriental physician, four as commercial, and three as others. The mean number of core asthma educational concepts on the whole web sites was 2.7 out of 8. By type of authorship, 1.7 on the commercial sites, 2.1 on the oriental physician sites, 3.5 on the western physician sites, and 5.0 on the others sites in decreasing order. One of the western physician sites, two of the commercial sites, and all of the oriental physician and others sites contained unreliable information. However all of them except one site failed to satisfy our criteria of justifiability. Asthma-related information currently available on the Korean internet is highly variable in quality and lacks core asthma educational concepts and justifiability.     

The effects of Internet or interactive computer-based patient education in the field of breast cancer: A systematic literature review

Objective

The aim of this systematic review was to analyze what kind of Internet or interactive computer-based patient education programs have been developed and to analyze the effectiveness of these programs in the field of breast cancer patient education. Patient education for breast cancer patients is an important intervention to empower the patient. However, we know very little about the effects and potential of Internet-based patient education in the empowerment of breast cancer patients.

Methods

Complete databases were searched covering the period from the beginning of each database to November 2008. Studies were included if they concerned patient education for breast cancer patients with Internet or interactive computer programs and were based on randomized controlled, on clinical trials or quasi-experimental studies.

Results

We identified 14 articles involving 2374 participants. The design was randomized controlled trial in nine papers, in two papers clinical trial and in three quasi-experimental. Seven of the studies were randomized to experimental and control groups, in two papers participants were grouped by ethnic and racial differences and by mode of Internet use and three studies measured the same group pre- and post-tests after using a computer program. The interventions used were described as interactive computer or multimedia programs and use of the Internet. The methodological solutions of the studies varied. The effects of the studies were diverse except for knowledge-related issues. Internet or interactive computer-based patient education programs in the care of breast cancer patients may have positive effect increasing breast cancer knowledge.

Conclusion

The results suggest a positive relationship between the Internet or computer-based patient education program use and the knowledge level of patients with breast cancer but a diverse relationship between patient's participation and other outcome measures.

Practice implications

There is need to develop and research more Internet-based patient education.