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. 2000 Jul 1;321(7252):47.

Patient information on cancer

Access to the information should be made easier

Michelle Gillies 1
PMCID: PMC1127690  PMID: 10939814

Editor—Jones et al found that patients with cancer preferred a computer system giving personalised information to one that gave general information.1 This raises questions about the usefulness of the internet as a source of primary information for these patients. Cost, technological barriers, and information retrieval are other reasons to question the use of the internet as a primary source of information.

To encourage home access the government has announced a scheme for cheaper computers. Telephone costs, however, are still relatively high. There may also be technological barriers: 18% of patients in one American practice (mean age 27) were initially unable to perform any computer functions on their own and required help from a medical student to use the internet.2 Computer experience among older British patients is much lower: among 200 gastroenterology outpatients in Glasgow (mean age 54) 68% had never used a computer before.3

Good quality information for patients with cancer does exist on the internet but may be difficult to find if users do not have suitable “gateways.” Using a simple medical search term and a range of popular search engines, I identified 49 707 indexed cancer web pages. For each engine I recorded the first 10 documents retrieved. Altogether I reviewed 292 web pages, which gave 126 unique sites. Only eight (three British and five American) were patient information resources. I evaluated these using DISCERN4 and a locally developed rating scale (table). Two sites—CancerHelpUK and CancerBACUP—achieved maximal scores in these evaluations. Unhelpfully for naive users looking for information on cancer, these sites were not among the first five sites retrieved by four of the eight commonly used search engines.

To overcome these barriers one possibility would be to use the internet as a secondary source of information, primary access being gained with touch screens on stand alone computers in public libraries. I redeveloped one section (on colorectal cancer) of CancerHelp UK for use on stand alone touch screen computers. This redesign entailed use of bigger buttons and division into screens of information that did not require scrollbars. It seemed acceptable to some professionals and patients, but more formal evaluation is needed and the redevelopment was time consuming. Either more intelligent internet browsers that can reconfigure web pages for simpler use are needed or providers of health information on the internet should be encouraged to produce CD Roms for offline access.

Table.

Locally developed criteria used to evaluate information websites for patients with cancer

Authority (reputation, credibility, trustworthiness of source)
 Scope (depth and breadth of information content)
 Completeness (includes gaps or omissions in coverage and content)
 Disclosure (of authors, sponsors, and site developers; includes privacy and security)
 Accuracy (correctness and quality of information)
 Validity (explains accuracy of information, provision of references)
 Objectivity (includes balance of arguments, states possible bias and conflicts of interest)
 Uniqueness (originality of information)
 Currency (date of creation of information, date and patterns of update, stability of resource)
 Audience (intended users and ability of resource to meet users' needs)
 Accessibility (required computing environment, fee/passwords required)
 Navigation (usability, user support)
 Information structure and design (functionality)
 Aesthetic features (use of graphic and multimedia design)
 Links (availability, integrity, currency, and quality of internal and external hyperlinks)
 Interactivity (feedback mechanisms, mechanisms of interaction with site and other users)
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Acknowledgments

Competing interests: This letter is based on work undertaken in a BSc clinical medicine intercalated project supervised by Ray Jones and Robin Knill-Jones at Glasgow University.

References

  • 1.Jones R, Pearson J, McGregor S, Cawsey AJ, Barrett A, Craig N, et al. Randomised trial of personalised computer based information for cancer patients. BMJ. 1999;319:1241–1247. doi: 10.1136/bmj.319.7219.1241. . (6 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Al-Barwani F, Jones RB, Cawsey A, Knill-Jones RP. HC97. Weybridge: BJHC Books; 1997. A randomised trial of different patient-computer interactions; pp. 77–84. [Google Scholar]
  • 3.Helwig AL, Lovelle A, Guse CE, Gottlieb MS. An office-based internet patient education system. J Fam Pract. 1999;48:123–127. [PubMed] [Google Scholar]
  • 4.Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health (in press). [DOI] [PMC free article] [PubMed]
BMJ. 2000 Jul 1;321(7252):47.

Newspaper read is good predictor of information needs

Lynne Gatherer 1

Editor—Jones et al suggest that the type of newspaper read (broadsheet or tabloid) could be used as an indicator of information need among patients.1-1 In a postal survey I compared the information needs of hypertensive patients by deprivation category, housing tenure, employment status, and newspaper read.

Patients diagnosed with essential hypertension were identified through case notes at two Glasgow practices. One practice, serving a mainly deprived population, had 239 eligible patients. The other, serving an affluent population, had 209 eligible patients. Random samples of 100 from the affluent practice and 150 from the deprived practice were contacted with postal questionnaires asking about needs for information, self perceived knowledge, and risk behaviours.

After one reminder I obtained 106 (71%) responses from the deprived practice and 65 (65%) from the affluent practice. I used four measures of social difference: Carstairs deprivation category,1-2 housing tenure (owner v other), employment status (paid employment v not working), and newspaper read. Seven people who had not read a newspaper were included with tabloid readers.

All patients in the affluent practice who responded were in deprivation categories 1-3, and 97 (92%) in the deprived practice who responded were in deprivation categories 6-7. No patients were in deprivation categories 4 and 5. Deprivation category was strongly associated with employment status (36 patients (49%) in deprivation categories 1-3 reported that they were in paid employment compared with 20 (21%) in deprivation categories 6-7), with housing tenure (home owners 66 (90%) v others 40 (42%)), and with newspaper read (broadsheet 46 (75%) v tabloid 15 (25%)).

The table shows differences in self perception or behaviour by sex, age, and the four social or economic indicators, indicating those that were significant predictors in a stepwise multiple logistic regression analysis.

Table.

Differences in self perception or behaviour of patients with hypertension, assessed by sex, age, and four social or economic indicators (values are percentages)

 Differences Sex
(M v F)		 Age (years) (<60 v ⩾60) Deprivation category (1-3 v 6-7) Newspaper read (broadsheet v tabloid) Employment (working v not working) Housing (owner v other)
Those who knew their last blood pressure reading (n=98) 62 v 55 69 v 53 74 v 47 79 v 471-150 73 v 51 69 v 401-150
Those who thought that, in general, they had a good knowledge about high blood pressure (n=61) 36 v 37 45 v 31 50 v 25 58 v 241-150 49 v 30 44 v 24
Those who had their blood pressure checked by more than one type of clinician (n=88) 55 v 51 51 v 54 66 v 421-150 64 v 46 50 v 54 59 v 43
Those who had received information about high blood pressure from more than one source (n=65) 47 v 39 55 v 371-150 54 v 34 62 v 331-150 57 v 37 52 v 29
Those who knew of friends or family with high blood pressure (n=107) 61 v 68 67 v 63 75 v 561-150 69 v 62 70 v 62 70 v 55
Those who were current smokers (n=37) 28 v 17 26 v 21 16 v 28 18 v 25 21 v 23 23 v 21
Those who drank alcohol daily (n=31) 29 v 71-150 20 v 17 30 v 101-150 26 v 14 26 v 15 23 v 11
Among those who drink, those who drank ⩾6 units on each occasion (n=36) 40 v 91-150 46 v 151-150 19 v 301-150 15 v 31 32 v 22 26 v 25
Those who took part in any hobbies that involved physical exercise (n=87) 57 v 47 49 v 53 78 v 321-150 83 v 341-150 64 v 46 64 v 31
Those who thought that they got enough exercise to keep healthy (n=86) 49 v 56 38 v 611-150 56 v 51 54 v 52 42 v 58 48 v 61
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1-150

Indicators that were significant predictors from multiple logistic regression (P<0.05). 

Broadsheet readers living in more affluent areas were more likely to know their blood pressure readings, to consider that they had a good knowledge about high blood pressure, and to obtain information from more than one source. Newspaper read was a better predictor of these outcomes than deprivation category. Deprivation category was a significant predictor of alcohol use and exercise.

Although used extensively in market research, the newspaper read has rarely been used in health research. Deprivation category is widely used when determinants of health are looked at but is not an individual characteristic. When information needs are being considered, it seems logical to ask which newspaper is read as it can be a good predictor.

Acknowledgments

Competing interests: This project was carried out as a requirement for the degree of master of public health at Glasgow University. Ray Jones supervised the project.

References

  • 1-1.Jones R, Pearson J, McGregor S, Gilmour WH, Atkinson JM, Barrett A, et al. Cross sectional survey of patients' satisfaction with information about cancer. BMJ. 1999;319:1247–1248. doi: 10.1136/bmj.319.7219.1247. . (6 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Carstairs V, Morris R. Deprivation and health in Scotland. Aberdeen: Aberdeen University Press; 1991. [Google Scholar]

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