Table 2.

Summary of findings of the articles.

Study	Themes
	Discussion of online information with physicians	Implications for the patient-physician relationship
Stevenson, 2007 [3]	Barriers to discussion of online information: Patients experienced resistance from doctors over bringing information, even about their day-to-day health management, into the consultation. Facilitators of discussion of online information: Some patients reported that doctors positively encouraged them to search for information on the Internet. They also felt that Internet information should be checked with physicians.	Quality of the patient-physician relationship: Patients saw the Internet as an additional resource to support doctors’ advice and enhance the relationship with their doctor.
Kivits, 2006 [4]	Strategies for using and revealing online information: During consultations, patients preferred to be silent, asking questions and discussing information based on their Internet search, but not revealing that they used the Internet.	Patients’ sense of control, confidence, and empowerment: By discussing information they accessed on the Internet or setting questions in advance, patients mentioned being able to better understand and participate in consultation sessions with their doctors. Patients were also better informed, as they used the knowledge gained from Internet searches to check and complete the information received from doctors. Although most patients felt that physicians would feel challenged if the patients discussed information they found on the Internet, those who discussed the information said they had received positive attention.
Broom, 2005 [7]	Barriers to discussion of online information: Patients might feel being disapproved of by the physician if they shared their Internet search. Some physicians discouraged patients asking questions from their Internet research, giving them the impression that they were disapproved of or being treated as problematic patients.	Patients’ sense of control, confidence, and empowerment: Internet search provided clarity in terms of treatments options and, as a result, diminished patients’ reliance on their specialists. Further, Internet search behavior led patients to experience a heightened sense of control and therefore enter into a comprehensive negotiation with their specialist. However, patients’ sense of empowerment depended on how receptive providers and specialists were to their desire to take part in the decision-making process.
Sommerhalder, 2009 [12]	Strategies for using and revealing online information: Patients used several different strategies to introduce information found on the Internet to their physicians: ask additional questions; suggest specific diagnoses, diagnostics, or treatments, without directly revealing where they found the information; bring printouts of Internet search results into consultations; silently verify doctor’s advice against their online findings; actively avoid talking about the online information findings. Barriers to discussion of online information: Patients did not discuss their online findings due to lack of time during consultations, or reluctance to interfere with the consultation process.	Patients’ perceived consultation effectiveness: Patients viewed the consultation as important to their understanding of online health information. Physicians recognized the change in their role. Patients were more knowledgeable, which made initiating an interaction on health-related issues easier and enabled discussion on a more elaborate level; discussing with physician gave patients greater clarity, orientation, and certainty. Quality of the patient-physician relationship: Bringing up online information during consultations also resulted in conflicts with patients, and some patients ignored their physicians’ expertise.
Murray, 2003 [15]	Demographic factors: Those who brought information to the consultation tended to have a higher self-rated ability to critically appraise health information on the Internet and their health status.	Patients’ sense of control, confidence, and empowerment: Most felt more in control and more confident during the consultation as a result of bringing information to their physician. Quality of the patient-physician relationship: The effect of taking information to the physician on the patient-physician relationship was likely to be positive as long as the physician had adequate communication skills and did not appear challenged by the patient bringing in information. Patients’ who felt their physicians were challenged tended to be uninsured patients, and those who described themselves as excellent or very good at critically appraising information on the Internet.
Sillence, 2007 [23]	Not available.	Patients’ perceived consultation effectiveness: Patients felt that using the Internet improved their communication with physicians Patients’ sense of control, confidence, and empowerment: Patients felt better equipped to go to the physician and more empowered. The online information and advice influenced patients’ decision making without threatening their desire to communicate with physicians, but they still saw the physician as the primary source of information and advice.
Chung, 2013 [24]	Demographic factors: Men were more likely than women to have a conversation regarding online information with physicians. Patients who had trouble understanding or trusting online health information were no more likely to ask questions or seek guidance during consultations. Reactions of physicians to online information were perceived as negative by patients who experienced poor health and those who had more concerns about the quality of their searched information.	Not available.
Silver, 2015 [25]	Barriers to discussion of online information: Patients had not discussed or revealed their online health information findings due to fear of embarrassment; feeling it would be insulting to the physician; using online information to negate the need to see a physician; not remembering to bring it up. Facilitators to discussion of online information: Patients discussed online findings during doctor visits when a family member was present; the doctor initiated inquiries about patient-acquired information; they had encountered an advertisement suggesting talking with a doctor.	Not available.
Hart, 2004 [26]	Strategies patients used to exchange online information: Patients who looked up health information on the Internet prior to their consultation usually had not directly revealed to the practitioner that they had done so. Barriers to discussion of online information: Some practitioners sought to assert their authority by dismissing the discussion of patients’ findings acquired from the Internet.	Quality of the patient-physician relationship: Patients’ trust in their physician as the main information source remained at a very high level, despite their Internet health information searches.
Schrank, 2010 [27]	Barriers to discussion of online information: Patients feared their doctors could feel criticized if they revealed online findings or had an unchangeable preconceived view.	Quality of the patient-physician relationship: Online information showed the potential to significantly change the relationship with the attending doctors, with the most important aspect being a shift of the subjectively perceived hierarchy. The quality of existing patient-physician relationships played a major role in how patients assessed doctors when discussing online findings, where reactions were mostly judged as positive in a good relationship.
Hay, 2008 [28]	Barriers to discussion of online information: Patients did not discuss their Internet information seeking mostly because they feared being perceived as challenging or confronting their physician.	Patient satisfaction: Physician and patient appointment satisfaction was significantly higher when the Internet information was discussed.
Newnham, 2006 [29]	Not available.	Quality of the patient-physician relationship: Most patients did not believe that information searching adversely affected the doctor-patient relationship. 40% felt that the doctor-patient relationship was unaffected by information searching, 24% felt it improved the relationship, while only 8% felt it had adversely affected the relationship. 42% of patients who searched for information trusted their doctor as much as nonsearchers did.
Chiu, 2011 [30]	Barriers to discussion of online information: Patients worried that it might offend the doctors, they respected doctors’ authority, and were not used to asking doctors questions. Demographic factors: In a culture where the patient-physician hierarchy is prominent, patients were hesitant to ask questions, as it might displease the doctor.	Patient perceived consultation efficiency: Participants who searched the Internet before seeing their doctors could understand their doctors and the jargon they used better, thus leading to better doctor-patient communication.
Russ, 2011 [31]	Demographic factors: Those who presented information to their doctors tended to be older (average 43 years) than nonsharers (36 years, not significant), and information sharers tended to have more children under the age of 18 years.	Patient satisfaction: Patients who searched the Internet for information tended to feel that they received satisfactory information about their health during their consultation more than those who did not, and that they received more attention than the nonsharers.
Ybarra, 2008 [32]	Not available.	Patients’ sense of control, confidence, and empowerment: Most respondents felt more comfortable with information from the health provider as a result of their Internet searches.
AlGhamdi, 2012 [33]	Not available.	Quality of the patient-physician relationship: Of 801 study participants, 45% had searched for online health information before coming to the clinic; 72.5% of those discussed the information with their doctors, and 71.7% of those who did so believed that this positively affected their relationship with their doctor.
Bianco, 2013 [34]	Not available.	Quality of the patient-physician relationship: Only 25% of those who searched the Internet for health-related information discussed the information they found with their general physician. Most believed it had no effect on the patient-physician relationship, 13.4% believed the Internet information search had a positive effect, and only 8.1% believed it had a negative effect.
Xie, 2009 [35]	Not available.	Patients’ sense of control, confidence, and empowerment: A total of 4 online health information needs of patients were highlighted, of which 2 focused on the interaction with the physician: (1) advanced knowledge found on the Internet, on a specific health condition or treatment, helped patients to feel that they were better prepared to interact with doctors in the sense that they could better understand what doctors said; (2) the basic information about a health condition found on the Internet provided a general understanding of their health issue, so that it would help patients to know what to expect and to be prepared to better cope with a stressful situation.