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Try out PMC Labs and tell us what you think. Learn More. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of to Empirical articles that were in English were included. We identified 18 articles that met the inclusion criteria and the quality requirement for the review. of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients.

Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic.

Patience vs. patients: how to choose the right word

In health care, the rapid proliferation of health information on the Internet has resulted in more patients turning to the Internet as their first source of health information [ 2 - 4 ] and acquiring knowledge on their health conditions before seeking a professional diagnosis.

Patients are feeling more empowered [ 56 ] and are more inclined toward being involved in their health and health decision making [ 7 ]. This may thus change the way in which patients interact with and participate in consultations with their physicians and how they feel about their relationship with their physicians. Notwithstanding the potential benefits of Internet health information seeking, some concerns have been raised about the plausible negative effects of Internet health information seeking on patients. First, as online health information content can range from being peer reviewed or professionally reviewed to personal blogs, opinions, or anecdotes of other patients, information quality can vary, and patients may not possess the necessary skills to evaluate medical information and relate it to their own health circumstances [ 8 - 10 ].

Internet-informed patients may have more questions and may request additional treatments or medications during consultations [ 11 ]. This may then result in dissatisfied patients who may seek a second opinion, change the physician, change their treatment plan [ 15 ], or self-medicate using recommendations found on the Internet [ 16 ]. Thus, it is pertinent to have a comprehensive understanding of the influence of online health information on the patient-physician relationship. The closest reviews we have found are by McMullan [ 17 ] and Wald et al [ 18 ].

Wald et al [ 18 ] reviewed the past literature to identify the advantages and disadvantages of Internet-acquired information, and the challenges to providing guidelines to health care providers for effective interaction with Internet-informed patients. The focus of this review was to systematically review and synthesize the existing research on Internet health information-seeking behavior and its impact on the patient-physician relationship to give implications for future research and practice.

We systematically searched PubMed to identify articles and citations from January 1, to October 1, PubMed searches yielded records, while journal searches yielded records. We removed duplicate articles and screened the remaining articles in 2 stages.

The first stage involved screening titles and abstracts to identify and exclude irrelevant articles. The remaining articles were then subjected to a second stage of screening of their main content. Figure 1 depicts the flow of the article selection procedure. We included articles that were in English and were empirical studies focused on the Internet health information-seeking behavior of health care consumers and aspects of the patient-physician relationship.

We excluded nonempirical articles, which included review articles, content assessment studies of websites, and research commentaries. The 19 articles selected were first assessed for research quality, and 2 researchers independently performed the quality assessment. We assessed intercoder consistency at the end.

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As the selected articles were mainly empirical cross-sectional studies, we used quality assessment tools that were able to assess the methodological quality, findings, and contribution of the research articles. We evaluated qualitative studies using the Critical Appraisal Skills Programme quality assessment tool [ 19 ], which consists of 10 questions that assess the quality of the research methodology and the contribution of the qualitative studies.

We assessed quantitative studies using a customized coding scheme that consists of 14 questions adapted from 3 well-established quality assessment tools used for quantitative studies US National Heart, Lung, and Blood Institute quality assessment tool for observational, cohort, and cross-sectional studies [ 20 ], and quality assessment criteria proposed by Young and Solomon [ 21 ] and Davids and Roman [ 22 ].

Multimedia Appendices 1 and 2 present the 2 quality assessment tools used in this review. We assessed the intercoder consistency to determine the inclusion of articles for the review. During the coding process, both researchers independently identified subthemes and then added them to the existing themes upon agreement. Any disagreements were discussed and resolved before the final subthemes were confirmed. The first category included themes related to characteristics of doctor-patient consultations that led patients to reveal their online findings during visits with their doctor, such as strategies for using and revealing online information, facilitators of and barriers to discussion of online findings during consultations, and demographic factors affecting the discussion of online information.

Our initial PubMed and journal search returned over titles and citations. By applying the inclusion and exclusion criteria, we identified records for further screening based on the title and abstract. Of these, we retained articles for content screening, and then selected 19 peer reviewed journal articles that met the review criteria. In 30 articles, the Internet was not the primary source of information.

Of the remaining articles, 16 were not empirical studies, 11 were not about active information seeking, 5 were not available in full-text version, 3 were not in English, 2 focused only on postconsultation information seeking, and 2 focused on professional information seeking. Finally, we excluded 1 article among the 19 during the quality assessment procedure, leaving only 18 articles for the review. Of these 18 articles, 7 used surveys to gather data, 6 used interviews, 3 used semistructured interviews, and 2 used a mixed-methods approach. All articles were published within the period of to see Table 1 and Table 2 for the complete list of articles and summaries [ 347121523 - 35 ].

Of the 18 articles, 6 focused primarily on the implications for the patient-physician relationship, 2 studied the discussion of online information with physicians, and the rest studied both themes.

These studies examined this category along 4 themes: 1 strategies patients use to reveal their Internet information searches, 2 facilitators of and 3 barriers to the discussion of online findings, and 4 demographic factors affecting discussion of online findings. A total of 3 articles examined strategies patients used to reveal their online findings during their doctor visits. These studies found 5 different strategies to be used by patients who brought online information to their consultations. These strategies were asking additional questions [ 412 ], making suggestions based on their online findings [ 12 ], directly disclosing online findings [ 12 ], verifying silently without asking any questions [ 412 ], and bringing printouts of online information [ 12 ].

Asking additional questions would allow patients to clarify contradictory points between their own view and the information from the physician.

Faq on access to patient information by friends and family

Making suggestions on different diagnostics and treatments would be helpful to patients in verifying their personal interpretations of online health information. Patients who preferred concealing their Internet search discussed online information without directly revealing that they had found the information on the Internet [ 41226 ]. However, some patients preferred more accurate verification of their online findings by showing printouts of their Internet research to prompt discussions during consultations [ 12 ]. Patients who silently verified their Internet search did so to avoid interrupting the diagnosis process [ 12 ].

Silver [ 25 ] highlighted 3 facilitating factors that encouraged patients to discuss online health information with their physicians: 1 having a family member present at doctor visits, 2 doctor-initiated inquiries, and 3 encountering a treatment-related advertisement that suggested talking with a doctor. Having a family member present would help patients remember what to ask and made the context more comfortable to share online findings.

Online advertisements or recommendations about certain medications and treatment options that contained information believed relevant to their own health condition prompted some patients to initiate a conversation with their physicians [ 25 ].

These factors spurred patients to communicate their Internet research findings during consultations.

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In a study by Newnham et al [ 29 ], more than half of the patients who searched for online information prior to consultations had discussed information obtained in their search with their physician and had found their physician to be willing to discuss this information. Patients were mindful in ensuring that doctors played the central role during consultations [ 27 ].

They feared that revealing their knowledge gained from Internet searches would be an insult to professional health care providers [ 25 ] who could feel criticized or have an unchangeable preconceived view [ 27 ].

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For example, Chiu [ 30 ] showed that patients cautiously made an effort not to offend doctors with their online findings. The second most common barrier for patients was the resistance or discouragement from physicians encountered when patients tried to discuss their Internet information research during consultations.

As a result, patients carefully observed their physicians before deciding whether to reveal their Internet research [ 2530 ], and patients would only bring up their Internet health searches if they felt the situation was right. A third major barrier was the fear of embarrassment [ 25 ].

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Patients who identified this to be a barrier felt they did not possess the required skill set to evaluate online medical information. They had a lower level of confidence in the trustworthiness and the credibility of online information.

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They manifested a sense of being unsure of how to explain the information they found and how to relate it to their own condition, and hence did not want to mention it to their physicians. Finally, other than the main barriers, some patients did not discuss their findings during consultations because they did not think the information was important enough and they searched the Internet just to be informed [ 15 ]. These studies examined demographic characteristics such as culture [ 30 ], sex [ 24 ], age, having children [ 31 ], health status [ 15 ], health literacy [ 24 ], and eHealth literacy [ 15 ].

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In a culture where the hierarchy of the patient-physician relationship is deemed to be like that of a son to a father, physicians have absolute authority to decide on the treatment, and patients must absolutely trust their doctors [ 36 ]. The impact of sex was studied in a study by Chung [ 24 ], which showed that men were more likely than women to have a conversation regarding online health information with their physicians. Russ et al [ 31 ] showed that the average age of those who shared online information with doctors tended to be higher and they tended to have more children under the age of 18 years.

Murray et al [ 15 ] found that people in poor health were more likely to talk to their physicians about online health information than were those in good health. Further, Chung [ 24 ] also showed that patients with low health literacy or who had trouble trusting online health information were not more likely to ask questions or to seek guidance during consultations. Patients who rated themselves as excellent or very good at assessing the reliability of information on the Internet were more likely to take information to their physicians than were those who were not confident in assessing the reliability of Internet information [ 15 ].

Table 4 summarizes the themes and subthemes related to implications for the patient-physician relationship covered by each study. Themes and subthemes on implications of patient-physician consultation for the patient-physician relationship.

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Of the 18 studies, 8 examined the factors directly affecting the patient-physician relationship. In the studies we reviewed, a greater proportion of participants were found to believe that Internet health information seeking did not adversely affect their relationship with physicians [ 3293334 ].

However, the articles we reviewed showed that the effect of online information on the patient-physician relationship depended on several factors. They valued their relationship with their doctors and expected doctors to be more welcoming toward their Internet health research [ 15 ]. The positive influence of online information was stronger when patients had an opportunity to discuss their online findings [ 313334 ].

On the other hand, bringing up online information during consultations also resulted in conflicts between patients and physicians.

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Conflicts stemming from different interpretation of online health information led to intensive discussions with physicians and patients [ 12 ]. Bringing information was found to have a positive effect when the physician did not appear challenged by the online information [ 71215 ]. Murray et al [ 15 ] showed that most patients felt their physicians reacted positively to online health information, but those who felt their physicians were challenged tended to be uninsured patients, who described themselves as excellent or very good at critically appraising information on the Internet.

Murray et al [ 15 ] showed that patients felt more in control and confident during the consultation as a result of bringing information to their physicians. Further, Internet search behavior led patients to experience a sense of control and therefore enter into a comprehensive negotiation with their specialist [ 7 ]. Of the studies we reviewed, 3 found that online health information can empower patients [ 2335 ] to play a more active role in their disease management. A study of prostate cancer patients showed how the Internet affected their decision-making ability.

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Although Internet information search was shown to shift the subjectively perceived hierarchy between the doctor and the patient [ 27 ], patients still valued traditional doctor-patient consultations as important to their understanding of online health information [ 27 ]. In the studies we reviewed, most patients felt that Internet health information seeking prior to consultations had improved their communication with doctors and the effectiveness of their consultations. First, participants who searched for online health information prior to their consultations felt better equipped to communicate with their physicians during the consultations [ 2335 ].

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