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Thursday, January 19, 2017

OA: Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review

JMIR-Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review | Tan | Journal of Medical Internet Research
 Published on 19.01.17

Principal Findings
Based on our review of the 18 empirical studies that examined patients’ Internet health information seeking and the implications for the patient-physician relationship, we found that a greater proportion of patients did not feel that their Internet health information-seeking activities had an adverse impact on the patient-physician relationship [3,29,33,34]. The recent proliferation of health information on the Internet has resulted in a shift in the traditional information balance [37,38], where patients are increasingly equipped with health information related to their conditions, eroding the prior exclusivity of health information among health professionals. However, our findings show that patients’ positive attitude toward physicians did not change unless physicians imposed restrictions on their online information sharing during consultations (eg, [3,7,26]). Patients went on the Internet mostly to be actively involved in the decision making related to their health. Patients still valued consultations with physicians [27], and their trust in physicians remained very high [26,27]. Patients used the information found on the Internet to help them prepare for their visit, ask better questions, and understand what the physicians told them. These were shown to empower patients to play a more active role in their disease management and to be more effective in understanding and communicating with their physicians [32]. Internet-informed patients were also more confident in and comfortable with their physicians’ advice [15].
In the studies we reviewed, some looked at how Internet health information seeking affected the patient-physician relationship, while others focused on how patients’ use of the online health information affected the patient-physician relationship. Although we identified 5 different types of strategies in the literature (including silently verifying information, bringing printouts, explicitly verifying information by asking questions, and asking extra questions without directly revealing their Internet search), most studies focused simply on whether patients discussed the online health information during physician consultations and the associated outcomes. Among these studies, evidence showed that patients experienced a better patient-physician relationship when they had the opportunity to discuss their online health information with their physicians, and their physicians were receptive to discussing the online information. However, if patients experienced resistance from their physicians to their discussion of online information, patients were found to become frustrated and anxious [7] and would withhold their discussion [3,7]. Conflicts arising from physicians and patients having different interpretations of the online information and when patients valued this information more also had adverse implications for the patient-physician relationship [12]. In general, we found more evidence of positive than of negative implications of discussing online health information.
As patients become better informed and like to be more actively involved in decision making about their health, traditional models of the patient-physician relationship need to be adapted to patients’ changing needs by incorporating their perspective into a relationship-centered medical paradigm [39]. In contrast to the physician-centric paternalistic models of care, a deliberative or participatory model has been recommended for encounters with Internet-informed patients [40], where physicians delineate the patients’ clinical situation and provide help in explaining and deciding on the available options [41]. Under this model of care, the physician acts as a teacher or a friend by engaging patients in a dialogue through the decision-making process [39].
Allowing or encouraging patients to discuss their Internet information searches with physicians is increasingly important, given that acquiring information on the Internet has the potential to misguide patients with inaccurate information and make them excessively anxious [8]. Therefore, the information patients wish to use in decision making ought to be verified to ensure that it is based on facts [40]. Additionally, not disclosing their Internet information searches could erode patients’ trust in their physicians if the diagnosis or the recommendations are different from their Internet research findings [2]. Our findings showed that enabling patients to communicate their Internet research was one of the key mechanisms to ensure that patients’ opinion was valued and to enhance physicians’ relationships with their Internet-informed patients. When physicians embrace openness to online information [7,12,15,24] and encourage patients to discuss the online information they have, patients’ perception of physician resistance and fear of embarrassment could be reduced and patients are more likely to discuss online information with their physicians.


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