Association Between Online Information-Seeking and Adherence to Guidelines for Breast and Prostate Cancer Screening
ORIGINAL RESEARCH — Volume 15 — April 19, 2018
Hankyul Kim, MSPH1; Christopher Filson, MD, MS2,3; Peter Joski, MSPH1; Silke von Esenwein, PhD1; Joseph Lipscomb, PhD1,3 (View author affiliations)
Suggested citation for this article: Kim H, Filson C, Joski P, von Esenwein S, Lipscomb J. Association Between Online Information-Seeking and Adherence to Guidelines for Breast and Prostate Cancer Screening. Prev Chronic Dis 2018;15:170147. DOI: http://dx.doi.org/10.5888/pcd15.170147.
From 2012 through 2014, the US Preventive Services Task Force (USPSTF) recommended biennial mammography for women aged 50 to 75 and recommended against the prostate specific antigen (PSA) test for men of any age, emphasizing informed decision making for patients. Because of time constraints and other patient health priorities, health care providers often do not discuss benefits and risks associated with cancer screening. We analyzed the association between seeking information online about breast and prostate cancer and undergoing mammography and PSA screening.
We assessed guideline concordance in mammogram and PSA screening, according to USPSTF guidelines for those at average risk for disease. We used data on 4,537 survey respondents from the National Cancer Institute’s Health Information National Trends Survey (HINTS) for 2012 through 2014 to assess online information-seeking, defined as whether people searched for cancer-related information online in the past 12 months. We used HINTS data to construct multivariable logistic regression models to isolate the effect of exposure to online information on the incidence of cancer screening.
After controlling for available covariates, we found no significant association between online information-seeking and guideline-concordant screening for breast or prostate cancer. Significant covariate values suggest that factors related to access to care were significantly associated with conformance to mammography guidelines for women recommended for screening and that physician discussion was significantly associated with nonconformance to guidelines for prostate-specific antigen screening (ie, having a PSA test in spite of the recommendation not to have it). Decomposition of differences between those who sought online information and those who did not indicated that uncontrolled confounders probably had little effect on findings.
We found little evidence that online information-seeking significantly affected screening for breast or prostate cancer in accordance with USPSTF guidelines among people at average risk.
Most cancer screening guidelines incorporate informed decision making as a required element (1–3). To qualify as informed decision making, people must be aware of their cancer risk and discuss the benefits and possible harms of screening with their health care provider (4). Despite the emphasis on the value of informed decision making in guidelines issued by the US Preventive Services Task Force (USPSTF) and other organizations, studies show that few people with average risk for cancer are aware of the ongoing debate about the potential harms associated with some types of cancer screening and may overestimate benefits and underestimate potential risks (5–7). Some studies show that interventions at clinics, with decision aids such as questionnaires and counseling, can increase patient understanding of potential harms of screening and may facilitate discussion between patients and their health care providers (7–11). However, little is known about how people at average risk acquire screening-related information and if and how they use this information in discussions with their providers to arrive at a screening decision.
To characterize the patient-centered issues surrounding informed decision making, we examined the relationship between online information-seeking and adherence to USPSTF recommendations for breast cancer and prostate cancer screening. USPSTF recommends that women aged 50 to 75 and at average risk for breast cancer undergo mammography screening every 2 years (3) and recommends against screening average-risk men with the prostate-specific antigen (PSA) test (during the 2012–2014 timeframe relevant to this study) (1). We hypothesized that people who engaged in online information-seeking would be more likely to adhere to USPSTF screening recommendations and that such information could be used to improve online information-seeking and informed decision making about cancer screening.