Ashok Kumbamu

Evaluating the Process of Online Health Information Searching: A Qualitative Approach to Exploring Consumer Perspectives

Background The Internet is a common resource that patients and consumers use to access health-related information. Multiple practical, cultural, and socioeconomic factors influence why, when, and how people utilize this tool. Improving the delivery of health-related information necessitates a thorough understanding of users’ searching-related needs, preferences, and experiences. Although a wide body of quantitative research examining search behavior exists, qualitative approaches have been under-utilized and provide unique perspectives that may prove useful in improving the delivery of health information over the Internet. Objective We conducted this study to gain a deeper understanding of online health-searching behavior in order to inform future developments of personalizing information searching and content delivery. Methods We completed three focus groups with adult residents of Olmsted County, Minnesota, which explored perceptions of online health information searching. Participants were recruited through flyers and classifieds advertisements posted throughout the community. We audio-recorded and transcribed all focus groups, and analyzed data using standard qualitative methods. Results Almost all participants reported using the Internet to gather health information. They described a common experience of searching, filtering, and comparing results in order to obtain information relevant to their intended search target. Information saturation and fatigue were cited as main reasons for terminating searching. This information was often used as a resource to enhance their interactions with health care providers. Conclusions Many participants viewed the Internet as a valuable tool for finding health information in order to support their existing health care resources. Although the Internet is a preferred source of health information, challenges persist in streamlining the search process. Content providers should continue to develop new strategies and technologies aimed at accommodating diverse populations, vocabularies, and health information needs.

Patients' views on incidental findings from clinical exome sequencing.

This article characterizes the opinions of patients and family members of patients undergoing clinical genomic-based testing regarding the return of incidental findings from these tests. Over sixteen months, we conducted 55 in-depth interviews with individuals to explore their preferences regarding which types of results they would like returned to them. Responses indicate a diversity of attitudes toward the return of incidental findings and a diversity of justifications for those attitudes. The majority of participants also described an imperative to include the patient in deciding which results to return rather than having universal, predetermined rules governing results disclosure. The results demonstrate the importance of a patient centered-approach to returning incidental findings.

Comparative Analysis of Online Health Queries Originating From Personal Computers and Smart Devices on a Consumer Health Information Portal

Background The number of people using the Internet and mobile/smart devices for health information seeking is increasing rapidly. Although the user experience for online health information seeking varies with the device used, for example, smart devices (SDs) like smartphones/tablets versus personal computers (PCs) like desktops/laptops, very few studies have investigated how online health information seeking behavior (OHISB) may differ by device. Objective The objective of this study is to examine differences in OHISB between PCs and SDs through a comparative analysis of large-scale health search queries submitted through Web search engines from both types of devices. Methods Using the Web analytics tool, IBM NetInsight OnDemand, and based on the type of devices used (PCs or SDs), we obtained the most frequent health search queries between June 2011 and May 2013 that were submitted on Web search engines and directed users to the Mayo Clinic’s consumer health information website. We performed analyses on “Queries with considering repetition counts (QwR)” and “Queries without considering repetition counts (QwoR)”. The dataset contains (1) 2.74 million and 3.94 million QwoR, respectively for PCs and SDs, and (2) more than 100 million QwR for both PCs and SDs. We analyzed structural properties of the queries (length of the search queries, usage of query operators and special characters in health queries), types of search queries (keyword-based, wh-questions, yes/no questions), categorization of the queries based on health categories and information mentioned in the queries (gender, age-groups, temporal references), misspellings in the health queries, and the linguistic structure of the health queries. Results Query strings used for health information searching via PCs and SDs differ by almost 50%. The most searched health categories are “Symptoms” (1 in 3 search queries), “Causes”, and “Treatments & Drugs”. The distribution of search queries for different health categories differs with the device used for the search. Health queries tend to be longer and more specific than general search queries. Health queries from SDs are longer and have slightly fewer spelling mistakes than those from PCs. Users specify words related to women and children more often than that of men and any other age group. Most of the health queries are formulated using keywords; the second-most common are wh- and yes/no questions. Users ask more health questions using SDs than PCs. Almost all health queries have at least one noun and health queries from SDs are more descriptive than those from PCs. Conclusions This study is a large-scale comparative analysis of health search queries to understand the effects of device type (PCs vs SDs) used on OHISB. The study indicates that the device used for online health information search plays an important role in shaping how health information searches by consumers and patients are executed.

Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology

BackgroundThe quality of communication in medical care has been shown to influence health outcomes. Cancer patients, a highly diverse population, communicate with their clinical care team in diverse ways over the course of their care trajectory. Whether that communication happens and how effective it is may relate to a variety of factors including the type of cancer and the patient’s position on the cancer care continuum. Yet, many of the routine needs of cancer patients after initial cancer treatment are often not addressed adequately. Our goal is to identify areas of strength and areas for improvement in cancer communication by investigating real-time cancer consultations in a cross section of patient-clinician interactions at diverse study sites.Methods/designIn this paper we describe the rationale and approach for an ongoing observational study involving three institutions that will utilize quantitative and qualitative methods and employ a short-term longitudinal, prospective follow-up component to investigate decision-making, key topics, and clinician-patient-companion communication dynamics in clinical oncology.DiscussionThrough a comprehensive, real-time approach, we hope to provide the fundamental groundwork from which to promote improved patient-centered communication in cancer care.

Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits

OBJECTIVE Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction. METHODS 327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue. RESULTS CAM was discussed in 36 of 327 visits; discussions were brief (<one minute), the majority patient initiated (65%) and more common for patients in early stages of cancer care. Longer visits (35 vs 29min; p<0.05), greater patient engagement in visit dialogue, lowered clinician verbal dominance and a more patient-centered pattern of visit communication were significantly related to visits with CAM discussions (all p values<0.01). Both patient and clinician visit satisfaction was higher with CAM discussion (p<0.05). CONCLUSIONS CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction. PRACTICE IMPLICATIONS CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.

Was a decision made? An assessment of patient-clinician discordance in medical oncology encounters.

Shared decision making is promoted to improve cancer care quality. Patients and clinicians may have different ideas about what constitutes a cancer care decision, which may limit the validity of self‐reported measures of shared decision making. We sought to estimate the extent to which patients and clinicians agree on whether a cancer care decision was made during an outpatient encounter.

Altered genes, twisted truth. How the venture to genetically engineer our food has subverted science, corrupted government, and systematically deceived the public

Altered genes, twisted truth is an unflinching attempt to expose the state of affairs of the business of science, in which Steven M. Druker deconstructs the metanarrative of scientific objectivity ...

Looking Back, Looking Forward: The Ethical Framing of Complementary and Alternative Medicine in Oncology Over the Last 20 Years

This commentary takes a look back at views on complementary and alternative medicine and reflects on how those views have evolved, advocating for a conversation around complementary and alternative medicine in cancer care that is more nuanced, patient‐centered, and respectful to best meet the needs of patients in the coming decades.

Contending Worldviews in the Clinical Encounter: An Empirical Study of Complementary and Alternative Medicine Deliberations in Contemporary Medical Oncology

OBJECTIVE In this article, the authors characterize the different ways patients and clinicians discuss complementary and alternative medicine (CAM) during routine cancer care. METHODS Over a period of two years, the authors audio-recorded clinical interactions between 37 medical oncology clinicians and a sample of 327 oncology patients at an academic cancer center in the Midwest United States. Recordings of conversations that included any discussion of CAM were transcribed and analyzed using a qualitative content analysis approach. RESULTS Out of 327 conversations, CAM was mentioned and/or discussed in only 31 encounters. Communication dynamics between clinician and patient involve several factors: the condition of the patient and his or her knowledge about and experience with CAM, the clinicians knowledge and values about CAM, perceived assumptions and stereotypes about CAM, and institutional response to the integration of CAM in cancer care. CONCLUSION Addressing the difficult and sensitive topic of CAM in cancer care requires hearing patients in a manner meaningful to them. In that sense, CAM can serve as an important marker and test case in the march toward shared decision-making and patient-centered communication generally.

Building sustainable social and solidarity economies: Place-based and network-based strategies of alternative development organizations in India

Abstract This article critically examines and analyzes place-based as well as network-based strategies of alternative development organizations that claim to be building sustainable social and solidarity economies (SSE) in the political context of neoliberal globalization. While the Indian state and market forces are actively promoting the neoliberal agri-food system, alternative development organizations are working with farmers to build the SSE based on the principles of democracy, inclusiveness, reciprocity, cooperativism, and socioecological sustainability. Using a case study approach, this article analyzes how SSE initiatives are aiming to reclaim control over the local agri-food sector. Specifically, this article examines how community development organizations mobilize farmers based on the principles of agro-ecology and the politics of seed and food sovereignties. This article uses the Center for Sustainable Agriculture, an alternative community development organization in south India, as a case study.