BackgroundHealth information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information.ObjectiveThis study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools.MethodsWe conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools.ResultsOverall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it.ConclusionsOverall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients.
IntroductionThe incidence of gastrointestinal (GI) cancer is rising and most patients with GI malignancies are discussed by a multidisciplinary team (MDT). We performed a systematic review to assess whether MDTs for patients with GI malignancies can correctly change diagnosis, tumor stage and subsequent treatment plan, and whether the treatment plan was implemented.MethodsWe performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a search of the PubMed, MEDLINE and EMBASE electronic databases, and included studies relating to adults with a GI malignancy discussed by an MDT prior to the start of treatment which described a change of initial diagnosis, stage or treatment plan. Two researchers independently evaluated all retrieved titles and abstracts from the abovementioned databases.ResultsOverall, 16 studies were included; the study quality was rated as fair. Four studies reported that MDTs changed the diagnoses formulated by individual physicians in 18.4–26.9% of evaluated cases; two studies reported that MDTs formulated an accurate diagnosis in 89 and 93.5% of evaluated cases, respectively; nine studies described that the treatment plan was altered in 23.0–41.7% of evaluated cases; and four studies found that MDT decisions were implemented in 90–100% of evaluated cases. The reasons for altering a treatment plan included the patient’s wishes, and comorbidities.ConclusionsMDT meetings for patients with a GI malignancy are responsible for changes in diagnoses and management in a significant number of patients. Treatment plans formulated by MDTs are implemented in 90–100% of discussed patients. All patients with a GI malignancy should be discussed by an MDT.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-017-5833-3) contains supplementary material, which is available to authorized users.
To make sure older cancer patients' needs are met, more attention should be paid to the development of interventions supporting both needs assessment and fulfillment.
Online health information tools (OHITs) have been found to be effective in improving health outcomes. However, the effectiveness of these tools for older patients has been far from clear. This systematic literature review therefore provides an overview of online health information tool effectiveness for older patients using a two-dimensional framework of OHIT functions (i.e., providing information, enhancing information exchange, and promoting self-management) and outcomes (i.e., immediate, intermediate, and long-term outcomes). Comprehensive searches of the PubMed, EMBASE, and PsycINFO databases are conducted to identify eligible studies. Articles describing outcomes of patient-directed OHITs in which a mean sample or subgroup of age ≥65 years was used are included in the literature review. A best evidence synthesis analysis provides evidence that OHITs improve self-efficacy, blood pressure, hemoglobin levels, and cholesterol levels. Limited evidence is found in support of OHIT effects on knowledge, perceived social support, health service utilization, glycemic control, self-care adherence, exercise performance, endurance, and quality of life. OHITs seem promising tools to facilitate immediate, intermediate, and long-term outcomes in older patients by providing information, enhancing information exchange, and promoting self-management. However, future studies should evaluate the effectiveness of OHITs for older patients to achieve stronger levels of evidence.
Little research has focused on what precedes the processing of health messages to predict recall of information and whether age matters in this regard. To address this gap, this study investigates the relationship between attention and recall among younger (<65 years) and older (≥65 years) adults. Using eye tracking, we exposed participants to a webpage consisting of text-only information, text with cognitive illustrations, or text with affective illustrations. When attention to text increased, older adults recalled more information, whereas younger adults did not. However, younger adults paid more attention to cognitive illustrations than older adults and recalled more information. These results reveal conditions under which health messages are effectively recalled by younger and older adults.Attention to information is a critical first step in information processing and eventual recall of information (Wedel & Pieters, 2000). Recall of information is the ability to remember and reproduce information correctly, and it plays an important role in predicting many health-related behaviors, such as successful disease management (Kravitz et al., 1993) and adherence to medical regimes (Ley, 1988;Linn, Van Dijk, Smit, Jansen, & Van Weert, 2013). Unfortunately, approximately 40% to 80% of medical information is immediately forgotten after exposure (Kessels, 2003), especially by older adults (Jansen et al., 2008). Older adults have more problems seeking, finding, and understanding health information than younger ones, particularly when information is presented online (Xie, 2008). Even though increasingly more older adults are using the Internet (Hart, Chaparro, & Halcomb, 2008; U.S. Census Bureau, 2010), this does not necessarily mean that they are able to understand and recall online health information. To optimize recall of information among older adults, information should be provided in such a way that older adults' cognitive abilities are taken into account (Van Gerven, Paas, Van Merriënboer, & Schmidt, 2000). One way to accomplish this is by using illustrations that complement online health texts. Illustrations can serve as cues that enable one to make connections between words and pictures in building mental images, thereby reducing working memory demands (Paivio, 1990). Numerous studies have revealed positive effects on recall of information when illustrations are added to information (e.g., Houts, Doak, Doak, & Loscalzo, 2006;Levie & Lentz, 1982).Although much research has focused on the effects of using illustrations in health messages (e.g., on recall of information), none to date has considered the process that precedes these effects. Even though three major subprocesses (encoding, storage, and retrieval) have been acknowledged (Lang, 2000), little is known about the association between encoding information (i.e., attention to text and illustrations) and retrieval (i.e., recall of such text and illustrations), whether the encoding process can predict retrieval, and whether age matters in this regard. This stu...
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