[ARTICLE] Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review – Full Text

ABSTRACT

Background: With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients’ Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship.Objective: Our objective was to systematically review existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship.Methods: We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients’ discussion of online findings during consultations and implications for the patient-physician relationship.

Results: We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients’ disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients’ relationship with their physicians.

Conclusions: Results 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

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Introduction

As the Internet becomes a ubiquitous part of individuals’ information lives, most people have access to and are becoming comfortable with using the Internet for their information needs [1]. 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 [5,6] 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]. As a consequence, online information can lead to patients’ being misinformed, lead to distress, and increase the tendency toward self-diagnosis or self-treatment [9]. Internet-informed patients may have more questions and may request additional treatments or medications during consultations [11]. Hence, online information can add a new interpretive role to physicians’ responsibilities during consultations [12,13]. Second, when patients’ online findings do not align with physicians’ diagnosis or treatments, concerns have been raised as to how a patient’s appointment satisfaction and trust in the physician would be affected [2,8,14] and how conflicts or even arguments could occur between the physician and patient [12]. 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].

As patients’ Internet health information seeking becomes more pervasive, the expectations and needs of Internet-informed patients in their interactions with their physicians are expected to change. Thus, it is pertinent to have a comprehensive understanding of the influence of online health information on the patient-physician relationship. To the best of our knowledge, no review has synthesized and analyzed how patients’ Internet health information seeking affects the patient-physician relationship. The closest reviews we have found are by McMullan [17] and Wald et al [18]. McMullan [17] examined physicians’ reactions to online information and identified 3 possibilities: (1) physicians could feel threatened by the information and respond defensively by asserting their “expert opinion,” (2) physicians and patients could collaborate in obtaining and analyzing the information, and (3) physicians could guide patients to reliable health information websites. 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. Specifically, our review sought to understand how and in what ways the Internet information search behavior of patients prior to consultations would affect doctor-patient encounters and patients’ relationships with their doctors. Our research question was “How and in what ways does patients’ Internet health information-seeking behavior influence the patient-physician relationship?”

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