Online Patient Research Articles

Socioeconomic Disparities in Online Patient Portal Utilization Among Total Knee Arthroplasty Recipients

BackgroundSince 2021, the Centers for Medicare and Medicaid Services have mandated that patients have open access to their medical records. Many institutions use online portals, which allow patients to access their health information and communicate with care teams. Our research aimed to evaluate demographic patterns for online patient portal utilization in patients undergoing total knee arthroplasty (TKA). Further, we assessed if and how portal engagement contributes to perioperative outcomes. MethodsThis study retrospectively reviewed primary and elective TKA from 2017 to 2022 at a single academic institution. Patients were stratified into 2 groups based on their online portal status: activated (A) or not-activated (NA). Baseline characteristics and postoperative outcomes were collected from the electronic medical record and compared. ResultsIn total, 10,995 patients were included: 8,330 (75.8%) were A and 2,625 (24.2%) were NA. The NA group was significantly older (P < .001); more likely to be Black (P < .001), women (P < .001), single/divorced/widowed (P < .001), non-English speaking (P < .001), and Medicare or Medicaid insured (P < .001); from zip codes with median incomes below $50,000 (P < .001), and more likely to be American Society of Anesthesiologists class III or IV (P < .001). Patient-reported outcome measure completion rates were significantly lower in the NA group (15.3 versus 47.7%, P < .001). Lengths of stay (LOS) were significantly higher in the NA group (2.7 versus 2.1 days, P < .001). The NA group was significantly more likely to be discharged to skilled nursing facilities (P < .001). Comparable rates of 90-day emergency department visits, readmissions, as well as 90-day and 2-year revisions, were observed across groups. ConclusionsThere are significant disparities in online portal activation status based on patient demographics. Patients who have A portals had significantly higher Patient-reported outcome measure completion rates, shorter LOS, and higher rates of home discharge. Further research should determine which other factors may affect patient portal utilization and inform interventions to improve portal utilization among minority populations.

Development of learning-based online C-arm CT imaging technique for image-guided adaptive brachytherapy

Existing protocols for image-guided adaptive brachytherapy (BT) pose distinct limitations, which include: (1) the possible misalignment of the application position as a consequence of patient translocation between the treatment room and the computed tomography (CT)/magnetic resonance imaging (MRI) suite, (2) an inherent inability to continually monitor physiological and anatomical changes during the course of 3–10 fraction treatment regimens, and (3) insufficient tracing of the radioactive source movement within the patient's body. In response to these challenges, this study proposes an innovative deep-learning-based C-arm CT/SPECT imaging system tailored specifically for image-guided adaptive BT. This technological advancement aims to enable the execution of high-precision online adaptive BT, thereby amplifying the adaptability and effectiveness of oncological care. An image dataset of 66 non-contrast pelvic CT studies was acquired and limited-angle cone-beam CT (CBCT) images were generated by mathematically calculating sinograms for voxel phantoms based on these CT images. Using a Generative Adversarial Network (GAN), low-quality CBCT images obtained using a 110° limited-angle rotating C-arm system were transformed into high-quality diagnostic CT images. The performances of these networks were evaluated by comparing them with CBCT images reconstructed using an iterative reconstruction method and ground-truth images. Synthetic CT images were successfully transformed from low-quality CBCT images, considerably reducing streaking artifacts and preserving the anatomical structures. Our deep-learning-based image reconstruction technique could successfully improve the image quality of limited-angle CBCT, similar to the ground-truth image quality, with a faster speed than the latest iterative reconstruction algorithm. We expect that this will be effectively implemented in online image-guided adaptive BT and patient dose verification.

E041 Feasibility and acceptability of electronic patient reported outcome measures in the routine care of people with inflammatory arthritis: Haywood Arthritis Portal study

Abstract Background/Aims Electronic patient-reported outcome measures (ePROMs) assessing disease activity, function, pain, and quality of life can facilitate innovative inflammatory arthritis (IA) care, such as automating patient-initiated follow-up. This mixed-methods study evaluated whether their use is feasible and acceptable in routine care of people with inflammatory arthritis in an NHS setting. Methods The Haywood Arthritis Portal (HAP) is an NHS co-designed online patient platform, enabling people with IA under the Midlands Partnership University NHS Foundation Trust (MPFT) to enter ePROMs using any internet-enabled device. People with IA attending recruiting clinics from January-October 2023 received text message/letter invitations to complete HAP pre-appointment. Non-completers could complete HAP on tablets at the clinic. Consenters also completed a survey assessing ePROMs acceptability and HAP usability. Responses were summarised as proportions, stratified by age, gender, IA type, and home/clinic-completion status. Purposively sampled survey-completers participated in semi-structured interviews, providing deeper understanding of ePROMs/HAP feasibility/acceptability. This abstract presents data from an interim analysis of consenting patients with available survey and case report form data. Results Survey Population: 210 patients were included: 107 (51%) home-completers; 98 (47%) clinic-completers; 5 (2%) HAP non-completers; 70% female; mean age 60 years. Most had RA (70%), followed by Axial SpA (15%), undifferentiated IA (8%), and PsA/other SpA (7%). ePROMs Acceptability: 86% rated ePROMs acceptable/completely acceptable; 82% felt their completion required little/no effort; 87% agreed/strongly agreed their answers were likely to help their care. Fewer people aged &amp;gt;70 years rated ePROMs acceptable/completely acceptable (70%) compared with younger age groups (ranging 82%-100%); the same was the case for clinic-completers (79%) vs. home-completers (93%). Perceived ePROMs Use by Clinicians: 58% agreed/strongly agreed their healthcare professional had looked at their ePROMs. This was proportionally more in people aged 18-40 (79%) than older age groups (ranging 48%-58%), in axial SpA (70%) than other IA types (ranging 50%-54%), and in males (67%) vs. females (53%). HAP Usability: 78% agreed/strongly agreed HAP was easy to use. This was higher in those aged 18-40 years (93%) than those aged &amp;gt;70 years (70%), and in home-completers (89%) than clinic-completers (67%), Interviews: involved 11 participants and findings supported quantitative results, in that participants generally considered ePROMs acceptable, HAP easy to use, yet they were uncertain if their entries were used by their healthcare professional. In addition, participants were reassured that HAP was NHS-developed and secure, and expressed interest in completing ePROMs more regularly. Conclusion Using ePROMs in routine NHS care is acceptable to most people with IA, particularly younger people and those able to enter them on their own devices. The next step in this study is to consider healthcare professionals’ perspectives on ePROMs, including how they can be best integrated into consultations to ensure patients feel their entries are considered. Disclosure N. Cox: None. C. Kettle: None. H. Wang: None. S. Dutta: None. J. Packham: None. J. Galloway: None. J. Hill: None. S. Muller: None. S. Hider: None. Z. Paskins: None. L. Bullock: None. I.C. Scott: None.

OA12 Patient reported pregnancy outcomes and experiences in women with axial spondyloarthritis: preliminary results from a UK patient survey

Abstract Background/Aims Axial spondyloarthritis (axSpA) affects women of childbearing age and is associated with increased prevalence of pregnancy complications. There are limited UK data published on women with axSpA and pregnancy. We aimed to analyse the pregnancy outcomes and perspectives from women in the UK with axSpA who have been pregnant, with a particular focus on their access to support, flares, medication, and pregnancy complications. Methods An online patient survey was launched using RedCAP for women in the UK with axSpA who are or have been pregnant. The survey including 5 parts for details on: 1) general information and axSpA; 2) maternal; 3) pre-pregnancy; 4) pregnancy; 5) postpartum. The project was approved by UCL Research and Ethics Committee and endorsed by NASS and BRITSpA. Patients were recruited through the NASS and BRITSpA websites, social media platforms and e-mail. The survey collected anonymous data from February to June 2023. Descriptive statistical analysis was performed using Stata17. Results Among the 172 respondents, 89% were white, mean age was 44 years, 74% were HLA-B27 positive and 35%, 22% and 17% self-reported a history of uveitis, skin psoriasis and inflammatory bowel disease, respectively. This abstract focuses on data from the first pregnancy after axSpA diagnosis (n = 60, 35% of respondents). Not all questions were answered by participants and data are reported as a percentage of questions answered. Overall, 42% (20/40) reported a flare during their first pregnancy, of which 30% (6/20) contacted their obstetrician, 45% (9/20) contacted rheumatology and 40% (8/20) self-managed. 92% (52/60) of respondents say they planned pregnancy but only 32 (57%) had discussed pregnancy plans with rheumatology and only 26% were seen in a combined obstetric-rheumatology clinic. Regarding medications, 48% (24/50) felt comfortable with their medication regime during pregnancy, 55% stopped their biologic during pregnancy, and 3% started on a biologic. Regarding pregnancy outcomes, 45% had a natural delivery and 54% had caesarean section. 80% (48/60) of first pregnancies resulted in live birth and 16% (7/44) of respondents reported birth defects. Pregnancy complications were reported in 23% (11/48), of which 45% had pre-eclampsia (5/11), 27% had diabetes, 9% had eclampsia and, overall, 19% (9/47) had a self-reported infection. Regarding postpartum, 54% (25/46) had a flare after first delivery; average time to flare post-delivery was 5.4 weeks. Conclusion Preliminary results from UK-based patient survey provides essential insights into self-reported issues of women with axSpA and pregnancy. The study highlights the need for improvement in pre-pregnancy counselling and access, the increased risk of flares during pregnancy, and complications such as pre-eclampsia. Limitations include recall bias as it was a retrospective survey, being unable to clarify respondents' understanding, self-reported outcomes, and incomplete data capturing. Full analyses of the further pregnancies is planned. Disclosure A. Mootoo: None. M. Mouyis: Other; Speaking and advisory fees from UCB and Galapagos. B. Farisogullari: None. P.M. Machado: Consultancies; Consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB. D. Webb: None. J. Hamilton: None. Z. Clark: None. H. Marzo-Ortega: Honoraria; AbbVie, Biogen, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB. Grants/research support; Janssen, Novartis and UCB.

Edge Computing Based Cardiac Monitoring and Detection System in the Internet of Medical Things

Currently, cardiac disease becomes one of the major health issues in the world. The death due to cardiac arrests has been increasing day by day. The survival rate for the sudden cardiac arrest is low. It is possible to save 60% human life by continuously monitoring the fitness of the person. In recent times, the Internet of Things is emerging promising technologies. If the doctor cannot monitor the patient face to face, there Internet of Things plays important role in remotely monitoring the patient’s condition. With the rise in the use of smart wearable gadgets, the contribution of IoT will be more. In this paper, about five predictor model are analyzed for a particular dataset and chosen the best as Random forest algorithm. The proposed system integrates oxygen saturation level and heart rate sensor data from MAX30100 sensor for monitoring the patient’s vital signs. The remaining parametric data of the patient (AGE, GENDER, BLOOD SUGAR LEVEL, BLOOD PRESSURE LEVEL, GENETIC ISSUE and CHLOESTEROL LEVEL) are fed through the matrix keypad. The designed system monitors the online patient’s vitals continuously. The patient’s vitals will be stored in the edge server and also analyzed. The chosen predictor model checks the vital data for any abnormality and based on abnormality data detection in the heart rate, the warning message is conveyed to the nearby health care center via Thingspeak cloud. By tracking the patient’s GPS location, the server cloud sends alert notification along with the GPS location to the nearby health center and to the registered mobile numbers.

Unscheduled health care interactions in patients with multiple myeloma receiving T-cell redirection therapies

AbstractOutcomes for patients with relapsed/refractory multiple myeloma (R/RMM) have dramatically improved after the development and now growing utilization of B-cell maturation antigen–targeted chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody (BsAb) therapy. However, health care utilization as a quality-of-life metric in these growing populations has not been thoroughly evaluated. We performed a retrospective cohort study evaluating the frequency and cause of unscheduled health care interactions (UHIs) among patients with R/RMM responding to B-cell maturation antigen–targeted BsAb and CAR T-cell therapies (N = 46). This included the analysis of remote UHIs including calls to physicians’ offices and messages sent through an online patient portal. Our results showed that nearly all patients with R/RMM (89%) receiving these therapies required a UHI during the first 125 days of treatment, with a mean of 3.7 UHIs per patient. Patients with R/RMM responding to BsAbs were significantly more likely to remotely contact their physicians’ offices (1.8-fold increase; P = .038) or visit an urgent care center (more than threefold increase; P = .012) than patients with R/RMM responding to CAR T-cell therapies. This was largely due to increased reports of mild upper respiratory tract infections in BsAb patients. Our results underscore the need to develop preemptive management strategies for commonly reported symptoms that patients with R/RMM experience while receiving CAR T-cell or BsAb therapies. This preemptive management may significantly reduce unnecessary health care utilization in this vulnerable patient population.

Gender-affirming vaginoplasty online resources exceed patient health literacy: A readability analysis

PurposeEnsuring that educational materials geared toward transgender and gender-diverse patients are comprehensible can mitigate barriers to accessing gender-affirming care and understanding postoperative care. This study evaluates the readability of online patient resources related to gender-affirming vaginoplasty. MethodsOnline searches for vaginoplasty were conducted in January 2023 using two search engines. The readability scores of the top ten websites and their associated hyperlinked webpages were derived using ten validated readability tests. ResultsA total of 40 pages were assessed from the vaginoplasty searches. The average reading grade level for all the webpages with relevant educational materials was 13.3 (i.e., college level), exceeding the American Medical Association's recommended 6th grade reading level. ConclusionComplex patient resources may impede patients’ understanding of gender-affirming vaginoplasty. Online patient education resources should be created that are more accessible to patients with diverse reading comprehension capabilities.

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment.

The aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment. A Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch-Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content. Fourteen sources were identified and assessed using the identified tools. The mean Flesch-Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch-Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources. The current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high-quality information, ideally co-produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia.

Readability and Quality of Online Patient Education Materials Concerning Posterior Cruciate Ligament Reconstruction.

Objective This study aimed to assess the quality of online patient educational materials regarding posterior cruciate ligament (PCL) reconstruction. Methods We performed a search of the top-50 results on Google® (terms: "posterior cruciate ligament reconstruction,""PCL reconstruction,""posterior cruciate ligament surgery," and "PCL surgery") and subsequently filtered to rule out duplicated/inaccessible websites or those containing only videos (67 websites included). Readability was assessed using six formulas: Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level (FKG), Gunning Fog Score (GF), Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index (CLI), Automated Readability Index (ARI); quality was assessed using the JAMA benchmark criteria and recording the presence of the HONcode seal. Results The mean FRE was 49.3 (SD 11.2) and the mean FKG level was 8.09. These results were confirmed by the other readability formulae (average: GF 8.9; SMOG Index 7.3; CLI 14.7; ARI 6.5). A HONcode seal was available for 7.4 % of websites. The average JAMA score was 1.3. Conclusion The reading level of online patient materials concerning PCL reconstruction is too high for the average reader, requiring high comprehension skills. Practice implications Online medical information has been shown to influence patient healthcare decision processes. Patient-oriented educational materials should be clear and easy to understand.

Readability of online patient education materials for shoulder instability surgery in English and Spanish

Online patient education materials (OPEMs) exist to inform patient medical decisions, yet the average adult in the United States reads at an eighth-grade level and 50% of Medicaid patients read at or below a fifth-grade level. To appropriately meet US health literacy needs, the American Medical Association and National Institutes of Health recommend that patient education materials not exceed a sixth-grade level. The purpose of this study was to assess and compare the readability of English and Spanish online patient education materials pertaining to shoulder instability surgery. Google searches of the terms "shoulder instability surgery" and "cirugía de inestabilidad de hombro'' were conducted to include 25 eligible online patient education materials OPEMs per language. English OPEM readability was calculated using Flesch-Kincaid Grade Level, Flesch Reading Ease, Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook. Spanish OPEM readability was assessed using Fernandez-Huerta Index (FHI) (the Spanish equivalent of Flesch Reading Ease), FHI Grade Level, Gutiérrez de Polini's Fórmula de comprensibilidad, and INFLESZ. Readability index analysis revealed that the mean Flesch Reading Ease of English online patient education materials was significantly lower than the mean FHI of Spanish online patient education materials. English materials were also found to be written at a significantly higher grade level than Spanish materials. Shoulder instability surgery online patient education materials in both English and Spanish are written at higher reading levels than recommended by the American Medical Association and National Institutes of Health, though Spanish online patient education materials were more readable on average.

Impact of Online Patient Reviews: Three Choice-based Conjoint Experiments of Hospital and Physician Ratings

Patients are increasingly using online healthcare reviews to make choices about their medical providers. This paper uses a series of three conjoint experiments, which required prospective patients to select a care provider, to examine how ratings of physicians and affiliated hospitals influence patients’ choice of medical providers. Participants (N = 1,030), recruited through a crowdsource website, were randomly assigned to online ratings corresponding to different choice-based experimental conditions. Study 1 (N = 263) showed that online quality ratings of a physicians’ hospital affiliation influenced people’s willingness to use the physicians’ service. This finding held in selection of both primary and specialty care. Study 2 (N = 511) demonstrated people were more willing to choose a physician when the physician’s affiliated hospital had higher clinical outcomes ratings versus patient experience ratings. This effect was stronger when people were choosing a specialist than a primary care physician. Study 3 (N = 256) utilizes the same materials as Study 2 within the context of seeking a physician to help with migraines and participants rated physician competence and perceived quality of medical care. Results show patients expected higher quality of medical care when they chose a physician with higher patient experience ratings. Implications for future research and practice are discussed.

How readable the online patient education materials of intensive and critical care societies: Assessment of the readability

How readable the online patient education materials of intensive and critical care societies: Assessment of the readability

O244: Patients’ priorities in Vulval lichen sclerosus – results of a patient and public involvement for a study investigating autologous lipotransfer and platelet-rich plasma in Vulval lichen sclerosus

Abstract Background Vulval lichen sclerosus (VLS) is a high-burden, under-researched chronic skin disease. It is characterised by itching, pain, sexual dysfunction and poor quality of life. Up to 70% of patients develop fibrosis and vulval architectural changes. The only evidence-based treatment includes topical steroids. New potential surgical treatments include autologous fat transfer (AFG) and platelet-rich plasma (PRP) injections but high-level evidence supporting these treatments is sparse. Aims To identify patients’ research priorities and evaluate the acceptability of AFG and PRP as treatments for VLS and design a trial co-produced by patients. Methods One-to-one interviews, focus groups and online questionnaires were used to investigate patients’ research priorities, acceptability of treatments, preferred outcome assessment tools, views on a sham procedure and trial design. Results A focus group (n=18) and an online patient survey (n=809) identified the top research priorities: changes to vulval anatomy, emotional impact on intimate relationships, inability to have penetrative intercourse and pain during intercourse. Patients reported poor quality of life and said that addressing these would be life-changing. Ninety-nine percent of patients agreed that this trial should be performed and 73% were willing to take part if a sham procedure was used. A patient advisory group (n=5) has been created to co-produce the trial. Conclusion VLS is a complex disease with no core outcome set. Patient co-production is a keystone to a successful trial design and ensures that research is aligned with patients’ priorities. This research defines the key priorities of research into current surgical interventions for VLS.

Providing Adolescents with Access to Online Patient Portals: Interviews with Parent-Adolescent Dyads

To identify perceived benefits, problems, facilitators, and barriers to adolescent online patient portal use. Qualitative, semi-structured interviews with dyads of parents and adolescents with or without chronic illness. The study team purposively sampled for racial and ethnic minorities and fathers. Three team members then performed thematic analysis of the transcripts, with subsequent dyadic analysis of themes represented by related parents and adolescents. We performed 102 interviews with 51 dyads of parents and adolescents (26 with chronic illness, 25 without chronic illness). Nearly all participants believed that adolescents should be permitted portal access. We identified 4 themes related to portal benefits: improves adolescent's knowledge of health; supports medical self-management and autonomy; strengthens communication and relationships; and supports parental influence. We identified 4 themes related to portal problems: misunderstanding or confusion; emotional distress; strain on relationships; and irresponsible use of portal. Facilitators of portal use included severity of illness, adolescent's curiosity, and ease of technology use. Barriers included lack of awareness or interest, complexity of information, and access difficulties. Twenty adolescents (39%) did not know they could access the portal, and 23 (45%) lacked interest in portals. Parents and adolescents seldom used the portal as a collaborative tool, and instead were engaging with the portal independently. Parents and adolescents perceive several benefits and problems with portal use, but many adolescents lack interest in using portals. Adolescent portals represent an underutilized resource to engage adolescents in their care.

An Environmental Scan and Appraisal of Patient Online Resources for Managing Rheumatoid Arthritis Flares.

To conduct an environmental scan and appraisal of online patient resources to support rheumatoid arthritis (RA) flare self-management. We used the Google search engine (last search March 2023) using the terms "rheumatoid arthritis" and "flare management." Additional searches targeted major arthritis organizations, as well as regional, national, and international resources. Appraisal of the resources was conducted by 2 research team members and 1 patient partner to assess the understandability and actionability of the resource using the Patient Education Materials Assessment Tool (PEMAT). Resources rating ≥ 60% in both domains by either the research team or the patient partner were further considered for content review. During content review, resources were excluded if they contained product advertisements, inaccurate information, or use of noninclusive language. If content review criteria were met, resources were designated as "highly recommended" if both patient partners and researchers' PEMAT ratings were ≥ 60%. If PEMAT ratings were divergent and had a rating ≥ 60% from only 1 group of reviewers, the resource was designated "acceptable." We identified 44 resources; 12 were excluded as they did not pass the PEMAT assessment. Fourteen resources received ratings ≥ 60% on understandability and actionability from both researchers and patient partners; 10 of these were retained following content review as "highly recommended" flare resources. Of the 18 divergent PEMAT ratings, 8 resources were retained as "acceptable" following content review. There is high variability in the actionability and understandability of online RA flare materials; only 23% of resources were highly recommended by researchers and patient partners.

Autonomy and Its Limits

Autonomy and Its Limits

From stories to solutions: A research cycle framework for enhancing trustworthiness in studies of online patient narratives (Preprint)

From stories to solutions: A research cycle framework for enhancing trustworthiness in studies of online patient narratives (Preprint)

A health literacy analysis of online patient-directed educational materials about mycobacterium avium complex

IntroductionMycobacterium avium complex (MAC) is a complex lung infection requiring multi-disciplinary approach and management. Due to limited clinician-patient interactions, clinicians may refer patients to online resources to learn about the diagnosis, prognosis, and treatment of MAC. The American Medical Association (AMA) recommends educational materials be written at a sixth-grade reading level and the National Institutes of Health (NIH) recommends that patient education materials be written at an eighth-grade reading level; however, several evaluations found these materials inaccessible due to high literacy levels. To date, there has never been a health literacy assessment of MAC patient education materials. The study aims to assess the health literacy of online patient education materials about MAC. MethodsThe patient education materials were evaluated for readability, actionability, understandability and clarity. Readability was assessed through the Flesch-Kincaid Grade Level Scale (FkGL), SMOG Index, Coleman Liau Index (CLI), Gunning Fog Index (GFI), and Automated Readability Index (ARI). Actionability and understandability was evaluated using the Patient Education Materials Assessment Tool (PEMAT). The Centers for Disease Control (CDC) Clear Communication Index (CCI) was used to assess clarity. ResultsTen patient education resources were evaluated: CDC, Cleveland Clinic, Mayo Clinic, JAMA, American Thoracic Society (ATS), National Jewish Health, UpToDate, CHEST, WebMD, and Medline. The mean readability scores were as follows: FkGL (9.76), SMOG index (9.82), CLI (13.54), GFI (11.66), ARI (9.15). Four patient education materials were written at a sixth-grade reading level and eight patient education materials were written at an eighth-grade reading level. The majority of the materials received a passing score for understandability but failed to achieve a passing score for actionability. Cleveland Clinic, JAMA, and ATS all received a passing clarity score, indicating that they are easy to read. No patient education materials were available on UpToDate. ConclusionMost patient education materials scored poorly for actionability and clarity while scoring highly for readability and understandability. This study should serve as a guide for clinicians interested in offering online education materials to their patients. Increasing access to readable MAC educational materials should be a priority for those working at the intersection of public health, clinical care, and communications.

Overweight and obese women’s symptoms, knowledge, and preferences regarding endometrial biopsy for endometrial cancer detection: A threshold technique survey

BackgroundThe incidence of endometrial cancer (EC) in the United States continues to rise, driven mainly by the obesity epidemic. We sought to determine overweight and obese women’s cancer risk knowledge and preferences regarding diagnostic endometrial biopsy (EMB) for EC detection. MethodsAn online survey was administered to overweight and obese women without EC recruited through the electronic medical record’s online patient portal. Baseline questions queried gynecologic history, cancer risk knowledge, and factors potentially influencing decision-making for EMB. We used the threshold survey technique to identify the minimum acceptable risk (MAR) threshold at which each respondent would be willing to undergo an EMB to detect EC. ResultsOf 357 respondents (median age 45 years (interquartile range [IQR]: 38–54); median BMI 39 [IQR: 36.0–44.6]), fewer than half (48.7 %) were aware that obesity is a risk factor for EC, and 10 % considered their risk of EC to be high. Almost half (42 %) of respondents reported MAR thresholds characterized as very low (0–1 %), and these were more common among respondents with higher BMIs. Forty percent identified their weight as a factor influencing their MAR threshold decision, while 76 % identified their perceived personal risk as a factor. Less than half cited immediate risks of the procedure. ConclusionMany patients reported being willing to undergo an EMB at very low risk thresholds for EC. Perceived personal risk is a stronger factor in decision-making than immediate procedural risks. Providers should focus on communicating patients’ risk to motivate EMB to detect EC where appropriate.

Patient-Provider Lung Cancer Screening Discussions: An Analysis of a National Survey

BackgroundThe US Preventative Service Task Force (USPSTF) updated lung cancer screening (LCS) recommendations with annual low-dose CT (LDCT) in 2021. We aimed to assess prevalence of patient-provider discussion about LCS and determine its associated factors. Materials and MethodsUsing data from Health Information National Trends Survey (HINTS) 2022 cycle 6, 2 cohorts were evaluated: (1) potentially LCS-eligible, included participants at least 50 years old with a history of smoking and no prior history of lung cancer; (2) LCS-ineligible individuals based on age (eg, 18-49 years old), smoking history (eg, never smoked), or history of lung cancer. We assessed association of demographic, clinical, and social factors with LDCT discussion in a multivariable logistic regression model. ResultsAmong potentially LCS-eligible patients, 19% had never heard of LDCT and only 9.4% had discussed LCS with their provider within the past year. Those who accessed online patient portals were more likely to discuss LCS with their healthcare provider (OR, 4.25; 95% CI, 1.67, 10.81; P, .003), as were respondents with a history of current (vs. former) smoking (OR, 3.15; 95% CI, 1.21, 8.19; P, .019). Among LCS-ineligible, 1.9% discussed LCS with their providers. Individuals with a personal history of cancer (OR, 6.70; 95% CI, 1.65, 27.19; P, .009), and those who discussed colorectal cancer screening (OR, 5.74; 95% CI, 1.63, 20.14; P, .007) were more likely to discuss LCS with their provider. ConclusionDespite updated USPSTF recommendations, rates of patient-provider LCS remains low. Multi-level interventions to address barriers to LCS are needed.