Patient Education by Computer

Abstract & Commentary

Synopsis: Patients are increasingly obtaining medical information from computer-based sources and, these days, physicians are commonly handed print-outs that may or may not be relevant to the patient’s medical condition. In two reports from the Department of Public Health at the University of Glasgow, research is presented that indicates that as many as 20% of cancer patients about to begin a course of radiation therapy are dissatisfied with the information they have been provided about their illness or treatment.

Sources: Jones R, et al. BMJ 1999;319:1241-1247; Jones R, et al. BMJ 1999;319:1247-1248.

Computers are in the mainstream and patients are increasingly using the internet to gain information relevant to their own medical condition. In companion articles written by faculty from the department of Public Health at the University of Glasgow, Scotland, patient education and computer use was examined.

The purpose of the first report was to compare the use and effect of a computer-based information system that is personalized to an individual patient’s medical record with a system providing only general information, either by computer or by written booklets. Volunteers were patients (n = 525) about to begin a course of radiation therapy. They were randomly assigned to one of three groups: computer personalized information, computerized general information, and general information by booklet. Patients’ views and preferences, use of computer and information, and psychological status were the measured outcomes as well as doctors’ perceptions and costs.

As expected, more patients offered the personalized information said that they had learned something new, thought the information was relevant, used the computer again, and showed their computer printouts to others. There were no major differences in doctors’ perceptions of patients. More of the general computer users were anxious at three months. Cost analysis showed that the computer information systems were less expensive over time than full use of booklet education.

The second report describes a cross sectional survey of these same 525 cancer patients, most of whom had breast cancer (n = 309) and were about to receive radiation therapy. Data from a recruitment interview, subsequent questionnaire, and from their clinical notes were examined, with a goal of determining their satisfaction with the medical information that had been provided to them up until that point. Four of five patients wanted as much information as possible and one in five were not satisfied with the information they had been provided. Dissatisfied patients were much more likely to be depressed and anxious.

COMMENT by William B. Ershler, MD

Although it is apparent that computer use among oncology patients is rising dramatically, the concept of personalizing educational programs is not developed. Experiments have been published in which different ways of personalizing computer-based information for patients is assessed, a study comparing this approach with general computer-based information retrieval has not previously been published.

The current trial showed that cancer patients thought a system giving them information based on their medical records was better than one giving only general information and they were more likely to use it repeatedly and show printouts to their family and doctors. The doctors were not able to perceive a difference in patients from the different groups, but patients assigned to the general computer information group were more likely to be anxious at the three months follow-up.

Although not specifically addressed in this report, physician’s acknowledgment of the computer-based education might be higher with the personalized program as well. Most clinicians are inundated with printouts from patients, and much of the provided material seems unrelated or only remotely related to the patient’s condition. The specialty of medical informatics is in its infancy and it should be expected that, within the next decade, highly sophisticated software will be developed that will provide a high level of specific information to our patients. It is also likely that cancer patients will be among the first to take advantage of this emerging technology.

References

1. Bental DS, et al. Patient Educ Couns 1999;36: 171-180.

2. Kreuter MW, et al. Health Educ Res 1996;11:97-105.

Regarding computer-based patient education programs, which one of the following statements has been shown to be true?

a. Patient satisfaction is high, but the cost in the long run far exceeds the provision of the same material in print form.

b. Patients are uncomfortable with computer-based educational programs and prefer the same educational material in print form.

c. Patients are comfortable with computer-based educational programs, but prefer to read general information about their illness and treatment than specific information that incorporates findings from their own medical record.

d. Patients are comfortable with computer-based educational programs, but prefer to read specific information that incorporates findings from their own medical record than more generalized information regarding their illness and treatment.