Internet Use and Advanced Practice Oncology Nursing

Joshua Fogel, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2002;2(4) 

In This Article

Clinical Applications

Nursing interventions center on care, information, and support.[27] Nurses tend to provide care to allow the cancer patient to be as independent in self-care as possible. They also provide the necessary acute care, all done in a calm, knowledgeable, and skilled manner.[28] Nurses can search the database PubMed or use the Medscape Hematology-Oncology site to determine the most current information on how to properly care for patients in their area of clinical practice. In addition, advanced practice nurses can also take advantage of electronic technology for patient encounters with the purpose of monitoring, triaging, and providing care and treatment for patients via email transmission.

Nurses interested in technology may want to consider offering their patients an email address in addition to an office telephone number. It is important to remember that a separate email address for business purposes should be used, just as one would hesitate to give a patient one's home telephone number. This method of communication has benefits and drawbacks. It can eliminate many telephone calls and also attract patients who are technologically savvy. The major drawback is patient expectations of instantaneous responses, which is quite difficult for nurses to do in a busy clinical setting.

Some guidelines for those considering this approach include creating a separate email account for patient communication and business purposes and obtaining patient informed consent about use of this medium. It is essential to communicate with patients both verbally and through written information regarding expectations of their use of email. There should be a discussion with them regarding turnaround time and what categories of questions are acceptable. Emergency questions through email should be discouraged. Also, just as there is clinical backup for vacation or absence, so too someone should be designated to reply to email during these times (or have an email auto-reply feature indicating that one is not in the office). A common-sense suggestion is to tell patients that if they do not hear a response in 3 business days, they should follow-up with a telephone call, as sometimes one may have inadvertently deleted or overlooked the email.

Nurses also provide information to teach patients and caregivers how to manage symptoms of cancer and its treatment, such as managing pain more effectively.[27] Besides searching PubMed, Cochrane, or Medscape (Web sites cited above) for their own use, professionals can recommend Web sites to patients and their caregivers. For example, the organization Cancer Care offers clear information for helping individuals with cancer to manage their pain more effectively. WebMD Health is a consumer site offering simple explanations to consumers.

Nurses provide support to the cancer patient and caregivers. Nurses can offer emotional support, assist with problem solving, and refer to resources that can help the patient and caregivers feel more comfortable with cancer.[27] Nurses can choose to recommend online support groups that they have found beneficial. For example, Friends in Touch is an online support group that has won a number of awards, and ACOR has numerous choices of online support groups.

Some practical tips exist for nurses when interacting with patients who use the Internet.[28,29] Often, nurses will be faced with the patient who has obtained information and support from the Internet. This patient will come in with a great deal of information printed from Web sites and ask the nurse for advice. Often, it is impossible to review all the material. Nurses might find it helpful to have viewed some Web sites, chosen which are most helpful, and be prepared to made recommendations based on their own review of Web sites. The nurse may say, "It is quite challenging for me to review all this material, but let me recommend to you a few Web sites that I have found to be helpful to my patients." Table 1 lists the most popular Web sites used by those with breast cancer.[30]

Nurses should keep in mind that not everything on the Web is from a reputable source or contains correct information. Anyone can be a publisher on the Internet. Many articles discuss ways to evaluate Web sites.[31,32,33,34] In general, information from prominent organizations; government-sponsored health agencies; and prominent hospitals, medical centers, or universities is acceptable to use (eg, American Cancer Society). Some additional guidelines to follow include:

  • Does the Web site quote a peer-reviewed source or other recognized source as the basis for the information?

  • Is a date listed indicating when the Web page was most recently updated?

  • Who owns or sponsors the Web site -- a recognized authority or reputable company or organization in the medical/cancer arena?

Some horror stories exist about patients who ignore standard medical advice and follow the "expert" on the Internet. For example, a patient with facial cancer refused standard medical treatment and pursued the advice of a Web site. This patient bought an alternative treatment, followed the Web treatment recommendations for use, and died from liver and kidney complications due to side effects of this treatment.[35] Web sites that recommend a particular treatment may be advertising that treatment/product and may have a vested interest in promoting it. The nurse should alert healthcare consumers to this and point out that testimonials and claims about a treatment may not be evidence-based. This does not imply that all commercial Web sites are not reputable, as many commercial sites offer important and valid information and services. In general, all the above discussions about quality of Web sites rely on researchers searching for Web sites on a particular topic. One report of actual patient choices for Web sites showed that breast cancer patients rated reputable Web sites as their favorite Web sites and did not typically rate alternative Web sites as their favorites.[30]

Email technology can facilitate communication because it does not have to be synchronous. Likewise, it is much faster than postal mail communication, as it is relatively instantaneous in the time it takes for a message to be received. However, protection of patient confidentiality should be undertaken with email communication. It is important to consider purchasing encryption software, software that scrambles messages in transit and requires an authentication code for both reception and transmission, to protect patient confidentiality.[36] If that is not done, patients should be informed beforehand about the risks that some computer hacker could access their messages and read the correspondence.

While some patients freely discuss their use of the Internet with their healthcare providers, others may not. It may be helpful for advanced practice nurses to inquire about Internet use for support and information. Patients may be reluctant to share this because they may have turned to the Internet for information and support when they felt that they did not obtain it from their healthcare providers due to poor communication.[29] Inquiry about Internet use offers a number of benefits to the patient. A good introductory question about Internet use is, "Have you used the Internet for medical information and/or support?" This question and others will allow the nurse to help the patient sort through information, help clarify misunderstood information, protect the patient from any potentially erroneous information, and also allow the patient to feel more comfortable with broaching topics of concern. Other questions that are helpful for an oncology nursing Internet interview are shown in Table 2 .

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