J. G. Bruce1, N. Steffens3, J. Tucholka3, H. B. Neuman1,2,3 1University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA 2University Of Wisconsin,Carbone Cancer Center,Madison, WI, USA 3University Of Wisconsin,Wisconsin Surgical Outcomes Research Program, Department Of Surgery, School Of Medicine And Public Health,Madison, WI, USA
Introduction: The Internet is a frequently used resource for breast cancer patients seeking information about their diagnosis and treatment options. While the Internet is a convenient information source, access and literacy vary widely. Our objective was to evaluate the feasibility of delivering online information to breast cancer patients in the setting of a clinical trial and assess for disparities in care.
Methods: We evaluated breast cancer patients (Stage 0-3) participating in a clinical trial investigating the delivery of Internet information prior to surgical consultation. Following their diagnosis phone call, women were emailed links to web-based information. A validated questionnaire was completed prior to their first surgical consult assessing breast cancer knowledge, goals for treatment, time spent reviewing the links, education history, and baseline Internet use. Descriptive statistics were performed.
Results: To date, 46 women have been approached to participate and 35 have enrolled (76%). Five of the approached women were found to be ineligible and an additional 7 declined due to issues related to access to or comfort with the Internet (n=5) and emotional distress (n=2). Non-participants citing Internet access/comfort issues had a median age of 73 [63-81] years.
Median participant age was 57 (29-78) years. The majority had Stage 1 breast cancer (64% Stage I, 15% Stage 2, 6% Stage 3, 15% DCIS). Two patients did not complete survey data. Of the remaining 33, 65% had at least a college degree, 29% had some college, and 6% had high school or less. Internet use was described as multiple times daily (68%), once daily (23%) or a couple of times per week (9%).
The median time between study email and surgeon consult was 4 (1-13) days; 7 women had ~24 hours prior to the consult. 26 women (79%) reviewed the emailed material (62% for >1 hour, 31% for 15-60 minutes, 7% for <15 minutes). Cited reasons for no review included no access to Internet following receipt of emailed links (n=2), not receiving study email (n=1), insufficient time before surgeon visit (n=1), finding it unnecessary (n=1) and unknown (n=1). No relationship was observed between likelihood to review websites and age, education or Internet use.
Conclusion: We determined that delivery of Internet breast cancer information via email is feasible. Disparities in Internet access and literacy are concerns for web-based interventions. However, we were able to successfully enroll 76% of women approached. Specific challenges included spam filters blocking study emails and short intervals between diagnosis and surgeon consult. Additionally, older patients were more likely to decline participation due to lack of comfort with or access to the Internet, and may require alternative interventions. Final study analysis will determine the impact delivery of this online information has on women’s experience with breast cancer surgery decision-making.