Faculty Bibliography

BACKGROUND/UNASSIGNED:Over the past two decades, use of social media has grown among US adults. Common social media platforms include Facebook, YouTube, Instagram, X, LinkedIn, and TikTok. People proactively use social media for a variety of purposes including searching for health information, peer-to-peer social support, and health-related information sharing. As these platforms often serve as sources of health information, understanding how, if at all, people use them may inform future behavioral interventions delivered via social media. Additionally, a better understanding of social engagement may have implications for public health messaging and patient-centered communication. OBJECTIVE/UNASSIGNED:Using a nationally representative sample of US adults, we explored how factors including subjective numeracy (ie, ease of understanding medical statistics), interpersonal communication with family and friends, and perceived discrimination influence whether people ever watched versus never watched health-related videos on social media platforms. METHODS/UNASSIGNED:We analyzed the National Cancer Institute's Health Information National Trends Survey data, which were collected from March to November 2022 (n=6252). After excluding participants who did not have complete data for all variables of interest, we analyzed responses from 4543 participants. Respondents were asked, "In the past 12 months, how often did you watch a health-related video on a social media site (eg, YouTube)?" Response options included: almost every day, at least once a week, a few times a month, less than once a month, and never. We collapsed answers into ever or never watched. Odds ratios (OR), 95% CIs, and P values were calculated. A multivariate logistic regression model was considered using all factors that were univariately significant (P<.10). Using backward elimination, factors that were not significant with P>.05 were removed one by one until remaining factors were all significant collectively (P<.05). RESULTS/UNASSIGNED:Of 4543 adults analyzed, 61.5% reported watching at least one health-related video in the past 12 months, whereas 38.5% had never watched one. In the multivariable analysis, all age group categories over 50 years were less likely to watch health-related videos compared to those aged 18-34 years, with respondents aged ≥75 years having the lowest odds of all groups for watching a health-related video (OR 0.16, P<.001). Higher odds of watching health-related videos were observed among respondents who were Black (OR 1.59, P<.01), Hispanic (OR 1.54, P=.01), and from "Other" minority groups (OR 2.07, P=.01) compared to White respondents. College graduates (OR 1.71, P<.01) and those who found medical statistics easy to understand (OR 1.29, P=.04), talked about health with friends or family (OR 1.68, P<.01), or experienced racial discrimination in medical care (OR 1.59, P=.02) also had higher odds of watching health-related videos on social media. CONCLUSIONS/UNASSIGNED:Findings from this study may help target health communication campaigns on social media designed to improve screening, lifestyle changes, medication adherence, and disease management.

Inaccurate information about prostate cancer is widespread on online social networks in English and Spanish and spans a variety of topics from prevention and screening to treatment and survivorship. Clinicians should raise awareness that social media can be a source of misinformation about prostate cancer, preemptively address prevalent myths, and actively participate in public dissemination of evidence-based information.

Social media can benefit prostate cancer care through education and empowerment, but also have the potential for exposure to misinformation, leading to adverse health and/or economic impacts for patients and damaging the patient-physician relationship. Clinicians should promote digital health literacy and provide recommended sources of reliable online content for additional information.

Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.

INTRODUCTION/UNASSIGNED:Colorectal cancer is a leading cause of cancer death in the U.S. Until 2021, the U.S. Preventive Services Task Force recommended colorectal cancer screening for all adults aged 50-75 years. Using a nationally representative sample, we explored the associations between having colorectal cancer screening and key sociodemographic and health-related factors among U.S. adults aged 50-75 years. METHODS/UNASSIGNED:<0.05. RESULTS/UNASSIGNED:Complete data were available for 1,649 respondents: 1,384 (81.2% weighted) had a colorectal cancer screening test, and 265 (18.8% weighted) did not. Multivariably, the odds of having had a colorectal cancer screening test increased with age (OR=1.07) and were higher for participants who identified as Black/African American than for White participants (OR=2.4), participants who had a family member who ever had cancer (OR=1.7), participants who believed that being overweight and obese influences development of cancer a lot than those who believed not at all (OR=2.0), and participants who had friends or family to talk with about health (OR=2.3). CONCLUSIONS/UNASSIGNED:Age, race, family history, weight-related beliefs about the causes of cancer, and having someone to talk with about health were associated with having colorectal cancer screening test.

PURPOSE/UNASSIGNED:Although the majority of US adults obtain health information on the internet, the quality of information about prostate cancer is highly variable. Black adults are underrepresented in online content about prostate cancer despite a higher incidence of and mortality from the disease. The goal of this study was to explore the perspectives of Black patients with prostate cancer on the importance of racial representation in online content and other factors influencing trust. MATERIALS AND METHODS/UNASSIGNED:We conducted 7 virtual focus groups with Black patients with prostate cancer in 2022 and 2023. Participants completed an intake questionnaire with demographics followed by a group discussion, including feedback on purposefully selected online content. Transcripts were independently analyzed by 2 investigators experienced in qualitative research using a constant comparative method. RESULTS/UNASSIGNED:Most participants use online sources to look for prostate cancer information. Racial representation is an important factor affecting trust in the content. A lack of Black representation has consequences, including misperceptions about a lower risk of prostate cancer and discouraging further information-seeking. Other key themes affecting trust in online content included the importance of a reputable source of information, professional website structure, and soliciting money. CONCLUSIONS/UNASSIGNED:Underrepresentation of Black adults in prostate cancer content has the potential to worsen health disparities. Optimal online communications should include racially diverse representation and evidence-based information in a professional format from reputable sources without financial conflict.

Black men have a greater risk of prostate cancer as well as worse quality of life and more decisional regret after prostate cancer treatment compared to non-Hispanic White men. Furthermore, patients with prostate cancer who primarily obtain information on the internet have significantly more decisional regret compared to other information sources. Our objective was to explore the perspectives of Black patients on the use and impact of the internet for their prostate cancer care. In 2022-2023, we conducted seven virtual focus groups with Black patients with prostate cancer (n = 22). Transcripts were independently analyzed by two experienced researchers using a constant comparative method. Online sources were commonly used by participants throughout their cancer journey, although informational needs varied over time. Patient factors affected use (e.g., physical health and experience with the internet), and family members played an active role in online information-seeking. The internet was used before and after visits to the doctor. Key topics that participants searched for online included nutrition and lifestyle, treatment options, and prostate cancer in Black men. Men reported many downstream benefits with internet use including feeling more empowered in decision-making, reducing anxiety about treatment and providing greater accountability for research. However, they also reported negative impacts such as feeling overwhelmed or discouraged sorting through the information to identify high-quality content that is personally relevant, as well as increased anxiety or loss of sleep from overuse. In summary, online sources have the potential to positively impact the cancer journey by reinforcing or supplementing information from health care providers, but can be harmful if the information is poor quality, not representative, or the internet is overused.

Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks-such as their extensive use and the relative ease it allows to share information quickly-facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.