2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

net makes it easier than ever to share ideas and information
means that the difference between this being a net benefit or
harm depends entirely on the quality of the information
available.
Practicing physicians have historically been reluctant to
create content or to participate in online communities for the
lay public. The most frequently cited reasons for physician
reluctance to engage online are wariness about liability,
patient privacy concerns, and a lack of time or reimbursement
for these efforts (Fig. 2). 4 Although there are a growing
number of online resources with professionally vetted information
for patients and caregivers, these are few and far
between compared with the volume of content from nonprofessional
sources. In addition, although a growing proportion
of physicians participate in online communities for
physicians, these are generally completely segregated from
patient-oriented communities, so that there are very few
online settings in which physicians and patients interact
together online.
Yet, the potential benefits for online physician engagement
are very substantial, not only for patients but also for
physicians and for the global practice of medicine. Patients
KEY POINTS
● Medicine in general, and oncology in particular, is
now experiencing a rapid growth in new content and
a reclassification of many cancers into smaller, molecularly
defined subgroups that has made it infeasible
for an individual physician to maintain sufficient
expertise to remain the sole source of treatment
information.
● Patients and caregivers are increasingly turning to
online sources to supplement what they learn from
their own medical care teams, and this can be a
beneficial or detrimental change depending entirely
on the quality of the medical information available
online.
● Physicians have historically remained wary to engage
in online communities or to provide information
via the Internet, largely because of concerns about
legal liability, patient privacy, and time limitations.
● Despite these challenges, there is a wide range of
examples in which physicians have produced credible
online content and/or partnered with communities of
motivated patients and caregivers facilitated by
Internet-based platforms to distribute highly relevant
and high-quality information and to conduct
valued clinical research.
● Reliance on Internet-based information will only escalate
as more patients and caregivers become connected,
making it more compelling for physicians to
embrace the constructive possibilities of collaborative
engagement and interaction between patients and
caregivers online rather than passively cede the ability
to influence these online communities in a constructive
way.
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WEST, DEBRONKART, AND DEMETRI
Fig. 1. Medical advice from unqualified sources is plentiful online
(theCancerCureMiracle.com).
rank a physician’s input as the most influential factor in
shaping their care decisions (see Table 1), 5 and timely and
credible information from experts can help overcome the gulf
between the prohibitive expanse of information for a patient’s
care and for the amount that any single physician can
review and retain. With the expanse of new content, physicians
are now apt to become a bottleneck and to limit care
options if medical practice follows an outdated unidirectional
model. Increasingly, patients with access to a network
of committed advocates, potentially including many other
fellow patients, in the context of highly accessible medical
information can collaborate with their own local medical
team to shape a more bidirectional or even a networked
model in which patients conduct their own research and
discuss their own views regarding the most appropriate or
preferred options with their physicians. This respects the
physician’s role as an expert and caring provider, while also
recognizing that no single physician can be expected to be
the sole source of all medical knowledge. In this new model,
the physician becomes the pivotal individual to provide
context and to shape recommendations for a patient who is
increasingly engaged in key decisions.
Provision of Readily Available, Vetted Content
through Physician Engagement
The substantial benefits from this new model are all
predicated on high-quality information being available online
from identifiable, credible sources to counter the abundance
of less reliable information, or even misinformation,
being promulgated by less qualified or less competent
sources. Practically speaking, physicians can engage by
offering “pushed” online content, in which knowledge is
offered and can be consumed by a limitless number of people
who can view this digital content without any additional
effort from its producer. Examples of this type of content
include blog posts, audio and video podcasts, or information
found on “micro-blogging” platforms such as Twitter. The