Educational benefits of Internet and computer-based programmes for prostate cancer patients: A systematic review

Abstract

Objective

This study aims to review systematically the available literature on Internet and computer-based patient education programmes, assess the quality of these studies and analyze the benefit of these programmes for prostate cancer patients.

Methods

Complete databases were searched. Studies were included if they concerned patient education of prostate cancer patients, were qualitative or quantitative and examined Internet or interactive CD-ROM use.

Results

Eighteen studies met the inclusion criteria. The majority of the studies reported a significant increase in the knowledge of the disease, satisfaction with treatment options and support for men. The benefit of the programmes was that the patients felt more empowered and obtained a heightened sense of control over their disease.

Conclusion

The Internet or computer-based programmes had a positive impact on prostate cancer patient education. Most papers reported that the programmes were beneficial, but few presented data from studies with rigorous research methodologies to support these claims.

Practice implications

Internet and computer-based programmes can be useful tools in prostate cancer patient education. In order to improve the benefits of the programmes, more Internet and computer-based programmes need to be developed and studied.

Introduction

Worldwide, an estimated 913,000 men were diagnosed with prostate cancer in 2008, with more than two-thirds of the cases diagnosed in developed countries^. The highest rates are found in Australia/New Zealand, Western and Northern Europe and North America, largely because the practice of prostate-specific antigen (PSA) testing and subsequent biopsy has become widespread in those regions [1]. Prostate cancer is the most commonly diagnosed cancer among men in the USA and the second most common cause of cancer death among men. Prostate cancer incidence rates increase in men until age 70, after which they decline. About 240,890 new cases of prostate cancer will be diagnosed in the USA in 2011 [2]. In 2008, around 338,000 men were diagnosed with prostate cancer in Europe (EU-27). The lowest European rates are in southern and Eastern Europe, the highest in northern and Western Europe [1]. Prostate cancer is the leading cancer among men in Finland. In 2009 the number of prostate cases was 4604, the percentage distribution was 31.1%, and incidence per 100,000 was 89.7 [3].

Today, patients expect and demand fast, accurate information about their illnesses, symptoms, medication and treatment options. Patients often turn to online services or the Internet to make more informed decisions about their healthcare [4], and people are increasingly relying on the Internet as a source of cancer information [5], [6]. In 2009, 82% of Finnish people accessed the Internet daily [7], and in the USA (2009), 51% of adults aged 18–64 had used the Internet to look up health information during the previous 12 months [2].

The shortage of professional staff and a challenging economic climate are forcing healthcare organizations to seek more efficient options for providing education [8]. To meet the increasing demand for online services, healthcare organizations have started to offer services to patients on their Web pages [4]. Computer-based patient education is an effective strategy for presenting information and improving knowledge outcomes and giving patients options about the health issue that concerns them [9], [10]. Another approach is to install a CD-ROM-based programme, the benefit of these programmes being that the information is easy to validate. The provider and patient can read through the contents and be assured that it is in line with practice [6]. Patients with a chronic disease or life-threatening illness are often the ones who are the most avid information seekers; they feel lost [8]. Cancer patients’ support needs most often deal with somatic, psychological, emotional and social complaints [40]. In addition to psychosocial problems, spiritual support may become important during the illness or crises. Many African Americans and Hispanic cancer patients reported that religion is an important issue; 47% reported that their spiritual needs were supported by religious communities to a small extent or not at all [39]. Multimedia computer or web-based programmes offer a promising, practical alternative for improving patients’ education and support them in conducting their own health checks [11], [12]. Computer-based learning interventions support “just-in time” learning when the patient is ready or has time to access the computer [9]. The Comprehensive Health Enhancement Support System (CHESS) has positively affected cancer patients’ sense of competence in dealing with cancer and health care information. The results show that the effects tend to be strongest early in the patient's illness; CHESS may thus provide the greatest benefits while patients are in the midst of early struggles with their illness and treatments, but may produce little residual advantage over Internet use [41].

The benefits of computer or Internet-based education have been shown in a number of studies indicating that the education has had a positive impact on clinical outcomes, skill development and self-care management in orthopaedic patients [13], patients with COPD [14], coronary artery disease [10], [12] and colon or breast cancer [15], [16]. Whilst there have been some literature reviews, to our knowledge no systematic review has been conducted focusing specifically on interventions prostate cancer patients’ education with Internet or computer-based programmes. The participants in the studies have been for example breast and lung patients [17], [18], [19]. In this review the concept of benefit is seen as wider than effect. The aim of our review was to evaluate the benefits of the published studies on the best available evidence for how prostate cancer patients use the Internet or computer-based programmes for cancer-related information and emotional or spiritual support. The purpose of this review is to describe the advantages and disadvantages of the Internet or computerized interventions.

The following research questions were addressed:

• What kinds of Internet or computer-based patient educational programmes have been developed for prostate cancer patients?

• What are the benefits of Internet or computer-based programmes for prostate cancer patients?

• What is the quality of the review studies?