Mitigating Health and Science Misinformation: A Scoping Review of Literature from 2017 to 2022.

Literature on how to address misinformation has rapidly expanded in recent years. The aim of this scoping review was to synthesize the growing published literature on health and science misinformation mitigation interventions. English-language articles published from January 2017 to July 2022 were included. After title/abstract screening, 115 publications (148 empirical studies) met inclusion criteria and were coded for sample characteristics, topics, mitigation strategies, research methods, outcomes, and intervention efficacy. A marked increase in misinformation mitigation research was observed in 2020-2022. COVID-19, vaccines, and climate change were the most frequently addressed topics. Most studies used general population samples recruited online; few focused on populations most vulnerable to misinformation. Most studies assessed cognitive outcomes (e.g., knowledge), with fewer assessing health behavior, communication behavior, or skills. Correction (k = 97) was the most used misinformation mitigation strategy, followed by education and other literacy initiatives (k = 39) and prebunking/inoculation (k = 24). Intervention efficacy varied, with 76 studies reporting positive, 17 reporting null, and 68 reporting mixed results. Most misinformation mitigation interventions were limited to short-term online experiments focused on improving cognitive outcomes. Priority research areas going forward include expanding and diversifying study samples, scaling interventions, conducting longitudinal observations, and focusing on communities susceptible to misinformation.

Contributions to Research and Practice Made by the National Cancer Institute's Health Communication and Informatics Research Branch.

The Health Communication and Informatics Research Branch at the U.S. National Cancer Institute was founded in 1999 in response to increasing evidence demonstrating a link between effective health communication and improved cancer-related outcomes and in recognition of the rapid and dramatic technological changes that were transforming health communication at the turn of the 21st century. For the past 25 years, the Health Communication and Informatics Research Branch has been conducting and supporting research at the forefront of emerging cancer communication trends and technologies, making numerous contributions to health communication science, public health, and cancer control practice. In this essay, we provide a brief history of the branch and the context that led to its establishment, discuss contributions made by the branch to health communication research and practice through key projects and initiatives, and conclude by highlighting health communication and informatics research priorities that offer opportunities for significant impact going forward in light of the challenges posed by the current communication environment.

Using Behavioral Science to Address COVID-19 Vaccine Hesitancy Among Cancer Survivors: Communication Strategies and Research Opportunities.

Due to cancer survivors' increased vulnerability to complications from COVID-19, addressing vaccine hesitancy and improving vaccine uptake among this population is a public health priority. However, several factors may complicate efforts to increase vaccine confidence in this population, including the underrepresentation of cancer patients in COVID-19 vaccine trials and distinct recommendations for vaccine administration and timing for certain subgroups of survivors. Evidence suggests vaccine communication efforts targeting survivors could benefit from strategies that consider factors such as social norms, risk perceptions, and trust. However, additional behavioral research is needed to help the clinical and public health community better understand, and more effectively respond to, drivers of vaccine hesitancy among survivors and ensure optimal protection against COVID-19 for this at-risk population. Knowledge generated by this research could also have an impact beyond the current COVID-19 pandemic by informing future vaccination efforts and communication with cancer survivors more broadly.

Correction: Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis.

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Factors Associated with Cancer Message Believability: a Mixed Methods Study on Simulated Facebook Posts.

The ability to share and obtain health information on social media (SM) places higher burden on individuals to evaluate the believability of such health messages given the growing nature of misinformation circulating on SM. Message features (i.e., format, veracity), message source, and an individual's health literacy all play significant roles in how a person evaluates health messages on SM. This study assesses how message features and SM users' health literacy predict assessment of message believability and time spent looking at simulated Facebook messages. SM users (N = 53) participated in a mixed methods experimental study, using eye-tracking technology, to measure relative time and message believability. Measures included individual health literacy, message format (narrative/non-narrative), and information veracity (evidence-based/non-evidence-based). Results showed individuals with adequate health literacy rated evidence-based posts as more believable than non-evidence-based posts. Additionally, individuals with limited health literacy spent more relative time on the source compared to individuals with adequate health literacy. Public health and health communication efforts should focus on addressing myths and misinformation found on SM. Additionally, the source of message may be equally important when evaluating messages on SM, and strategies should identify reliable sources to prevent limited health literate individuals from falling prey to misinformation.

Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis.

PURPOSE: To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. METHODS: iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. RESULTS: Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. CONCLUSION: NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.

State of recent literature on communication about cancer genetic testing among Latinx populations.

Cancer-related genetic testing (hereafter CGT) has transformed cancer prevention, treatment, and care. Researchers debate whether diffusion and use of genetic testing will reduce or widen cancer health disparities through effects on improving or worsening cancer-related mortality, morbidity, and outcomes that disproportionately affect racial and ethnic minority populations. Cancer disparities by race and ethnicity have been associated with social determinants of health and healthcare access and experience. However, little research has explored how communication about CGT may contribute to these disparities. As such, the goal of this study was to characterize the literature published between 2010 and 2017 on communication about CGT among Latinx populations through a secondary analysis of papers identified in a larger scoping review. We found thirteen (2.5%) of 513 papers in the parent scoping review had over 50% Latinx representation; only nine of these (69%) had fully Latinx comprised study cohorts. The majority of the 13 identified studies (n = 9) were conducted to assess knowledge and attitudes regarding CGT. Most studies included services or materials in both Spanish and English. Few studies assessed language preference or acculturation or compared outcomes across sub-ethnicities. We identified opportunities for researchers to explore differences in outcomes by language preference and acculturation, and between sub-ethnicities in future studies. Leveraging a greater understanding of the heterogeneity within the Latinx population will allow genetics researchers and providers to improve utilization of CGT and therein health outcomes to advance health equity.

Predictors of Patient-Centered Communication among U.S. Adults: Analysis of the 2017-2018 Health Information National Trends Survey (HINTS).

An essential component of patient-centered care is the communication between patients and their providers, which can affect patients' health outcomes A cancer care model, developed by Epstein and Street, includes a multi-dimensional patient-centered communication (PCC) framework with six functions: foster healing relationships, exchange information, respond to emotions, manage uncertainty, make decisions, and enable patient self-management. Seven domains that describe the functions were included on the Health Information National Trends Survey (HINTS) to assess PCC. We examined the association between sociodemographic and health-related factors and PCC as well as how U.S. adults, by different age groups, ranked different domains of PCC.Nationally representative data (n = 5,738) from 2017 to 2018 HINTS were merged to examine predictors of PCC among U.S. adults. Weighted statistics describe the study sample and prevalence for ratings of PCC domains. A multivariate linear regression model was computed to assess associations among predictors and PCC.Participants rated their communication with doctors in the last year with an overall mean of 80 out of 100. Older age, those reporting excellent health, and those with higher confidence in taking care of one's health predicted better PCC. Individuals who reported being non-Hispanic Asian and having lower household income were associated with poorer communication. Participants' lowest rating of PCC concentrated on providers dealing with their emotional needs.Findings suggest that many patients do not feel that their providers adequately manage, communicate, nor respond to their emotional needs. Future efforts should enhance interpersonal exchanges among sub-populations who report poorer communication with providers during clinical visits.

Using Social Media for Health: National Data from HINTS 2019.

Social media (SM) have fundamentally changed the way we exchange information, including how we communicate about health. The goal of this study was to describe current prevalence and predictors of SM use by analyzing nationally representative data from the 2019 Health Information National Trends Survey (HINTS). Multivariate logistic regression models examined the odds of engaging in four SM activities: visiting social networking sites, sharing health information on SM, participating in online support groups, and watching health-related videos. In 2019, approximately 86% of Internet users reported engaging in at least one SM activity. Younger age and female gender were associated with higher likelihood of engaging in all SM activities. No significant ethnic/racial disparities were observed for most SM activities, but Hispanics were found to be more likely to report watching health-related videos. Additionally, those with regular health care access were more likely to participate in online support groups. Previous HINTS survey cycles were also used to examine change in SM use over time, showing that general SM use has increased substantially since 2007, but the use of SM for health-related purposes has not increased to the same extent. The dynamic and evolving nature of SM makes systematic assessment vital. Knowledge of current SM use patterns could make health communication efforts more effective and equitable.

Online social support for cancer caregivers: alignment between requests and offers on CaringBridge.

OBJECTIVES: Exploring CaringBridge, we describe types of social support caregivers requested, types of social support offered, and the alignment between the two. RESEARCH APPROACH: A retrospective, longitudinal, descriptive approach. SAMPLE: Twenty public CaringBridge sites. METHODOLOGICAL APPROACH: The Social Support Behavior Code system was adapted and applied to cancer-caregiver journal entries (n = 389) and guestbook posts (n = 2,466) to identify types of support (emotional, esteem, informational, network, tangible, and no support requested/offered). Matches between requests and offers were examined. FINDINGS: Cancer caregivers requested different types of support from their guests, most commonly emotional support. However, in most posts, caregivers did not request any support (n = 238, 61.18%). Guests offered all support types, but predominately offered emotional support (n = 2,353, 95%). When support was requested, 66.67% of requests received a matched offer within 24 hours. INTERPRETATION: Social media platforms may provide all types of support to caregivers.

Digital interventions to facilitate patient-provider communication in cancer care: A systematic review.

OBJECTIVE: Patient-provider communication is a critical component of cancer care. Digital tools have been applied to facilitate cancer care and patient-provider communication. However, to date, there is no systematic review on this growing body of literature. The objective of this study is to identify the existing digital interventions to improve patient-provider communication among cancer patients and survivors, summarize their characteristics, and synthesize the outcomes of these interventions. METHODS: We searched the databases of PubMed, CINAHL, and PsycINFO using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines with the following criteria: (a) empirical studies focusing on digital interventions to facilitate communication between cancer patients or survivors and their health care providers, (b) reporting qualitative or quantitative health outcomes of the cancer patients or survivors after the digital intervention, and (c) English articles published after 2000. RESULTS: The initial literature search generated 1006 articles; only 13 met the inclusion criteria. Most of the studies were conducted among breast, prostate, and lung cancer patients. Ten out of 13 studies used randomized controlled trials to evaluate intervention efficacy. The outcomes assessed included symptoms reporting and management, decision making, distress and quality of life, and utilization of health care. Most studies reported positive outcomes following the interventions. CONCLUSIONS: The existing evidence on the number, characteristics, and outcomes of digital interventions to improve patient-provider communication suggests the preliminary efficacy of such interventions. It is essential to develop and implement more evidence-based digital interventions to engage patients, enhance patient-provider communication, and facilitate patient-centered decision making to improve patient-centered health outcomes, especially in underserved communities of cancer patients and survivors.

Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence.

Long-term control of the COVID-19 pandemic hinges in part on the development and uptake of a preventive vaccine. In addition to a segment of population that refuses vaccines, the novelty of the disease and concerns over safety and efficacy of the vaccine have a sizable proportion of the U.S. indicating reluctance to getting vaccinated against COVID-19. Among various efforts to address vaccine hesitancy and foster vaccine confidence, evidence-based communication strategies are critical. There are opportunities to consider the role of emotion in communication efforts. In this commentary, we highlight several ways negative as well as positive emotions may be considered and leveraged. Examples include attending to negative emotions such as fear and anxiety, raising awareness of emotional manipulations by anti-vaccine disinformation efforts, and activating positive emotions such as altruism and hope as part of vaccine education endeavors.

Cancer communication research in the era of genomics and precision medicine: a scoping review.

Effective use of genetic and genomic data in cancer prevention and treatment depends on adequate communication with patients and the public. Although relevant empirical work has emerged, the scope and outcomes of this communication research have not been characterized. We conducted a comprehensive scoping review of recent published research (2010-2017) on communication of cancer-related genetic and genomic testing (CGT) information. Searches in six databases revealed 9243 unique records; 513 papers were included. Most papers utilized an observational quantitative design; fewer utilized an experimental design. More attention has been paid to outcomes of CGT results disclosure than to decision making regarding CGT uptake or the process of results disclosure. Psychosocial outcomes were most common across studies. This literature has a strong focus on BRCA1/2, with few papers focused on Lynch syndrome or next-generation technologies. Women, Caucasians, older adults, and those of higher socioeconomic status were overrepresented. Research gaps identified include the need for studies on the process of CGT communication; examining behavioral, decision making, and communication outcomes; and inclusion of diverse populations. Addressing these gaps can help improve the use of genomics in cancer control and reduce disparities in access to and use of CGT.

Health Information in 2023 (and Beyond): Confronting Emergent Realities With Health Communication Science.

This Viewpoint describes how health communication science can be used to improve response to health challenges by providing credible health information to the public.

The role of medical social workers in cancer clinical trial teams: A group case study of multidisciplinary perspectives.

INTRODUCTION: Social workers collaborate with a wide range of healthcare providers in clinical trial teams, yet their roles may not always be understood or supported by team members. It is currently unknown how social workers and multidisciplinary team members perceive social workers' roles in the clinical trial context. METHODS: Using a group case-study approach, social workers, core medical team members, and allied healthcare workers (n = 19) completed in-depth interviews to discuss the roles of social workers in a cancer clinical trial setting. FINDINGS: Social workers discussed their role as primarily patient-centered, perceiving themselves to be a counselor, patient advocate, and conduit. They also described areas of perceived limited role contribution. Other members of the multidisciplinary teams viewed the roles of social workers to be focused on being a conduit and coordinator. DISCUSSION: We found discordance in the way that social workers and their team members view the roles of social workers in clinical trials. Our data suggest that structural and interpersonal barriers may prevent social workers from working to the full extent of their license in a clinical trial context. Implications, future research, and suggestions for interventions to more fully integrate social workers into clinical trial settings are discussed.

Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists' language.

BACKGROUND: The National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information. OBJECTIVE: This qualitative study describes oncologists' language during discussions of prognosis and treatment goals in clinical interactions with African American patients diagnosed with cancer. DESIGN: We analysed transcripts from video recordings of clinical interactions between patients with Stage III or IV cancer (n=26) and their oncologists (n=9). In-depth discourse analysis was conducted to describe and interpret oncologists' communication behaviours and common linguistic features in the interactions. SETTING AND PARTICIPANTS: Data were from a larger study of patient-provider communication between African Americans and oncologists at two cancer hospitals in Detroit. RESULTS: Prognosis was discussed in 73.1% (n=19) of the interactions; treatment goals were discussed in 92.3% (n=24). However, analysis revealed that oncologists' description of prognosis was vague (e.g. "prognosis is a bit worse in your case") and rarely included a survival estimate. Oncologists often used ambiguous terminology, including euphemisms and jargon, and emphasized uncertainty (e.g. "lesions are suspicious for the disease"). Conversation about prognosis was frequently brief, moving quickly to the urgency and details of treatment. DISCUSSION: This study demonstrates how oncologists' language may obscure discussion of prognosis and treatment goals. The identified behaviours may lead to missed opportunities in eliciting and discussing patients' knowledge about and preferences for their care. Patient-, provider- and system-oriented interventions are needed to improve clinical communication, especially among minority patients with advanced cancer.

Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis.

BACKGROUND: In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC. OBJECTIVE: The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public's use of ePHRs varies across subpopulations, including those with MCC. METHODS: This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models. RESULTS: Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03). CONCLUSIONS: We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC.

Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving.

Informal/family caregivers are a fundamental source of care for cancer patients in the United States, yet the population of caregivers and their tasks, psychosocial needs, and health outcomes are not well understood. Changes in the nature of cancer care and its delivery, along with the growing population of survivors and their caregivers, warrant increased attention to the roles and demands of caregiving. This article reviews current evidence presented at a 2-day meeting examining the state of the science of informal cancer caregiving that was convened by the National Cancer Institute and the National Institute of Nursing Research. The meeting sought to define who is an informal cancer caregiver, summarize the state of the science in informal cancer caregiving, and describe both the kinds of interventions developed to address caregiving challenges and the various outcomes used to evaluate their impact. This article offers recommendations for moving science forward in 4 areas: 1) improving the estimation of the prevalence and burden of informal cancer caregiving; 2) advancing the development of interventions designed to improve outcomes for cancer patients, caregivers, and patient-caregiver dyads; 3) generating and testing strategies for integrating caregivers into formal health care settings; and 4) promoting the use of technology to support informal cancer caregivers. Cancer 2016;122:1987-95. © 2016 American Cancer Society.

What Do People Like to "Share" About Obesity? A Content Analysis of Frequent Retweets About Obesity on Twitter.

Twitter has been recognized as a useful channel for the sharing and dissemination of health information, owing in part to its "retweet" function. This study reports findings from a content analysis of frequently retweeted obesity-related tweets to identify the prevalent beliefs and attitudes about obesity on Twitter, as well as key message features that prompt retweeting behavior conducive to maximizing the reach of health messages on Twitter. The findings show that tweets that are emotionally evocative, humorous, and concern individual-level causes for obesity were more frequently retweeted than their counterparts. Specifically, tweets that evoke amusement were retweeted most frequently, followed by tweets evoking contentment, surprise, and anger. In regard to humor, derogatory jokes were more frequently retweeted than nonderogatory ones, and in terms of specific types of humor, weight-related puns, repartee, and parody were shared frequently. Consistent with extant literature about obesity, the findings demonstrated the predominance of the individual-level (e.g., problematic diet, lack of exercise) over social-level causes for obesity (e.g., availability of cheap and unhealthy food). Implications for designing social-media-based health campaign messages are discussed.