Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country.

BACKGROUND: Type 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) has proven to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Health Service - Osakidetza (Spain). METHOD/DESIGN: This is a randomised clinical trial in which patients diagnosed with DM2, 18-79 years of age, from four health regions within the Basque Health Service will be randomised into two groups: an intervention group, who will follow the SDSMP, and a control group, who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region. The intervention consists of 2,5 hour-group sessions once a week for six weeks. The sessions cover target setting and problem solving techniques, promotion of physical exercise, basic knowledge of nutrition, proper use of medication, effective communication with relatives and health professionals, and basic knowledge about DM2 and its complications. This content is complemented by educational material: books, leaflets and CDs. The primary outcome measure will be the change in glycated haemoglobin (HbA1c), and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables, cardiovascular risk, quality of life, self-efficacy, number of consultations and drug prescriptions. The results will be analysed 6, 12 and 24 months after the intervention. DISCUSSION: If the intervention were to be effective, the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01642394.

Use of medicinal herbs by patients with severe asthma managed at a Referral Center / Uso de plantas medicinais por pacientes com asma grave gerido a um Centro de Referência

Asthma is a chronic inflammatory disease of the airways that may lead to limitations in regular activities, to hospitalizations and a decrease in quality of life. Adherence to drug treatment is crucial for control of the disease. The use of medicinal herbs can reduce adherence to prescriptions, as the medication may be replaced by infusions or herbal products. The objective of this study was to evaluate the frequency of use of traditional herbal medicine among severe asthmatics in Salvador. Information on use of homemade remedies was obtained through application of a questionnaire during patient visits to a referral center. We also collected data on economic and social aspects as well as disease control. One hundred and forty-four (91,1 percent) out of one hundred and fifty-eight patients evaluated used herbal medicines, but only 26.5 percent attributed improvement of asthma symptoms to this alternative treatment and only 8 had substituted a prescribed medication by herbal medicines. There was a trend towards lower adherence to prescription drug treatment in this group of patients. Despite the high frequency of use of medicinal herbs in our sample, there was no improvement in the asthma treatment in this population compared to non-users. Adherence to conventional drug treatment was satisfactory and there was neither reduction in asthma control nor increase in hospitalizations among the users of medicinal plants.

A asma é uma enfermidade inflamatória crônica das vias aéreas que pode resultar em limitações nas atividades diárias, internações e prejuízo da qualidade de vida. A adesão ao tratamento medicamentoso é fundamental para o controle da doença. O uso de plantas medicinais pode reduzir a adesão ao tratamento prescrito, à medida que os medicamentos são substituídos por chás ou ervas. O objetivo deste estudo foi avaliar a frequência de uso de plantas medicinais entre asmáticos graves em Salvador. As informações sobre uso de remédios caseiros foram obtidas por meio de questionário durante a visita dos pacientes a um centro de referência. Foram coletados dados econômicos, sociais e de controle da doença. Cento e quarenta e quatro (91,1 por cento) dos cento e cinqüenta e oito pacientes avaliados utilizavam plantas medicinais, dos quais apenas 26,5 por cento atribuíam melhora dos sintomas da asma a este tratamento alternativo e somente 8 pacientes já haviam feito a substituição de medicamento por alguma planta medicinal. Houve tendência a menor adesão ao tratamento medicamentoso neste grupo de pacientes. Apesar da alta frequência do uso de plantas medicinais na nossa amostra, não houve melhora no tratamento da asma desta população em relação aos não-usuários. A adesão ao tratamento medicamentoso foi satisfatória, não havendo piora no controle da asma ou aumento em hospitalizações entre os usuários de plantas medicinais.

[Analysis of health concept in low-educated workers of 4 European Union countries for improving efforts to preserve health at workplace].

Study carried out in 4 EC countries revealed significant differences in attitude towards health between two examined groups of workers with various education levels, and between countries. Low-educated workers, when compared to more educated workers, are different in acceptable information sources on health state and in general view of study.

Efficacy of natural health products in treating osteoporosis: what is the quality of internet patient advice?

BACKGROUND: With Canadians increasing their use of the Internet to find health-related information, especially regarding natural health products (NHPs), there is a need for high-quality, evidence-based information on Web sites to aid consumers in making informed decisions regarding the appropriate and safe use of NHPs. OBJECTIVE: To determine the quality of Web sites that target consumers and advocate the use of NHPs in the management of osteoporosis in postmenopausal women. METHODS: Web sites were identified via the Google search engine using the key words "natural treatment osteoporosis." The first pages of the first 91 Web sites identified were assessed for relevance based on the following criteria: (1) written in English, (2) contained consumer information, and (3) claimed a benefit of a single NHP in the management of osteoporosis. This task was completed by 2 investigators; differences were resolved by consensus after discussion with the third investigator. Quality of relevant sites was assessed using an expanded DISCERN instrument that also examined the evidence supporting the claim of benefit. Additionally, readability of the sites was assessed. RESULTS: Thirty-eight Web sites met the inclusion criteria. Using the DISCERN instrument, we found that many of the sites scored low, suggesting serious or extensive shortcomings. On many Web sites, benefit claims regarding calcium, vitamin D, phytoestrogens, dehydroepiandrosterone and vitamin K were consistent with empirical evidence. However, for other NHPs, many of these same sites made effectiveness claims that were not supported by current evidence from randomized controlled trials. Twenty-five sites did not provide information as to what resources were used to support their claims. The average reading grade score was grade 11.9 (based on US school grades) and the mean Flesch Reading Ease Score was 41.7. (A higher score out of 100 indicates ease of reading.) CONCLUSIONS: Due to the poor quality and content from unknown sources found on some Web sites, consumers who access Web sites for information regarding the use of NHPs in osteoporosis should do so cautiously and discuss results with their healthcare providers.

How important is research-based practice to chiropractors and massage therapists?

OBJECTIVE: This study evaluated the perceptions of research, frequency of use of research findings in practice, and the level of research skills of chiropractors and massage therapists in Canada. Predictors of application of research findings in clinical practice were also explored. METHODS: A survey was mailed to members of the College of Chiropractors of Alberta (n = 833) and the Massage Therapist Association of Alberta (n = 650). Univariate and logistic regression analysis were conducted with SPSS and Stata. RESULTS: A total of 483 questionnaires were returned (response rate, 32.6%). Chiropractors and massage therapists reported an overall positive perception toward research, acknowledging the importance of research to validate their practice. Although both groups felt comfortable using the library, they had little confidence in their research skills and overall application of research in practice was limited. Significant differences were found between the 2 professional groups, with chiropractors reporting more research skills and evidence-based practice. Primary discipline, frequent referral to peer-reviewed journals, and strong agreement with the statement that "research adds credibility to my discipline" were predictors of research application in practice. CONCLUSION: It appears that in Canada neither chiropractors nor massage therapists consistently apply research in practice, which may result from a lack of research education and research skills. The differences between the 2 professional groups may be attributed to the chiropractic profession's relatively more research-focused professional training. Strategies to encourage greater research uptake and evidence-based behavior by practitioners include professional association incentives, such as education credits or practitioner cooperatives that would provide time and support for research.

Comparative survey of Complementary and Alternative Medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents & faculty.

BACKGROUND: There is significant and growing national interest for introducing Complementary and Alternative Medicine (CAM) instruction into allopathic medical education. We measured CAM attitudes, use, and information-seeking behaviors as a baseline to evaluate future planned CAM instruction. METHODS: Cross-sectional and longitudinal survey data on CAM attitudes, modality use, and common information resources was collected for (a) medical students (n = 355), (b) interns entering residencies in medical and surgical disciplines (n = 258), and (c) faculty from diverse health professions attending workshops on evidence-based CAM (n = 54). One student cohort was tracked longitudinally in their first, second and third years of training. RESULTS: Compared to medical students and interns, faculty who teach or intend to integrate CAM into their instruction had significantly (p < .0005) more positive attitudes and used CAM modalities significantly (p < .0005) more often. Medical students followed longitudinally showed no change in their already positive attitudes. The 3 survey groups did not differ on the total number of CAM information resources they used. Each group surveyed used about two out of the five common information sources listed, with the Internet and journals most frequently cited. CONCLUSION: Students, interns and a selected faculty group demonstrate positive attitudes toward CAM and frequently use various CAM modalities. CAM instruction should therefore be focused on acquiring knowledge of available CAM modalities and skills to appraise evidence to appropriately advise patients on best approaches to CAM use. Trainees may benefit from exposure to a wider array of CAM information resources.

Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines.

OBJECTIVE: To determine, by surveying Australian community pharmacists, the perceived barriers to the provision of information about complementary and alternative medicines (CAMs) and suggestions for overcoming them. METHOD: Anonymous, self-administered survey sent to a random sample of 701 pharmacists registered in three states of Australia in 2004. MAIN OUTCOME MEASURE: Pharmacists' perceived barriers to the provision of information about CAMs. RESULTS: A total of 344 questionnaires were returned by pharmacists (49% response) of which 211 (30%) were currently practising in community pharmacy. Ninety-five percent of surveyed community pharmacists indicated that they personally received enquires about CAMs, with fewer than 15% reporting they were "very confident" in answering queries about safety, interactions or benefits of CAMs. Frequently used CAM information sources were those from manufacturers and distributors, professional newsletters and journals and textbooks. Pharmacists' perceived barriers to the provision of CAM information included a lack of suitable training (most training was informal), deficiencies in available information sources, a lack of managerial support, the need for regulatory changes, consumer beliefs about CAM safety and time constraints due to competing demands in daily practice. Pharmacists proposed improvements to overcome these barriers including improvements to training. CONCLUSION: There is scope for pharmacy professional organisations and educational institutions to further support pharmacists in their practice through providing information on the best information sources available and training that meets the needs of undergraduate students, pharmacists and other pharmacy staff. There is a need to examine regulatory requirements concerning the provision of product information with CAMs in Australia and to implement mechanisms for increasing consumer awareness of regulatory procedures for these medicines.

Experiences and perceptions of people with headache: a qualitative study.

BACKGROUND: Few qualitative studies of headache have been conducted and as a result we have little in-depth understanding of the experiences and perceptions of people with headache. The aim of this paper was to explore the perceptions and experiences of individuals with headache and their experiences of associated healthcare and treatment. METHODS: A qualitative study of individuals with headache, sampled from a population-based study of chronic pain was conducted in the North-East of Scotland, UK. Seventeen semi-structured interviews were conducted with adults aged 65 or less. Interviews were analysed using the Framework approach utilising thematic analysis. RESULTS: Almost every participant reported that they were unable to function fully as a result of the nature and unpredictability of their headaches and this had caused disruption to their work, family life and social activities. Many also reported a negative impact on mood including feeling depressed, aggressive or embarrassed. Most participants had formed their own ideas about different aspects of their headache and several had searched for, or were seeking, increased understanding of their headache from a variety of sources. Many participants reported that their headaches caused them constant worry and anguish, and they were concerned that there was a serious underlying cause. A variety of methods were being used to manage headaches including conventional medication, complementary therapies and self-developed management techniques. Problems associated with all of these management strategies emerged. CONCLUSION: Headache has wide-ranging adverse effects on individuals and is often accompanied by considerable worry. The development of new interventions or educational strategies aimed at reducing the burden of the disorder and associated anxiety are needed.

Early experiences with e-health services (1999-2002): promise, reality, and implications.

BACKGROUND: E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use. OBJECTIVE: The objective of this study was to examine trends in e-health use and user characteristics. RESEARCH DESIGN: This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services. SUBJECTS: Approximately 3.3 million members of a large, prepaid IDS. MEASUREMENTS: Amount and frequency of e-health use over time and characteristics of users. RESULTS: The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types. CONCLUSIONS: Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.

Consumer e-health education in HIV/AIDS: a pilot study of a web-based video workshop.

BACKGROUND: Members of the HIV/AIDS community are known to use web-based tools to support learning about treatment issues. Initial research indicated components such as message forums or web-based documentation were effectively used by persons with HIV/AIDS. Video has also shown promise as a technology to aid consumer health education. However, no research has been published thus far investigating the impact of web-based environments combining these components in an educational workshop format. METHODS: In this qualitative study HIV/AIDS community members provided feedback on an integrated web-based consumer health education environment. Participants were recruited through organizations that serve the HIV/AIDS community located in Toronto, Canada. Demographics, data on Internet use, including messages exchanged in the study environment were collected. A group interview provided feedback on usability of the study environment, preferences for information formats, use of the message forum, and other sources for learning about treatment information. RESULTS: In this pilot study analysis of the posted messages did not demonstrate use for learning of the workshop content. Participants did not generally find the environment of value for learning about treatment information. However, participants did share how they were meeting these needs. It was indicated that a combination of resources are being used to find and discuss treatment information, including in-person sources. CONCLUSION: More research on the ways in which treatment information needs are being met by HIV/AIDS community members and how technology fits in this process is necessary before investing large amounts of money into web-based interventions. Although this study had a limited number of participants, the findings were unexpected and, therefore, of interest to those who intend to implement online consumer health education initiatives or interventions.

What factors induce health care decision-makers to use clinical guidelines? Evidence from provincial health ministries, regional health authorities and hospitals in Canada.

This paper addresses three questions: What is the extent of clinical guideline utilization by decision-makers in provincial health ministries, regional health authorities and hospitals in Canada? Are there differences between these work settings in regard to the extent of clinical guideline utilization? What are the determinants of clinical guidelines utilization in health ministries, regional health authorities and hospitals? Based on a survey of 899 decision-makers from Canadian provincial health ministries, regional health authorities and hospitals, the results indicate that there are large differences between work settings in regard to clinical guideline utilization. Not surprisingly, work settings like hospitals rely more intensively on clinical guidelines than the other work settings (health ministries or agencies and regional health authorities). The results of the regression models indicate that cognitive factors, social factors, technological factors, organizational factors and individual attributes significantly predict the utilization of clinical practice guidelines by decision-makers. However, the results of the regression models also indicate that some factors that predict clinical guideline utilization by decision-makers in hospitals do not predict clinical guidelines utilization by decision-makers working in ministries or in regional health authorities. Therefore, these results suggest that customized interventions would be appropriate in order to efficiently increase the utilization of clinical practice guidelines in different work settings. The paper concludes with suggestions for future research.

'Parcours de Femme 2001': a French opinion survey on overall disease and everyday life management in 1870 women presenting with gynecological or breast cancer and their caregivers.

PURPOSE: The aim of the survey 'Parcours de Femmes 2001' was to evaluate the overall management and care of women with female cancers and to determine their needs. METHODS: Women with breast or gynecological cancer who had either received at least 3 months of treatment or had completed treatment <1 year before the study were enrolled in this cross-sectional, observational study. RESULTS: From February to November 2001, 2839 questionnaires were distributed; 1870 were returned (66% response rate), mainly by breast cancer patients (87%). While 92% of women reported having received information at diagnosis, 34% of relapsed patients complained of lack of information concerning their disease and treatment. Only 18% of patients were included in the treatment decision process and 66% of women obtained complementary information from the media, patients and care professionals. Fatigue was the most severe problem quoted (78% of cases) and was poorly managed by caregivers due to diagnostic and treatment difficulties. Problems relating to family and to affective and socio-professional life were poorly identified and remained largely unmanaged. CONCLUSIONS: Information given to female cancer patients must be improved in relapsed patients, particularly regarding the adverse effects of treatment. Psychosocial management requires a more holistic approach through new channels, together with the coordination of existing structures.

HolisticKids.org--evolution of information resources in pediatric complementary and alternative medicine projects: from monographs to Web learning.

Use of complementary and alternative medicine (CAM) is growing in the United States. Children are a part of this trend, with adolescent self-care exceeding adult use. As a result, the necessity of educating pediatricians on CAM practices has become clear. This paper describes the Pediatric Integrative Medicine Education (PIME) project with a focus on the creation of HolisticKids.org, a Website designed to educate pediatric residents. HolisticKids.org also addresses the needs and interests of medical students, fellows, faculty, and community-based care providers who work with children and CAM. An outstanding aspect of this effort is its interdisciplinary nature, involving physicians, pharmacists, dieticians, nurses, medical librarians, and Web specialists. Collaboration is mirrored on an institutional level, where the participating institutions include Children's Hospital Boston, Harvard Medical School, Boston Medical Center, the Massachusetts College of Pharmacy and Health Sciences, and Dana Farber Cancer Institute. Now in the third year of development, this Web-based education project demonstrates how integrative medical education can contribute to pediatric care for diverse families and complement cultural competency efforts. Ongoing efforts focus on adding content, developing evaluation techniques, and disseminating this resource to the health sciences community.

Information-seeking behavior in complementary and alternative medicine (CAM): an online survey of faculty at a health sciences campus.

BACKGROUND: The amount of reliable information available for complementary and alternative medicine (CAM) is limited, and few authoritative resources are available. OBJECTIVE: The objective is to investigate the information-seeking behavior of health professionals seeking CAM information. METHODS: Data were gathered using a Web-based questionnaire made available to health sciences faculty affiliated with the University of California, San Francisco. RESULTS: The areas of greatest interest were herbal medicine (67%), relaxation exercises (53%), and acupuncture (52%). About half the respondents perceived their CAM searches as being only partially successful. Eighty-two percent rated MEDLINE as a useful resource, 46% personal contacts with colleagues, 46% the Web, 40% journals, and 20% textbooks. Books and databases most frequently cited as useful had information about herbs. The largest group of respondents was in internal medicine (26%), though 15% identified their specialties as psychiatry, psychology, behavioral medicine, or addiction medicine. There was no correlation between specialty and patterns of information-seeking behavior. Sixty-six percent expressed an interest in learning more about CAM resources. CONCLUSIONS: Health professionals are frequently unable to locate the CAM information they need, and the majority have little knowledge of existing CAM resources, relying instead on MEDLINE. Medical librarians need to educate health professionals in the identification and use of authoritative CAM resources.

Evaluation of an Internet-based database on infectious disorders during pregnancy: INFPREG.

OBJECTIVE: To evaluate the use of an Internet-based information system on infectious disorders (INFPREG) in antenatal care in Sweden. METHODS: A postal questionnaire was sent to all antenatal clinics in Sweden in 2000 (n = 515) and 2002 (n = 503). The questionnaire consisted of sections covering use of computers, availability of Internet connections and the use of INFPREG in patient care. RESULTS: We received 404 completed questionnaires in 2000 and 501 in 2002. In 2000, 81% of the midwives had access to computers at their antenatal clinics, and this number had increased to 93% in 2002. Sixty-eight percent and 88% in 2000 and 2002, respectively, had computers with an Internet connection. Of the responding midwives, 74% in 2000 and 84% in 2002 had received information concerning INFPREG. In 2000, 29% of the midwives had visited INFPREG and this figure had increased to 58% in 2002. Of the midwives that had used INFPREG, 67% in 2000 and 81% in 2002 reported that the information obtained from the site was implemented in the patient care. Of the responders, 45% in 2000 and 43% in 2002 claimed that they needed more information on how to use INFPREG. CONCLUSIONS: A majority of midwives at antenatal clinics in Sweden have access to the Internet and are confident in using an Internet-based knowledge center on infectious disorders in pregnancy. The present study indicates a rapid acceptance among health care providers in antenatal care in Sweden of this new method for dissemination of information and guidelines. However, many midwives still want more information and knowledge on how to use an Internet-based information system.

Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: an exploratory study with correspondence analysis.

This study examined patterns in the use of health information among Caucasian, Japanese, and non-Japanese Asian Pacific Islander cancer patients in Hawaii and explored the relation of ethnicity and educational level to choices of health information sources. Information from 140 cancer patients, most of whom were users of complementary and alternative medicine (CAM), was analyzed using correspondence analysis. Three clusters of health information pertinent to the three ethnic groups emerged from the data. The results of this study revealed that Caucasian patients preferred objective, scientific, and updated information obtained through medical journals or newsletters from research institutions, telephone information services, and the internet. Japanese patients relied on media and commercial sources including television, newspapers, books, magazines and CAM providers. Non-Japanese Asians and Pacific Islanders used information sources involving person-to-person communication with their physicians, social groups, and other cancer patients. A higher educational level was closely related to a cluster of health information stressing objective, scientific and updated information, while a lower educational level was associated with interpersonally communicated information. The three ethnicity-specific patterns of health information use remained relatively stable at different educational levels, implying that the effect of patients' ethnicity overrides their educational level in shaping their choices of health information. The results of this study indicate the importance of recognizing cancer patients' culturally developed world views when understanding their health information-seeking behavior. For medical practice, these findings indicate the need for healthcare providers to assist cancer patients to obtain accurate health information in a culturally sensitive way.

Conducting intervention research through the Cancer Information Service: a feasibility study.

PURPOSE/OBJECTIVES: To determine the feasibility of conducting trials of educational interventions regarding pain and quality of life (QOL) with people who call the National Cancer Institute's Cancer Information Service (CIS). DESIGN: Descriptive. SETTING: North Central CIS, located at the University of Wisconsin Comprehensive Cancer Center in Madison. SAMPLE: Callers to the North Central CIS who self-identified as people diagnosed with cancer or as family members or friends of people diagnosed with cancer were eligible. 102 people with cancer and 103 significant others answered questions concerning the feasibility of a pain study, and 101 significant others completed questions about the feasibility of a QOL study. METHODS: Eligible CIS callers were invited at the end of usual service to participate in a research study. Those who agreed were asked structured questions regarding pain or QOL. MAIN RESEARCH VARIABLES: Response rate, length of time to complete recruitment, concerns about reporting pain and using analgesics, concerns about QOL, demographic variables, and willingness to join a hypothetical study. FINDINGS: The majority of callers had concerns about pain and QOL, and the vast majority (78%-89%) of participants indicated a willingness to join a future educational intervention study. CONCLUSIONS: Using subjects recruited through CIS, conducting trials of brief telephone interventions designed to help patients overcome barriers to pain management or assist families in addressing QOL concerns may be feasible. IMPLICATIONS FOR NURSING: Researchers may wish to consider the opportunities afforded by collaborating with CIS colleagues in planning and conducting studies of educational interventions.

Internet message board use by patients with cancer and their families.

The Life After Cancer Care (LACC) Internet Web site and message board were created at a comprehensive cancer center to provide up-to-date information about different types of cancer, treatments, late effects, and research findings. The message board enables patients with cancer to exchange information on a more personal basis. During the 16-month period since the creation of the Web site, 972 people logged on to the message board and 284 people posted 619 messages. Most (64%) posted only one message. The posted messages were related most frequently to cancers of the breast, gastrointestinal system, lung, gynecologic system, head and neck, and colon. Sixty percent of the people posting messages were cancer survivors; the remaining 40% were family or friends of survivors. The most frequent query themes were concerns about treatment, support, and long-term side effects of treatment. Individuals with cancer were significantly more likely to post messages about long-term side effects of treatment than family and friends. Message boards are a useful tool for sharing information with others who have similar experiences. Message board entry data also provide valuable information that can be used to refine the boards. Message boards have not been used traditionally in healthcare research but hold considerable promise as an information resource for people affected by cancer.