Purpose: Cancer is a complex disease for which often multiple treatment options exist, and patients, armed with medical information, have become active participants in their treatment decision making. Since cancer is associated with mortality, morbidity, stress, and costs, patients desire concrete answers related to benefits and harms of a cancer treatment(s). However, it is not known how oncologists cope with patients’ request for such information. Therefore, the goals of this pilot project were to assess the information seeking behavior of oncologists regarding answering patients’ specific questions related to the benefits and harms of cancer treatments, and to discern how medical oncologists judged the scientific reliability of the accessed resources.
Methods: Qualitative, semi-structured, in-depth interviews were conducted with 31 oncologists at an NCI cancer center in the United States. Stratified random purposive sampling was used for participant selection. Data were analyzed for key themes using the constant comparative method and grounded theory.
Results: The majority of oncologists used the Internet as a primary source to find information on benefits and harms of cancer treatments. In particular, PubMed and Up-to-date were accessed most often, followed by oncology association websites (ASCO, NCCN etc.) and Google. A small number of oncologists relied on peers and experts in the field. Textbooks were rarely used. The majority of oncologists judged scientific reliability of obtained information according to the reputation of the author, journal or website. Few judged reliability based on the sample size, or data analysis methods or by publication date. A small minority determined reliability by study design or methodological quality. Almost all the participants did not indicate considering a hierarchy of evidence in determining scientific reliability. None of the oncologists reported receiving formal training in performing a systematic literature search. The majority also reported being dissatisfied with their current search process, and reported time constraints as a significant barrier in searching for reliable information.
Conclusions: To our knowledge, this is the first qualitative study on information seeking behavior of oncologists specifically in regards to benefits and harms of cancer treatments. Results show medical oncologists lack knowledge and familiarity with the basic skills of literature searching and critical appraisal. The findings show urgency for creating awareness among oncologists about Evidence Based Medicine issues and imparting skills for the same.
Candidate for the Lee B. Lusted Student Prize Competition