Information sources and online information seeking behaviours of cancer patients in Singapore

1 Resea ch Published: 31/10/2018 Recei ed: 20/06/2018 ecance 2018, 12:880 h ps://doi.o g/10.3332/ecance .2018.880 Copy igh : © he au ho s; licensee ecance medicalscience. This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/3.0), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. In o ma ion sou ces and online in o ma ion seeking beha iou s o cance pa ien s in Singapo e Gek Phin Chua1, Hiang Khoon Tan2,3 and Mihi Gandhi4,5 1Pa ien and Family Educa ion Depa men , Na ional Cance Cen e Singapo e, 11 Hospi al D i e, Singapo e 169610, Singapo e 2Di ision o Communi y Ou each and Philan h opy, Na ional Cance Cen e Singapo e, 11 Hospi al D i e, Singapo e 169610, Singapo e 3Di ision o Su gical Oncology, Na ional Cance Cen e Singapo e, 11 Hospi al D i e, 11 Hospi al D i e, Singapo e 169610, Singapo e 4Depa men o Bios a is ics, Singapo e Clinical Resea ch Ins i u e, 31 Biopolis Way Nanos, #02-01, Singapo e 138669, Singapo e 5Tampe e Cen e o Child Heal h Resea ch, Uni e si y o Tampe e and Tampe e Uni e si y Hospi al, Teiskon ie 35, 33521 Tampe e, Finland Co espondence o: Gek Phin Chua. Email: [email p o ec ed] Abs ac The aim o his s udy was o in es iga e he p e alence o In e ne usage among cance pa ien s in seeking heal h- ela ed in o ma ion and he ype o in o ma ion sough . Sou ces o in o ma ion ecei ed om, p e e ences o in o ma ion sou ces and he pe cei ed use ulness o in o ma ion om hese sou ces we e also examined in his s udy. A sel -adminis e ed ques ionnai e was used o e alua e he in o ma ion needs o pa ien s unde going cance ea men . The ques ionnai e also e alua ed he cu en sou ce and p e e ed sou ce o in o ma ion as well as hei online in o ma ion seeking beha iou s. A o al o 411 pa ien s wi h cance we e ec ui ed om an ambula o y cance cen e. The pa ien s’ physicians and heal hca e specialis s comp ised a la ge majo i y o he pa ien s’ in o ma ion sou ces; hey we e also he mos p e e ed sou ce o in o ma ion. 59.1% o he esponden s used he In e ne o sea ch o cance - ela ed in o ma ion, namely diagnosis and ea men op ions, side e ec s o ea men and complemen a y and al e na i e he apy; demons a ing he impo ance o he abo e in o ma ion. Physicians (60.3%) and heal hca e specialis s (26.5%) we e he la ges and mos p e e ed sou ces o in o ma ion o cance pa ien s in ou s udy. I was no uncommon o cance pa ien s o use he In e ne o sea ch o addi ional in o ma ion demons a ing he need o in eg a e his ool mo e e ec i ely o knowledge ans e o hose pa ien s who wan i . I is impo an o heal hca e p o essionals o help cance pa ien s by di ec ing hem o sou ces o quali y in o ma ion (including websi es). In addi ion, he p o ision o guidelines on how o e alua e heal h in o ma ion on he In e ne would be help ul o cance pa ien s. Keywo ds: in o ma ion sou ces, p e e ed sou ces, use ulness, cance , oncology, In e ne Resea ch 2 www.ecance .o g ecance 2018, 12:880 Backg ound A diagnosis o cance is a e y auma ic e en and pa ien s need in o ma ion o help hem make ea men decisions and lea n coping skills, bo h physically and emo ionally. Good pa ien suppo in e ms o in o ma ion p o ision plays an impo an ole in alle ia ing hei anxi- e y and s ess and can acili a e hei decision making and enhance hei coping skills and psychological well-being [1–3]. Howe e , he ype and amoun o in o ma ion wan ed a ies amongs indi iduals and can be in luenced by he ype o cance , s age o disease, ea men , age, sex, cul u al and educa ional backg ound [4, 5]. Pa ien s wi h cance a e also becoming ac i e pa icipan s in hei own ca e and in o ma ion seeking has been demons a ed o play a c i ical ole in helping pa ien s cope wi h he unce ain ies associa ed wi h a diagnosis o cance and i s concu en ea men [6, 7]. S udies ha e indica ed ha pa ien s end o use a combina ion o in o ma ion sou ces and ha age, gende , educa ion [7–12] and social economic s a us [8, 12–15] as well as s age o cance a diagnosis, and hei ole in decision-making [2, 16] can in luence pa ien s’ in o ma ion seeking beha iou . Heal hca e p o essionals such as physicians, nu ses, adia ion s a and pha macis s [17–19], p in in o ma ion [2], o he s wi h simila illnesses [17] and websi es [20–22] a e he p e e ed sou ces o in o ma ion. The apid g ow h o in o ma ion echnologies has also led o he p oli e a ion o in o ma ion a ailable ia he In e ne and i ollows na u ally ha an inc easing numbe o pa ien s a e using he In e ne o access heal h in o ma ion [10, 14, 20, 22–25]. In Ha oonian e al’ [20] s udy, i was es ablished ha he In e ne was he mos p e e ed sou ce o ob aining in o ma ion, wi h wice as many su i o s p e e ing he In e ne o hei heal hca e p o ide s. Howe e , o he indings indica ed ha heal hca e p o essionals we e he mos p e e ed sou ce o ob aining in o ma ion [2, 7–9, 13, 17–19, 26]. In Singapo e, he In e ne is widely accessible as 91% o household ha e In e ne access and 84% o indi iduals a e In e ne use s [27]. The In e ne may be a use ul sou ce o supplemen in o ma ion acquisi ion; howe e , i s use is no wi hou isk. The huge olume o in o - ma ion a ailable on he In e ne may o e whelm and con use pa ien s [8, 12, 25, 28–30]. I may also impa misleading and inaccu a e in o ma ion, especially om sou ces ou side heal h ca e se ings [12, 23, 28, 30]. Gi en subs an ial e idence o he impo ance o in o ma- ion in helping cance pa ien s wi h decision making [2, 3, 31] and coping [31] wi h hei illness, an unde s anding o pa ien s’ sou ces o in o ma ion and hei p e e ence o hese sou ces a e needed. Al hough esea che s ha e explo ed he in o ma ion seeking beha iou s o cance pa ien s including hei p e e ed sou ces o ob ain in o ma ion, he e a e, howe e , con lic ing indings and as such may no be applicable o he se ings in Singapo e. Fu he mo e, he e is no epo ed s udy done in he local se ing on he in o ma ion sou ces and p e e ed sou ces among cance pa ien s. Knowledge o his is impo an o help ensu e he deli e y o quali y cance ca e by add essing pa ien s’ in o ma ion needs h ough p e e ed sou ces as well as di ec ing hem o sou ces o quali y in o ma ion. In his s udy, we examine he p e alence o In e ne use in seeking heal h- ela ed in o ma ion and he ype o in o ma ion sough by pa ien s unde going ea men o cance . We also s udy he sou ces o in o ma ion p o ision, he p e e ed sou ces and he pe cei ed use ulness o in o ma ion om hese sou ces by hese pa ien s. Ou goal is o ad ance he unde s anding o he p e e ed in o ma ion sou ces and he p e alence o In e ne use o acili a e he p o ision o pa ien -cen ed s a egies o be e mee he in o ma ion needs o pa ien s du ing cance ea men . Me hods S udy conduc and analysis All eligible pa ien s [(1) diagnosed wi h cance and ecei ing ea men ; (2) able o unde s and and communica e in English/Manda in and (3) 21 yea s and abo e] a ending he ambula o y ea men uni o he Na ional Cance Cen e Singapo e du ing he 5-mon h pe iod om 2015 o 2016 we e in i ed o comple e a 76-i em su ey. This su ey was designed o e alua e sel - epo ed in o ma ion needs and le el o sa is ac ion wi h he in o ma ion ecei ed while unde going cance ea men ; a sec ion o he su ey (36 i ems) was designed o assess he p e alence o In e ne use in seeking cance - ela ed in o ma ion and hei sou ces and p e e ed sou ces o in o ma ion. The ques ion- nai e was pilo es ed on 11 cance pa ien s and subsequen ly used wi hou modi ica ion on ano he 411 pa ien s. Da a we e collec ed by a esea ch assis an who was p o icien in bo h English and Chinese and was ho oughly b ie ed by he P incipal In es iga o ega ding he Resea ch 3 www.ecance .o g ecance 2018, 12:880 da a collec ion p ocess including sampling and con iden iali y. Consen ing pa ien s we e asked o sel -adminis e he Need Assessmen Ques ionnai e in a language o hei p e e ence (ei he English o Chinese). Demog aphics o esponden s we e also collec ed such as ace, le el o educa ion, ype o diagnosis and ea men ecei ed. Sou ces o in o ma ion we e p esen ed using equency dis ibu ion. Associa ion be ween he use o online sea ch o ecei e he in o ma ion and demog aphic cha ac e is ics we e assessed using he Fishe ’s exac es . A P- alue less han 0.05 was conside ed s a is ically signi ican . This s udy was app o ed by he Cen alized Ins i u ional Re iew Boa d o he Singapo e Heal h Se ices. Resul s Response a e and cha ac e is ics o esponden s The majo i y o he 411 pa ien s pa icipa ing in he s udy we e Chinese; almos wo- hi ds o he esponden s we e emale, had a leas seconda y educa ion and we e newly diagnosed. Table 1 p esen s he demog aphics and he disease s a us o he ull s udy pa icipan s. Table 1. Cha ac e is ics o su ey esponden s. Cha ac e is ics, n (%) N = 411 Sex Male 153 (37.0) Female 259 (63.0) Age (yea s) 21–40 45 (10.9) 41–60 223 (54.3) 60 and abo e 142 (34.5) Unknown 1 E hnici y Chinese 317 (77.1) Malay 46 (11.2) Indian 20 (4.9) O he s 27 (6.6) Unknown 1 Highes le el o educa ion P ima y o less 81 (19.7) Seconda y/Highe Seconda y 213 (51.8) Te ia y 109 (26.5) Unknown 8 Type o ea men (n = 411) Su ge y 248 (60.3) Radia ion he apy 118 (28.7) Chemo he apy 404 (98.3) Ho monal he apy 45 (10.9) Clinical ials 62 (15.1) Resea ch 4 www.ecance .o g ecance 2018, 12:880 Table 1. Con inued Cance ype B eas 115 (28.0) Colon/ ec al 60 (14.6) Lung 52 (12.6) O he s 171 (41.6) Unknown 39 Disease s a us Newly diagnosed 304 (74.0) Recu en 98 (23.8) Unknown 9 Figu e 1. Sou ce o in o ma ion ecei ed. Sou ces o in o ma ion and p e e ences Doc o s, heal hca e specialis s (e.g. nu ses, pha macis and adia ion he apis ), p in ma e ial (e.g. pamphle s and b ochu es) om he ins i u ion and amily/ iends we e he mos common sou ces o in o ma ion (Figu e 1). When esponden s we e asked o hei p e e ence among a selec ion o sou ces, doc o s we e he mos p e e ed, ollowed by heal hca e specialis s and p in ma e ial (Figu e 2). Ob aining in o ma ion om websi es was p e e ed o e ob aining i om amily and iends, and heal h apps we e p e e ed o e common in o ma ion deli e y sys ems such as o he s wi h simila illnesses, cance helplines and ideos (Figu e 2). Use ulness o sou ce o in o ma ion ecei ed When asked o a e he use ulness o he in o ma ion ecei ed, esponden s a ed in o ma ion om doc o s and heal hca e specialis as he mos use ul, ollowed by hose om amily/ iends (Figu e 3). Al hough p in in o ma ion anked hi d as he p e e ed sou ce o in o ma ion (Figu e 2), i was anked ou h in e m o use ulness (Figu e 3). Resea ch 5 www.ecance .o g ecance 2018, 12:880 Figu e 2. P e e ence o sou ce o in o ma ion o ecei e. Figu e 3. Use ulness o sou ce o in o ma ion ecei ed a he Na ional Cance Cen e Singapo e. In e ne use The s udy e ealed ha he In e ne was ano he esou ce ha cance pa ien s sough in o ma ion om o e he pas yea . Mo e han hal o he esponden s had used he In e ne o ind in o ma ion, wi h cance diagnosis and ea men op ions being he mos sough a e (90%), ollowed by possible side e ec s o ea men (87%) and complemen a y and al e na i e he apy (70%). Only 43% used he In e ne o ind suppo i e esou ces and less han hal (47%) disag eed ha he in o ma ion was ha d o unde s and (Table 2). Younge pa ien s, hose o a highe educa ion s anda d and emale pa ien s we e ound o be mo e likely o sea ch o in o ma ion online (Table 3). Resea ch 6 www.ecance .o g ecance 2018, 12:880 Table 2. Usage o In e ne in he pas yea o ind in o ma ion ela ed o he disease. Ca ego y, n (%) All pa ien s (N = 411) Usage o In e ne Ne e 162 (39.4) Ra ely 35 (8.5) Some imes 106 (25.3) O en 104 (25.3) Unknown 4 In o ma ion sea ched* n = 245 Cance diagnosis and ea men op ions 221 (90.2) Possible side e ec s o you ea men 213 (86.9) Complemen a y and al e na i e he apy 172 (70.2) Suppo i e esou ces 105 (42.9) In o ma ion ob ained online ha d o unde s and?* S ongly ag ee 2 (0.8) Ag ee 35 (14.3) Neu al 91 (37.1) Disag ee 94 (38.4) S ongly disag ee 20 (8.2) *Pe cen ages a e based on pa ien s who ha e used he In e ne in he pas yea (n = 245) Table 3. Associa ion be ween demog aphic cha ac e is ics and online in o ma ion sea ch. Cha ac e is ics, n (%) NOnline in o ma ion sea ch Yes (Some imes, O en) No (Ne e , Ra ely) P- alue Age < 0.001 21–40 yea s 45 35 (77.8) 10 (22.2) 41–60 yea s 220 136 (61.8) 84 (38.2) > 60 yea s 141 39 (27.7) 102 (72.3) Sex 0.024 Male 150 66 (44.0) 84 (56.0) Female 257 144 (56.0) 113 (44.0) Educa ion le el < 0.001 P ima y o less 80 14 (17.5) 66 (82.5) Seconda y/highe seconda y 210 109 (51.9) 101 (48.1) Te ia y o highe 109 83 (76.1) 26 (23.9) Discussion In o ma ion sou ce and p e e ed sou ce o in o ma ion and use ulness o in o ma ion ecei ed om a ious sou ces Pa ien s in ou s udy indica ed ha he op h ee p e e ed sou ces o cance in o ma ion a e a doc o , a heal hca e specialis and p in ma e ial, espec i ely. The inding ha doc o s and heal hca e specialis s a e p e e ed in o ma ion sou ces emphasises he c ucial ole ha Resea ch 7 www.ecance .o g ecance 2018, 12:880 hey play in mee ing pa ien s’ in o ma ion needs. This pa e n o in o ma ion use and p e e ence is o be expec ed as pa ien s pe cei ed hese p o essionals o possess he expe knowledge and p in ma e ial om heal hca e ins i u ions o be mo e eliable. Ou indings sup- po hose o p e ious s udies [2, 7–9, 13, 17–19, 31]. A s udy by Shea-Budgell e al [7] ound heal hca e p o essionals (84%) o be he mos p e e ed sou ce o in o ma ion, ollowed by pe sonalised eading ma e ial (75%). Heal h ca e p o essionals we e also ound o be he mos us ed sou ce o cance in o ma ion, including pe sonalised w i en in o ma ion om hei heal hca e p o ide . Hesse e al’ s udy [9] also e ealed physicians o be he mos highly us ed in o ma ion sou ce o pa ien s (wi h 62% o adul s exp essing a lo o us in hei physicians). Howe e , almos hal (49%) o he pa ien s in ha s udy epo ed going online o in o ma ion i s , wi h only 11% going o hei physicians i s . This demons a es he desi e o apid access o in o ma ion among cance pa ien s. The p e e ence o ob ain in o ma ion om doc o s and heal hca e specialis s in ou s udy may a ise om he pe cei ed use ulness o in o ma ion om hese sou ces. The in o ma ion gi en by he doc o s and heal hca e p o essionals we e a ed as use ul o e y use ul by 90% and 83% o he pa ien s in ou s udy, espec i ely. The pe cei ed use ulness o amily and iends as in o ma ion sou ces (66%) in ou s udy indica es ha amily and iends play an impo an ole when dealing wi h a complex disease, especially when he pa ien ’s abili y o p ocess and comp ehend in o ma ion may be impai ed due o he s ess o illness [13]. This is e idenced by he indings ha pa ien o a lowe educa ion le el (p ima y o lowe ) is mo e likely o ecei e in o ma ion om amily and iends compa ed o hose o a highe educa- ion le el (seconda y and highe ). Ou s udy also ound ha he le el o educa ion is no associa ed wi h he usage o p in in o ma ion which may in e ha he le el a which he in o ma ion is w i en in such ma e ial app op ia ely mee s hei needs o ha hei in o ma ion needs a e being me by hei amily and iends (Table 4). Online in o ma ion seeking beha iou and unde s anding heal h in o ma ion The complexi y o cance in o ma ion, as well as he challenge in making ea men decisions, may compel pa ien s o seek an al e na i e sou ce o in o ma ion. Responses in ou s udy indica ed ha sligh ly mo e han hal o he esponden s used he In e ne and ha hal o hese In e ne use s used i equen ly o seek cance in o ma ion du ing he pas 1 yea . The majo i y o pa ien s used he In e ne o seek in o ma ion on cance diagnosis and ea men op ions, possible side e ec s o ea men and complemen a y and al e na i e he apy, demons a ing he impo ance o he abo e in o ma ion. In a sys ema ic e iew o 112 a icles, Ru en e al [13] es ablished ha he mos equen in o ma ion need was ea men - ela ed (38%) and ha du ing diagnosis and ea men , in o ma ion needs abou he s age o dis- ease, ea men op ions and side-e ec s o ea men we e p ominen . O he s udies also suppo ed hese indings [3, 16, 18, 32]. Table 4. Associa ion be ween demog aphic cha ac e is ics and cu en and p e e ed sou ce o in o ma ion Cha ac e is ics, n (%) NDoc o s Heal hca e specialis W i en ma e ial Family o iends Cu en P e e ed Cu en P e e ed Cu en P e e ed Cu en P e e ed Age 21–40 yea s 45 44 (97.8) 42 (93.3) 27 (60.0) 26 (57.8) 18 (40.0) 15 (33.3) 18 (40.0) 7 (15.6) 41–60 yea s 223 210 (94.2) 200 (89.7) 114 (51.1) 118 (52.9) 69 (30.9) 82 (36.8) 62 (27.8) 40 (17.9) > 60 yea s 142 136 (95.8) 128 (90.1) 68 (47.9) 57 (40.1) 30 (21.1) 28 (19.7) 38 (26.8) 32 (22.5) P- alue o associa ion 0.672 0.860 0.360 0.027 0.024 0.002 0.210 0.452 Sex Male 152 144 (94.7) 133 (87.5) 63 (41.4) 64 (42.1) 32 (21.1) 37 (24.3) 36 (23.7) 22 (14.5) Female 259 247 (95.7) 238 (91.9) 146 (56.4) 138 (53.3) 85 (32.8) 88 (34.0) 83 (32.0) 58 (22.4) P- alue o associa ion 0.814 0.169 0.004 0.032 0.013 0.046 0.073 0.054 Educa ion le el P ima y o less 81 77 (95.1) 68 (84.0) 49 (60.5) 41 (50.6) 21 (25.9) 16 (19.8) 33 (40.7) 29 (35.8) Seconda y/highe seconda y 213 201 (94.4) 192 (90.1) 97 (45.5) 94 (44.1) 56 (26.3) 56 (26.3) 55 (25.8) 31 (14.6) Te ia y o highe 109 105 (96.3) 103 (94.5) 58 (53.2) 63 (57.8) 36 (33.0) 50 (45.9) 27 (24.8) 17 (15.6) P- alue o associa ion 0.786 0.057 0.058 0.065 0.404 < 0.001 0.028 < 0.001 Resea ch 8 www.ecance .o g ecance 2018, 12:880 Ou s udy also indica ed ha bo h younge pa ien s (who end o be be e educa ed) as well as emale pa ien s a e mo e likely o go online o sea ch o cance in o ma ion. This inding is simila o p e ious wo k [8, 9, 14]. In Maye e al’ s udy [8], he esea che s ound ha pa ien s wi h cance who use he In e ne as a main sou ce o in o ma ion we e ypically women, unde he age o 65 and wi h a highe le el o income. Thei s udy also e ealed ha he mos equen ly ci ed easons o seeking cance in o ma ion on he In e ne we e con- enience, mo e a ailable in o ma ion and immediacy o access. Dec easing age and ha ing a highe educa ion le el we e also ound o be associa ed wi h pa ien s wan ing o play an ac i e ole in medical decision making [33]. The In e ne has emendous po en ial o empowe pa ien s and suppo hei abili y o make in o med heal h- ela ed decisions. Howe e , in o ma ion om he In e ne is o highly a iable quali y and no necessa ily easy o comp ehend [8, 12, 23, 25, 28–30]. The lack o egula o y o e sigh on he pos ing o medical and heal h in o ma ion on he In e ne hus poses inhe en isks. Some in o ma ion may no be de eloped by heal hca e p o essionals, e idence-based o sys ema ically e iewed and as such, may be incomple e, inaccu a e, inapp op ia e o e oneous [12, 23, 30]. Ano he isk is he esou ces ecommended may be comme cially d i en and o e expensi e solu ions ha would no o he wise be ecommended by heal hca e p o essionals. These can po en ially lead o misin o med and dis- essed pa ien s and an inc eased endency owa d sel -diagnosis o sel - ea men [23] o engaged in a beha iou coun e o hei heal h ca e needs [20, 28]. Fu he mo e, quali y heal h in o ma ion is ine ec i e i i is p esen ed in such a way as o ende i incomp ehensible o he consume . O he 245 esponden s who used he In e ne in he pas yea , only 114 (46.6%) o he In e ne use s in ou s udy ound such in o ma ion o be easily comp ehensible. The isks o un eliable and unclea in o ma ion om he In e ne a e suppo ed by o he s udies [23, 28, 34]. In Hel e al’ [34] s udy, he esea che s ound ha 54% o oncologis s conside ed he In e ne o ha e a nega i e e ec on hei pa ien s and he pa ien –physician ela ionship as a esul o inc eased con usion. Howe e , hei indings on pa ien –physician ela ionship con adic ed wi h o he s udies [35–37]. Published s udies indica e ha only a small p opo ion o pa ien s discussed in o ma ion ob ained om he In e ne wi h hei heal hca e p o ide s [7, 10, 30, 34]. Ba ie s o discussion o online in o ma ion we e conce ns abou emba assmen , conce ns ha he doc o doesn’ wan o hea abou i , belie e ha he e is no need o b ing i up, o ge ing o b ing i up [30], ea o being pe cei ed as challenging o con on ing hei physician [25, 29, 35, 38, 39], espec ed doc o s’ au ho i y and no used o ask ques ions o doc o s [39], and lack o ime o eluc ance o in e e e wi h he consul a ion p ocess [25, 29]. Facili a o s o communica ion included ha ing a amily membe p esen a doc o ’s isi [30], doc o -ini ia ed inqui ies [30, 40] and encoun e ing an ad e isemen ha sugges ed alking wi h a doc o [30]. Al hough he e ec o in o ma ion ob ained om he In e ne on he pa ien –physician ela ionship is deba able [34–37], he e is e idence ha he In e ne may ad e sely a ec he decisions made by pa ien s wi h cance [29, 34]. I is he e o e impo an o heal hca e p o essionals o encou age pa ien s o discuss hei In e ne in o ma ion sea ches and help pa ien s by di ec ing hem o sou ces o quali y in o ma ion on he In e ne . In addi ion, guidelines on how o e alua e heal h in o ma ion on he In e ne would be help ul o cance pa ien s. Al hough doc o s and heal hca e specialis s a e consis en ly ci ed as impo an sou ces o heal h in o ma ion, con inued e alua ion o he sou ces om which cance pa ien s seek in o ma ion is necessa y. This is due o he cons an e olu ion o in o ma ion echnology as well as iden i ying hei p e e ences on how in o ma ion is o be deli e ed will enable deli e y sys ems ha would bes ma ch hei needs. This is also impo an as ou s udy also e ealed ha esponden s also p e e ed o ecei e in o ma ion om websi es and heal h apps in place o o he common o ms o in o ma ion deli e y sys ems such as cance su i o s, cance helplines and ideos. P o iding pa ien s wi h us ed in o ma ion sou ces ha ma ch hei in o ma ional needs may assis pa ien s wi h eco e y [10]. Limi a ions The e a e se e al limi a ions inhe en in his s udy. Fi s , he esul s we e ob ained om a sample o pa ien s ea ed in only one ins i u ion (Na ional Cance Cen e Singapo e). I is unclea whe he he esul s a e gene alisable o o he pa ien popula ions and o he heal hca e se ings in a di e en coun y. Fu he mo e, his epo is a pa o a la ge s udy, and ac o s ha may p eclude a mo e comple e analysis ha e no been included. These include, bu a e no limi ed o, he le el o us in he heal hca e sou ces and he easons o going o no going online o in o ma ion. Ne e heless, he s udy p o ides use ul baseline in o ma ion o aid in he be e deli e y o heal hca e in o ma- ion o cance pa ien s. Resea ch 9 www.ecance .o g ecance 2018, 12:880 Conclusions Cance pa ien s need in o ma ion o help hem make ea men decisions and o cope wi h hei physical and psychological needs. Ou s udy indica es ha he mos p e e ed sou ces o in o ma ion a e om doc o s, heal hca e specialis s and p in ma e ial. I demons a es he c ucial ole ha physicians, heal hca e specialis s and p in ma e ial play in mee ing pa ien s’ in o ma ion needs. The p e e ence o ecei e in o ma ion om hese sou ces may ha e a isen om he pe cei ed use ulness o in o ma ion om hese sou ces. Mo e han hal o he esponden s, howe e , also used he In e ne o seek in o ma ion on cance diagnosis and ea men op ions, possible side e ec s o ea men and complemen a y and al e na i e he apy. Age, gende and educa ion a e p edic o s o online in o ma ion sea ch. To ou knowledge, he p esen s udy is he i s o examine he in o ma ion seeking beha iou o cance pa ien s unde going ea men in Singapo e (wi h ega d o he in o ma ion sou ces consul ed, he p e e ences o hese sou ces and he pe cei ed use ulness o in o ma ion om hese sou ces). P ac ice implica ions P o iding cance pa ien s wi h quali y in o ma ion in o de o hem o make in o med decisions and o enhance hei coping skills is one o he aspec s o pa ien -cen ed ca e. Howe e , his can be ex emely challenging du ing ypical consul a ions o ea men sessions. As such, a mul ip onged app oach wi h ega d o in o ma ion deli e y based on iden i ied p e e ences could be an e ec i e s a egy. As he p in ma e ial was ound o be ano he sou ce ha he pa ien s p e e , his could be an e ec i e supplemen a y sou ce o in o ma- ion deli e y. Pa ien s a e also using he In e ne o sea ch o cance in o ma ion and hei p e e ence o use heal h apps in place o o he common o ms o in o ma ion deli e y sys em emphasise he need o heal hca e p o essionals o emb ace hese ools o enhance in o ma ion deli e y. S a egies o mi iga e he isks o e oneous o con lic ing in o ma ion ha may be ound online could include p o id- ing pa ien s wi h a lis o us ed in o ma ion sou ces ha ma ch hei in o ma ion needs and es ablishing guidelines on how o e alua e heal h in o ma ion om he In e ne . Iden i ying and con inuing e alua ion o he sou ces om which cance pa ien s seek in o ma ion and hei usage o hese sou ces, and ype o in o ma ion sough , is necessa y o ensu e he in o ma ion and he mode o deli e y bes ma ches hei needs. Acknowledgmen The au ho s hank he pa ien s who pa icipa ed in his s udy and he 15 oncology nu se specialis s who con ibu ed o he s udy. App ecia- ion is ex ended o D Ng Heok Hee o his in aluable con ibu ions. Con lic s o in e es The au ho s ha e no inancial con lic s o in e es o decla e. Funding This esea ch was made possible by a g an om he Communi y Cance Fund [COMCF-YR2015-MAY-NS1].