How Cancer Patients Use the Internet to Search for Health Information: A Scenario-Based Think Aloud Study (Preprint)

BACKGROUND Cancer patients increasingly use the internet to seek health information. However, thus far it is largely unknown how motives and emotions guide online health information seeking (OHIS) behavior, in consecutive phases of the cancer disease trajectory. Such insights can be used to support effective patient-doctor communication about OHIS and it can lead to better-designed online health platforms. OBJECTIVE Therefore, this study aims to explore patterns and motivations behind cancer patients' online information-seeking at different stages of their disease trajectory, as well as the cognitive and emotional responses evoked by OHIS. METHODS Employing a scenario-based online concurrent think aloud approach, 15 analogue patients were recruited, representing cancer patients, survivors, and informal caregivers. They were asked to search for online health information while prompted by an interviewer to verbalize their thoughts, imagining themselves in three scenarios: pre-diagnosis phase (n=5), treatment phase (n=5), and cancer survivor (n=5). Two researchers independently coded the sessions, categorizing the codes into broader themes to comprehend analogue patients' experiences during OHIS. RESULTS Overarching motives for OHIS included reducing uncertainty, seeking reassurance, and gaining empowerment. Analogue patients’ OHIS approaches varied from exploratory to focused, or a combination of both. They adapted their search strategy when faced with challenging cognitive or emotional content. OHIS triggered diverse emotions, fluctuating throughout the search. Complex, confrontational, and unexpected information mainly induced negative emotions. CONCLUSIONS This study provides valuable insights into cancer patients’ motivations underlying OHIS, and the emotions experienced at different stages of the disease trajectory. Understanding patients' search patterns is pivotal in optimizing online health platforms to cater to specific needs. Additionally, these findings can guide clinicians in accommodating patients’ specific needs and directing patients toward reliable sources of online health information.