A mixed methods systematic review of the effects of patient online self-diagnosing in the ‘smart-phone society’ on the healthcare professional-patient relationship and medical authority

Problem

As technology continues to advance, the internet is becoming increasingly popular and it is becoming a commonplace for patients to self-diagnose and seek health information online. It is important to understand the influence this may have on the patient-healthcare professional relationship in primary care.

Approach

A mixed-method systematic review of quantitative, qualitative and mixed method studies, concerning the public and healthcare professionals’ perceptions of online self-diagnosis and health information seeking, and how this can impact the patient-healthcare professional relationship, was undertaken. The systematic literature search was conducted using five databases: MEDLINE, EMBASE, CINAHL, SCOPUS and ACM. The search terms, among others, included ‘information seeking behaviour’, ‘online self-diagnosis’, ‘internet’ and ‘professional-patient relations’. Relevant data were extracted, and quality appraised using the mixed methods appraisal tool. A thematic analysis was conducted. The review addressed the following research questions: 1. What are the effects of patients seeking online health information on the healthcare professional-patient relationship and medical authority?2. How do healthcare professionals perceive patients use of online health information?3. How do public/patients perceive the use of online health information?

Findings

We identified 6107 papers and 28 articles (16 qualitative, 11 quantitative and 1 mixed methods study), met the inclusion criteria for the review. The findings indicated that patients found the internet to be a complementary information source alongside healthcare professionals, as well as a means for self-diagnosis. Patients used the internet to reduce uncertainty, often because they had not fully understood everything said in consultations. Several studies found the most common time to access the internet for health information was after a medical consultation. People also feel responsible for their own health and thus see online self-diagnosis and health information seeking as fulfilling a basic need in an easily accessible manner. Healthcare professionals had mixed reviews regarding patient’s online health information seeking but generally agreed on the importance of collaboration with patients, though they struggled to find the time to do this efficiently. Patients tended to present information to the healthcare professional to support the therapeutic relationship rather than to challenge it. Most patients hoped the outcome of presenting with online health information would help support the development of a partnership with their healthcare professional and becoming more involved in their decision-making.

Consequences

Overall, most patients found healthcare professionals to be the most valued source of health information and typically found the internet to be a useful complementary tool. The internet has the potential to be beneficial if the online health information being sought, is accurate and relevant and healthcare professionals react in a positive and supportive manner to internet-informed patients. These findings can inform recommendations for practice, professional development and further research.