An Overview of Possibilities and Challenges of Patient-Focused EHealth in Fertility Care



Annemijn Aarts*, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
Pieter Van Den Haak, MijnZorgnet.nl, Nijmegen, Netherlands
Willianne Nelen, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
Marjan Faber*, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
Jan Kremer, Radboud University Nijmegen Medical Center / MijnZorgnet.nl, Nijmegen, Netherlands


Track: Research
Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues
Presentation Type: Oral presentation
Submission Type: Single Presentation

Building: MECC
Room: 0.8 Rome
Date: 2010-11-29 04:45 PM – 06:15 PM
Last modified: 2010-09-22
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Abstract


Background
The Internet is revolutionizing healthcare. Defined as eHealth, it can provide a toolset for patients to deal with health issues by offering medical information and facilitating peer-to-peer interaction via support groups and virtual communities. Using these Internet-driven possibilities patients become co-producers of their own healthcare. On a higher level, it may improve patient centredness, as one of the core dimensions of quality of care.
Although an increasing amount of research is performed, eHealth is not fully integrated into clinical practice yet and solid evidence is needed. Unfortunately, effects are not consistently demonstrated and best practice of evaluating eHealth is still under debate.
With 80 million people worldwide affected by fertility problems, these relatively young and highly educated patients are, by their demographic profile, an ideal Internet population. As the emotional impact of being infertile is high, the Internet has become an increasingly popular source of support and information for infertility.

Objective
The ‘perfect match’ between the World Wide Web and infertile couples makes it a suitable population to shed some light on the current state of eHealth research and the methodological challenges researchers are confronted with.

Methods
A systematic search on current literature was conducted to identify studies on patient-focused Internet applications in fertility care published up to February 2010. Several databases were searched using synonyms of “eHealth” combined with “Infertility”. We selected a study if it included men and/or women facing infertility using a patient-focused fertility-related Internet applications in studies with at least an observational study design, written in Dutch or English.

Results
We included 27 studies in this review and structured these into four categories: 1) Patients’ reasons to use the Internet concerning health issues, 2) Quality of fertility-related information on the Internet, 3) Patient’s use of eHealth applications, and 4) Impact of eHealth on patients. The eHealth applications that were studied comprised a personal health record, online support groups, a decision-aid on fertility issues for men with cancer, an expert forum and web-based psycho-educational treatment. Nearly all were highly appreciated and used by patients. Patients’ behavior and topics discussed online related to psychological, physical and social aspects of being infertile. Studies demonstrated no effects on patient-related outcomes, such as knowledge and anxiety, except one study.

Conclusions
The match between fertility care and the Internet has not been remained unnoticed, as research groups developed and studied a variety of Internet applications. Based on the patient’s use of eHealth, the present study shows that it might fill a gap between the patient’s needs and the support that a clinic can offer. This may help patients getting more empowered, but may also provide health care professionals tools to deliver patient-centred care. However, the lack of a sound impact on several patient-related outcome measures does not support these advantages of eHealth. This could be due to methodological shortcomings within these studies. As an attempt to bridge the gap between evidence-based medicine and eHealth, we provide some recommendations for future research based on our findings within this ‘ideal’ Internet population.




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