Association of online health information seeking behavior with levels of knowledge about palliative care among older adults

Palliative care is a specialized type of care for people and their families facing serious or life-threatening illnesses which could be physical, psychosocial, or spiritual.1 An estimated 40 million people are in need of palliative care worldwide which is expected to grow due to the aging of populations and the burden of comorbidity.1 In the Unites States (US), approximately 85% of older adults have at least one chronic disease, and 60% of them have at least two chronic conditions.2 Older adults in the United States with a serious illness frequently report inadequate symptoms control and poor quality of life.3 Palliative care interventions significantly reduced the rate of acute health care use and lowered symptom burden.4 Although the benefits of palliative care are well-documented, palliative care is still underutilized by older adults who would benefit from palliative care interventions.5,6 Lack of knowledge and misconceptions about palliative care are barriers to palliative care utilization.6, 7, 8, 9 Among US adults, more than two-thirds reported that they had never heard of palliative care, and many of them misbelieved that palliative care was the same as hospice.10,11 To promote palliative care utilization among older adults, we must have a better understanding of their knowledge level, attitudes and beliefs towards palliative care, and barriers to accepting palliative care.

The internet has been gradually adopted by the older people and become a preferred source of health information over the past decades due to its access convenience, real-time interaction, affordability of access, interactivity, and anonymity.12,13 Adjei Boakye et al.11 reported that the internet was the second most trusted source to obtain palliative care information for general population next to healthcare providers. In the US, only 34% of older adults (≥65 years old) were confident to obtain health information through the internet in 2008 which was slightly increased to 40% in 2017.14 However, the internet was a preferred source of health information and a medium for patient empowerment among older people who used the internet.13 Online health information seeking behavior enables patients to participate in their own medical care and improves patient compliance and outcomes through education on disease processes and treatments, as well as the patient-provider relationship.15, 16, 17 It was also found that older individuals who used the internet to seek health-related information reported decreased anxiety levels about health-related issues and experienced improved outcomes with respect to their knowledge of health issues and proper use of health services.18,19 It is unclear whether online health information seeking behavior would be associated with the knowledge level of palliative care among older adults.

According to Roger's Diffusion of Innovation Theory,20 the internet as an innovative source of health information has been successfully adopted and adapted by older adults. Therefore, we hypothesized that older adults who reported online health information seeking behavior would be more knowledgeable about palliative care than those who did not use the internet as a source of health information. Overall, the purposes of this study were 1) to examine the level of knowledge about palliative care among US older adults; and 2) to test our hypothesis that online health information seeking behavior would be positively associated with the level of knowledge about palliative care among American older adults.

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