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Online health tools can play an important role in expanding patient participation among older cancer patients and older Turkish-Dutch and Moroccan-Dutch cancer patients. Nida Gizem Yılmaz discovered that the use of audiovisual information and multi-language eHealth tools offer a promising approach. On 30 October, she will defend her doctoral research at the University of Amsterdam.

image of a patient who undergoes medical treatment
(Still from animation produced by Behandeling Begrepen -‘Treatment Understood’- in association withWatch4Health)

Patient participation in western health care is an important core value. However, not all patients are capable of actively taking part in deciding on their treatment or in selecting a health-care institution. Older cancer patients are not always able to process complex information properly, because their cognitive and analytical reasoning skills have deteriorated with age. Furthermore, older cancer patients with a migration background often also have a language barrier in communicating with care providers.

eHealth interventions can be extremely useful in helping to overcome information processing problems and language barriers. In eHealth interventions, information can be provided in different ways using audiovisual aids, for instance, or accounts of other patients’ experiences in the patient’s native language. Health communication researcher Nida Gizem Yilmaz researched how effective online interventions are, or could be, and what adjustments need to be made to support patient participation among older patients and older migrant patients with inadequate Dutch language proficiency in oncological care.

Large amounts of text and a factual style

During the first part of her research, Yilmaz studied the effects of audiovisual and narrative information on information processing by older cancer patients and tested a number of online assistance options among various age groups. The information in assistance options is usually provided in text written in a factual style, which may make the information difficult to process. Yilmaz discovered that providing information in an audiovisual format had a positive effect on a number of outcomes. It reduced the uncertainty over choices, among other aspects. She found that the use of narratives has a positive effect on satisfaction with information but had less effect on cognitive information processing.

patient is talking with a doctor
(still from movieclip by Gökçe Sungur)

A different need for information than stereotypically believed

The second part of her research focused on older Turkish-Dutch and Moroccan-Dutch cancer patients' needs and preferences for health-related information and patient participation. It emerged during this part of her research that patients would like to receive more information than is currently the case on a large number of cancer-related topics, such as factual information on cancer, cancer treatment and health care, the possibilities of psychosocial assistance and affective doctor-patient communication.

‘There appears to be a discrepancy between the stereotypical image of patients from ethnic minority groups, in that they hardly ask any questions and are passive during consultations, and their actual preferences and needs for information and participation,’ says Yilmaz. She believes that this discrepancy is at least partially attributable to the language barrier between the doctor and the patient. ‘In order to meet the information and participation preferences and needs of older patients from ethnic minority groups and enable them to participate during the consultation, a logical first step is to focus eHealth interventions in this area on overcoming the language barrier.’

Audiovisual information in online selection tools is a promising approach

Yilmaz concludes that the use of audiovisual information in online selection tools offers a promising approach to improving information processing, and consequently patient participation, among older cancer patients. A multi-language eHealth tool, such as the oncological module Gesprekstarter (Conversation Starter), that can be integrated into the Health Communicator (a multi-language system that is used for communication between the care provider and the patient in numerous GP practices) could be used to further support patient participation among older patients with a migration background.

‘In terms of content, the Health Communicator should include options for obtaining information about cancer, cancer treatment and the Dutch health-care system, while also offering the possibility of receiving psychosocial support and creating a more affective bond with the care provider,’ says Yılmaz.

PhD details

Nida Gizem Yılmaz, ’Enhancing patient participation among older and migrant cancer patients through eHealth.’ Supervisors: Prof. Julia van Weert (UvA) and Prof. Danielle Timmermans (VUmc). Co-supervisors: Dr Olga Damman (Amsterdam UMC) and Dr Barbara Schouten (UvA). The research was funded by the Dutch Cancer Society.

Time and location of the defence ceremony

The defence ceremony will take place online on 30 October at 13:00. A livestream of the defence ceremony can be viewed at the indicated time on YouTube. The link will be deactivated and the livestream removed after the defence ceremony,

This study forms part of a line of research into the possibilities of eHealth in communicating with older cancer patients. The projects described in Gizem Yilmaz’s doctoral thesis were funded by the Dutch Cancer Society. The Health Communicator is a collaboration between the University of Amsterdam, Pharos and Nedtalk.