Viewing cancer misinformation on social media negatively influenced patients’ decisions and adversely affected their mental health, according to a new study published in the journal Cancer. While online social networks can be useful resources for cancer patients, they’re also scattered with potentially dangerous misinformation.
Researchers at Huntsman Cancer Institute at the University of Utah (U of U) created a resource for scientists that lays the foundation for building clinical and patient-friendly tools called the Online Cancer Nutrition Misinformation (ONC-M). The tool tracks and organizes cancer misinformation that comes from social media.
Echo Warner, PhD, MPH, researcher at Huntsman Cancer Institute and assistant professor of nursing at the U of U, asked patients and caregivers how they used social media during their cancer experiences. “The benefits of their social media use were mired by exposure to cancer misinformation. They were met with misinformation from many sources, all the way from well-intentioned friends and family to shadow scams selling ‘cancer cures’ to the highest bidder,” Warner says.
ONC-M provides a way for researchers to document how exposure to health misinformation online influences patients and caregivers.
“It’s the first framework to document the process by which exposure to health misinformation online influences patient and caregiver health behaviors and health outcomes,” says Warner. “Before now, the lack of a clear conceptual process, and the factors that influence that process, has been a major roadblock in the study of online health misinformation.”
The ONC-M describes how cancer misinformation is organized, and also creates potential pathways linking misinformation exposure, health behaviors, and cancer health outcomes. Researchers identified several primary cancer misinformation categories and factors that associate with each type of claim. Researchers found untrue claims about cancer prevention, treatment, and cures. These claims were backed by false disclaimers, anecdotes, and misinterpreted scientific articles.
“While still somewhat early in refinement, ONC-M has broad applicability and likely extends beyond cancer-related misinformation to other health domains as well,” says Warner. “We plan to test each part of the framework and study new ways of using technology to measure how much cancer patients are exposed to misinformation online.”
Warner recommends discussing any treatment or therapy questions with healthcare providers. Patients can also use an information quality tool to help identify potential biases, financial incentives, and misleading content about cancer treatments or therapies. One example is the CRAAP test.
The study was supported by the National Institutes of Health/National Cancer Institute including P30 CA042014, the University of Arizona Cancer Center Cancer Health Disparities Training Program (T32CA078447), University of Arizona College of Nursing Eleanor Bauwens’s Research Award, University of Arizona Postdoctoral Research Development Grant, the U.S. Department of Agriculture, Agricultural Research Service under Cooperative Agreement No. 58-3092-0-001, the MD Anderson Cancer Center Support Grant (P30CA16672), the Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute, and Huntsman Cancer Foundation. Key collaborators included Margaret Raber Ramsey, DrPH, Baylor College of Medicine, Tracy Crane, PhD, University of Miami Sylvester Comprehensive Cancer Center, Terry Badger, RN, PhD, University of Arizona College of Medicine, and Karen Basen-Engquist, PhD, MD Anderson Cancer Center.
On June 24, 2022, the U.S. Supreme Court overruled Roe v. Wade, the landmark 1973 decision that established the nationwide right to choose an abortion.
For decades, the rancorous debate about the ruling has often been dominated by politics. Ethics garners less attention, although it lies at the heart of the legal controversy. As a philosopher and bioethicist, I study moral problems in medicine and health policy, including abortion.
Bioethical approaches to abortion often appeal to four principles: respect for patients’ autonomy; nonmaleficence, or “do no harm”; beneficence, or providing beneficial care; and justice. These principles were first developed during the 1970s to guide research involving human subjects. Today, they are essential guides for many doctors and ethicists in challenging medical cases.
Patient autonomy
The ethical principle of autonomy states that patients are entitled to make decisions about their own medical care when able. The American Medical Association’s Code of Medical Ethics recognizes a patient’s right to “receive information and ask questions about recommended treatments” in order to “make well-considered decisions about care.” Respect for autonomy is enshrined in laws governing informed consent, which protects patients’ right to know the medical options available and make an informed voluntary decision.
Some bioethicists regard respect for autonomy as lending firm support to the right to choose abortion, arguing that if a pregnant person wishes to end their pregnancy, the state should not interfere. According to one interpretation of this view, the principle of autonomy means that a person owns their body and should be free to decide what happens in and to it.
Abortion opponents do not necessarily challenge the soundness of respecting people’s autonomy, but may disagree about how to interpret this principle. Some regard a pregnant person as “two patients” – the pregnant person and the fetus.
One way to reconcile these views is to say that as an immature human being becomes “increasingly self-conscious, rational and autonomous it is harmed to an increasing degree,” as philosopher Jeff McMahan writes. In this view, a late-stage fetus has more interest in its future than a fertilized egg, and therefore the later in pregnancy an abortion takes place, the more it may hinder the fetus’s developing interests. In the U.S., where 92.7% of abortions occur at or before 13 weeks’ gestation, a pregnant person’s rights may often outweigh those attributed to the fetus. Later in pregnancy, however, rights attributed to the fetus may assume greater weight. Balancing these competing claims remains contentious.
Nonmaleficence and beneficence
The ethical principle of “do no harm” forbids intentionally harming or injuring a patient. It demands medically competent care that minimizes risks. Nonmaleficence is often paired with a principle of beneficence, a duty to benefit patients. Together, these principles emphasize doing more good than harm.
Although 97% of unsafe abortions occur in developing countries, developed countries that have narrowed abortion access have produced unintended harms. In Poland, for example, doctors fearing prosecution have hesitated to administer cancer treatments during pregnancy or remove a fetus after a pregnant person’s water breaks early in the pregnancy, before the fetus is viable. In the U.S., restrictive abortion laws in some states, like Texas, have complicated care for miscarriages and high-risk pregnancies, putting pregnant people’s lives at risk.
Justice, a final principle of bioethics, requires treating similar cases similarly. If the pregnant person and fetus are moral equals, many argue that it would be unjust to kill the fetus except in self-defense, if the fetus threatens the pregnant person’s life. Others hold that even in self-defense, terminating the fetus’s life is wrong because a fetus is not morally responsible for any threat it poses.
Yet defenders of abortion point out that even if abortion results in the death of an innocent person, that is not its goal. If the ethics of an action is judged by its goals, then abortion might be justified in cases where it realizes an ethical aim, such as saving a woman’s life or protecting a family’s ability to care for their current children. Defenders of abortion also argue that even if the fetus has a right to life, a person does not have a right to everything they need to stay alive. For example, having a right to life does not entail a right to threaten another’s health or life, or ride roughshod over another’s life plans and goals.
Justice also deals with the fair distribution of benefits and burdens. Among wealthy countries, the U.S. has the highest rate of deaths linked to pregnancy and childbirth. Without legal protection for abortion, pregnancy and childbirth for Americans could become even riskier. Studies show that women are more likely to die while pregnant or shortly thereafter in states with the most restrictive abortion policies.
Other marginalized groups, including low-income families, could also be hard hit by abortion restrictions because abortions are expected to get pricier.
Politics aside, abortion raises profound ethical questions that remain unsettled, which courts are left to settle using the blunt instrument of law. In this sense, abortion “begins as a moral argument and ends as a legal argument,” in the words of law and ethics scholar Katherine Watson.
Putting to rest legal controversies surrounding abortion would require reaching moral consensus. Short of that, articulating our own moral views and understanding others’ can bring all sides closer to a principled compromise.
A majority of American men who die by suicide don’t have any known history of mental health problems, according to new research by UCLA professor Mark Kaplan and colleagues.
“What’s striking about our study is the conspicuous absence of standard psychiatric markers of suicidality among a large number of males of all ages who die by suicide,” said Kaplan, a professor of social welfare at the UCLA Luskin School of Public Affairs.
For the study, published online in the American Journal of Preventive Medicine, Kaplan and his co-authors from the Centers for Disease Control and Prevention tracked recent suicide deaths among U.S. males aged 10 and older. They found that 60% of victims had no documented mental health conditions.
Further, males without a history of mental health issues died more frequently by firearms than those with known mental health issues, and many were found to have alcohol in their systems, the researchers noted.
The report highlights the major public health challenge of addressing suicide among males, who are far more likely to die by suicide and less likely to have known mental health conditions than females. In 2019, for instance, males accounted for 80% of all suicide deaths in the U.S., the authors said, and suicide is the eighth leading cause of death among males 10 and older.
Kaplan and his colleagues examined data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System for the most recent three-year period available, 2016 to 2018, during which more than 70,000 American males died by suicide. More than 42,000 of them had no known mental health conditions, they found.
The researchers then compared characteristics of those with and without known mental health conditions across their life span in four age groups: adolescents (10–17 years old), young adults (18–34), middle-aged adults (35–64) and older adults (65 and older). Identifying the various factors that contribute to suicides among these groups is crucial to developing targeted suicide prevention efforts, especially outside of mental health systems, the team emphasized.
Among their findings, they discovered that across all groups, those without known mental health conditions were less likely to have had a history of contemplating or attempting suicide, or both, than those with such issues. In particular, young and middle-aged adults without known mental health conditions disclosed suicidal intent significantly less often, they said.
In addition, males with no mental health history who died by suicide in three of the four age groups — adolescents, young adults, and middle-aged men — more commonly experienced relationship problems, arguments or another type of personal crisis as precipitating circumstances than for those with prior histories.
The researchers emphasized the importance of focusing on these kinds of acute situational stressors as part of suicide prevention efforts and working to discourage the use of alcohol, drugs, and guns during times of crisis — particularly for teens and young adults, who may be more prone to act impulsively.
Kaplan and his colleagues said the findings highlight the potential benefits of strategies to create protective environments, provide support during stressful transitions, and enhance coping and problem-solving skills across the life span.
“Suicide prevention initiatives for males might benefit from comprehensive approaches focusing on age-specific stressors reported in this study, in addition to standard psychiatric markers,” the researchers wrote.
“These findings,” Kaplan said, “could begin to change views on the non–mental health factors driving up the rate of suicide among men.”
Changes in the status of women’s reproductive health and protections have been at the forefront of new headlines in recent weeks. The leaked Supreme Court documents indicating that the justices are on the precipice of turning over 50 years worth of reproductive health precedent has a lot of people pausing to consider the implications of losing something they have largely taken for granted. Many women are recognizing that if Roe v. Wade is overturned, they will have less bodily autonomy than corpses often have in their home states.
Of course, for many women – particularly minority women in deeply conservative states – these rights were slipping away long before this. In many of these states, the number of reproductive health clinics is extremely limited and causes undue burdens on women trying to access them. Multiple studies on the topic have shown that minority women, especially those from poorer backgrounds, are the most likely to face difficulties accessing any sort of reproductive healthcare than their more affluent, white peers.
Regardless of where our personal beliefs related to abortion rights fall, we can all agree that women having better access to reproductive healthcare is a valuable endeavor. For many nurses out there, this means striving to break down barriers that limit healthcare access. It also means becoming an advocate for health equity. But how does one become an advocate within their own community?
Address Inequalities
Many of the inequalities that nurses see every day aren’t easy ones to just address and deal with. Rather, they are ingrained, pervasive community and cultural issues that will take years to fully unpack and start to address in a positive manner. However, there are things that nurses can do to help address some of the healthcare inequalities that minority women face regularly.
Perhaps one of the most powerful things nurses can do to help address health disparities is to recognize and empathize with the differences. Minority nurses with a background in minority communities are in the position to play a unique and powerful role here. Who better to build a bridge of understanding and trust than someone who already has an understanding of the social, cultural, and economic factors that may be influencing healthcare choices.
Immediately addressing any form of blatant discrimination.
Advocating for policies that promote human rights and equity.
Working with numerous professionals across disciplines to ensure patients are receiving holistic healthcare.
Encouraging medical trials that are inclusive and address the concerns of minorities.
Seeking out and promoting other professionals that are striving to address equity issues in their communities.
Encourage Screenings
When working directly with patients there are a few things that can be done to help decrease health disparities. Arguably the most important is building trust in the community, which most certainly will not happen overnight. Small steps to start can include things like doing preventative health education out in the community, finding strategies that can help with payment for medical services, and being available for health-related questions without requiring an appointment.
Unfortunately, minority women are typically at greater risk for developing a number of diseases. For instance, African American women are twice as likely to develop breast cancer. Likewise, African American women are more likely to develop high blood pressure earlier in life than white women. There are many factors that influence this, but ultimately detection is one of the best forms of prevention.
Women can benefit from regular health screenings, but many are reluctant to do so. Going to the doctor’s office is uncomfortable, time-consuming, and potentially expensive. Helping women, especially minority women, understand the value of preventative health screenings over the long term is a vital role that nurses can play. Promoting more screenings can be one straightforward way to catch and treat issues before they become life-altering health problems.
Soft Skills Matter
Minority women, particularly women of color, are more likely to face negative health outcomes than other groups. Ingrained inequalities and cultural perceptions of the healthcare system play a major role in this. As nurses work to address these health disparities it becomes apparent that not only is a deep knowledge of nursing and healthcare important, but so are the soft skills that help convey the message.
For example, soft skills such as empathy are critical to understanding and adequately responding to the difficulties that some patients are facing. Empathy can lead to better, more realistic health prescriptions and outcomes. Patients are also more inclined to trust and listen to someone that shows an understanding and compassion for the information they are providing about themselves and their health.
Communication is another important factor. Even the best messages can be lost if they are not delivered in an understandable and relatable way. Patients do not like to feel talked down to and many very deeply want to understand the healthcare system before they have to make major decisions within it. Clear communication about procedures, health factors, costs, and outcomes are also imperative for building trust and making patients feel comfortable about their health choices.
Healthcare inequalities are significant for some demographics of the population, particularly minority women seeking reproductive healthcare. Nurses can make a real difference in starting to address some of these disparities by becoming advocates for their patients. It involves building trust, showing empathy, and encouraging positive health choices. None of it is easy, but it can add up to make a powerful difference in local communities.
When Dr. Roy Guerrero, a pediatrician in Uvalde, Texas, testified before a U.S. House committee Wednesday about gun violence, he told lawmakers about the horror of seeing the bodies of two of the 19 children killed in the Robb Elementary massacre. They were so pulverized, he said, that they could be identified only by their clothing.
In recent years, the medical profession has developed techniques to help save more gunshot victims, such as evacuating patients rapidly. But trauma surgeons interviewed by KHN say that even those improvements can save only a fraction of patients when military-style rifles inflict the injury. Suffering gaping wounds, many victims die at the shooting scene and never make it to a hospital, they said. Those victims who do arrive at trauma centers appear to have more wounds than in years past, according to the surgeons.
But, the doctors added, the weapons used aren’t new. Instead, they said, the issue is that more of these especially deadly guns exist, and these weapons are being used more frequently in mass shootings and the day-to-day violence that plagues communities across the nation.
The doctors, frustrated by the carnage, are clamoring for broad measures to curb the rise in gun violence.
Weeks after the Uvalde school shooting, what steps the country will take to prevent another attack of this magnitude remain unclear. The House on Wednesday and Thursday passed measures aimed at reducing gun violence, but approval in the Senate seems uncertain at best.
Many physicians agree something substantial must be done. “One solution won’t solve this crisis,” said Dr. Ashley Hink of Charleston, South Carolina, who was working as a trauma surgery resident at the Medical University of South Carolina in 2015 when a white supremacist killed nine Black members of the Mother Emanuel African Methodist Episcopal Church. “If anyone wants to hang their hat on one solution, they’re clearly not informed enough about this problem.”
The weapons being fired in mass shootings — often defined as incidents in which at least four people are shot — aren’t just military-style rifles, such as the AR-15-style weapon used in Uvalde. Trauma surgeons said they are seeing a rise in the use of semiautomatic handguns, such as the one used during the Charleston church shooting. They can contain more ammunition than revolvers and fire more rapidly.
Overall gun violence has increased in recent years. In 2020, firearm injuries became the leading cause of death among children and adolescents. Gun-related homicides rose almost 35% in 2020, the Centers for Disease Control and Prevention reported in May. Most of those deaths are attributed to handguns.
A study recently published by JAMA Network Open found that for every mass shooting death, about six other people were injured. Trauma surgeons interviewed by KHN said the number of wounds per patient appears to have increased.
“I feel we are seeing an increase in the intensity of violence over the past decade,” said Dr. Joseph Sakran, a trauma surgeon at Johns Hopkins Hospital in Baltimore. He cited the number of times a person is shot and said more gun victims are being shot at close range.
Survival rates in mass shootings depend on multiple factors, including the type of firearm used, the proximity of the shooter, and the number and location of the wounds, said Dr. Christopher Kang of Tacoma, Washington, who is president-elect of the American College of Emergency Physicians.
Several recent shootings have left few survivors.
The perpetrator of the Charleston massacre shot each of the nine people who were killed multiple times. Only one of those people was transported to the hospital, and, upon arrival, he had no pulse.
Last year, shootings at three Atlanta-area spas left eight dead — only one person who was shot survived.
The chaos at a mass shooting scene — and the presence of an “active” shooter — can add crucial delays to getting victims to a hospital, said Dr. John Armstrong, a professor of surgery at the University of South Florida. “With higher-energy weapons, one sees greater injury, greater tissue destruction, greater bleeding,” he added.
Dr. Sanjay Gupta, a neurosurgeon who is chief medical correspondent for CNN, wrote about the energy and force of gunshots from an AR-15-style rifle, the type also used in the recent mass shooting in Buffalo, New York. That energy is equal to dropping a watermelon onto cement, Gupta said, quoting Dr. Ernest Moore, director of surgical research at the Denver Health Medical Center.
Medical advances over the years, including lessons learned from the battlefields of Iraq and Afghanistan, have helped save the lives of shooting victims, said Armstrong, who trained U.S. Army surgical teams.
Those techniques, he said, include appropriate use of tourniquets, rapid evacuations of the wounded, and the use of “whole blood” to treat patients who need large amounts of all the components of blood, such as those who have lost a significant amount of blood. It’s used instead of blood that has been separated into plasma, platelets, and red blood cells.
Another effective strategy is to train bystanders to help shooting victims. A protocol called “Stop the Bleed” teaches people how to apply pressure to a wound, pack a wound to control bleeding, and apply a tourniquet. Stop the Bleed arose after the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, where 20 children and six adults were killed.
The CDC, which in the past two years has been able to conduct gun research after years of congressional prohibitions, has funded more than a dozen projects to address the problem of gun violence from a public health perspective. Those projects include studies on firearm injuries and the collection of data on those wounds from emergency rooms across the country.
For some doctors, gun violence has fueled political action. Dr. Annie Andrews, a pediatrician at the Medical University of South Carolina, is running as a Democrat for a seat in the U.S. House on a platform to prevent gun violence. After the school shooting in Uvalde, Andrews said, many women in her neighborhood reached out to ask, “What can be done about this? I’m worried about my kids.”
Dr. Ronald Stewart, chair of surgery at San Antonio-based University Health, told KHN that the people shot in Uvalde had wounds from “high energy, high velocity” rounds. Four of them — including three children — were taken to University Hospital, which offers high-level trauma care.
The hospital and Stewart had seen such carnage before. In 2017, the San Antonio hospital treated victims from the Sutherland Springs church shooting that left more than two dozen dead.
Two of the four Uvalde shooting victims have been discharged, University Health spokesperson Elizabeth Allen said, and the other two remained hospitalized as of Thursday.
It will take a bipartisan effort that doesn’t threaten Second Amendment rights to make meaningful change on what Stewart, a gun owner, called a “significant epidemic.” Stewart noted that public safety measures have curbed unintentional injuries in car crashes. For intentional violence, he said, progress hasn’t been made.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Yet another tragic mass shooting demonstrates the importance of legislation currently in the U.S. Senate that would provide substantial safety protection for our nation’s health care workers, patients, and their families, noted National Nurses United.
S. 4182, the Workplace Violence Prevention for Health Care and Social Service Workers Act currently supported by 27 Senators, would mandate that the Occupational Safety and Health Administration (OSHA) create a federal standard requiring health care and social service employers to develop and implement a comprehensive workplace violence prevention plan. S. 4182 is a companion to H.R. 1195, which passed the House of Representatives in a strong bipartisan vote in April 2021.
This legislation is especially important given that health care and social service workers face extremely high rates of workplace violence, noted NNU.
“Tulsa’s terror on Wednesday should remind us all of both the accelerating incidents of violence in health care settings and the urgency of legislative action to safeguard our caregivers, other health care staff, and every patient or family member in those facilities,” said NNU President Jean Ross, RN.
Reports now confirm that the Tulsa gunman was a former patient who, according to The Washington Post, murdered two doctors, a receptionist, and another patient in an orthopedic clinic at the St. Francis Hospital Natalie Building. He was also reportedly armed with an AR-15-style weapon he bought on the same day as the attack, a reminder also of the need for a national ban on assault weapons, added Ross.
“If the caregivers who save our lives and who provide therapeutic healing when we are at our most vulnerable cannot be safe, we are all in danger,” said Ross. “Protecting public safety must be a top national priority. As the past few weeks have grimly proven, we have a horrifying national crisis of public safety, whether it is in our schools, supermarkets, houses of worship, or hospitals.”
“With S. 4182, there is legislation ready to be enacted to address a vital part of the national solution for this emergency,” Ross added. “We urge the Senate to act.”
S. 4182 was introduced in the Senate in May by Sen. Tammy Baldwin, D-Wis., at a press conference that also included Rep. Joe Courtney, D-Conn., chief sponsor of H.R. 1195, as well as NNU President Ross and representatives of the AFL-CIO, American Federation of Teachers, United Steelworkers, and American Federation of State, County and Municipal Employees.
“We need the Workplace Violence Prevention for Health Care and Social Service Workers Act to help protect us on the job, so we can continue to care for you, your loved ones, and our communities,” Ross said then. “We strongly urge the Senate to take up this bill with the urgency it deserves, pass it, and send it to the president’s desk for his signature.”
A recent NNU national survey of more than 2,500 hospital nurses found that nearly half of RNs (48 percent) reported a small or significant increase in workplace violence, up from 30.6 percent in September 2021 and 21.9 percent in a March 2021 survey. This is a nearly 57 percent increase from September 2021 and a 119 percent increase from March 2021.
Between 2011 and 2016, as reported in the U.S. Bureau of Labor Statistics Census of Fatal Occupational Injuries, at least 58 hospital workers died as a result of violence in their workplaces. In 2016, the Government Accountability Office found that health care workers at inpatient facilities were five to 12 times more likely to experience nonfatal workplace violence than workers overall.
National Nurses United is the largest and fastest-growing union and professional association of registered nurses in the United States with more than 175,000 members nationwide.
