摘要：Little is known about how social media are used in cancer care. We conducted a systematic review of the use and taxonomy of social media in cancer-related studies, in PubMed, Web of Knowledge, CINAHL, and Google Scholar. We located 1350 articles published through October 2013; 69 met study inclusion criteria. Early research (1996–2007) was predominantly descriptive studies of online forums. Later, researchers began analyzing blogs, videos shared on YouTube, and social networking sites. Most studies (n = 62) were descriptive, and only 7 reported intervention studies published since 2010. Future research should include more intervention studies to determine how social media can influence behavior, and more empirical research is needed on how social media may be used to reduce health disparities. Social media are defined as interactive Web sites that enable users to create, share, comment on, and, often, modify content. 1 The Centers for Disease Control and Prevention lists the following as social media sites: social networking sites, blogs, microblogs, RSS (Really Simple Syndication) feeds, and online forums. 2 A more complete list of social media types is shown in the box on the next page. With social media, the public largely controls what content is created and circulated online, including health-related information. Researchers are interested in social media because the public and health practitioners are beginning to use these sites to connect individuals to reliable health promotion information, address impediments to health literacy, enhance patients’ communication with health care providers, and invite diverse audiences to participate in research studies, such as clinical trials. 3 In short, social media sites can serve as key health communication channels to increase the bidirectional flow of information. 4 The sites provide a location for online dialogue and encourage individuals and communities to interact by providing their opinions, personal accounts, and other information related to disease prevention, early detection, treatment, and survivorship. The Centers for Disease Control and Prevention adds that social media sites enable users to share health information in a timely manner and empower users to make health decisions informed by the contributions of other visitors. 2 Examples of Social Media and Other Types of Electronic Communication Social Media Not Social Media Blogs E-mail Microblogs Listserv Social networking sites Regular Web page Social bookmarking sites Prerecorded podcast Online support groups (online forum) Online message boards (online forum) Video-sharing sites Photo-sharing sites Virtual worlds Wikis Some forms of online games Open in a separate window Little is known about how social media are used in health care research. Chou et al. conducted a systematic review of social media sites (Web sites hosted on the Web 2.0 platform) in general health promotion. 5 They recommended that more intervention studies should use social media and that social media measurement tools and methods should be developed and refined for future research. Public health researchers, including those whose focus is cancer, are beginning to examine how social media are changing the health communication landscape. 3 The type of information shared, purpose of use, and application of social media sites for cancer-related information may differ from the use of social media sites for general health promotion and in other health contexts. In particular, it is unclear whether the complexity of cancer treatment and survivorship and the need for provider and caregiver involvement influence how social media sites are used for health information. For example, individuals or organizations who search for general health promotion information (nonspecific to particular diseases and treatments) on social media sites may be looking for information about general positive lifestyle behaviors (e.g., diet, nutrition, smoking cessation). Individuals who browse social media sites for cancer-related information, however, may be searching for more specific content related to the different stages of the cancer continuum (prevention, diagnosis, treatment, treatment aftermath). They may also search for online social support to share or understand others’ cancer-related experiences. For example, cancer survivors and their caregivers may more actively seek support and search for information about treatment, treatment side effects, and symptom management. Interventions for cancer survivors may also entail challenges in study implementation arising from the health of study participants. Similarly, it is unclear whether interventions that use social media sites as the vehicle for cancer communication would elicit similar efficacy or participation levels as those reported by Chou et al. 5 Nevertheless, in light of the potential power of social media to affect cancer information sharing and seeking and the enactment of prevention behaviors, it is important to explore how these new, widely and increasingly accepted communication channels can be used across the cancer continuum. Communication technologies that allow users to access social media sites (e.g., computers, tablets, smartphones) are increasingly available. Newer devices can bring information to wider populations, including those who have had limited computer Internet access and have traditionally have been affected by the digital divide. 5,6 Chou et al. have examined ways that social media can narrow this communication digital divide for health promotion. 5 Similarly, it is important to examine how social media may bring cancer-related information and interventions to populations affected by the digital divide and subject to disparities in both cancer and cancer communication. In response to this gap in knowledge, we conducted a systematic review of peer-reviewed studies specific to social media and cancer. We aimed to (1) examine the taxonomy and time line of social media sites used in cancer care, and (2) categorize the designs of studies that assessed the role of social media in the context of cancer care. Although it was not a primary aim of our review, we also examined the extent to which cancer-related articles published on social media discussed the digital divide, health literacy, and the potential impact of social media interventions on cancer disparities.
