title: Identifying barriers to patient acceptance of active surveillance: content analysis of online patient communications.
abstract: OBJECTIVE
  Qualitative research aimed at identifying patient acceptance of active surveillance (AS) has been identified as a public health research priority. The primary objective of this study was to determine if analysis of a large-sample of anonymous internet conversations (ICs) could be utilized to identify unmet public needs regarding AS.
  
  
  METHODS
  English-language ICs regarding prostate cancer (PC) treatment with AS from 2002-12 were identified using a novel internet search methodology. Web spiders were developed to mine, aggregate, and analyze content from the world-wide-web for ICs centered on AS. Collection of ICs was not restricted to any specific geographic region of origin. NLP was used to evaluate content and perform a sentiment analysis. Conversations were scored as positive, negative, or neutral. A sentiment index (SI) was subsequently calculated according to the following formula to compare temporal trends in public sentiment towards AS: [(# Positive IC/#Total IC)-(#Negative IC/#Total IC) x 100].
  
  
  RESULTS
  A total of 464 ICs were identified. Sentiment increased from -13 to +2 over the study period. The increase sentiment has been driven by increased patient emphasis on quality-of-life factors and endorsement of AS by national medical organizations. Unmet needs identified in these ICs include: a gap between quantitative data regarding long-term outcomes with AS vs. conventional treatments, desire for treatment information from an unbiased specialist, and absence of public role models managed with AS.
  
  
  CONCLUSIONS
  This study demonstrates the potential utility of online patient communications to provide insight into patient preferences and decision-making. Based on our findings, we recommend that multidisciplinary clinics consider including an unbiased specialist to present treatment options and that future decision tools for AS include quantitative data regarding outcomes after AS.
authors.affiliation: Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, United States of America.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mishra
authors.forename: Michele
authors.initials: M
authors.lastname: Bennett
authors.forename: Armon
authors.initials: A
authors.lastname: Vincent
authors.forename: Olivia T
authors.initials: OT
authors.lastname: Lee
authors.forename: Costas D
authors.initials: CD
authors.lastname: Lallas
authors.forename: Edouard J
authors.initials: EJ
authors.lastname: Trabulsi
authors.forename: Leonard G
authors.initials: LG
authors.lastname: Gomella
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
mesh_terms: D062665:Epidemiological Monitoring; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet; D008297:Male; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000523:psychology; D011788:Quality of Life; D057832:Watchful Waiting
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