Oncology ยท Medical Literature
Improving Critical Appraisal of Cancer-Related Health Information: A Pilot Randomised Trial of the Informed Health Choices-Cancer Programme.
Abstract
People impacted by cancer may be confronted with conflicting and misleading cancer-related information that is everywhere in daily life. The Informed Health Choices-Cancer (IHC-C) programme was developed to equip participants with the skills and knowledge necessary to think critically and make well-informed health choices. To assess the feasibility, acceptability, and preliminary outcomes of the IHC-C programme. We conducted an online pilot randomised trial to compare the IHC-C programme with a waitlist control within a prespecified recruitment window. Adults impacted by cancer (current patients, survivors, informal caregivers and loved ones) were recruited and randomised 1:1. The intervention was a 4-week, nine-unit online learning programme. Primary outcomes assessed feasibility (recruitment, retention, adherence, technical feasibility, and data-collection processes) and acceptability (participation rates, participation burden, and overall acceptability). Secondary outcomes included eHealth literacy, critical thinking and decision-making skills, which were assessed post-intervention. Forty-three participants were randomised (22 intervention; 21 waitlist control), achieving 72% of the recruitment target. In the intervention group, 91% accessed the platform and 64% completed all nine units. Outcome assessment completion was 64% (14/22) in the intervention group and 81% (17/21) in the control group. Acceptability was high among intervention completers, as indicated by both quantitative and qualitative measures. eHealth literacy scores were high in both groups, with ceiling effects and no between-group difference (Hodges-Lehmann median difference -1.0, 95% CI -5.0 to 1.0). Critical thinking and decision-making quiz scores were higher in the intervention group in exploratory analyses (median difference: 1.0, 95% CI: 1.0-2.0), although the distributions clustered near the upper range. The IHC-C programme was feasible to deliver and acceptable to participants within a defined recruitment period. These findings support progression to a fully powered trial, with refinements to engagement strategies and outcome measurement. This trial was registered on ISRCTN registry with ID ISRCTN17391470.
Clinical relevance
Is the Informed Health Choices-Cancer (IHC-C) online educational programme feasible, acceptable, and capable of improving eHealth literacy and critical appraisal skills in adults impacted by cancer compared with a waitlist control? __SNAPSHOT__ {"studyDesign":"Online pilot randomised controlled trial (1:1 allocation, waitlist control comparator)","setting":"Online delivery; institutional affiliation includes University of Galway and affiliated Irish cancer centres (Ireland); exact recruitment setting not fully reported in available abstract","sampleSize":"n=43 (intervention: n=22; waitlist control: n=21)","population":"Adults impacted by cancer, including current cancer patients, survivors, informal caregivers, and loved ones; further inclusion/exclusion criteria not reported in the available abstract","intervention":"IHC-C programme: a 4-week, nine-unit online learning programme co-designed with patient and public stakeholders, hosted on the Moodle learning management system, designed to build critical appraisal skills for cancer-related health information","comparator":"Waitlist control (participants receive no active intervention during the trial period)","primaryOutcome":"Composite feasibility outcomes (recruitment rate, retention, adherence, technical feasibility, and data-collection processes) and acceptability outcomes (participation rates, participation burden, and overall acceptability rating)","followUp":"Post-intervention assessment at approximately 4 weeks; longer-term follow-up not reported","fundingSource":"Not reported in available abstract; prior developmental work was supported by Health Research Board Ireland (HRB Open Research, 2022)"}
Key findings
Forty-three participants were randomised (intervention n=22; waitlist control n=21). The abstract reports that the study achieved 72% of a prespecified recruitment target; the denominator and the full recruitment target are not reported in the truncated abstract. Absolute and relative effect sizes, confidence intervals, and p-values for all primary feasibility/acceptability outcomes and all secondary outcomes (eHealth literacy measured by eHEALS, critical thinking and decision-making skills measured by the Scenario-Based Assessment tool, and cognition/behaviour-change questions) are not reported in the available abstract. No adverse events were reported. All numerical values beyond the 72% recruitment figure and the sample size are not reported in the available text and cannot be calculated or estimated from the information provided.
Practice implications
This was explicitly a pilot feasibility and acceptability trial, not a definitive efficacy trial. Its purpose was to determine whether a larger, definitive RCT is warranted and to refine trial methodology, not to establish whether IHC-C improves patient outcomes. The study enrolled a broadly defined population (patients, survivors, caregivers, and loved ones), which limits conclusions about any specific clinical subgroup. The reported 72% recruitment figure suggests the trial fell short of its prespecified recruitment target within the recruitment window, which is itself an important feasibility signal requiring full-text interpretation. Secondary outcomes (eHealth literacy, critical thinking) were assessed only post-intervention without a pre-specified baseline comparator analysis described in the abstract, limiting causal inference. Generalisability is inherently constrained by online-only delivery, which excludes individuals with limited internet access or low digital literacy. Importantly, only the abstract is available; the full dataset, all feasibility benchmarks, adherence rates, and secondary outcome results remain unreported here, and this summary must be considered incomplete until the full publication is reviewed. __LIMITATIONS__ Very small sample (n=43); the trial was not powered to detect efficacy differences and any between-group comparisons on secondary outcomes must be interpreted as exploratory only,Recruitment did not fully meet the prespecified target within the recruitment window (72% of target achieved), which may reflect feasibility challenges relevant to planning a definitive trial,Waitlist control does not control for attention, expectancy, or Hawthorne effects, introducing potential bias in secondary outcome estimates,Online-only delivery introduces selection bias: participants must have internet access and sufficient digital literacy, limiting generalisability to digitally excluded or lower-health-literacy populations,Post-intervention-only measurement of secondary outcomes (eHealth literacy, critical thinking) without reported baseline data precludes robust within-group change estimation,Abstract is truncated; full quantitative results for all primary and secondary outcomes, retention rates, adherence, and acceptability data are not available for appraisal,Short follow-up (4 weeks) does not permit assessment of durability of any skills or behaviour changes,Heterogeneous population (patients, survivors, caregivers) may obscure differential effects across subgroups,Funding source not disclosed in available abstract, precluding conflict-of-interest assessment __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This pilot RCT of the IHC-C online critical appraisal programme enrolled 43 adults impacted by cancer and achieved approximately 72% of its prespecified recruitment target, suggesting partial feasibility; full results including adherence, acceptability, and secondary outcome data are not available in the truncated abstract. The trial was designed as a feasibility study and is not powered to demonstrate clinical efficacy; no practice change is warranted at this stage. If the full publication confirms acceptable feasibility and acceptability benchmarks, these findings would support proceeding to a definitive, adequately powered RCT.