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Ethics-Centered Guidelines for Social Media Use by Oncology Professionals: A Call to Action

Ethics-Centered Guidelines for Social Media Use by Oncology Professionals: A Call to Action editorials CARE DELIVERY Ethics-Centered Guidelines for Social Media Use by Oncology Professionals: A Call to Action 1 2 3 4 Utkarsh C. Shukla, MD ; Rachel B. Jimenez, MD ; Reshma Jagsi, MD, DPhil ; Abby R. Rosenberg, MD, MS ; 5 6 7 8 9 Jonathan M. Marron, MD, MPH ; Laura J. Carfang, EdD ; Colleen A. Lawton, MD ; Don S. Dizon, MD ; and Matthew S. Katz, MD Perspective We are now in a pivotal time of virtual medicine and online influence where stakeholders, including those For as long as healers have existed, so too have ideas with cancer and their HCPs, interact in a broader about their roles and responsibilities. Biomedical digital environment, with conversations taking place in ethics strives to guide these, in part, via principles a public space for many to listen to and join. Oncology including beneficence, nonmaleficence, respect for 1 clinicians, who have traditionally been engaged in patient autonomy, and justice. Combined with core research, teaching, and/or administrative roles, may virtues such as integrity, respect, compassion, and find themselves drawn to or curious about this new discernment, these principles have developed from frontier, seeking ways to explore how social media can ancient roots to help guide providers in their practice of 2,3 be used as a means to educate people beyond the medicine. Fast forward to the increasingly complex confines of their own clinical practice and specialty. As era of digital health and social media, clinicians are a result, there is an increasing demand for clinicians to challenged to further evolve and adapt this ethics- engage with the public online. centered approach to the virtual environment. To remain a trusted source in the virtual landscape, Over the past two decades, internet access to health HCPs must be able to help people navigate the un- information has changed the dynamics of the patient- certainty of both the cancer experience and internet- doctor relationship. A person newly diagnosed with based information. The risks of social media en- cancer now has access to a wide variety of online tools gagement continue to serve as a barrier to online to obtain information. Through social media, online engagement for HCPs. Risks and benefits of social community forms, and general website searches, media use will also depend upon the ways in which people with cancer may leverage these tools to further HCPs use it. HCPs have an ethical duty to provide prepare themselves for meaningful and substantive accurate information to their patients; on social media, dialogue with their doctors, not only during an intro- however, this can present a never-ending situation ductory consultation but also throughout their cancer given the evolving nature of science, which some may journey. This phenomenon has shifted the modern weaponize for ulterior motives, as has been seen biomedical ethics emphasis from a relational, trust- during the COVID-19 vaccine debacle. There is also a based approach to one of shared decision making, risk that HCPs may use social media to build a per- with more focus on autonomy and patient-centered sonal brand, using these forums to gain internet fame values. People diagnosed with cancer often turn to through editorializing, shaming others, and other ac- 5,6 online support systems for complementary care. tivities that increase likes, shares, and influence. Pa- However, they may not be able to discern factual tients expect their providers to be reliable, empathetic, and accurate medical data in this era of misinfor- composed, and accountable. When we behave in mation. They may be misled by incorrect information, ways that disrespect our colleagues and/or patients, which potentially may cloud their ability to make ac- millions of patients are audience to such behavior, Author affiliations curate and informed decisions or undermine trust in and support 7 which may further contribute to decreased trust in our their treating oncologists. In this context, health care 10-12 information (if field offline. To date, evidence-based guidance on professionals (HCPs) are seen as important and applicable) appear best practices is scarce, leaving clinicians with little trusted resources that help to distinguish correct, at the end of this direction and the potential for a misstep. article. trustworthy, and peer-reviewed resources from unre- Accepted on March liable sources of health information. In so doing, HCPs Historically, nurses, doctors, and other HCPs have 31, 2022 and have a more expansive role not only as educators but been among the most trusted professionals, and we published at also as apomediators of information, hoping to ensure risk harming or even losing that trust if we do not ascopubs.org/journal/ that patients make informed health decisions that extend the ethical practice of medicine to the way we op on May 4, 2022: serve their personal interests and decision-making communicate on social media. An ethics-centered, DOI https://doi.org/10. 1200/OP.21.00765 preferences. evidence-based approach to digital communication Volume 18, Issue 8 537 Editorial and engagement is essential to continuing to fulfill our and transparency of intent), clinical practice (performance, covenant with patients. What we share in the characters of communication skills, and education), professional health/ our content reflects the content of our character. It is time well-being (privacy protection, mental and physical health, that we determine how to maximize the utility of social and limits on use), advocacy (patient, professional, and media and minimize the risk it can pose to patients and to societal-centered), career management (networking and the therapeutic relationships we seek both online and collaboration), and medicolegal (Health Insurance Porta- offline. bility and Accountability Act, malpractice, copyright viola- tion, and defamation; Table 2). All these areas are essential Although the American Medical Association’s Code of parts of the clinical practice of medicine. Developing Ethics (Section 2.3.2) provides cautionary directions for guidelines will not be easy and may require looking at online professionalism and privacy standards, highlighting published data not only on social media in medicine but traditional ethical principles, formal consensus-driven also on human psychology and interactions using social guidelines, as are generated for clinical practice, are media. In this special issue on social media, we expand on lacking. Indeed, few professional societies related to many of these themes. cancer care have released frameworks for ethical practice in the online setting. We reviewed the websites for 20 Online portals have been shown to benefit patients by filling cancer-related professional societies in the United States, their need for information with the opportunity to re-read Canada, and Europe, and only one offers evidence-based, and revisit content overtime and throughout their 5,6 ethical guidelines for social media use (Table 1). survivorship. Furthermore, the advent of online tech- nology continues to enable access to care, information, and We propose addressing this gap with the development of cancer awareness reaching communities in rural areas. rigorously considered consensus guidelines, following Wise use of social media should enhance clinical care, standards of evidence review and best practices, including rather than undermining it. It also gives health care facilities stakeholder input from HCPs, advocates, and patients, to and institutions a core set of guidelines and expectations provide defined guidance to cancer professionals. Relative with which to hold their employees accountable, thereby domains could include ethical (including patient-clinical boundaries, integrity, credible heath information, respect, reducing the risk to reputation and liability. Balancing the TABLE 1. Medical Society Guidelines for Ethics-Centered Use of Social Media Ethics-Centered Guidelines, No Evidence Ethics-Centered Guidelines, Some Evidence No Guidelines Base Base American Society of Radiation Oncology American Medical Association American College of Surgeons American Society of Clinical Oncology American College of Physician American Association for Cancer Research Society of Surgical Oncology Oncology Nursing Society American Association of Medical Dosimetry American Association of Physicists in Medicine American Society of Radiologic Technologists Society for Immunotherapy of Cancer American Brachytherapy Society American College of Radiation Oncology American Radium Society American College of Radiology Radiological Society of North America European Society for Radiotherapy and Oncology European Society for Medical Oncology European Federation of Internal Medicine European Union of General Practitioners/Family Physicians Canadian Association of Radiation Oncology Canadian Association of Medical Oncologists Canadian Society of Internal Medicine 538 © 2022 by American Society of Clinical Oncology Volume 18, Issue 8 Editorial TABLE 2. Selected Questions Requiring Guidance for Integrating Ethical Social Media Use Into the Practice of Oncology Domain Question Examples Ethical How do I establish boundaries for myself, with my patients, Define how to separate personal and professional online activity or with others online? and understand institutional social media policies How do I ensure patients find reliable health information? Create or curate resources that can be shared easily How do I demonstrate transparency of intent, including any Provide public access to disclosures (financial and otherwise) potential conflicts of interest in what I share online? and state them if relevant to conversation How do I balance public engagement with maintaining Recognize that online activities may have offline consequences. or building patient trust in me and public trust in the Be aware that social media posts may affect public trust in me profession? and other health professionals Clinical What are the risks of “opting out” of social media to my May be less able to monitor and define your reputation online clinical role in cancer care? Do I need to learn to value patient experience and need for Identify ways to learn about patient experiences without health information differently, in order to better educate establishing a relationship online and with respect for the them for informed health decisions? boundaries of people sharing health information Professional How do I balance the time I spend online with the need for Define learning and patient care goals to ensure time on social well-being continuous learning and the time necessary for patient care? media doesn’t compromise them How do I avoid risks of internet misuse that may be harmful to Perform periodic personal “check-ins” to assess the impact of my mental or physical health? your social media use on time management and mental and physical health How do I ensure that my social media use complements or Define personal and professional goals, regularly re-evaluate augments my professional career, rather than undermining it? status Advocacy How do I balance advocating for what matters to me as a Estimate and periodically reassess desire to be a public figure on citizen and as a health professional with the importance of nonmedical topics remaining patient-centered? Medicolegal Are there ways to mitigate or decrease risk of malpractice or Understand how privacy laws, regulations, and guidelines apply moral hazard related to social media use? online and how public perception of professionalism influences opinion of patients, public competing values of confidentiality required offline with the paramount. One thing is certain: social media is not going expectations of transparency online will remain a challenge away and HCPs cannot ignore it as a source for medical in health care. Although our tactics must change, our information. The need for thoughtfully considered, ethically commitment to the ethical practice of medicine must remain based guidelines is essential, and it is time to get started. AFFILIATIONS EQUAL CONTRIBUTION Department of Radiation Oncology, Tufts University School of Medicine, D.S.D. and M.S.K. are cosenior authors. Boston, MA Department of Radiation Oncology, Massachusetts General Hospital, AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF Harvard Medical School, Boston, MA INTEREST Department of Radiation Oncology, Center for Bioethics and Social Disclosures provided by the authors are available with this article at DOI Sciences in Medicine, University of Michigan, Ann Arbor, MI 4 https://doi.org/10.1200/OP.21.00765. Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA Department of Pediatric Oncology, Dana-Farber/Boston Children’s AUTHOR CONTRIBUTIONS Cancer and Blood Disorders Center, Center for Bioethics, Harvard Conception and design: Utkarsh C. Shukla, Rachel B. Jimenez, Reshma Medical School, Boston, MA Jagsi, Abby R. Rosenberg, Laura J. Carfang, Colleen A. Lawton, Don S. SurvivingBreastCancer.org, Boston, MA Dizon, Matthew S. Katz Department of Radiation Oncology, Medical College of Wisconsin, Financial support: Matthew S. Katz Milwaukee, WI Administrative support: Don S. Dizon Department of Medicine, Warren Alpert Medical School, Lifespan Collection and assembly of data: Utkarsh C. Shukla, Jonathan M. Marron, Cancer Institute, and Legoretta Cancer Center at Brown University, Laura J. Carfang, Matthew S. Katz Providence, RI Data analysis and interpretation: Utkarsh C. Shukla, Reshma Jagsi, Abby Radiation Oncology Associates, PA, Department of Radiation Medicine, R. Rosenberg, Jonathan M. Marron, Don S. Dizon, Lowell General Hospital, Lowell, MA Manuscript writing: All authors Final approval of manuscript: All authors Accountable for all aspects of the work: All authors CORRESPONDING AUTHOR Matthew S. Katz, MD, The Cancer Center at Lowell General Hospital, 295 Varnum Ave, Lowell, MA 01854; e-mail: Matthew.Katz@roa-ne.com. JCO Oncology Practice 539 Editorial REFERENCES 1. Beauchamp TL, Childress JF: Principles of Biomedical Ethics. New York, NY, Oxford University Press, 2001 2. Jotterand F: The Hippocratic oath and contemporary medicine: Dialectic between past ideals and present reality? J Med Philos 30:107-128, 2005 3. Rosner F: The physician’s prayer attributed to Moses Maimonides. Bull Hist Med 41:440-454, 1967 4. Tauber AI: Patient Autonomy and the Ethics of Responsibility. Cambridge, MA, MIT Press, 2005 5. Johansson V, Islind AS, Lindroth T, et al: Online communities as a driver for patient empowerment: Systematic review. J Med Internet Res 23:e19910, 2021 6. Kuijpers W, Groen WG, Loos R, et al: An interactive portal to empower cancer survivors: A qualitative study on user expectations. Support Care Cancer 23: 2535-2542, 2015 7. Abel GA, Burstein HJ, Hevelone ND, et al: Cancer-related direct-to-consumer advertising: Awareness, perceptions, and reported impact among patients undergoing active cancer treatment. J Clin Oncol 27:4182-4187, 2009 8. Eysenbach G: Medicine 2.0: Social networking, collaboration, participation, apomediation, and openness. J Med Internet Res 10:e1030, 2008 9. Moorhead SA, Hazlett DE, Harrison L, et al: A new dimension of health care: Systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res 15:e1933, 2013 10. Fatollahi JJ, Colbert JA, Agarwal P, et al: The impact of physician social media behavior on patient trust. AJOB Empir Bioeth 11:77-82, 2020 11. Levy AG, Scherer AM, Zikmund-Fisher BJ, et al: Prevalence of and factors associated with patient nondisclosure of medically relevant information to clinicians. JAMA Netw Open 1:e185293, 2018 12. Ahmed W, Jagsi R, Gutheil TG, et al: Public disclosure on social media of identifiable patient information by health professionals: Content analysis of Twitter data. J Med Internet Res 22:e19746, 2020 13. Gallup Poll: Honesty/Ethics in Professions. December, 2020 Update. www.gallup.com/poll/1654/honesty-ethics-professions.aspx 14. Code of Medical Ethics. Chicago, IL. American Medical Association, 2017 15. Cueva K, Revels L, Cueva M, et al: Culturally-relevant online cancer education modules empower Alaska’s community health aides/practitioners to disseminate cancer information and reduce cancer risk. J Cancer Educ 33:1102-1109, 2018 nn n 540 © 2022 by American Society of Clinical Oncology Volume 18, Issue 8 Editorial AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I 5 Immediate Family Member, Inst 5 My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center. Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments). Rachel B. Jimenez Jonathan M. Marron Employment: Massachusetts General Hospital Honoraria: Genzyme Stock and Other Ownership Interests: Biogen Consulting or Advisory Role: Partner Therapeutics Research Funding: Focal Therapeutics Open Payments Link: https://openpaymentsdata.cms.gov/physician/802634/ summary Reshma Jagsi Don S. Dizon This author is a member of the JCO Oncology Practice Editorial Board. Journal policy recused the author from having any role in the peer review of this This author is a member of the JCO Oncology Practice Editorial Board. Journal manuscript. policy recused the author from having any role in the peer review of this Employment: University of Michigan manuscript. Stock and Other Ownership Interests: Equity Quotient Consulting or Advisory Role: I-Mab, Clovis Oncology, AstraZeneca, Regeneron, Research Funding: Genentech (Inst) Tesaro, Pfizer, Oasmia Pharmaceutical AB Expert Testimony: Baptist Health/Dressman Benzinger Lavelle Law, Kleinbard, Research Funding: Bristol Myers Squibb (Inst), Kazia Therapeutics (Inst), Pfizer Sherinian & Hasso Law Firm (Inst) Travel, Accommodations, Expenses: Amgen Open Payments Link: https://openpaymentsdata.cms.gov/physician/744193/ Other Relationship: JAMA Oncology summary Open Payments Link: https://openpaymentsdata.cms.gov/physician/373670/ No other potential conflicts of interest were reported. summary Matthew S. Katz Employment: Radiation Oncology Associates, PA Stock: CVS Health, Dr. Reddy's Laboratories, Healthcare Services Group, Hologic, Pfizer Open Payments Link: https://openpaymentsdata.cms.gov/physician/1027599 JCO Oncology Practice http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JCO Oncology Practice Wolters Kluwer Health

Ethics-Centered Guidelines for Social Media Use by Oncology Professionals: A Call to Action

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Wolters Kluwer Health
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© 2022 by American Society of Clinical Oncology
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2688-1527
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2688-1535
DOI
10.1200/op.21.00765
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Abstract

editorials CARE DELIVERY Ethics-Centered Guidelines for Social Media Use by Oncology Professionals: A Call to Action 1 2 3 4 Utkarsh C. Shukla, MD ; Rachel B. Jimenez, MD ; Reshma Jagsi, MD, DPhil ; Abby R. Rosenberg, MD, MS ; 5 6 7 8 9 Jonathan M. Marron, MD, MPH ; Laura J. Carfang, EdD ; Colleen A. Lawton, MD ; Don S. Dizon, MD ; and Matthew S. Katz, MD Perspective We are now in a pivotal time of virtual medicine and online influence where stakeholders, including those For as long as healers have existed, so too have ideas with cancer and their HCPs, interact in a broader about their roles and responsibilities. Biomedical digital environment, with conversations taking place in ethics strives to guide these, in part, via principles a public space for many to listen to and join. Oncology including beneficence, nonmaleficence, respect for 1 clinicians, who have traditionally been engaged in patient autonomy, and justice. Combined with core research, teaching, and/or administrative roles, may virtues such as integrity, respect, compassion, and find themselves drawn to or curious about this new discernment, these principles have developed from frontier, seeking ways to explore how social media can ancient roots to help guide providers in their practice of 2,3 be used as a means to educate people beyond the medicine. Fast forward to the increasingly complex confines of their own clinical practice and specialty. As era of digital health and social media, clinicians are a result, there is an increasing demand for clinicians to challenged to further evolve and adapt this ethics- engage with the public online. centered approach to the virtual environment. To remain a trusted source in the virtual landscape, Over the past two decades, internet access to health HCPs must be able to help people navigate the un- information has changed the dynamics of the patient- certainty of both the cancer experience and internet- doctor relationship. A person newly diagnosed with based information. The risks of social media en- cancer now has access to a wide variety of online tools gagement continue to serve as a barrier to online to obtain information. Through social media, online engagement for HCPs. Risks and benefits of social community forms, and general website searches, media use will also depend upon the ways in which people with cancer may leverage these tools to further HCPs use it. HCPs have an ethical duty to provide prepare themselves for meaningful and substantive accurate information to their patients; on social media, dialogue with their doctors, not only during an intro- however, this can present a never-ending situation ductory consultation but also throughout their cancer given the evolving nature of science, which some may journey. This phenomenon has shifted the modern weaponize for ulterior motives, as has been seen biomedical ethics emphasis from a relational, trust- during the COVID-19 vaccine debacle. There is also a based approach to one of shared decision making, risk that HCPs may use social media to build a per- with more focus on autonomy and patient-centered sonal brand, using these forums to gain internet fame values. People diagnosed with cancer often turn to through editorializing, shaming others, and other ac- 5,6 online support systems for complementary care. tivities that increase likes, shares, and influence. Pa- However, they may not be able to discern factual tients expect their providers to be reliable, empathetic, and accurate medical data in this era of misinfor- composed, and accountable. When we behave in mation. They may be misled by incorrect information, ways that disrespect our colleagues and/or patients, which potentially may cloud their ability to make ac- millions of patients are audience to such behavior, Author affiliations curate and informed decisions or undermine trust in and support 7 which may further contribute to decreased trust in our their treating oncologists. In this context, health care 10-12 information (if field offline. To date, evidence-based guidance on professionals (HCPs) are seen as important and applicable) appear best practices is scarce, leaving clinicians with little trusted resources that help to distinguish correct, at the end of this direction and the potential for a misstep. article. trustworthy, and peer-reviewed resources from unre- Accepted on March liable sources of health information. In so doing, HCPs Historically, nurses, doctors, and other HCPs have 31, 2022 and have a more expansive role not only as educators but been among the most trusted professionals, and we published at also as apomediators of information, hoping to ensure risk harming or even losing that trust if we do not ascopubs.org/journal/ that patients make informed health decisions that extend the ethical practice of medicine to the way we op on May 4, 2022: serve their personal interests and decision-making communicate on social media. An ethics-centered, DOI https://doi.org/10. 1200/OP.21.00765 preferences. evidence-based approach to digital communication Volume 18, Issue 8 537 Editorial and engagement is essential to continuing to fulfill our and transparency of intent), clinical practice (performance, covenant with patients. What we share in the characters of communication skills, and education), professional health/ our content reflects the content of our character. It is time well-being (privacy protection, mental and physical health, that we determine how to maximize the utility of social and limits on use), advocacy (patient, professional, and media and minimize the risk it can pose to patients and to societal-centered), career management (networking and the therapeutic relationships we seek both online and collaboration), and medicolegal (Health Insurance Porta- offline. bility and Accountability Act, malpractice, copyright viola- tion, and defamation; Table 2). All these areas are essential Although the American Medical Association’s Code of parts of the clinical practice of medicine. Developing Ethics (Section 2.3.2) provides cautionary directions for guidelines will not be easy and may require looking at online professionalism and privacy standards, highlighting published data not only on social media in medicine but traditional ethical principles, formal consensus-driven also on human psychology and interactions using social guidelines, as are generated for clinical practice, are media. In this special issue on social media, we expand on lacking. Indeed, few professional societies related to many of these themes. cancer care have released frameworks for ethical practice in the online setting. We reviewed the websites for 20 Online portals have been shown to benefit patients by filling cancer-related professional societies in the United States, their need for information with the opportunity to re-read Canada, and Europe, and only one offers evidence-based, and revisit content overtime and throughout their 5,6 ethical guidelines for social media use (Table 1). survivorship. Furthermore, the advent of online tech- nology continues to enable access to care, information, and We propose addressing this gap with the development of cancer awareness reaching communities in rural areas. rigorously considered consensus guidelines, following Wise use of social media should enhance clinical care, standards of evidence review and best practices, including rather than undermining it. It also gives health care facilities stakeholder input from HCPs, advocates, and patients, to and institutions a core set of guidelines and expectations provide defined guidance to cancer professionals. Relative with which to hold their employees accountable, thereby domains could include ethical (including patient-clinical boundaries, integrity, credible heath information, respect, reducing the risk to reputation and liability. Balancing the TABLE 1. Medical Society Guidelines for Ethics-Centered Use of Social Media Ethics-Centered Guidelines, No Evidence Ethics-Centered Guidelines, Some Evidence No Guidelines Base Base American Society of Radiation Oncology American Medical Association American College of Surgeons American Society of Clinical Oncology American College of Physician American Association for Cancer Research Society of Surgical Oncology Oncology Nursing Society American Association of Medical Dosimetry American Association of Physicists in Medicine American Society of Radiologic Technologists Society for Immunotherapy of Cancer American Brachytherapy Society American College of Radiation Oncology American Radium Society American College of Radiology Radiological Society of North America European Society for Radiotherapy and Oncology European Society for Medical Oncology European Federation of Internal Medicine European Union of General Practitioners/Family Physicians Canadian Association of Radiation Oncology Canadian Association of Medical Oncologists Canadian Society of Internal Medicine 538 © 2022 by American Society of Clinical Oncology Volume 18, Issue 8 Editorial TABLE 2. Selected Questions Requiring Guidance for Integrating Ethical Social Media Use Into the Practice of Oncology Domain Question Examples Ethical How do I establish boundaries for myself, with my patients, Define how to separate personal and professional online activity or with others online? and understand institutional social media policies How do I ensure patients find reliable health information? Create or curate resources that can be shared easily How do I demonstrate transparency of intent, including any Provide public access to disclosures (financial and otherwise) potential conflicts of interest in what I share online? and state them if relevant to conversation How do I balance public engagement with maintaining Recognize that online activities may have offline consequences. or building patient trust in me and public trust in the Be aware that social media posts may affect public trust in me profession? and other health professionals Clinical What are the risks of “opting out” of social media to my May be less able to monitor and define your reputation online clinical role in cancer care? Do I need to learn to value patient experience and need for Identify ways to learn about patient experiences without health information differently, in order to better educate establishing a relationship online and with respect for the them for informed health decisions? boundaries of people sharing health information Professional How do I balance the time I spend online with the need for Define learning and patient care goals to ensure time on social well-being continuous learning and the time necessary for patient care? media doesn’t compromise them How do I avoid risks of internet misuse that may be harmful to Perform periodic personal “check-ins” to assess the impact of my mental or physical health? your social media use on time management and mental and physical health How do I ensure that my social media use complements or Define personal and professional goals, regularly re-evaluate augments my professional career, rather than undermining it? status Advocacy How do I balance advocating for what matters to me as a Estimate and periodically reassess desire to be a public figure on citizen and as a health professional with the importance of nonmedical topics remaining patient-centered? Medicolegal Are there ways to mitigate or decrease risk of malpractice or Understand how privacy laws, regulations, and guidelines apply moral hazard related to social media use? online and how public perception of professionalism influences opinion of patients, public competing values of confidentiality required offline with the paramount. One thing is certain: social media is not going expectations of transparency online will remain a challenge away and HCPs cannot ignore it as a source for medical in health care. Although our tactics must change, our information. The need for thoughtfully considered, ethically commitment to the ethical practice of medicine must remain based guidelines is essential, and it is time to get started. AFFILIATIONS EQUAL CONTRIBUTION Department of Radiation Oncology, Tufts University School of Medicine, D.S.D. and M.S.K. are cosenior authors. Boston, MA Department of Radiation Oncology, Massachusetts General Hospital, AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF Harvard Medical School, Boston, MA INTEREST Department of Radiation Oncology, Center for Bioethics and Social Disclosures provided by the authors are available with this article at DOI Sciences in Medicine, University of Michigan, Ann Arbor, MI 4 https://doi.org/10.1200/OP.21.00765. Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA Department of Pediatric Oncology, Dana-Farber/Boston Children’s AUTHOR CONTRIBUTIONS Cancer and Blood Disorders Center, Center for Bioethics, Harvard Conception and design: Utkarsh C. Shukla, Rachel B. Jimenez, Reshma Medical School, Boston, MA Jagsi, Abby R. Rosenberg, Laura J. Carfang, Colleen A. Lawton, Don S. SurvivingBreastCancer.org, Boston, MA Dizon, Matthew S. Katz Department of Radiation Oncology, Medical College of Wisconsin, Financial support: Matthew S. Katz Milwaukee, WI Administrative support: Don S. Dizon Department of Medicine, Warren Alpert Medical School, Lifespan Collection and assembly of data: Utkarsh C. Shukla, Jonathan M. Marron, Cancer Institute, and Legoretta Cancer Center at Brown University, Laura J. Carfang, Matthew S. Katz Providence, RI Data analysis and interpretation: Utkarsh C. Shukla, Reshma Jagsi, Abby Radiation Oncology Associates, PA, Department of Radiation Medicine, R. Rosenberg, Jonathan M. Marron, Don S. Dizon, Lowell General Hospital, Lowell, MA Manuscript writing: All authors Final approval of manuscript: All authors Accountable for all aspects of the work: All authors CORRESPONDING AUTHOR Matthew S. Katz, MD, The Cancer Center at Lowell General Hospital, 295 Varnum Ave, Lowell, MA 01854; e-mail: Matthew.Katz@roa-ne.com. JCO Oncology Practice 539 Editorial REFERENCES 1. Beauchamp TL, Childress JF: Principles of Biomedical Ethics. New York, NY, Oxford University Press, 2001 2. Jotterand F: The Hippocratic oath and contemporary medicine: Dialectic between past ideals and present reality? J Med Philos 30:107-128, 2005 3. Rosner F: The physician’s prayer attributed to Moses Maimonides. Bull Hist Med 41:440-454, 1967 4. Tauber AI: Patient Autonomy and the Ethics of Responsibility. Cambridge, MA, MIT Press, 2005 5. Johansson V, Islind AS, Lindroth T, et al: Online communities as a driver for patient empowerment: Systematic review. J Med Internet Res 23:e19910, 2021 6. Kuijpers W, Groen WG, Loos R, et al: An interactive portal to empower cancer survivors: A qualitative study on user expectations. Support Care Cancer 23: 2535-2542, 2015 7. Abel GA, Burstein HJ, Hevelone ND, et al: Cancer-related direct-to-consumer advertising: Awareness, perceptions, and reported impact among patients undergoing active cancer treatment. J Clin Oncol 27:4182-4187, 2009 8. Eysenbach G: Medicine 2.0: Social networking, collaboration, participation, apomediation, and openness. J Med Internet Res 10:e1030, 2008 9. Moorhead SA, Hazlett DE, Harrison L, et al: A new dimension of health care: Systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res 15:e1933, 2013 10. Fatollahi JJ, Colbert JA, Agarwal P, et al: The impact of physician social media behavior on patient trust. AJOB Empir Bioeth 11:77-82, 2020 11. Levy AG, Scherer AM, Zikmund-Fisher BJ, et al: Prevalence of and factors associated with patient nondisclosure of medically relevant information to clinicians. JAMA Netw Open 1:e185293, 2018 12. Ahmed W, Jagsi R, Gutheil TG, et al: Public disclosure on social media of identifiable patient information by health professionals: Content analysis of Twitter data. J Med Internet Res 22:e19746, 2020 13. Gallup Poll: Honesty/Ethics in Professions. December, 2020 Update. www.gallup.com/poll/1654/honesty-ethics-professions.aspx 14. Code of Medical Ethics. Chicago, IL. American Medical Association, 2017 15. Cueva K, Revels L, Cueva M, et al: Culturally-relevant online cancer education modules empower Alaska’s community health aides/practitioners to disseminate cancer information and reduce cancer risk. J Cancer Educ 33:1102-1109, 2018 nn n 540 © 2022 by American Society of Clinical Oncology Volume 18, Issue 8 Editorial AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I 5 Immediate Family Member, Inst 5 My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center. Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments). Rachel B. Jimenez Jonathan M. Marron Employment: Massachusetts General Hospital Honoraria: Genzyme Stock and Other Ownership Interests: Biogen Consulting or Advisory Role: Partner Therapeutics Research Funding: Focal Therapeutics Open Payments Link: https://openpaymentsdata.cms.gov/physician/802634/ summary Reshma Jagsi Don S. Dizon This author is a member of the JCO Oncology Practice Editorial Board. Journal policy recused the author from having any role in the peer review of this This author is a member of the JCO Oncology Practice Editorial Board. Journal manuscript. policy recused the author from having any role in the peer review of this Employment: University of Michigan manuscript. Stock and Other Ownership Interests: Equity Quotient Consulting or Advisory Role: I-Mab, Clovis Oncology, AstraZeneca, Regeneron, Research Funding: Genentech (Inst) Tesaro, Pfizer, Oasmia Pharmaceutical AB Expert Testimony: Baptist Health/Dressman Benzinger Lavelle Law, Kleinbard, Research Funding: Bristol Myers Squibb (Inst), Kazia Therapeutics (Inst), Pfizer Sherinian & Hasso Law Firm (Inst) Travel, Accommodations, Expenses: Amgen Open Payments Link: https://openpaymentsdata.cms.gov/physician/744193/ Other Relationship: JAMA Oncology summary Open Payments Link: https://openpaymentsdata.cms.gov/physician/373670/ No other potential conflicts of interest were reported. summary Matthew S. Katz Employment: Radiation Oncology Associates, PA Stock: CVS Health, Dr. Reddy's Laboratories, Healthcare Services Group, Hologic, Pfizer Open Payments Link: https://openpaymentsdata.cms.gov/physician/1027599 JCO Oncology Practice

Journal

JCO Oncology PracticeWolters Kluwer Health

Published: Aug 4, 2022

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