Sources of Medical Information for Oncology Physicians During the COVID-19 Pandemic: Results From a National Cross-Sectional Survey

Abstract Because the coronavirus disease 2019 (COVID-19) has completely transformed the accepted norms and approaches to cancer care delivery in the United States, we sought to understand the sources of medical information that oncology physicians seek and trust. We recruited 486 oncology physicians to an anonymous cross-sectional online survey through social media from March 27, 2020, to April 10, 2020, with 79.2% reporting their sources of medical information during the COVID-19 pandemic. We found a diverse array of reported sources for COVID-19 information that most commonly included professional societies (90.7%), hospital or institutional communications (88.6%), and the Centers for Disease Control and Prevention (69.9%); however, trust in these sources of information varied widely, with professional societies being the most trusted source. These results highlight the important role that professional societies, hospitals, and the Centers for Disease Control and Prevention play in ensuring dissemination of consistent, high-quality practice recommendations for oncology physicians.

The coronavirus disease 2019 (COVID-19) has completely transformed the accepted norms and approaches to cancer care delivery in the US. 1 To stem growth of the pandemic and protect immunocompromised patients, governments, health systems and professional societies have upended their treatment guidelines to include widespread telemedicine, postponing or cancelling non-essential procedures and modifying courses of treatment. [2][3][4] While many overarching recommendations are consistent across organizations, the rapid spread of COVID-19 has resulted in continually evolving guidance on treatment and protective measures for patients and physicians. Therefore, understanding the sources of medical information that oncology physicians seek and trust is critical to ensure consistent recommendations and practice concordant with the most current knowledge.
We enrolled 486 eligible oncology physicians (surgeons, medical and radiation oncologists) onto an anonymous cross-sectional online survey using snowball convenience sampling methods over social media platforms (Facebook, LinkedIn, Twitter, American Cancer Society discussion forums) 5 from March 27, 2020 to April 10, 2020. All participants were provided with information about the study and confirmed eligibility as an oncology physician prior to completing the survey. Eligibility criteria included being a physician (MD or DO) who treats cancer patients in the US, age ≥18 years, and ability to read/write in English. Survey items included physician demographics, practice characteristics, cancer treatment decisions and sources of medical information. Validated measures were used or modified as appropriate (Supplementary Materials) and usability/technical functionality was tested prior to fielding the questionnaire. Participants could review/change answers as they progressed through the survey. Additional details on survey design can be found elsewhere. 5 . 385 physicians (79.2%) reported their sources of medical information during the COVID-19 pandemic and degree of trust in these sources for general health information. Survey data were collected and stored using REDCap. 6 We analyzed frequencies and conducted chi-square tests of the relationships between sources of COVID-19 information and trust in these sources by physician characteristics using SAS 9.4 (Cary, NC). P-values <0.05 were considered statistically significant. Statistical tests were two-sided. The University of Minnesota Institutional Review Board approved the study.
In our study, 56.1% were surgeons, 23.6% medical oncologists, 14.9% radiation oncologists and 4.9% other oncology physicians (Table 1). Participants were more commonly female (63.0%), with an average age of 45.9 years (SD=9.7 years). The majority practiced in larger hospitals with 500 and more beds (46.0%), were affiliated with academic institutions (54.3%) and treated a wide range of cancers. Participants reported a variety of sources for COVID-19 information, mostly commonly professional society recommendations/guidelines (90.7%), hospital/institution communications (88.6%) and the Centers for Disease Control and Prevention (CDC, 69.9%) ( Table 2).
However, 60.3% also derived COVID-19 information from social media (physician groups) and traditional news/media (57.7%). Physician trust in information about health and medical topics varied widely by source. Among all physicians, 63.1% reported trusting information from professional society recommendations/guidelines 'a lot', followed by literature searches (50.2%), the World Health Organization (46.4%) and the CDC (45.3%). Few reported 'a lot' of trust in social media (0.5%) or news/media reports (1.8%), although over a quarter (25.2%) showed confidence in physician-only social media groups. When searching for COVID-19 information, over 73.0% were concerned about the quality of information, 42.1% felt it took a lot of effort to get needed information and 42.1% were frustrated during their search; however, only 16.6% felt the information was hard to understand. While sources of information generally did not vary by physician characteristics, we found surgeons were more likely to report using society recommendations (96.7% vs. 78.0% medical oncologists and 84.2% radiation oncologists; p<0.001) and were less likely to use grand rounds (31.0% vs. 51.6% medical oncologists and 47.4% radiation oncologists; p<0.001; data not shown).
In a sample of oncology physicians practicing across the US, we found a diverse array of reported sources for COVID-19 information that most commonly included professional societies, hospitals and the CDC; however, trust in these sources of information varied widely, with professional societies the most trusted source. However, while we found that oncology physicians trust sources such as professional societies, they also report concerns about the quality of COVID-19 related information which is consistent with early editorials and viewpoints published in the literature from leading healthcare professionals. 7,8 These individuals recognized early on in the pandemic a need to balance rapid publication of information on disease transmission, characteristics and outcomes of individuals diagnosed with COVID-19 with rigorous reporting standards, extensive follow-up and validation which may translate into initial concerns with early published data on COVID-19 outcomes.
Initial reports suggest that COVID-19 may be particularly lethal in patients with cancer. 9,10 These findings highlight sources of information most utilized by oncology physicians that can be targeted for up-to-date information on best practices around cancer care delivery, treatment modifications, and allocation of limited healthcare resources during this crisis. Additionally, as professional societies are reported as one of the most trusted sources for COVID-19 information, these findings suggest that societies may consider added review to their posted information to ensure it is consistent with the continually evolving literature and of high scientific quality. Further, added efforts to ensure treatment standards and scientific evidence are easily accessible on these venues are warranted, as we report >40% of oncology physicians reported undertaking 'a lot of effort' to identify COVID-19 related information.
Limitations of the study include reliance on convenience sampling to identify respondents, an inability to directly compare characteristics of non-respondents, targeting of social media groups in order to reach a broad audience quickly, potential overrepresentation of female oncology physicians relative to the general oncology workforce, lack of detailed information on concerns with specific sources of COVID-19 information, and lower proportion of respondents from some states with highest impact from COVID-19.
Despite these limitations, we provide current insights on COVID-19 information seeking from a large population of physicians currently treating cancer patients around the US, highlighting the important role that professional societies, hospitals and the CDC play in ensuring dissemination of high-quality practice recommendations for oncology physicians. These data provide an important starting point for understanding to best provide information to oncology physicians as the pandemic evolves as well as plan for dissemination of information in future outbreaks.

DATA AVAILABILITY STATEMENT
Data available upon request from the corresponding author.