OBJECTIVES:To evaluate the effects of diagnostic labels and management benefit-to-harms information for low-risk prostate pathology. METHODS:Two factorial (3x2) online hypothetical experiments randomised participants 11:1 to three labels: "low-risk prostate cancer, Gleason Group 1", "low-risk prostate neoplasm", or "low-risk prostate lesion", with second randomisation 1:1 to high or low information on management options. Participants were Australians aged ≥50 years with a prostate (males) or with a male partner aged ≥50 years (females). The primary outcome was preference for management with curative-intent (prostatectomy; radiation therapy) or conservative management (PSA monitoring; active surveillance). RESULTS:For 1340 males and 1435 females randomised April to June 2024, 50% vs 34% preferred PSA monitoring, 37% vs 46% active surveillance, 7% vs 11% prostatectomy, and 7% vs 8% radiotherapy. The "neoplasm" label reduced preference for curative-intent treatment in both males (low information Risk Difference (RD)-3.9%[95% CI:-10.5%,2.7%], high information RD: -5.2%[95% CI:-10.6%,0.2%]) and females (low information RD:-6.6% [95% CI:-14.3%,1.1%], high information RD: -2.3%[95%CI:-8.9%,4.3%]). The "lesion" label reduced preference for curative-intent treatment in females within low information groups (RD:-11.6%[95%CI:-18.9%,-4.3%]) but had minimal effect in males and in females within high information groups. High information reduced preference for curative-intent treatment within "cancer" label in both studies (males RD:-4.0%[95% CI:-10.5%,2.5%]; females RD:-10.3%[95%CI:-17.7%,-2.9%]). The combination of "neoplasm" and high information resulted in the largest effects (males RD:-9.2%[95%CI:-15.1%,-3.3%]; females RD:-12.6% [95% CI: -19.9%, -5.2%]). CONCLUSIONS:Clear communication about management benefit-to-harms, and using "neoplasm" to describe low-risk prostate pathology may support conservative management choices and mitigate overtreatment. TRIAL REGISTRATION:ANZCTR 386701;386889.

INTRODUCTION:Lung cancer stigma is widespread, with consequences for patients psychologically and clinically. It can also be a barrier to lung cancer screening (LCS), though current evidence is limited. With LCS programs in development globally, this qualitative study explored the views, expectations, and potential impacts of stigma with people eligible for LCS before commencement of the Australian National LCS Program. METHODS:Participants met eligibility criteria for the Australian National LCS Program (asymptomatic of lung cancer; aged 50-70 years; currently smoking tobacco cigarettes or quit within 10 years; ≥30 pack-year smoking history). Abductive thematic analysis was used. Interview questions and theory-based codes were guided by the Health Stigma and Discrimination Framework. RESULTS:Twenty-four participants were interviewed; 50% (n = 12) were currently smoking and 25% (n = 6) were from culturally or linguistically diverse backgrounds. Most participants had high levels of education, high self-reported health literacy and lived in major cities. Four themes were identified: (1) Harmful narratives of personal responsibility and self-infliction; (2) Smoking stigma is a "necessary evil" and is inevitable in LCS; (3) Identity as part of the LCS cohort; (4) Previous perceptions of stigma in healthcare shape expectations for LCS. CONCLUSION:Stigma in LCS - to some degree - is unavoidable given smoking-based eligibility criteria but may be reduced through: (1) messaging that dismantles industry-driven narratives around responsibility, blame and choice in tobacco use (e.g., by referencing external determinants of smoking behavior); (2) privacy and confidentiality of LCS participation; (3) communication training for LCS staff. Further work in priority communities considering intersectional stigmas is needed.

BACKGROUND:Alternative diagnostic labels for melanoma in situ may better reflect its lower risk (15-y survival of 98%) compared with invasive melanoma (10-y survival ranging from 98% for American Joint Committee on Cancer stage IA to 19% for stage IV). DESIGN:Secondary analysis of an online randomized experiment in Australian adults without melanoma. Participants were randomized to a hypothetical diagnosis of "melanoma in situ (MIS)" (control), "low-risk melanocytic neoplasm," or "low-risk melanocytic neoplasm, in situ" and completed a survey. OUTCOMES:Perceived risk measures were future invasive melanoma and mortality risk (0%-100%), comparative risk, affective risk, and vulnerability (7-point Likert scales). Calculated risk measures were lifetime invasive melanoma risk (from participants' risk factors) and melanoma mortality probability (Australian sex-/age-specific mortality rates). ANALYSIS:An intention-to-treat analysis across randomized groups was performed, unadjusted and adjusted for covariates (linear regression models). RESULTS:In total, 1,668 adults were recruited. Compared with MIS, perceived melanoma mortality risk was lower for low-risk melanocytic neoplasm (-10.4%, 95% confidence interval [CI]: -13.1% to -7.63%, P < 0.001) and for low-risk melanocytic neoplasm, in situ (-7.4%, 95% CI: -10.2% to -4.6%, P < 0.001). Similar patterns were observed for perceived risk of invasive melanoma; comparative, affective risk; and vulnerability. Participants in all groups substantially overestimated their lifetime risk of invasive melanoma (by 48.7%) and of dying from melanoma (by 32.0%) compared with the calculated risk; overestimation was lower in alternative label groups. CONCLUSIONS:Diagnostic labels without the word "melanoma" reduced risk overestimation, supporting MIS relabeling to mitigate overdiagnosis harm by reflecting its largely indolent nature. TRIAL REGISTRATION:ANZCTR: 386943HighlightsAlternative diagnostic labels for melanoma in situ that do not include the word "melanoma" significantly decreased perceived risk compared with melanoma in situ.Participants substantially overestimated their risk; alternative labels reduced this overestimation of perceived risk compared with calculated risk.A new label for melanoma in situ may better communicate the lower risk of adverse outcomes for this lesion compared with invasive melanoma. This may reduce patient anxiety and allow for management decisions that align with their values and preferences.

BackgroundDespite many women learning about endometriosis on social media, posts about the condition often fail to reflect current evidence. With the content and credibility of online health messages being found to influence behavioral intentions in other areas, this study aimed to explore how the format of endometriosis-related social media posts affects women's intentions to get a laparoscopy for the diagnosis and treatment of endometriosis.DesignIn this 2 × 2 × (2) online randomized controlled trial, Australian women aged 18 to 45 y who had no prior endometriosis diagnosis were randomly assigned to view 1 of 4 mock Instagram posts. Post content (personal anecdote v. nonnarrative, factual information) and source (high-credibility "World Health Organization" (WHO) account v. low credibility layperson account) varied across conditions. A within-subjects component investigated change in intention when participants were informed of new treatment guidelines.ResultsA total of 1,473 women were included in the analysis. Instagram posts featuring an anecdote produced higher treatment-seeking intentions (mean difference [MD] = 0.22, 95% confidence interval [CI] = 0.04-0.39) and more favorable attitudes toward getting a laparoscopy compared with posts containing nonnarrative information (MD = 0.13, 95% CI = 0.01-0.25). While the WHO account was perceived as more credible (MD = 0.29, 95% CI = 0.17-0.41), there were no differences in intentions, perceived norms, or self-efficacy toward laparoscopy compared with the layperson account. Advising participants of new evidence regarding the limitations of laparoscopy reduced intentions to get the procedure (MD = 0.29, 95% CI = 0.21-0.37), irrespective of condition.ConclusionsFindings demonstrate the power of anecdotes in shaping treatment preferences. Supplementing evidence-based information with personal anecdotes may ensure accurate yet engaging health information is used by online endometriosis communities to seek appropriate care. Trial registration. Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/; ACTRN12624000767505p)HighlightsFraming health information on Instagram as a personal anecdote increased women's intentions to get a laparoscopy for the diagnosis and treatment of endometriosis.We found few differences between high- and low-credibility sources.Informing participants of new evidence and clinical guidelines reduced intentions across all conditions, potentially reflecting more informed decision making.

The Lancet Commission reconceptualises coronary artery disease as atherosclerotic coronary artery disease (ACAD)—a lifelong, systemic condition driven by atheroma rather than its late ischaemic consequences. This review summarises digital educational approaches that can support evidence-based ACAD prevention and management earlier in the disease course. Evidence is strongest for text messaging, which improves medication adherence and smoking cessation and yields modest cardiometabolic benefits. Video education consistently enhances knowledge and engagement, though behavioural and clinical effects are mixed. Multicomponent and app-based strategies can support physical activity, weight, and glycaemic control, but results depend on design and integration. Conversational agents show small to moderate lifestyle improvements, mainly in primary prevention, but robust ACAD-specific outcome data are limited. Generative AI may enhance readability and access, yet clinical benefit is unproven and requires strong governance. Digital education can support ACAD care when well-designed, clinically integrated, and health-literacy aligned.

Period tracking applications (apps) are increasingly being used by people who menstruate to predict the timing of their next period, monitor symptoms, and avoid or plan pregnancy. Despite their growing popularity, there has been a lack of critical engagement regarding their development, usage, regulation, claimed benefits, and unintended harms. This study aimed to explore how popular international period trackers are promoted, including the quality of the information provided and the communication strategies used in the app descriptions and websites. 'Period tracker' and 'Menstrual cycle calculator' were searched in the Apple and Google app stores and results were combined with Statista's report on the most downloaded period trackers and women's health apps globally. The top ten recurring apps were selected and analysed using an inductive content analysis. The content extracted was categorised into four overarching themes: (1) function and abilities, (2) marketing language, (3) health claims made, and (4) any caveats described. Most apps (60%) featured empowerment language and claimed that users would gain knowledge and understanding of their bodies (60%), yet few (40%) disclosed that they should not replace professional medical advice, diagnosis or treatment. None of the apps included a caveat that their predictions may be inaccurate and should only be interpreted as a guide. By summarising the quality of information and questioning the use of non-evidence-based claims in the promotion of period tracking apps, our findings highlight the need for greater transparency and regulation. Improving information quality, disclosing how predictions are generated, and openly communicating limitations is vital in setting realistic user expectations, enhancing menstrual health literacy, and maximising the benefits of period tracking apps for women and people who menstruate overall.

ABSTRACT Introduction Organised lung cancer screening (LCS) programs are being developed worldwide in response to recent landmark trial evidence. Targeting high‐risk individuals primarily based on smoking history, LCS faces challenges from smoking‐related stigma, which can cause psychological harm and hinder participation. With limited interventions addressing this issue, this study aimed to co‐design a communication‐based strategy to reduce stigma in the LCS context. Methods Using best‐practice co‐design principles, this study involved workshops, focus groups, and interviews with 5 consumers (people eligible for LCS in Australia) and 44 health professionals and other experts (including clinicians, radiographers, behavioural scientists, and health managers). Participants were purposively sampled to achieve representation across key variables – e.g., smoking history for consumers, professional roles for experts. Consultation with experts was conducted as part of a larger project developing a suite of information materials for the National Lung Cancer Screening Program in Australia. Key literature and concurrent qualitative research with consumers (n = 24) also informed co‐design. Qualitative data were analysed using abductive thematic analysis. Results Early consultation identified the preferred format for the strategy as a resource targeted for health professionals involved in the LCS pathway. Resource content was iteratively revised, with three key themes developed: (1) Taking the onus off the individual; (2) Fostering understanding and empathy; (3) Positive framing. A lexicon guide promoting person‐first and empowerment language was also included guided by previous literature. The final resource was a four‐page A4 document for health professionals and LCS staff, designed to support effective, stigma‐sensitive communication during LCS. Conclusion We co‐designed a practical, scalable resource to reduce stigma for use in the Australian National Lung Cancer Screening Program, expected to ultimately reduce psychological harm for LCS participants and enhance screening participation. Future research should evaluate the resource as an implementation strategy for LCS uptake. Cultural adaptation and tailoring of the resource for specific populations considering intersectional stigmas is also needed. Patient or Public Contribution We collaborated with a consumer advisor for the project's duration, including study design, co‐facilitation of consumer workshops, analysis and manuscript writing.

INTRODUCTION:Breast density notification is now implemented in the United States and parts of Australia and Canada despite limited understanding of how it impacts women and their psychosocial health. This study explored the psychosocial impact of receiving a notification of dense breasts through a population-based breast cancer screening programme. METHODS:We interviewed 19 Australian women who indicated being anxious in a survey. This survey was part of the first randomised controlled trial aiming to quantify the psychosocial impact of breast density notifications. Semi-structured interviews were conducted over the phone and analysed thematically to provide nuance and perspectives on the psychosocial impact. RESULTS:The women were 42-78 years old and had diverse ethnic and educational backgrounds. Women generally perceived breast density notifications as valuable for making health decisions, citing female empowerment and the value of information in health. Women described experiences of immediate panic and worry as well as changes to their perceived individual risk of breast cancer. The breast density notification challenged women's previous perceptions of risk of breast cancer, leaving them to reinterpret their need for medical assistance. Women thus described an increased general awareness about breast cancer, which increased their likelihood of performing self-exams and attending breast screenings. DISCUSSION:While empowerment and increased vigilance in health might present positive strides for women's health, the derivative worry highlights the paradoxical value of health awareness and risk communication. This tension is important to consider in future notification practices and decisions on whether to implement breast density notification. PATIENT OR PUBLIC CONTRIBUTION:This study is based on interviews with 19 women who have lived experience with breast density information. The semi-structured interview guide allowed the women to influence what was considered important and relevant.

OBJECTIVE:To explore women's thoughts about and experiences with using period tracking apps, including their perceived benefits and harms. METHODS:Qualitative phenomenological approach using semi-structured interviews with 32 women across Australia between the ages of 18-55 years who had used a period tracking app within the past year. Women were recruited via social media advertising. Audio recordings were transcribed verbatim and analysed thematically using Framework analysis. RESULTS:Findings were categorised into three overarching themes: 1) benefits of using a period tracking app, 2) harms of using a period tracking app, and 3) other described app limitations. While some women found value in having an accurate record of their cycle and experienced an increased sense of control and understanding of bodily cues, others received inaccurate predictions, alarmist notifications that they may have a disorder or were left with unmet expectations, highlighting app inaccuracies and the risk of overmedicalisation. Concerns were also raised around unethical advertising, paywalled information and data privacy. CONCLUSION:This study provides nuanced insights to the benefits and harms of period tracking apps for women in the Australian community. In addition to the benefits of having access and control over one's health information, and concerns about privacy, this study contributes novel findings about the risk of overmedicalising women's cycles through alarmist and sometimes incorrect app notifications, and how this impacts women's perceptions of and feelings about their bodies. PRACTICE IMPLICATIONS:Findings may be used by policy professionals to advocate for increased transparency, safety, and regulation of period tracking apps, as well as for health professionals to recognise the role period tracking apps may have in supporting women's needs but also the risks.

Half of the participants in this randomized online experiment of 1655 Australian adults would prefer to not have a wide local excision (WLE) after a completely excised low-risk melanocytic lesion, if offered this option. Using the term ‘low-risk melanocytic neoplasm’ instead of ‘melanoma in situ’ reduced anxiety and the proportion choosing a WLE. Across all label groups, most participants preferred to attend routine 6-monthly clinic visits for follow-up, most likely reflecting the high prevalence of this in the Australian context.

BACKGROUND AND OBJECTIVES:The impact of health information from social media on general practice consultations remains largely unknown. This study investigates general practitioner (GP) management of such encounters. METHOD:This study comprised a cross-sectional survey of Australian GPs. Descriptive statistics and inferential analyses were used. RESULTS:Of 1889 GP respondents, 59.2% reported patients raise health information from social media in consultations weekly, most commonly regarding medication (72.0%) and diagnoses (56.5%). Most GPs (60.1%) stated that such requests are rarely/never supported by scientific evidence, and 76.0% rarely/never fulfill them. Despite this, 45.5% reported social media having no effect on the doctor-patient relationship. Younger GPs were more likely than older GPs to report social media interactions and negative effects. DISCUSSION:GPs encounter social media health information and generally appear to be managing patient requests. As the use of social media for health information continues to evolve, further GP research and support is needed.

Most celebrities are not formally trained in evaluating medical evidence. Accordingly, their testimonials or endorsements may lack solid scientific backing, relying on 'anecdotal evidence', which can potentially convince consumers to seek unsafe or ineffective therapies. This is especially concerning when financial interests may inadvertently cloud judgement and generate personal endorsements of ineffective, or even harmful, medical interventions to the public. Cancer patients are particularly vulnerable to these messages, while the rest of the public is interested in avoiding life-threatening conditions such as cancer. Social media amplifies adverse consequences by allowing wide circulation and reach of such misleading information. In this paper, we showcase these trends, discuss the ethical considerations as well as implications for healthcare systems, and call for more effective scrutiny and enforcement of current regulation of celebrity testimonials and endorsements.

Objective To investigate the effect of notifying women of their dense breasts on their psychosocial outcomes and health service use intentions. Design Multisite parallel arm randomised controlled trial. Setting Population based breast screening programme in Queensland, Australia. Participants Women aged ≥40 years having screening and classified as having mammographically dense breasts (BI-RADS C-D from automated density measure). Intervention Women were randomised equally to standard care (no notification of breast density), notification of breast density plus written health literacy sensitive information (intervention 1), or notification of density plus a link to online video based health literacy sensitive information (intervention 2). Main outcome measures Psychological (feeling anxious, confused, or informed) and health service use intentions (general practitioner consultation related to breast density, supplemental screening) at 8 weeks post-screening. Results Between September 2023 and July 2024, 3107 women (1030 control, 1003 intervention 1, and 1074 intervention 2) were randomised, and 2401 women (802 control, 776 intervention 1, and 823 intervention 2) with a mean age at baseline of 57.4 (standard deviation 9.9) years were included in the analysis. Compared with the control group, women who were notified of their dense breasts reported feeling significantly more anxious (intervention 1: odds ratio 1.30, 95% confidence interval (CI) 1.08 to 1.57; intervention 2: odds ratio 1.28, 1.07 to 1.54) and confused (intervention 1: odds ratio 1.92, 1.58 to 2.33; intervention 2: odds ratio 1.76, 1.46 to 2.13) and had significantly higher intentions to talk to their general practitioner about their screening results (intervention1: relative risk ratio 2.08, 95% CI 1.59 to 2.73; intervention 2: relative risk ratio 1.71, 1.31 to 2.25) and to rely on their general practitioner for supplemental screening advice (intervention 1: relative risk ratio 2.61, 1.80 to 3.79; intervention 2: relative risk ratio 2.29, 1.58 to 3.33). However, most women did not intend to have supplemental screening (control: 91.3%; intervention 1: 78.9%; intervention 2: 81.4%). Notified women did not feel more informed (intervention 1: odds ratio 0.83, 0.68 to 1.01; intervention 2: odds ratio 0.80, 0.66 to 0.97). Conclusions Women notified of their dense breasts felt anxious and confused, did not feel more informed to make decisions about their breast health, and wanted to be guided by their general practitioners. Notification of breast density as part of population based breast screening may have adverse outcomes including additional consultation burden on general practitioners to advise women. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12623000001695).

This randomised controlled trial evaluated two brief co-designed health literacy educational interventions (animation; images) to help people critically reflect on asking ChatGPT health questions. Australian adults with experience of ChatGPT, and without university education, were recruited via an online panel. Primary outcomes were intention to ask ChatGPT questions in ‘lower’ and ‘higher’ risk health scenarios. The analysis sample comprised 592 of 619 participants. The animation group (n = 191) reported lower intention to use ChatGPT for higher risk scenarios (M = 2.42/5, 95%CI: 2.27 to 2.56) compared to the images group (n = 203, M = 2.69/5, 95%CI: 2.54 to 2.83, p = 0.010). Both reported lower intentions compared to a control group who had not viewed the educational content (n = 205, M = 3.12/5, 95%CI: 2.98 to 3.27, p < 0.001). There was no effect on intentions to use ChatGPT for lower risk scenarios (p = 0.800). This study represents an initial step towards addressing health literacy skills for navigating AI tools safely. Australia and New Zealand Clinical Trials registration: ACTRN 12624000641594.

Hybrid digital breast tomosynthesis (DBT)/digital mammography (DM) (mediolateral oblique from DBT with synthetic 2D, craniocaudal from DM) can potentially improve breast cancer detection and address longer DBT screen-reading time. This pre-specified interim analysis presents the first 5,000 (of target 20,000) hybrid DBT/DM screens in an ongoing prospective trial in BreastScreen Australia. Cancer detection rate for hybrid DBT/DM was 10.6/1,000 screens; recall rate was 4.2 %; median screen-reading time was 36 seconds; and mean glandular dose was 2.49 mGy. Cancer detection and recall rates for hybrid DBT/DM were consistent with DBT metrics in a previous pilot study; screen-reading time was approximately halved.

OBJECTIVE:This study aimed to assess whether information from AI chatbots on benefits and harms of breast and prostate cancer screening were concordant with evidence-based cancer screening recommendations. METHODS:Seven unique prompts (four breast cancer; three prostate cancer) were presented to ChatGPT in March 2024. A total of 60 criteria (30 breast; 30 prostate) were used to assess the concordance of information. Concordance was scored between 0 and 2 against the United States Preventive Services Task Force (USPSTF) breast and prostate cancer screening recommendations independently by international cancer screening experts. RESULTS:43 of 60 (71.7 %) criteria were completely concordant, 3 (5 %) were moderately concordant and 14 (23.3 %) were not concordant or not present, with most of the non-concordant criteria (9 of 14, 64.3 %) being from prompts for the oldest age groups. ChatGPT hallucinations (i.e., completely made up, non-sensical or irrelevant information) were found in 9 of 60 criteria (15 %). CONCLUSIONS:ChatGPT provided information mostly concordant with USPSTF breast and prostate cancer screening recommendations, however, important gaps exist. These findings provide insights into the role of AI to communicate cancer screening benefits and harms and hold increased relevance for periods of guideline change. PRACTICE IMPLICATIONS:AI generated information on cancer screening should be taken in conjunction with official screening recommendations and/or information from clinicians.

AIM:The use of artificial intelligence (AI) and machine learning (ML) is increasingly widespread in radiation oncology. However, patient engagement to date has been poor. Respect for persons in the healthcare setting and the principle of informed consent requires recognition of patient perspectives. The aim of this study was to provide a baseline understanding of patient views about the use of AI/ML in the specific context of radiotherapy to contribute towards future governance of the technology. METHODS:We developed a new questionnaire regarding AI/ML use in radiotherapy. Radiation oncology patients were surveyed from June to October 2024 at two public hospitals in Australia. Questions were on a five-point Likert scale and grouped into six topics. A free text item allowed participants to comment further. RESULTS:We analysed 474 completed questionnaires (474/811, 58 % completion rate). Most participants supported using AI/ML to help physicians with radiation oncology specific tasks (Median Score (MS) 4.3) and held positive views on the general benefits of AI/ML (MS 4.0). Patients also strongly expressed a preference to be aware and informed (MS 2.2). Significant uncertainty remained about whether AI/ML use would enable retention of the human touch and equity in care (MS 3.1). CONCLUSION:This is the largest questionnaire study to date of radiation oncology patients' perceptions of AI/ML, establishing a clear baseline. These results can inform future governance around AI/ML in radiotherapy. Actionable steps include informing patients of AI/ML use in their care and engaging physicians during development and regulation of the technology.