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Ruchika Talwar: Hi everyone. My name's Ruchika Talwar and I'm excited to welcome you back to UroToday's Health Policy Center of Excellence. Today I'm joined by Dr. Nikita Bhatt, who is a fellow at Newcastle Hospital in the UK. She's done a variety of work exploring how urologists can utilize social media interventions, and most recently was first author of a very interesting piece published in European Urology. Dr. Bhatt, thanks so much for joining us today.

Nikita Bhatt: Thanks, Dr. Talwar for having me. Pleasure to be here. So thanks, Dr. Talwar, for that introduction. As she mentioned, we've recently published this paper in European Urology. It's on behalf of our EAU Dissemination Committee and we work together with the EAU Patient Office on this study. I'm going to go through it quite briefly. You can read it. It's a platinum opinion article, so it's onlyin press so hopefully you'll go back and check this out later. But basically the reason we decided to do this is because we know social media is being used by a lot of people across the world. On average, an adult spends about three hours, I'm guilty of that, on social media. And we found that social media interventions enhance engagement by almost 83% and can positively impact health behavior outcomes in almost 89% of users.

So what exactly are social media interventions? So the definition is that they're interactive platforms that enable two-way communication between peers or between the platform and the users. And the key to this dynamic is the multi-directional interaction. And this can be the communication within the group as well as between the group and the healthcare provider. There has been a lot of work that has already been done on this, and a Cochrane Review was published that was highlighting social media interventions in other specialties. And this is a busy slide, but I just wanted to sort of highlight the different areas, where these interventions have already been used to things such as health behavior change, smoking cessation, HIV testing in high risk patients, nutrition in young adults.

And you can see the kind of interventions that have been used such as education, goal setting, social support, data sharing, peer support, et cetera. So a variety of social media platforms can also be used starting from Facebook to Twitter, Instagram, and then you can also have online chat rooms and gaming apps. These are some of the other kind of things that social media interventions have been used for, like cancer prevention, sexual health behavior, overall physical activity, and in obesity for promoting weight loss.

It's interesting that we haven't still used this in urology and there are a number of applications that we thought we could use this within our field. And things such as smoking cessation, for example, can apply to urological disease. Healthy lifestyle is obviously universally applicable. Sexual health promotion is applicable for our patients as well. And then we can think of newer areas that we can use this for such as incontinence. So we can have a sort of multifaceted program for our patients with pelvic floor muscle training, bladder training, you can have a chronic pelvic pain app, you could have a sexual dysfunction interaction for patients with erectile dysfunction where you're promoting healthy lifestyle, smoking cessation, et cetera.

And in urology we are quite good with involving patient advocacy groups. So we have the bladder cancer, prostate cancer, and kidney cancer advocacy groups. And the EAU certainly have been doing a lot with that patient groups to try and involve them into these. So the key is that we try and involve patients, find out what's important to them and find out what would work for them. And hopefully you start using these in urology.

Ruchika Talwar: Thank you so much, Dr. Bhatt for going through your article. I think a lot of the points that you bring up are really fascinating. We have recently seen an increase in things like podcasts or YouTube channels, especially here in the US. There's a few urologists who lean on those platforms to disseminate information to patients. But I agree with you. I think the world of Instagram, the two-way, social media platforms like you referenced, Instagram, Twitter or X and things like TikTok, I think that still remains to be seen how we can fully integrate that into having patients interface directly with physicians. Now, the one thing I wanted to get your thoughts on is this idea of misinformation or inaccurate information that's out there on the internet. I think the silver lining of urologists adopting these sorts of platforms is that we're able to combat some of that by being an accurate source. But what is your advice to urologists who have patients coming in saying, "I read this, I saw this," and it's really inaccurate information.

Nikita Bhatt: So I mean that goes hand in hand with social media, unfortunately. And a lot of work has been published, for example by Stacy Loeb and lots of urologists across the pond as well in the UK and the EAU guidelines are actually coming up with a new chapter that's going to guide urologists on how to use social media. I suppose when patients ask us questions and there's a lot of misinformation, it's our job to obviously inform them, but if we have something better to offer them or suggest, it means that you can actually give an alternative option for them to find because they're going to go out there, look for information. That's what we all do. It's quite natural. So doing this ourselves and having that sort of quality control ourselves would make a massive difference. So my thoughts are that we should get into this and make sure we have credible sources out there and that we follow the sort of guidelines of how to be professional on social media and give patients the right information.

Ruchika Talwar: Yeah, exactly. And what is your suggestion on when a urologist does, for example, put out an X thread or if a urologist decides to make an Instagram post on a specific topic, what are your suggestions on how to incorporate where the information came from? Should they be putting citations in? Should they be quoting specific studies just to tell our patients that this advice we're giving you is evidence based.

Nikita Bhatt: Yeah. I think that's important to have some sort of credibility to what you are posting. The problem with obviously X and even Instagram is that you have limited word count. So our Dissemination Committee always tries to do visual abstracts and images, and then it's quite easy, isn't it, that if you have an image or a visual abstract suggesting whatever you want to say at the bottom, you just have a reference. That means you can get more information in in a concise manner. So that would be my suggestion. But yeah, I think if you do post a lot of patient information, then they do want to know where it came from. And some patients are actually interested in reading studies and there's lay summaries now, like European Urology has a patient lay summary for all its articles, so they might actually be interested in reading that themselves. So they should have that option.

Ruchika Talwar: Yeah. Yeah, that's great. And then a lot of scholarly work is done too that does not necessarily reach patients right away. There's a big delay in an article being published, that information actually being integrated into practice and eventually it reaching patients. So I definitely see social media as a way for patients to keep up with some of the most cutting edge information that's out there. Obviously sites like this one, UroToday features groundbreaking research, but what are your thoughts on the ability of social media to be an interface between research and our patients?

Nikita Bhatt: I think the answer to that really is patient advocacy groups and PPI, patient public involvement panels. So a lot of the research that we are doing now, we always have a PPI panel involved, and then they are our main go-to for understanding how best to disseminate this among patients. But like you said, sites like yours and a lot of the newsletters are doing great work trying to promote research among patients as well as the EAU guidelines have patient public members on their guideline panels. So they obviously bring the point of view of the patient and then help to disseminate the guidelines among the relevant groups of bladder cancer groups and prostate cancer groups. And there's so many charities out there that do the same work. For example, in the UK there's the Urology Foundation and their work has a lot to do with spreading information and new research among patients. So I think all of us put together can sort of keep working in that direction of spreading the right evidence to the patients in a timely manner.

Ruchika Talwar: Before we wrap up, there are a lot of urologists out there who are hesitant or nervous about putting themselves out there on social media. What's your advice to them?

Nikita Bhatt: So I mean, I won't lie, it's not an easy sort of world out there. It can be quite dangerous if you've put something and it's upset people and you have to understand what's the best way to sort of post or what's the right way or the tone of posting, et cetera. But my suggestion is read the EAU guidelines chapter that's coming up. It's written by this committee, and a lot of the social media experts within urology have given their input. So hopefully you can understand what's the best way of interacting with social media without being afraid. And again, there are a lot of papers that are hopefully going to be referenced in that chapter that you would be able to read that are excellent, absolutely excellent at giving you advice on how best to utilize social media as a professional.

Ruchika Talwar: Great advice. I think a lot of people will appreciate the guidelines that are coming out. Thank you so much, Dr. Bhatt, for spending time with us today. I think we covered a really important topic that is very practical and timely, and thanks to our audience for joining in yet again here at UroToday.

Nikita Bhatt: Thanks so much for having me.