Should Web-Based Education Be Implemented for Colorectal Cancer Patients?


  • Semra Bağrıaçık Altıntaş
  • Fatma Vural

Received Date: 17.08.2017 Accepted Date: 03.10.2017 Turk J Colorectal Dis 2018;28(1):1-8

Improved access to health-related information through increased access to the internet can be viewed as an important opportunity for both healthcare professionals and patients. The internet has fundamentally changed the dynamics of the patient/healthcare provider relationship, turning patients from passive receivers of information to actively researching information consumers, and thus paving the way for technological advances. Individuals primarily research chronic diseases, especially cancer. Of all the cancers, colorectal cancer is steadily and significantly increasing worldwide. Colorectal cancer patients are faced with physiological, sociocultural, and psychological problems during the treatment process. This negatively affects the patients’ health. Educational interventions prepared especially for patients with colorectal cancer may help reduce the symptom burden and improve care by providing information when and where patients need it. Patient education has a major role in health management. Standard training using written materials such as brochures and educational booklets are insufficient for patients to acquire positive health behaviors. Web-based education (WBE) is considered an effective tool for presenting health education because of its many advantages over written materials. This new training model makes it possible for patients to act together with health professionals during the treatment process. Through WBE, patients who otherwise would not be able to meet can share their knowledge and experiences with each other, which can reduce repeat hospital admissions. Although there are web-based patient education applications in different areas in Turkey, there are none specifically designed for colorectal cancer patients. Therefore, the aim of this review was to raise awareness of the need for a WBE program to prepare individuals with colorectal cancer to manage their illness and treatment process.

Keywords: Colorectal cancer, web-based education, nursing


With technology advancing at an astonishing pace, new communication tools are enabling individuals both to obtain information more easily and from verifiable resources, and to express their ideas freely.1,2 Innovation and improvement in modern treatment methods and management has considerably increased and changed opportunities for home treatment.3 Health- and disease-related issues are among the topics people most need to exchange information about.4 With the shift from personal computers to smartphones, both healthcare personnel and patients have more opportunities to make use of social media.5 Thanks to the internet, the general public can access information about diseases with no limitation of time and place, as well as receive emotional support and motivation during the treatment process.6 People primarily search online for information about chronic illnesses, particularly cancer.3 One of the main ways of providing cancer patients cost- and time-effective supportive care is to empower them with knowledge. The purpose of educating cancer patients and their families is to support them in terms of improving the course of the illness, ensuring adherence to both self-care and the recommended treatment, recognizing/managing side effects, and sustaining activities of daily living.7,8,9,10,11 Of the many types of cancer, the incidence of colorectal cancer is rising significantly worldwide.12 Patients diagnosed with colorectal cancer are faced with therapeutic procedures including surgery, chemotherapy, and/or radiotherapy, depending on the extent of their disease. The basic principle of the surgical treatment of colorectal cancer is to remove the primary tumour and regional lymphatics, ensuring clean surgical margins. Creating a temporary or permanent stoma to divert flow from part of the colon is among the most commonly utilized surgical strategies.13 Whether a stoma is created or not, colorectal cancer patients often suffer physiological, sociocultural and psychological problems following surgery.14,15,16 It is important for nurses to educate these patients and their families so that they experience less postoperative anxiety, adapt more readily to treatment, and better cope with the postoperative problems they face in the hospital and at home.17,18 Nurses play a vital part in teaching the patients how to perform self-care and use interactive health communication applications to facilitate disease management. The standard informational material currently offered, which uses printed materials such as brochures and training booklets, is not sufficient for the individual to develop positive health behaviors.19,20,21 Web-based education (WBE), a distance learning model, is recognized by nurses as an effective tool for providing health education because of the many advantages it offers compared to printed materials. This education model helps create a group of healthcare professionals and patients who collaborate throughout the treatment process.22,23,24 Although web-based patient education applications have been implemented in various areas both in Turkey and abroad, there is no WBE designed specifically for colorectal cancer patients and their management. Due to the psychosocial problems colorectal cancer patients experience during the treatment process, it is believed that specialized WBE may reduce the symptom burden and enhance the care of these patients by providing them information when and where they need it. Therefore, the aim of this review was to evaluate previous studies focusing on individuals’ attitudes and behaviours regarding obtaining information about their diseases from the internet, in order to raise awareness of the current necessity for a WBE program to help colorectal cancer patients and their families manage the treatment process.

Materials and Methods

To achieve the primary objective of this review, we examined academic studies conducted in various countries in and after 2005 regarding the effects of health-related internet use on the treatment process. For our secondary objective, we examined studies related to colorectal cancer patients’ need to acquire information. The study focused on forums where people found disease-related information and how they benefited from the internet, as well as search engine results regarding websites, social networking sites, internet-based education, and distance education. This included studies related to online information sources and the correct use of the information obtained therefrom, and how such websites alter the relationship between patient and healthcare providers and influence how individuals cope with their disease.

The Frequency of Internet Use in Turkey and Worldwide

Statistics indicate that there is a sharp increase in internet use all over the world. As of March 30, 2017, the proportion of the global population with internet access is reported to be 49.7%, with the number of internet users having drastically increased by 936% in the last five years to reach 3.739.698.500. Internet use varies by continent and region depending on the rates of development. The continents and regions with the highest rates of internet use are North America (88.1%), Europe (77.4%), and Australia (68.1%).25 Internet use in Turkey is also developing rapidly, in keeping with this global increase. According to data from the Turkish Statistical Institute, in April 2016 the rate of internet use between the ages of 16 and 74 was 54.9% and 61.2%, respectively (Graph 1). In the same year, 76.3% of households had internet access and 96.9% had mobile telephones or smartphones.26 According to 2015 data from “We Are Social”, which is a bank of data obtained from the Global Web Index, the average time spent browsing the internet is 4 hours 37 minutes and the average time spent on mobile internet is 2 hours 51 minutes in Turkey.27 These rates indicate that the internet may be used for sharing healthcare information in our country as it is elsewhere in the world.

Health-Related Internet Use

The widespread availability of internet access both at work and in the home, affordable internet options, overcrowded hospitals, and the need to make hospital appointments and check test results online are all factors that encourage people to use internet for their health problems.23 Health communication is one of the key areas in the effective use of the internet, which is expanding rapidly and becoming a tool actively used by large populations. Health communication encompasses a wide range of topics including informing the public about diseases and health, improving their general health, providing information about the treatment process, and changing their attitudes towards health.4,28 In the USA, the “Healthy People 2020” project listed the following goals of internet and social media use under the subheading of “health communication and health information technology”:29

- To improve the health literacy of the population,

- To increase the proportion of people using electronic personal health management tools,

- To increase individuals’ access to the internet,

- To increase the quality of websites related to health communication,

- To increase the number of crisis and emergency risk messages intended to protect public health,

- To increase social marketing in health promotion and disease prevention.

Every day, more and more people are using health-related social media, learning information from online encyclopedias, and viewing pictures and videos.29 In 2013, Social Touch surveyed 8.001 subjects about their use of the internet for health-related purposes. Their results showed that 78.77% of the respondents had consulted the internet about a health-related issue. Their study revealed that people used the internet primarily for researching topics about health and disease (89.73%), obtaining information about drugs (55.92%), learning about healthcare services (44.12%), and making appointments to see physicians (42.03%).29 Another study performed in 2016 focusing on individuals’ reasons for using the internet determined that 65.9% used the internet for researching health-related information.26 In a study by Görkemli,5 the internet emerged as the preferred tool for finding information about how to maintain health (71.4%), with sources such as relatives (28.2%), television (24.3%), and printed materials (20.6%) following with similar rates. The same study indicated that, other than doctors, the internet was the most important means (69.7%) of obtaining information about treatment and drugs.5

Web-Based Patient Education

The aim of patient education is to identify health-related problems, promote healthy behaviors, and facilitate a holistic state of physical, social, and psychological wellness.30 Patient education is an important part of health management.31 There are many options for providing patient education; in addition to face-to-face education in individual and group training settings, large groups can be reached via television and radio programs and the internet (WBE).23 With recent developments in internet technology, information is not available only as plain text, but also in the form of animations and videos, with the options of synchronous or asynchronous communication.32 Currently, WBE is one of the most important tools used for this purpose.33 WBE encompasses all aspects and processes of education provided via the “World Wide Web” using technology and communication tools.34 In other words, WBE is a form of education provided over a network such as internet or intranet to support remote education and enable access regardless of time and place.35 The WBE model has both benefits and limitations. These benefits and limitations can be categorized as logistical, educational, and economic, as summarized in Table 1.32,36,37,38 Although WBE is often used interchangeably with terms such as distance education, computer-assisted education, and internet-supported education, WBE is considered a form of internet-based distance education, which is a sub-branch of distance education in which education is provided through a digital environment (Figure 1).32,39,40

Certain points must be considered when designing health education using WBE:23,41

  1. Who will be using the website (what topic, age, gender, and educational level is being targeted)?
  2. How will access to the website be managed?
  3. What will the scope of the subject be?
  4. At what times does the target audience use the internet most?
  5. Will feedback be accepted?
  6. Will opportunities for interactive education such as webcam, forum page, and e-mail be provided?23,41

Other important factors in increasing the reliability of a website include citing the sources of the information provided on the site, ensuring the content of the website is informative and not commercial, educators providing personalized suggestions and feedback for the individuals, presenting information that is consistent with that obtained from healthcare professionals, ensuring there is no misinformation on the website, and clearly identifying the persons or institutions responsible for creating the website.8,23,42,43 Numerous studies have been conducted abroad on the effects of WBE interventions on patient outcomes. These studies were conducted mainly in areas such as diabetes,35,44,45,46 breast cancer,10,35,47 prostate cancer,48 colorectal cancer,49 heart failure,50 asthma,51 cardiovascular surgery,52 weight control,53,54 and stroke.55 In most of these studies, the education and guidance given in relation to the health problem have had a positive impact on patient outcomes.23 Studies conducted in Turkey have also shown that online health education and consulting increases patients’ quality of life. There are numerous examples of studies in which web-based health education and consultation have led to favorable outcomes in various areas,23 including the regular follow-up of pregnant women,56 glycemic control and health responsibility in patients with type 2 diabetes,57 promoting participation of adult males in prostate scans,8 increasing quality of life for lung cancer patients,24 shock anxiety levels and quality of life in patients with implantable cardioverter defibrillator,58 and the quality of life and spouse relations of breast cancer patients.59

Need for Web-Based Education for Colorectal Cancer Patients

Of all the cancer types, the incidence of colorectal cancer is rising significantly worldwide. According to the American Cancer Association and a 2016 report from Turkish Cancer Statistics, colorectal cancer has been steadily increasing both globally and in Turkey, and is now the third most common cancer in both males and females.12,60,61,62 Patients with colorectal cancer are particularly affected by and experience various problems due to surgical treatments and risk factors for later difficulties such as stoma. A study revealed that rectal cancer patients felt socially isolated and excluded, and quality of life was adversely affected, particularly for younger patients and those who underwent colostomy.63 A study conducted in Brazil with 144 colorectal cancer patients investigated whether social support was a predictor of low stress, high quality of life and psychological resilience and the results revealed that psychological resilience positively affected quality of life, social support had a strong and direct effect on quality of life, and psychological resilience was negatively correlated with stress perception.64 Russell et al.65 determined that colorectal patients had declines in the roles, cognitive and social functions sub-dimensions of quality of life six months after the treatment, that they experienced fatigue, nausea/vomiting, loss of appetite, impotence, diarrhea, and constipation, and felt anxious about the future because of financial problems. In their qualitative study, Karaveli et al.66 reported that in the periods before and after colorectal surgery individuals experienced “an inability to accept their illness, fear of the treatment process, dread being dependent on relatives, are embarrassed because of the illness, and regret what they are going through.” Patients who undergo surgery for colorectal cancer experience dietary changes, stomal and peristomal problems, altered bowel movements, and sexual problems after discharge from the hospital.67,68 Another qualitative study by Jonsson et al.69 showed that patients who undergo colorectal cancer surgery are afraid of scarring, anastomosis leakage, and other complications that may develop after being discharged, and are not knowledgeable about what to do when faced with such complications. The results of the studies conducted on colorectal cancer patients reveal the extent of the problems faced by these patients both before and after surgery. These patients need support during the treatment process that is always accessible, regardless of time and place. This can be achieved using WBE, which has gained currency as the rate of internet use increases. Already in use in some other countries, this mode of education should also be implemented in Turkey to educate colorectal cancer patients. It is believed that WBE designed specifically for colorectal cancer patients will be useful in facilitating the postoperative care at the hospital and after discharge, thereby preventing readmission and reducing the economic burden of healthcare costs. WBE is expected to establish a new approach in nursing care and make scientific contributions to the literature. A website prepared specifically for colorectal cancer patients should include several important features, including a section with educational forms to assist patients and their relatives in the management of symptoms related to pain, nutrition, nausea/vomiting, constipation, sexuality, fatigue, worshipping, etc.; a video of a specialist describing colorectal cancer and treatment methods in a clear, simple way; a psychiatrist or senior psychologist who may be consulted about psychosocial problems; care training videos focusing on self-care; links to other websites giving information about care and products; a specialist doctor and a specialist nurse who can be available online at least once a week in order to answer any questions; a section of frequently asked questions; a section where questions are answered with current, evidence-based information; a section where the educator provides customized recommendations and feedback; a forum page where patients can communicate with each other; a test for evaluating patients and their families with regard to the information they have acquired; a scale for assessment at 1, 3, and 6 months after training; and a feedback form for patients to indicate how efficient they think the website is.


The objective of this study was to compile the scientific studies conducted in the world and in Turkey regarding use of the internet for health/disease-related purposes. The results indicate that there are a large number of people obtaining healthcare and disease-related information through the internet, and that cancer patients in particular believed that it strengthened their decision-making process and felt that the knowledge they gained from online sources was helpful during appointments with their physician. In light of this information, the importance of using WBE in colorectal cancer becomes more evident because it is among the most common cancer types and can have serious physical and psychosocial impacts on patients. Although WBE interventions have been implemented in various areas in our country, there is no WBE specifically for colorectal cancer patients and their care. Therefore, we recommend that focus be given to web-based studies providing individuals with colorectal cancer unobstructed access to evidence-based information.


Peer-review: External and internal peer-reviewed.

Authorship Contributions

Concept: F.V., S.B.A., Design: F.V., S.B.A., Data Collection or Processing: F.V., S.B.A., Literature Search: F.V., S.B.A., Writing: F.V., S.B.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.

  1. Eşitti Ş. Bilgi Çağinda Problemli İnternet Kullanimi Ve Enformasyon Obezitesi: Problemli İnternet Kullanimi Ölçeğinin Üniversite Öğrencilerine Uygulanmasi. University Faculty of Communication Journal/Istanbul Üniversitesi Iletisim Fakültesi Hakemli Dergisi. 2015(49).
  2. Bass SB, Ruzek SB, Gordon TF, Fleisher L, McKeown-Conn N, Moore D. Relationship of Internet health information use with patient behavior and self-efficacy: experiences of newly diagnosed cancer patients who contact the National Cancer Institute›s Cancer Information Service. J Health Commun 2006;11:219-236.
  3. Zülfikar H. Hastaların İnternet kullanımı ve elektronik ortamdaki sağlık bilgilerine erişim davranışları. Florence Nightingale Hemşirelik Dergisi 2014;22:46-52.
  4. Gülay GÖ. Sağlık İletişiminde Sosyal Medya Kullanımının Stratejik Önemi: Türkiye’de Kalp Sağlığı ile İlgili Kâr Amacı Gütmeyen Kuruluşlar Üzerine Bir Değerlendirme. İLETİŞİM 2013:109-132.
  5. Görkemli N. Sağlik İletişiminde İnternet Kullanimi Üzerine Bir Araştirma. Turkish Online J Des 2017;7.
  6. Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A, Hoving C. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res 2013;15:e85.
  7. Altuntas Y, Kement M, Gezen C, Eker HH, Aydin H, Sahin F, Okkabaz N, Oncel M. The role of group education on quality of life in patients with a stoma. Eur J Cancer Care (Engl) 2012;21:776-781.
  8. Çapık C, Gözüm S. The effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening. Eur J Oncol Nurs 2012;16:71-77.
  9. Li C-C, Rew L, Hwang S-L. The relationship between spiritual well-being and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy. J Wound Ostomy Continence Nurs 2012;39:161-9; quiz 170-171.
  10. Lin ZC, Effken JA, Li YJ, Kuo CH. Designing a tailored Web-based educational mammography program. Comput Inform Nurs 2011;29:16-23.
  11. Zhang JE, Wong FK, You LM, Zheng MC. A qualitative study exploring the nurse telephone follow‐up of patients returning home with a colostomy. J Clin Nurs 2012;21:1407-1415.
  12. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, Jemal A. Colorectal cancer statistics, 2017. CA Cancer J Clin 2017;67:177-193.
  13. AKÇAL S, ERTÜRK S. Kolon kanseri cerrahisi: ameliyat teknikleri In: Baykan E ZA, Geçim İE, Terzi C., ed. Kolon ve Rektum Kanserleri. Vol 1. İstanbul 2010:235-245.
  14. Yıldız I. Stoması Olan Ve Olmayan Kolorektal Kanser Hastalarında Yaşam Kalitesi, Başa Çıkma Tarzı Ve Psikososyal Uyum [Yüksek Lisans Tezi]. İstanbul: Prevantif Onkoloji Anabilim Dali, İstanbul Üniversitesi Sağlik Bilimleri Enstitüsü; 2012.
  15. Ohlsson‐Nevo E, Andershed B, Nilsson U, Anderzen‐Carlsson A. Life is back to normal and yet not-partners’ and patient’s experiences of life of the first year after colorectal cancer surgery. J Clin Nurs 2012;21:555-563.
  16. Özbayır T, Karacabay K. Kolorektal Kanser Ameliyati Geçiren Hastalarin Ameliyat Öncesi Ve Ameliyat Sonrasi Dönemde Yaşadiklari Deneyimlerin Incelenmesi. Journal of Anatolia Nursing and Health Sciences 2014;17:90-96.
  17. Dayılar H, Oyur G, Kamer E, Sarıçiçek A, Cengiz F, Hacıyanlı M. Kolon Ameliyatı Öncesi Hastaların Anksiyete Düzeylerinin Değerlendirilmesi. 2017.
  18. Wood C, Lawton S, Downing A, et al. Quality of life of colorectal cancer survivors in England: report on a national survey of colorectal cancer survivors using Patient Reported Outcome Measures (PROMs). 2015.
  19. Batman D. Prematüre yenidoğanların ebeveynlerine uygulanan web tabanlı eğitimin bebeğin bakımına yönelik özgüven ve kaygı düzeylerine etkisi [Yüksek Lisans Tezi]. Ulusal Tez Merkezi: Ebelik Anabilim Dalı, Adnan Menderes Üniversitesi; 2014.
  20. Ruland CM, Andersen T, Jeneson A, Moore S, Grimsbø GH, Borosund E, Ellison MC. Effects of an internet support system to assist cancer patients in reducing symptom distress: a randomized controlled trial. Cancer Nurs 2013;36:6-17.
  21. Ugur O, Elcigil A, Arslan D, Sonmez A. Responsibilities and difficulties of caregivers of cancer patients in home care. Asian Pac J Cancer Prev 2014;15:725-729.
  22. Üsal Avdal E. Web Tabanli Verilen Diyabet Eğitiminin Bakim Sonuçlarina Etkisi Randomize Kontrollü Çalişma [Doktora Tezi]. Ulusal Tez Merkezi: İç Hastaliklari Hemşireliği Anabilim Dalı, Dokuz Eylül Üniversitesi Sağlik Bilimleri Enstitüsü; 2010.
  23. Demir Y, Gözüm S. Sağlık eğitiminde yeni yönelimler; web destekli sağlık eğitimi. Dokuz Eylül Üniversitesi Hemşirelik Yüksekokulu Dergisi 2011;4(4).
  24. Karakuşer Z. Akciğer Kanseri Tanisi Alan Hastalarda Web Destekli Hasta Eğitiminin Semptom Yönetimine Ve Yaşam Kalitesine Etkisi [Yüksek Lisans Tezi]. Ulusal Tez Merkezi: İç Hastalıkları Hemşireliği Anabilim Dalı, Akdeniz Üniversitesi Sağlik Bilimleri Enstitüsü; 2015.
  25. World Internet Users Statistics and 2017 World Population Stats. Available at. Accessed August 17, 2017.
  26. Hanehalkı Bilişim Teknolojileri Kullanım Araştırması, 2016. 18 Ağustos 2016; Available at. Accessed August 17, 2017.
  27. Social WA. Digital, social & mobile in 2015. Retrieved from slideshare. net/wearesocialsg/digital-social-mobile-in-2015. 2015.
  28. Mendi B. Sağlik İletişiminde Sosyal Medyanin Kullanimi: Dünyadaki Ve Türkiye’deki Uygulamalar. Öneri Dergisi 2015;11:275-290.
  29. Türkiye›de İnternetin Sağlık Amaçlı Kullanımı - Social Touch.®-turkiyede-internetin-saglik-amacli-kullanimi/. Available at. Accessed August 17, 2017.
  30. Avşar G, Kaşıkcı M. Ülkemizde hasta eğitiminin durumu. Journal of Anatolia Nursing and Health Sciences 2009;12.
  31. Bozkurt S, Zayim N, Gulkesen KH, Samur MK, Karaağaoglu N, Saka O. Usability of a web-based personal nutrition management tool. Inform Health Soc Care 2011;36:190-205.
  32. Behçet O, Kenanoğlu R. Web Tabanlı Uzaktan Eğitim Sistemlerinin Öğrenci Başarısına Ve Bilgisayara Yönelik Tutumlarına Etkisi. Elektronik Eğitim Bilimleri Dergisi 2012;1:58-67.
  33. Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res 2013;15:e37.
  34. Ryhanen AM, Rankinen S, Tulus K, Korvenranta H, Leino-Kilpi H. Internet based patient pathway as an educational tool for breast cancer patients. Int J Med Inform 2012;81:270-278.
  35. Heinrich E, de Nooijer J, Schaper NC, Schoonus-Spit MH, Janssen MA, de Vries NK. Evaluation of the web-based Diabetes Interactive Education Programme (DIEP) for patients with type 2 diabetes. Patient Educ Couns 2012;86:172-178.
  36. Hannum W. Web-based training: advantages and limitations. Web-based traigning, New Jersey, Educational Technology Publications 2001:13-20.
  37. Kahn BH. Web-based training: An introduction. Paper presented at: Web-based Training 2001.
  38. Driscoll M. Web-based training: Creating e-learning experiences: John Wiley & Sons; 2010.
  39. Carliner S, Shank P. The e-learning handbook: past promises, present challenges: John Wiley & Sons; 2016.
  40. Carliner S. An overview of online learning: Human Resource Development; 2004.
  41. Umut A, Madran RO. Web tabanlı uzaktan eğitim sistemleri: Sahip olması gereken özellikler ve standartlar. Bilgi Dünyası 2004;5:259-271.
  42. Demirel M, Tekin A, Özbek S, Kaya E. E-sağlık kapsamında internet kullanıcılarının sağlık web sitelerini kullanma durumu üzerine bir araştırma. Uluslararası Davraz Kongresi 2009:1057-1075.
  43. Khazaal Y, Chatton A, Zullino D, Khan R. HON label and DISCERN as content quality indicators of health-related websites. Psychiatric Quarterly 2012;83:15-27.
  44. Bell JA, Patel B, Malasanos T. Knowledge improvement with web-based diabetes education program: brainfood. Diabetes Technol Ther 2006;8:444-448.
  45. Chau JP, Chung LC, Wong RY, Loo KM, Lo SH, So TT, Lau MS, Yeung TH, Leung BS, Tong ML, Li CY, Kwok WW, Thompson DR, Lee DT. An evaluation of a web-based diabetes education program designed to enhance self-management among patients living with diabetes. Comput Inform Nurs 2012;30:672-679.
  46. Noh JH, Cho YJ, Nam HW, Kim JH, Kim DJ, Yoo HS, Kwon YW, Woo MH, Cho JW, Hong MH, Yoo JH, Gu MJ, Kim SA, An KE, Jang SM, Kim EK, Yoo HJ. Web-based comprehensive information system for self-management of diabetes mellitus. Diabetes Technol Ther 2010;12:333-337.
  47. Sivell S, Edwards A, Manstead AS, Reed MW, Caldon L, Collins K, Clements A, Elwyn G; BresDex Group. Increasing readiness to decide and strengthening behavioral intentions: Evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: www. bresdex. com). Patient Educ Couns 2012;88:209-217. Epub 2012 Apr 26.
  48. Krist AH, Woolf SH, Johnson RE, Kerns JW. Patient education on prostate cancer screening and involvement in decision making. Ann Fam Med 2007;5:112-119.
  49. Weinberg DS, Keenan E, Ruth K, Devarajan K, Rodoletz M, Bieber EJ. A randomized comparison of print and web communication on colorectal cancer screening. JAMA Intern Med 2013;173:122-129.
  50. Westlake C, Evangelista LS, Strömberg A, Ter‐Galstanyan A, Vazirani S, Dracup K. Evaluation of a Web‐Based Education and Counseling Pilot Program for Older Heart Failure Patients. Prog Cardiovasc Nurs 2007;22:20-26.
  51. Runge C, Lecheler J, Horn M, Tews J-T, Schaefer M. Outcomes of a Web-based patient education program for asthmatic children and adolescents. Chest 2006;129:581-593.
  52. Martorella G, Cote J, Racine M, Choiniere M. Web-based nursing intervention for self-management of pain after cardiac surgery: pilot randomized controlled trial. J Med Internet Res 2012;14:e177.
  53. Collins C, Morgan P, McElduff P, Callister R. Efficacy of Commercial Web-Based Weight Loss: A Randomized Controlled Trial Comparing Programs with Basic Versus Enhanced Features. Journal of the American Dietetic Association. 2011;111(9):A11.
  54. Johnson F, Wardle J. The association between weight loss and engagement with a web-based food and exercise diary in a commercial weight loss programme: a retrospective analysis. Int J Behav Nutr Phys Act 2011;8:83.
  55. Chul-Gyu K, Hyeoun P. Development and Evaluation of a Web-based Education Program to Prevent Secondary Stroke. J Korean Acad Nurs 2011;41:47-60.
  56. Yenal K. Web ortamında yapılan gebe eğitim programının gebelerin günlük yaşam aktivitelerine etkisinin incelenmesi, Ege Üniversitesi; 2006.
  57. Avdal EU, Kizilci S, Demirel N. The effects of web-based diabetes education on diabetes care results: a randomized control study. Comput Inform Nurs 2011;29:101-106.
  58. Yardımcı T. İmplante Edilebilen Kardiyoverter Defibrilatörlü (Icd) Hastalara Uygulanan Web Tabanlı Eğitimin Şok Anksiyete Düzeyine Ve Yaşam Kalitesine Etkisi. [Dokora]. Ulusal Tez Merkezi: İç Hastalıkları Hemşireliği ABD., Dokuz Eylül Üniversitesi Sağlık Bilimleri Enstitüsü; 2015.
  59. Çömez S. Meme Kanseri Olan Kadınlar Ve Eşleri İçin Oluşturulan Web Tabanlı Eğitimin Yaşam Kalitesi Ve Eş Uyumuna Etkisi [Doktora]. Ulusal Tez Merkezi: Cerrahi Hastalıkları Hemşireliği ABD Dokuz Eylül Üniversitesi Sağlık Bilimleri Enstitüsü; 2016.
  60. Vural F, Sütsünbüloğlu E, Şelimen D. Literatür İnceleme: Stomalı Bireylere Yönelik Yayınların Türkiye Profili. Turk J Colorectal Dis 2016;26:59-70.
  61. Kanser İstatistikleri 2017; Available at. Accessed 16 August, 2017.
  62. WHO | World Health Statistics. Health data and statistics 2017; Available at. Accessed 16 September, 2017.
  63. Van Cutsem E, Cervantes A, Nordlinger B, Arnold D ; ESMO Guidelines Working Group. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii1-9.
  64. Costa ALS, Heitkemper MM, Alencar GP, Damiani LP, Da Silva RM, Jarrett ME. Social support is a predictor of lower stress and higher quality of life and resilience in Brazilian patients with colorectal cancer. Cancer Nurs 2017;40:352-360.
  65. Russell L, Gough K, Drosdowsky A, Schofield P, Aranda S, Butow PN, Westwood JA, Krishnasamy M, Young JM, Phipps-Nelson J, King D, Jefford M. Psychological distress, quality of life, symptoms and unmet needs of colorectal cancer survivors near the end of treatment. J Cancer Surviv 2015;9:462-470.
  66. Karaveli S, Özbayır T, Karacabay K, Karacabay K. Kolorektal Kanser Ameliyati Geçiren Hastalarin Ameliyat Öncesi Ve Ameliyat Sonrasi Dönemde Yaşadiklari Deneyimlerin İncelenmesi. 2013.
  67. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Feldman LS, Steele SR. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017;60:761-784.
  68. Langman G, Loughrey M, Shepherd N, Quirke P. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017)‐Pathology Standards and Datasets. Colorectal Dis 2017;19 Suppl 1:74-81.
  69. Jonsson CA, Stenberg A, Frisman GH. The lived experience of the early postoperative period after colorectal cancer surgery. Eur J Cancer Care (Engl) 2011;20:248-256.