Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE)

Evaluating the SEND eHealth Application to Improve Patients' Secure Message Writing

Secure messaging (SM) is an important aspect of communication for patients with cancer. SM fosters patient-clinician communication and helps patients with symptom management and treatment support. However, patients are uncertain about how to phrase messages appropriately and have expressed the need for guidance. In response, we designed a user-centered, web-based application named SEND The application focuses on specificity, expression, needs, and directness through interactive video tutorials and quizzes. Our objective was to comprehensively evaluate SEND based on its levels of engagement, satisfaction, acceptability, and appropriateness. We recruited 101 patients with various cancer diagnoses to use SEND and then fill out a survey 1 to 2 weeks later about their experience. Patients' mean age was 64 years; most were male (55%), white (83%), diagnosed with cancer in 2020 with high levels of self-efficacy, and 51% had a bachelor's degree or higher. 65% were engaged in the application, and respondents spent an average of 15 min interacting with SEND Satisfaction was 90.4%, 85.4% found it acceptable, and 88.6% appropriate. There were no statistically significant differences across age, sex, race, education, or year of diagnosis. Results underscore the potential of eHealth interventions, like SEND, in enhancing patient-clinician communication in cancer care. By empowering patients with effective message-writing techniques, SEND has the potential to improve the quality of SM, which can lead to faster response times and more patient-centered responses.

Identifying the mechanisms of patient-centred communication in secure messages between clinicians and cancer patients

Objective

Identify how patients and clinicians incorporate patient-centered communication (PCC) within secure messaging.

Methods

A random sample of 199 secure messages from patient portal communication between patients and clinicians were collected and analyzed. Via manual annotation, the task of tagging target words/phrases in text, we identified five components of PCC: information giving, information seeking, emotional support, partnership, and shared decision-making. Textual analysis was also performed to understand the context of PCC expressions within messages.

Results

Information-giving was the predominant (n = 346, 68.1%) PCC category used in secure messaging, more than double of the other four PCC codes, information-seeking (n = 82, 16.1%), emotional support (n = 52, 10.2%), shared decision making (n = 5, 1.0%), combined. The textual analysis revealed that clinicians informed patients about appointment reminders and new protocols while patients reminded clinicians about upcoming procedures and outcomes of test results conducted by other clinicians. Although less common, patients expressed statements of concern, uncertainty, and fear; enabling clinicians to provide support.

Conclusion

Secure messaging is mainly used for exchanging information, but other aspects of PCC emerge using this channel of communication.

Innovation

Meaningful discussions can occur via secure messaging, and clinicians should be mindful of incorporating PCC when communicating with patients through secure messaging.

Integrating patient-centeredness into online patient-clinician communication: a qualitative analysis of clinicians' secure messaging usage

Purpose

Patient-centered communication (PCC) in cancer care is helpful to nurture the patient-clinician relationship and respond to patients’ emotions. However, it is unknown how PCC is incorporated into electronic patient-clinician communication.

Methods

In-depth, semi-structured qualitative interviews with clinicians were conducted to understand how PCC was integrated into asynchronous communication between patients and clinicians; otherwise, known as secure messaging. The constant comparative method was used to develop a codebook and formulate themes.

Results

Twenty clinicians in medical and radiation oncology participated in audio-recorded interviews. Three main themes addressed how clinicians incorporate PCC within messages: (1) being mindful of the patient-clinician relationship, (2) encouraging participation and partnership, and (3) responding promptly suggests accessibility and approachability. Clinicians recommended that patients could craft more effective messages by being specific, expressing concern, needs, and directness, summarized by the acronym S.E.N.D.

Conclusions

Clinicians value secure messaging to connect with patients and demonstrate their accessibility. They acknowledge that secure messaging can influence the patient-clinician relationship and make efforts to include considerate and supportive language. As secure messaging is increasingly relied upon for patient-clinician communication, patients’ message quality must improve to assist clinicians in being able to provide prompt responses inclusive of PCC.

Secure Messaging and COVID-19: A Content Analysis of Patient-Clinician Communication During the Pandemic

Background: Coronavirus disease 2019 (COVID-19) immediately impacted patient-clinician communication, particularly in the oncology setting. Relatedly, secure messaging (SM) usage greatly increased, yet it is unknown what was discussed and whether the technology was utilized to disseminate information. Aims: This study aimed at identifying the most frequently discussed topics using SM as well as at understanding how the communication process transpired during the early stages of the pandemic. Materials and Methods: A mixed-methods design was utilized, consisting of a content analysis of more than 4,200 secure messages, aggregated into 1,454 patient-clinician discussions. Data were collected from February 2020 to May 2020. Discussions were from various oncology departments and included physicians, physician assistants, and nurses. Based on the identified categories, a thematic analysis was conducted to understand the nuances occurring within discussions. Results: Out of the 1,454 discussions, 26% (n = 373) related to COVID-19. Of the COVID-19 discussion, the most frequently coded category was "changes, adjustments, and re-arranging care" (65%, n = 241), followed by "risk for COVID-19" (24%, n = 90), "precautions inside the hospital" (18%, n = 66), and "precautions outside the hospital" (14%, n = 52). Natural language processing techniques were used to confirm the validity of the results. Thematic analysis revealed that patients were proactive in rescheduling appointments, expressed anxiety about being immunocompromised, and clinicians were uncertain about providing recommendations related to COVID-19. Conclusions: The COVID-19 outbreak revealed the need for responsive and effective public health communication. The SM can disseminate information from trusted sources, clinicians, but can be better utilized to deliver tailored information for specific patient populations.

Clinicians' Attitudes and Behaviors Towards Communicating Electronically with Patients: A Grounded Practical Theory Approach

Secure messaging (SM), asynchronous communication between patients and clinicians, is an increasingly popular tool among patients to contact clinicians about their care. Despite patients' enthusiasm, clinicians have been hesitant to embrace the technology to communicate with patients. Using the theoretical and methodological framework of Grounded Practical Theory (GPT), we analyzed and interpreted clinicians' perceptions, attitudes, and approaches toward SM to communicate with patients. Twenty clinicians in medical oncology and radiation oncology participated in audio-recorded, semi-structured interviews. Findings revealed the problems with using SM, such as difficulty interpreting low-quality messages, the amount of time needed to devote to responding, and its potential to negatively affect the patient-clinician relationship. Techniques employed to manage such problems consisted of using different forms of communication and utilizing messaging to expedite workloads. The philosophical rationale of clinicians toward SM was that it can improve patient care and this form of communication is already embedded within existing patient care. Overall, this article clarifies how clinicians can re-conceptualize how they think about SM so that it becomes a productive, informative, and useful aspect of patient care.

Strategies to Improve Clinician-Patient Communication Experiences for Patients With Neurologic Conditions

Increasing research supports that effective clinician communication with patients and families leads to improved patient outcomes, higher patient satisfaction, and improved clinician experiences. As a result, patient- and family-centered communication is the focus of a 2020 American Academy of Neurology quality measure and part of neurology residency training milestones. Clinicians across training levels can implement strategies for improving patient- and family-centered communication, including optimizing the communication environment, using verbal and nonverbal skills, focusing on the patient's agenda, practicing active listening, demonstrating respect and empathy, individualizing encounters to patient and family needs, and providing clear explanations. These skills can be tailored for specialized encounters (e.g., when wearing masks, telemedicine) and for electronic communication. By purposefully identifying and incorporating key communication skills in everyday practice, clinicians have the opportunity to improve patient care and satisfaction and their own experiences in neurology clinical practice.

Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature

BACKGROUND

Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance.

OBJECTIVE

The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework.

METHODS

Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS.

RESULTS

There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (β = 0.21, p = 0.01) and attitude (β = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships.

CONCLUSION

Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.