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Nafees A, Khan M, Chow R, Fazelzad R, Hope A, Liu G, Letourneau D, Raman S. Evaluation of clinical decision support systems in oncology: An updated systematic review. Crit Rev Oncol Hematol 2023; 192:104143. [PMID: 37742884 DOI: 10.1016/j.critrevonc.2023.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
With increasing reliance on technology in oncology, the impact of digital clinical decision support (CDS) tools needs to be examined. A systematic review update was conducted and peer-reviewed literature from 2016 to 2022 were included if CDS tools were used for live decision making and comparatively assessed quantitative outcomes. 3369 studies were screened and 19 were included in this updated review. Combined with a previous review of 24 studies, a total of 43 studies were analyzed. Improvements in outcomes were observed in 42 studies, and 34 of these were of statistical significance. Computerized physician order entry and clinical practice guideline systems comprise the greatest number of evaluated CDS tools (13 and 10 respectively), followed by those that utilize patient-reported outcomes (8), clinical pathway systems (8) and prescriber alerts for best-practice advisories (4). Our review indicates that CDS can improve guideline adherence, patient-centered care, and care delivery processes in oncology.
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Affiliation(s)
- Abdulwadud Nafees
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Maha Khan
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Ronald Chow
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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2
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Pitt E, Bradford N, Robertson E, Sansom-Daly UM, Alexander K. The effects of cancer clinical decision support systems on patient-reported outcomes: A systematic review. Eur J Oncol Nurs 2023; 66:102398. [PMID: 37633024 DOI: 10.1016/j.ejon.2023.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The implementation of high-quality decision-making support are integral to ensuring the delivery of quality cancer care and subsequently achieving positive patient outcomes. Decision Support Systems (DSS) are increasingly used, however it is not known what the effects are beyond supporting the decision-making process. We aimed to identify and synthesize the available literature regarding the effects of DSS on patient-reported outcomes both during and after cancer treatment. METHODS A systematic review was conducted using dual processes to identify empirical literature that reported an evaluation of DSS interventions and patient-reported outcomes. We appraised study quality using the Mixed Methods Appraisal Tool (MMAT). Data were narratively synthesized. RESULTS We included 15 studies, categorized as symptom assessment interventions or interactive educational interventions. Findings were mixed regarding the effectiveness of DSS interventions in improving total symptom distress and severity, whereas the majority were effective in reducing mean scores for worst and usual pain. Interventions were not effective in improving other health-related patient-reported outcomes including quality of life, global distress, depression, or self-efficacy and there were mixed effects for reducing decisional conflict. There was moderate to high patient adherence to the interventions and generally high satisfaction and acceptability, yet minimal evidence for the effect of DSS interventions in clinician adherence to intervention recommendations. CONCLUSIONS Including patient-reported outcomes in the evaluation of DSS is critical to understand their impact. Inconsistencies in reporting of interventions may, however, be a contributing factor to heterogeneous effects of clinical DSS regarding a broad range of patient-reported outcomes.
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Affiliation(s)
- Erin Pitt
- Cancer and Palliative Care Outcomes Centre and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia; Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, 62 Graham St, South Brisbane, QLD, 4101, Australia.
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia; Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, 62 Graham St, South Brisbane, QLD, 4101, Australia.
| | - Eden Robertson
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, High St, Kensington, NSW, 2052, Australia.
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, High St, Kensington, NSW, 2052, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High St, Randwick, NSW, 2031, Australia; Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High Street, Randwick, NSW, Australia.
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia; Faculty of Health, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.
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3
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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4
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Sezgin MG, Bektas H. The effect of decision support systems on pain in patients with cancer: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2022; 54:578-588. [PMID: 35166032 DOI: 10.1111/jnu.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE This study was conducted to systematically examine the effect of decision support systems (DSSs) applied to patients with cancer on pain severity. REVIEW METHODS Systematic review and meta-analysis. A search was done on Web of Science, Science Direct, PubMed, ProQuest, EBSCOhost/CINAHL Complete, Scopus, Springer Link, Cochrane Library, and Ovid databases, which covered a period until September 2021. Meta-analysis of the data was conducted on the CMA 3 software package. Comprehensive reviews were conducted by two independent researchers in line with the PICOS criteria. The study was conducted according to the PRISMA checklist. FINDINGS Five randomized controlled trials with 1.880 participants were included in this systematic review and meta-analysis. In the study, visits, consultations, simulation of patient outcomes, telephone support, and email applications were employed for periods ranging from 6 weeks to 6 months. The evaluation of the meta-analysis results indicated that DSSs had positive effects on pain severity in patients with cancer (Hedge's g = 0.22; p < 0.001). CONCLUSION The findings of this systematic review and meta-analysis show that DSSs can be used as an effective and comfortable technological application in reducing the severity of pain in patients with cancer. CLINICAL RELEVANCE The use of DSSs for pain severity in patients with cancer is an effective method. In line with the findings of this systematic review and meta-analysis, awareness and knowledge levels of all health disciplines about DSSs will increase. It is believed that the use of DSSs to improve patient-centered care will be guiding.
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Affiliation(s)
- Merve Gozde Sezgin
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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5
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Yung A, Kay J, Beale P, Gibson KA, Shaw T. Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review. JMIR Cancer 2021; 7:e31616. [PMID: 34544680 PMCID: PMC8579220 DOI: 10.2196/31616] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Therapeutic decision-making in oncology is a complex process because physicians must consider many forms of medical data and protocols. Another challenge for physicians is to clearly communicate their decision-making process to patients to ensure informed consent. Computer-based decision tools have the potential to play a valuable role in supporting this process. OBJECTIVE This systematic review aims to investigate the extent to which computer-based decision tools have been successfully adopted in oncology consultations to improve patient-physician joint therapeutic decision-making. METHODS This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist and guidelines. A literature search was conducted on February 4, 2021, across the Cochrane Database of Systematic Reviews (from 2005 to January 28, 2021), the Cochrane Central Register of Controlled Trials (December 2020), MEDLINE (from 1946 to February 4, 2021), Embase (from 1947 to February 4, 2021), Web of Science (from 1900 to 2021), Scopus (from 1969 to 2021), and PubMed (from 1991 to 2021). We used a snowball approach to identify additional studies by searching the reference lists of the studies included for full-text review. Additional supplementary searches of relevant journals and gray literature websites were conducted. The reviewers screened the articles eligible for review for quality and inclusion before data extraction. RESULTS There are relatively few studies looking at the use of computer-based decision tools in oncology consultations. Of the 4431 unique articles obtained from the searches, only 10 (0.22%) satisfied the selection criteria. From the 10 selected studies, 8 computer-based decision tools were identified. Of the 10 studies, 6 (60%) were conducted in the United States. Communication and information-sharing were improved between physicians and patients. However, physicians did not change their habits to take advantage of computer-assisted decision-making tools or the information they provide. On average, the use of these computer-based decision tools added approximately 5 minutes to the total length of consultations. In addition, some physicians felt that the technology increased patients' anxiety. CONCLUSIONS Of the 10 selected studies, 6 (60%) demonstrated positive outcomes, 1 (10%) showed negative results, and 3 (30%) were neutral. Adoption of computer-based decision tools during oncology consultations continues to be low. This review shows that information-sharing and communication between physicians and patients can be improved with the assistance of technology. However, the lack of integration with electronic health records is a barrier. This review provides key requirements for enhancing the chance of success of future computer-based decision tools. However, it does not show the effects of health care policies, regulations, or business administration on physicians' propensity to adopt the technology. Nevertheless, it is important that future research address the influence of these higher-level factors as well. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021226087; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226087.
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Affiliation(s)
- Alan Yung
- Research in Implementation Science and eHealth, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Judy Kay
- Human Centred Technology Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Philip Beale
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, Australia
| | - Tim Shaw
- Research in Implementation Science and eHealth, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Catalyst Translational Cancer Research Centre, The University of Sydney, Sydney, Australia
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6
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Thronæs M, Løhre ET, Kvikstad A, Brenne E, Norvaag R, Aalberg KO, Moen MK, Jakobsen G, Klepstad P, Solberg A, Solheim TS. Interventions and symptom relief in hospital palliative cancer care: results from a prospective longitudinal study. Support Care Cancer 2021; 29:6595-6603. [PMID: 33942192 PMCID: PMC8464577 DOI: 10.1007/s00520-021-06248-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the use of interventions and symptom relief for adult patients with incurable cancer admitted to an acute palliative care unit providing integrated oncology and palliative care services. METHODS All admissions during 1 year were assessed. The use of interventions was evaluated for all hospitalizations. Patients with assessments for worst and average pain intensity, tiredness, drowsiness, nausea, appetite, dyspnea, depression, anxiety, well-being, constipation, and sleep were evaluated for symptom development during hospitalization. Descriptive statistics was applied for the use of interventions and the paired sample t-test to compare symptom intensities (SIs). RESULTS For 451 admissions, mean hospital length of stay was 7.0 days and mean patient age 69 years. More than one-third received systemic cancer therapy. Diagnostic imaging was performed in 66% of the hospitalizations, intravenous rehydration in 45%, 37% received antibiotics, and 39% were attended by the multidisciplinary team. At admission and at discharge, respectively, 55% and 44% received oral opioids and 27% and 45% subcutaneous opioids. For the majority, opioid dose was adjusted during hospitalization. Symptom registrations were available for 180 patients. Tiredness yielded the highest mean SI score (5.6, NRS 0-10) at admission and nausea the lowest (2.2). Significant reductions during hospitalization were reported for all assessed SIs (p ≤ 0.01). Patients receiving systemic cancer therapy reported symptom relief similar to those not on systemic cancer therapy. CONCLUSION Clinical practice and symptom relief during hospitalization were described. Symptom improvements were similar for oncological and palliative care patients.
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Affiliation(s)
- Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway. .,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.
| | - Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Anne Kvikstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Elisabeth Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Robin Norvaag
- Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Kathrine Otelie Aalberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Martine Kjølberg Moen
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnhild Jakobsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Solberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
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7
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Lang EV, Jackson W, Senn P, Aroni DKK, Finkelman MD, Corino TA, Conway G, Kulich RJ. Efficacy of a Self-Hypnotic Relaxation App on Pain and Anxiety in a Randomized Clinical Trial: Results and Considerations on the Design of Active and Control Apps. Int J Clin Exp Hypn 2021; 69:277-295. [PMID: 33724898 PMCID: PMC9976960 DOI: 10.1080/00207144.2021.1883988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite an explosion of mobile app offerings for management of pain and anxiety, the evidence for effectiveness is scarce. Placebo-controlled trials are the most desirable but designing inactive placebo apps can be challenging. For a prospective randomized clinical trial with 72 patients in a craniofacial pain center, we created an app with self-hypnotic relaxation (SHR) for use with iOS and Android systems. A placebo background audio (BA) app was built with the same look and functionality. Both iOS and Android SHR apps alone and in comparison to the BA group significantly reduced pain and anxiety during the waiting-room time. The Android BA app significantly reduced anxiety but not pain. The iOS BA app affected neither pain nor anxiety, functioning as an ideal placebo. Usage analysis revealed that different default approaches of the iOS and Android devices accounted for the difference in results.
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Affiliation(s)
| | - William Jackson
- Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Paul Senn
- Hypnalgesics, LLC, Brookline, Massachusetts, USA
| | - Donavon Khosrow K Aroni
- Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Matthew D Finkelman
- Department of Public Health and Community Service, TuftsUniversity School of Dental Medicine, Boston, Massachusetts, USA
| | | | | | - Ronald J Kulich
- Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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8
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Ahluwalia P, Gupta B. Mobile applications for chronic pain management: An analysis of pain apps available in the app store. INDIAN JOURNAL OF PAIN 2021. [DOI: 10.4103/ijpn.ijpn_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Kruse CS, Ehrbar N. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review. JMIR Med Inform 2020; 8:e17283. [PMID: 32780714 PMCID: PMC7448176 DOI: 10.2196/17283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/08/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. Objective The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried. Methods Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. Results Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs. Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Nolan Ehrbar
- School of Health Administration, Texas State University, San Marcos, TX, United States
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10
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Tomasone JR, Kauffeldt KD, Chaudhary R, Brouwers MC. Effectiveness of guideline dissemination and implementation strategies on health care professionals' behaviour and patient outcomes in the cancer care context: a systematic review. Implement Sci 2020; 15:41. [PMID: 32493348 PMCID: PMC7268663 DOI: 10.1186/s13012-020-0971-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care professionals (HCPs) use clinical practice guidelines (CPGs) to make evidence-informed decisions regarding patient care. Although a large number of cancer-related CPGs exist, it is unknown which CPG dissemination and implementation strategies are effective for improving HCP behaviour and patient outcomes in a cancer care context. This review aimed to determine the effectiveness of CPG dissemination and/or implementation strategies among HCPs in a cancer care context. METHODS A comprehensive search of five electronic databases was conducted. Studies were limited to the dissemination and/or implementation of a CPG targeting both medical and/or allied HCPs in cancer care. Two reviewers independently coded strategies using the Mazza taxonomy, extracted study findings, and assessed study quality. RESULTS The search strategy identified 33 studies targeting medical and/or allied HCPs. Across the 33 studies, 23 of a possible 49 strategies in the Mazza taxonomy were used, with a mean number of 3.25 (SD = 1.45) strategies per intervention. The number of strategies used per intervention was not associated with positive outcomes. Educational strategies (n = 24), feedback on guideline compliance (n = 11), and providing reminders (n = 10) were the most utilized strategies. When used independently, providing reminders and feedback on CPG compliance corresponded with positive significant changes in outcomes. Further, when used as part of multi-strategy interventions, group education and organizational strategies (e.g. creation of an implementation team) corresponded with positive significant changes in outcomes. CONCLUSIONS Future CPG dissemination and implementation interventions for cancer care HCPs may benefit from utilizing the identified strategies. Research in this area should aim for better alignment between study objectives, intervention design, and evaluation measures, and should seek to incorporate theory in intervention design, so that behavioural antecedents are considered and measured; doing so would enhance the field's understanding of the causal mechanisms by which interventions lead, or do not lead, to changes in outcomes at all levels.
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Affiliation(s)
- Jennifer R Tomasone
- School of Kinesiology & Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada.
| | - Kaitlyn D Kauffeldt
- School of Kinesiology & Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada
| | - Rushil Chaudhary
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada
| | - Melissa C Brouwers
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada
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11
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Beauchemin M, Murray MT, Sung L, Hershman DL, Weng C, Schnall R. Clinical decision support for therapeutic decision-making in cancer: A systematic review. Int J Med Inform 2019; 130:103940. [PMID: 31450082 PMCID: PMC7024607 DOI: 10.1016/j.ijmedinf.2019.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/05/2019] [Accepted: 07/31/2019] [Indexed: 12/28/2022]
Abstract
Cancer management, including supportive care, is complex and requires availability and synthesis of published and patient-specific data to make appropriate therapeutic decisions. Clinical decision support (CDS) may be an effective implementation strategy to support complex decision making although it is unclear whether it improves process outcomes, patient outcomes or both in cancer settings. We therefore conducted a systematic review to identify CDS that have been used to support therapeutic decision making in clinical cancer settings. Outcomes of interest included the effect of CDS on the process, such as clinician's decision making and effect on patient outcomes. Ten studies met inclusion criteria, with variability in the study design, setting, and intervention. Of the nine studies that measured process outcomes, five demonstrated significant improvement; and of the six that measured patient outcomes, four demonstrated significant improvement. All included studies utilized CDS that were informed by clinical practice guidelines. In conclusion, CDS to guide cancer therapeutic decision making is an understudied but promising area. Further research is needed.
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Affiliation(s)
- Melissa Beauchemin
- School of Nursing, Columbia University, New York, NY, 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, United States.
| | - Meghan T Murray
- School of Nursing, Columbia University, New York, NY, 10032, United States
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, 10032, United States
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12
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Løhre ET, Thronæs M, Brunelli C, Kaasa S, Klepstad P. An in-hospital clinical care pathway with integrated decision support for cancer pain management reduced pain intensity and needs for hospital stay. Support Care Cancer 2019; 28:671-682. [PMID: 31123870 DOI: 10.1007/s00520-019-04836-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE A clinical care pathway for pain management in a palliative care unit was studied with outcomes related to patients, physicians, and health care service. Mandatory use of patient-reported outcome measures (PROMs) and physician-directed decision support (DS) were integrated parts of the pathway. METHODS Adult cancer patients with pain intensity (PI) ≥ 5 (NRS 0-10) at admission were eligible. The patients reported average and worst PI at admission, day four, and discharge. The physicians completed the DS at admission and day four. The DS presented potential needs for treatment changes based on pain severity and pathophysiology. The physicians reported treatment changes due to input from the DS system. The two primary outcomes were average and worst PI changes from admission to discharge. Hospital length of stay (LOS) was registered. RESULTS Of 52 included patients, 41 were discharged alive. For those, the mean average PI at admission and at discharge was 5.8 and 2.4, respectively, a reduction of 3.4 points (CI 95% 2.7-4.1). The corresponding worst pain intensities were 7.9 and 3.8, a reduction of 4.1 points (CI 95% 3.4-4.8). The physicians completed DS forms for all patients. Fifty-five percent (CI 95% 41-69) of the patients had pain intervention changes based on the DS. A significant reduction in LOS (4.4 days, CI 95% 0.5-8.3) was observed during the study period. CONCLUSIONS The interventions were implemented according to the intentions and PI was reduced as hypothesized. For evaluation of generalizability, the interventions should be studied in other settings and with a controlled design.
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Affiliation(s)
- Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway. .,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,European Palliative Care Research Centre (PRC), Department of Oncology and Institute of Clinical Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Stein Kaasa
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology , N-7491, Trondheim, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology and Institute of Clinical Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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13
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Thurnheer SE, Gravestock I, Pichierri G, Steurer J, Burgstaller JM. Benefits of Mobile Apps in Pain Management: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e11231. [PMID: 30348633 PMCID: PMC6231845 DOI: 10.2196/11231] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/16/2022] Open
Abstract
Background Pain is a common condition with a significant physical, psychosocial, and economic impact. Due to enormous progress in mobile device technology as well as the increase in smartphone ownership in the general population, mobile apps can be used to monitor patients with pain and support them in pain management. Objective The aim of this review was to assess the efficacy of smartphone or computer tablet apps in the management of patients with pain. Methods In December 2017, a literature search was performed in the following databases: MEDLINE, EMBASE, CINAHL, Cochrane, and PsycINFO. In addition, a bibliography search was conducted. We included studies with at least 20 participants per arm that evaluated the effects of apps on smartphones or computer tablets on improvement in pain. Results A total of 15 studies with 1962 patients met the inclusion criteria. Of these, 4 studies examined the effect of mobile apps on pain management in an in-clinic setting and 11 in an out-clinic setting. The majority of the original studies reported beneficial effects of the use of a pain app. Severity of pain decreased in most studies where patients were using an app compared with patients not using an app. Other outcomes, such as worst pain or quality of life showed improvements in patients using an app. Due to heterogeneity between the original studies—patient characteristics, app content, and study setting—a synthesis of the results by statistical methods was not performed. Conclusions Apps for pain management may be beneficial for patients, particularly in an out-clinic setting. Studies have shown that pain apps are workable and well liked by patients and health care professionals. There is no doubt that in the near future, mobile technologies will develop further. Medicine could profit from this development as indicated by our results, but there is a need for more scientific inputs. It is desirable to know which elements of apps or additional devices and tools may improve usability and help patients in pain management.
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Affiliation(s)
- Simon E Thurnheer
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Isaac Gravestock
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Giuseppe Pichierri
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Johann Steurer
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Jakob M Burgstaller
- Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
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