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Dunlop E, Ferguson A, Mueller T, Baillie K, Laskey J, Clarke J, Kurdi A, Wales A, Connolly T, Bennie M. Involving Patients and Clinicians in the Design of Wireframes for Cancer Medicines Electronic Patient Reported Outcome Measures in Clinical Care: Mixed Methods Study. JMIR Form Res 2023; 7:e48296. [PMID: 38127422 PMCID: PMC10767627 DOI: 10.2196/48296] [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: 04/18/2023] [Revised: 09/28/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients' lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. OBJECTIVE The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. METHODS We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow & Clyde, the largest health board in Scotland. RESULTS A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was "quite likely" that the technologies would be easy to use and they would be "quite likely" to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions "with around half" of their patients. CONCLUSIONS This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research.
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Affiliation(s)
- Emma Dunlop
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Aimee Ferguson
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | | | | | - Julie Clarke
- NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Ann Wales
- NHS Healthcare Improvement Scotland, Glasgow, United Kingdom
| | | | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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Fleshner L, Lagree A, Shiner A, Alera MA, Bielecki M, Grant R, Kiss A, Krzyzanowska MK, Cheng I, Tran WT, Gandhi S. Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review. Oncologist 2023; 28:1020-1033. [PMID: 37302801 PMCID: PMC10712716 DOI: 10.1093/oncolo/oyad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Patients diagnosed with cancer are frequent users of the emergency department (ED). While many visits are unavoidable, a significant portion may be potentially preventable ED visits (PPEDs). Cancer treatments have greatly advanced, whereby patients may present with unique toxicities from targeted therapies and are often living longer with advanced disease. Prior work focused on patients undergoing cytotoxic chemotherapy, and often excluded those on supportive care alone. Other contributors to ED visits in oncology, such as patient-level variables, are less well-established. Finally, prior studies focused on ED diagnoses to describe trends and did not evaluate PPEDs. An updated systematic review was completed to focus on PPEDs, novel cancer therapies, and patient-level variables, including those on supportive care alone. METHODS Three online databases were used. Included publications were in English, from 2012-2022, with sample sizes of ≥50, and reported predictors of ED presentation or ED diagnoses in oncology. RESULTS 45 studies were included. Six studies highlighted PPEDs with variable definitions. Common reasons for ED visits included pain (66%) or chemotherapy toxicities (69.1%). PPEDs were most frequent amongst breast cancer patients (13.4%) or patients receiving cytotoxic chemotherapy (20%). Three manuscripts included immunotherapy agents, and only one focused on end-of-life patients. CONCLUSION This updated systematic review highlights variability in oncology ED visits during the last decade. There is limited work on the concept of PPEDs, patient-level variables and patients on supportive care alone. Overall, pain and chemotherapy toxicities remain key drivers of ED visits in cancer patients. Further work is needed in this realm.
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Affiliation(s)
- Lauren Fleshner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Andrew Lagree
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Temerty Centre for AI Research and Education, University of Toronto, Toronto, Canada
| | - Audrey Shiner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Marie Angeli Alera
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mateusz Bielecki
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robert Grant
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
- The Cancer Quality Lab, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Ivy Cheng
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Emergency Medicine, University of Toronto, Toronto, Canada
| | - William T Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Temerty Centre for AI Research and Education, University of Toronto, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Sonal Gandhi
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
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Blok AC, Costa DK, Wright NC, Manojlovich M, Friese CR. Development and Evaluation of a Data-Driven, Interactive Workshop to Facilitate Communication and Teamwork in Ambulatory Medical Oncology Settings. CANCER CARE RESEARCH ONLINE 2023; 3:e043. [PMID: 37719163 PMCID: PMC10501213 DOI: 10.1097/cr9.0000000000000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background While adverse events and toxicities related to cancer drug therapy in the ambulatory oncology setting are common and often rooted in communication challenges, few studies have examined the problems of communication or tested tools to improve communication in this unique, high-risk setting. Objective To determine the feasibility and acceptability of a virtual interdisciplinary communication Workshop designed to strengthen communication across ambulatory oncology teams members. Methods Surveys of patients and clinicians in one ambulatory oncology clinic were analyzed and informed the communication intervention: an interdisciplinary virtual Workshop. Workshop evaluation included an implementation survey measure and a structured debrief with Workshop attendees. Results 87 patients and 56 clinicians participated in pre-workshop surveys that revealed patient satisfaction with timely care and information, yet a range of rating communication experiences with the clinical team, and clinicians perceiving a high amount of organizational safety, yet rated discussion of alternatives to normal work processes low. Survey results guided reflection and discussion within the Workshop. Six clinicians participated in the interactive Workshop. Feasibility and acceptability of the virtual Workshop were supported by formative and summative data, along with suggestions for improvement. Conclusions The patient and clinician surveys coupled with an interactive virtual Workshop were feasible and acceptable. Implications for Practice The Workshop identified opportunities for individual- and system-level improvements in clinical team communication. This promising strategy requires replication in larger, diverse practice samples. Foundational Clinicians accepted an interactive workshop that incorporated clinic-specific data and communication strategies. The program is feasible and acceptable in ambulatory oncology settings.
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Affiliation(s)
- Amanda C Blok
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan; Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System
| | - Deena Kelly Costa
- Yale School of Nursing and Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine
| | - Nathan C Wright
- Center for Improving Patient and Population Health, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan
| | - Milisa Manojlovich
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan
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Friese CR, Fauer AJ, Kuisell C, Mendelsohn-Victor K, Wright NC, Griggs JJ, Manojlovich M. Patient-reported outcomes collected in ambulatory oncology practices: Feasibility, patterns, and correlates. Health Serv Res 2020; 55:966-972. [PMID: 33125170 DOI: 10.1111/1475-6773.13574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and describe the patterns and correlates of patient-reported toxicities. DATA SOURCES Patient survey data from 29 Michigan ambulatory oncology practices collected in 2017. STUDY DESIGN Secondary analysis of patient survey data. Descriptive statistics were generated at the patient and practice levels. Thematic analysis of open-text comments identified clusters of frequently reported toxicities. DATA COLLECTION METHODS Patients completed 11 items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Using a 5-point Likert scale, patients rated the frequency of nausea, vomiting, diarrhea, and pain; the severity of nausea, vomiting, constipation, numbness/tingling, and pain; and how much numbness/tingling and pain interfered with usual or daily activities. Patients could also report two toxicities in open-text comments. Finally, patients reported unplanned health care service for toxicity or side effect management. PRINCIPAL FINDINGS Of 3565 eligible patients, 2245 participated (63%) and 457 (20%) rated at least one toxicity as severe/very severe. Across practices, the proportion of patients who reported at least one severe/very severe toxicity ranged from 8% to 50%. Troubling toxicities included pain frequency (mean 2.3, SD 1.3), pain severity (2.1, 1.1), and diarrhea frequency (1.9, 1.0). From completed assessments, 1653 (74%) reported at least one toxicity in open-text comments; fatigue (n = 182), stomach discomfort (n = 53), and skin/nail changes (n = 41) were most frequently reported. Regarding consequences, 156 patients (7%) reported unplanned health care service use: 41 (26%) visited an emergency department and 32 (21%) were admitted to a hospital. CONCLUSIONS Querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, which informed quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens.
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Affiliation(s)
- Christopher R Friese
- Center for Improving Patient and Population Health, School of Nursing, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Alex J Fauer
- National Clinician Scholars Program, David Geffen School of Medicine, and Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Clare Kuisell
- Hillman Scholar in Nursing Innovation, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Kari Mendelsohn-Victor
- Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Nathan C Wright
- Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.,Michigan Oncology Quality Collaborative, Ann Arbor, MI, USA
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