Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach

How do hospital providers perceive and experience the information-delivery process? A qualitative exploratory study

Objective

To explore how professionals deal with informing their patients and how they experience the process per se, in order to deepen understanding of the issues involved and to identify areas of focus for improvement.

Methods

Semi-structured qualitative interviews were conducted with 13 hospital professionals at Lausanne University Hospital, Switzerland.

Results

Information includes feedback, practical information, patient condition, treatment/process of care, and educational material. Information-delivery is a process that involves informing the patient then checking patient reception of the information. The main expected outcome is patient action. Providers can feel trapped, guilty, inadequate, powerless, disenchanted when the process fails to achieve its expected purpose.

Conclusions

Informing and checking strategies are not implemented optimally, and providers could benefit from guidance in order to decrease discomfort and become more proficient at delivering information.

Innovation

Addressing the information-delivery process per se provides us with a novel insight into the complexity of the process and contributes to identifying essential ingredients of future innovative training programs for providers at large.

Translating Evidence-based Approaches into optimal Care for individuals at High-risk of ASCVD: Pilot testing of case-based e-learning modules and design of the TEACH-ASCVD study

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. Case-based learning using electronic delivery of the modules can educate clinicians and improve translation of evidence-based guidelines into practice for high-risk ASCVD patients.

OBJECTIVE

To develop and optimize module design, content, and usability of e-learning modules to teach clinicians evidence-based management in accordance with multi-society guidelines for high-risk ASCVD patients that will be implemented and evaluated in U.S. health systems in the TEACH-ASCVD study.

METHODS

Seven e-learning modules were created by a committee of lipid experts. Focus groups were conducted with lipid experts to elicit feedback on case content followed by interviews with a target audience of clinicians to assess usability of the online module platform. Responses from both groups were evaluated, and appropriate changes were made to improve the e-learning modules. Design of the TEACH-ASCVD study is presented.

RESULTS

Feedback regarding case content by lipid experts included providing more detailed patient histories, clarifying various diagnostic criteria, and emphasizing clinical best practices based on evidence-based guidelines. The target audience clinician group reported an agreeable experience with the e-learning modules but noted a discordance between the evidence-based guidelines and clinical decision-making in their own practices. Participants felt the modules would help educate clinicians in managing high-risk ASCVD patients.

CONCLUSION

Clinicians must be informed of best practices as the field of lipidology continues to evolve. E-learning modules provide a concise, valuable, and accessible mechanism for educating clinicians regarding changes in the field to deliver the best patient care.

Educational Psychology Aspects of Learning with Chatbots without Artificial Intelligence: Suggestions for Designers

Chatbots without artificial intelligence can play the role of practical and easy-to-implement learning objects in e-learning environments, allowing a reduction in social or psychological isolation. This research, with a sample of 79 students, explores the principles that need to be followed in designing this kind of chatbot in education in order to ensure an acceptable outcome for students. Research has shown that students interacting with a chatbot without artificial intelligence expect similar psychological and communicative responses to those of a live human, project the characteristics of the chatbot from the dialogue, and are taken aback when the chatbot does not understand or cannot help them sufficiently. The study is based on a design through research approach, in which students in information studies and library science interacted with a specific chatbot focused on information retrieval, and recorded their experiences and feelings in an online questionnaire. The study intends to find principles for the design of chatbots without artificial intelligence so that students feel comfortable interacting with them.

Continuous care needs in patients with cancer receiving chemotherapy during the recent omicron wave of COVID-19 in Shanghai: A qualitative study

Aims

This study aimed to investigate the care needs, to clarify the factors affecting the quality of homecare, and to provide reference for constructing a homecare system for patients with cancer receiving chemotherapy during the recent omicron wave of COVID-19 in Shanghai.

Methods

From March to May 2022 when the omicron wave emerged in Shanghai, 50 consecutive patients who received chemotherapy at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, were enrolled, and underwent face-to-face or telephone-based semi-structured interviews regarding continuous care needs. Some of their homecare-givers, caring nurses, and physicians were also interviewed. The Colaizzi method was used for data analysis.

Results

Fifty patients, 4 homecare-givers, 4 nurses, and 4 physicians were interviewed. Three themes and six subthemes emerged from analysis of the interviews: The first theme was "Disease management needs," including needs for knowledge of managing adverse events associated with chemotherapy, and needs for treatment-related information. Patients expressed most concern about not being able to go to the hospital for blood review and disease evaluation in time due to the outbreak. With the COVID-19 pandemic being ongoing, factors such as pandemic panic, inconvenient medical treatment, and worry about hospital cross-infection might reduce disease management for patients with cancer. The second theme was "Medical needs," including needs for mobile healthcare and needs for medical resources. All interviewees emphasized the importance of mobile healthcare during the COVID-19 pandemic, as access to hospitals was difficult. The third theme was "Spiritual needs," including demands for psychological counseling and intervention, and needs for spiritual care. Patients and homecare-givers commonly lacked a feeling of security and needed communication, encouragement, and reassurance that medical care could be delivered to them, and patients reported that they very much wanted psychological advice.

Conclusion

For patients with cancer receiving chemotherapy during the COVID-19 pandemic, continuous care is greatly needed. Medical personnel should strengthen the healthcare education for patients and their caregivers during hospitalization, and further improve the patients' information intake rate through Internet-based digital healthcare methods during homecare, to further meet the information needs of patients after discharge from hospital.

The Use of Chatbots in Oncological Care: A Narrative Review

Background

Few reports have investigated chatbots in patient care. We aimed to assess the current applications, limitations, and challenges in the literature on chatbots employed in oncological care.

Methods

We queried the PubMed database through April 2022 and included studies that investigated the use of chatbots in different phases of oncological care. The search used five different combinations of the specific terms "chatbot", "cancer", "oncology", and "conversational agent". Inclusion criteria were chatbot use in any aspect of oncological care-prevention, patient education, treatment, and surveillance.

Results

The initial search yielded 196 records, 21 of which met inclusion criteria. The identified chatbots mostly focused on breast and ovarian cancer (n=8), with the second most common being cervical cancer (n=3). Good patient satisfaction was reported among 14 of 21 chatbots. The most reported chatbot applications were cancer screening, prevention, risk stratification, treatment, monitoring, and management. Of 12 studies examining efficacy of care via chatbot, 9 demonstrated improvements compared to standard care.

Conclusion

Chatbots used for oncological care to date demonstrate high user satisfaction, and many have shown efficacy in improving patient-centered communication, accessibility to cancer-related information, and access to care. Currently, chatbots are primarily limited by the need for extensive user-testing and iterative improvement before widespread implementation.

Using a Virtual Patient via an Artificial Intelligence Chatbot to Develop Dental Students’ Diagnostic Skills

Knowing how to diagnose effectively and efficiently is a fundamental skill that a good dental professional should acquire. If students perform a greater number of clinical cases, they will improve their performance with patients. In this sense, virtual patients with artificial intelligence offer a controlled, stimulating, and safe environment for students. To assess student satisfaction after interaction with an artificially intelligent chatbot that recreates a virtual patient, a descriptive cross-sectional study was carried out in which a virtual patient was created with artificial intelligence in the form of a chatbot and presented to fourth and fifth year dental students. After several weeks interacting with the AI, they were given a survey to find out their assessment. A total of 193 students participated. A large majority of the students were satisfied with the interaction (mean 4.36), the fifth year students rated the interaction better and showed higher satisfaction values. The students who reached a correct diagnosis rated this technology more positively. Our research suggests that the incorporation of this technology in dental curricula would be positively valued by students and would also ensure their training and adaptation to new technological developments.

Methods for Human-Centered eHealth Development: Narrative Scoping Review

Background

Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes.

Objective

The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods.

Methods

We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach.

Results

In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided.

Conclusions

This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.

Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations (Preprint)

Background

Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients’ health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations.

Objective

This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals.

Methods

Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models.

Results

Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001).

Conclusions

In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient’s recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most—but plausibly not yet all—end users in trauma care will value. This study could inspire the trauma care community.

Developing an e-learning course on the use of PRO measures in oncological practice: health care professionals' preferences for learning content and methods

Purpose

Implementation of patient-reported outcome measures (PROMs) in clinical routine requires knowledge and competences regarding their use. In order to facilitate implementation, an e-learning course for health care professionals (HCPs) on the utilisation of European Organisation for Research and Treatment of Cancer (EORTC) PROMs in oncological clinical practice is being developed. This study aimed to explore future users’ educational needs regarding content and learning methods.

Methods

The sequential mixed methods approach was applied. A scoping literature review informed the guideline for qualitative interviews with HCPs with diverse professional backgrounds in oncology and cancer advocates recruited using a purposive sampling strategy. An international online survey was conducted to validate the qualitative findings.

Results

Between December 2019 and May 2020, 73 interviews were conducted in 9 countries resulting in 8 topic areas (Basic information on PROs in clinical routine, Benefits of PRO assessments in clinical practice, Implementation of PRO assessments in clinical routine, Setup of PRO assessments for clinical application, Interpretation of PRO data, Integration of PROs into the communication with patients, Use of PROs in clinical practice, Self-management recommendations for patients based on PROs) subsequently presented in the online survey. The online survey (open between 3 June and 19 July 2020) was completed by 233 HCPs from 33 countries. The highest preference was indicated for content on interpretation of PRO data (97%), clinical benefits of assessing PRO data (95.3%) and implementation of routine PRO data assessment (94.8%). Regarding learning methods, participants indicated a high preference for practical examples that use a mixed approach of presentation (written, audio, video and interactive).

Conclusion

Educational needs for an integration of PROs in communication in clinical care and coherent implementation strategies became evident. These results inform the development of an e-learning course to support HCPs in the clinical use of EORTC PRO measures.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06676-x.

Development of a data utility framework to support effective health data curation

Objectives

The value of healthcare data is being increasingly recognised, including the need to improve health dataset utility. There is no established mechanism for evaluating healthcare dataset utility making it difficult to evaluate the effectiveness of activities improving the data. To describe the method for generating and involving the user community in developing a proposed framework for evaluation and communication of healthcare dataset utility for given research areas.

Methods

An initial version of a matrix to review datasets across a range of dimensions was developed based on previous published findings regarding healthcare data. This was used to initiate a design process through interviews and surveys with data users representing a broad range of user types and use cases, to help develop a focused framework for characterising datasets.

Results

Following 21 interviews, 31 survey responses and testing on 43 datasets, five major categories and 13 subcategories were identified as useful for a dataset, including Data Model, Completeness and Linkage. Each sub-category was graded to facilitate rapid and reproducible evaluation of dataset utility for specific use-cases. Testing of applicability to >40 existing datasets demonstrated potential usefulness for subsequent evaluation in real-world practice.

Discussion

The research has developed an evidenced-based initial approach for a framework to understand the utility of a healthcare dataset. It is likely to require further refinement following wider application and additional categories may be required.

Conclusion

The process has resulted in a user-centred designed framework for objectively evaluating the likely utility of specific healthcare datasets, and therefore, should be of value both for potential users of health data, and for data custodians to identify the areas to provide the optimal value for data curation investment.

COVID-19 and Disruption in Management and Education Academics: Bibliometric Mapping and Analysis

COVID-19, What to do now? This issue has had devastating effects in all domains of society worldwide. Lockdowns, the lack of freedom and social distancing meant the closure of a country’s entire activity. Having effects at all levels, beside incalculable ones in health, it is argued that scientific activity in education, business, economics and management suffered some of the most drastic impacts of this pandemic. This study aims to map the scientific literature in these areas in the context of COVID-19 and analyze its content through bibliometrics, which made it possible to highlight the scarcity of studies on the topic, namely empirical studies on the effects of this pandemic on scientific research and teaching/education. The results show there is a lack of peer-reviewed publications on this topic, with the studies covered (93) via the threads used revealing only 28 articles coming within the proposed objective. The bibliometrics corroborates that shortage. Finally, the contributions and implications for theory and practice are presented, followed by the limitations and suggestions for future research.