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Weis A, Pohlmann S, Poss-Doering R, Strauss B, Ullrich C, Hofmann H, Ose D, Winkler EC, Szecsenyi J, Wensing M. Caregivers' role in using a personal electronic health record: a qualitative study of cancer patients and caregivers in Germany. BMC Med Inform Decis Mak 2020; 20:158. [PMID: 32660600 PMCID: PMC7358207 DOI: 10.1186/s12911-020-01172-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background Particularly in the context of severe diseases like cancer, many patients wish to include caregivers in the planning of treatment and care. Many caregivers like to be involved but feel insufficiently enabled. This study aimed at providing insight into patients’ and caregivers’ perspectives on caregivers’ roles in managing the patient portal of an electronic personal health record (PHR). Methods A descriptive qualitative study was conducted comprising two study phases: (1) Usability tests and interviews with patients with cancer and caregivers (2) additional patient interviews after a 3-month-pilot-testing of the PHR. For both study parts, a convenience sample was selected, focusing on current state of health and therapy process and basic willingness to participate and ending up with a mixed sample as well as saturation of data. All interviews were audio-recorded, pseudonymized, transcribed verbatim and qualitatively analyzed. Results Two main categories emerged from qualitative data: ‘Caregivers’ role’ and ‘Graduation of access rights’ – consisting of four subcategories each. The interviewed patients (n = 22) and caregivers (n = 9) felt that the involvement of caregivers is central to foster the acceptance of a PHR for cancer patients. However, their role varied from providing technical support to representing patients, e.g. if the patient’s state of health made this necessary. Heterogeneous opinions emerged regarding the question whether caregivers should receive full or graduated access on a patient’s PHR. Conclusions In order to support the patient and to participate in the care process, caregivers need up-to-date information on the patient’s health and treatment. Nevertheless, some patients do not want to share all medical data with caregivers, which might strain the patient-caregiver relationship. This needs to be considered in development and implementation of personal health records. Generally, in the debate on patient portals of a personal health record, paying attention to the role of caregivers is essential. By appreciating the important relationship between patients and caregivers right from the beginning, implementation, of a PHR would be enhanced. Trial registration ISRCTN85224823. Date of registration: 23/12/2015 (retrospectively registered).
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Affiliation(s)
- Aline Weis
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Sabrina Pohlmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Beate Strauss
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Helene Hofmann
- Ethics and Patient-Oriented Care, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Dominik Ose
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Eva C Winkler
- Ethics and Patient-Oriented Care, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Quintana Y, Fahy D, Abdelfattah AM, Henao J, Safran C. The design and methodology of a usability protocol for the management of medications by families for aging older adults. BMC Med Inform Decis Mak 2019; 19:181. [PMID: 31488134 PMCID: PMC6729072 DOI: 10.1186/s12911-019-0907-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background Health research apps often do not focus on usability as a design priority. This is problematic when the population of interest is disproportionately underrepresented as users of mobile apps, especially observed with aging older adults (> = 75). Challenges with the adoption of health information technology (HIT) among this group are exacerbated by poor design and user interface/experience (UI/UX) choices. This protocol describes the testing and evaluation process of one HIT app for the family-based collaboration platform InfoSAGE. Methods We aim to recruit twenty subjects from both informal family-caregivers and aging older adults to examine the usability of the InfoSAGE mobile medication manager. Participants will be audio and visually recorded, in addition to the use of screen capture recordings, while ‘thinking aloud’ as they complete eight common use-case scenarios. Multiple independent reviewers will code video and audio recordings for thematic analysis and use problems will be evaluated. Success and failure of each scenario will be determined by completion of sub-events. Time-to-complete analysis will be used to ascertain the learning curve associated with the app. Discussion Frequently observed problem areas will be used as the basis of further evolution of the app, and will further inform generalized recommendations for the design of HIT apps for research and public use. This study aims to improve the model of development for dual user populations with dissimilar technological literacy to improve retention and use. Results of this study will form the foundation of a design framework for mobile health apps.
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Affiliation(s)
- Y Quintana
- Harvard Medical School, Boston, MA, USA. .,Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - D Fahy
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - J Henao
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C Safran
- Harvard Medical School, Boston, MA, USA.,Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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