1
|
Kiss N, Jongebloed H, Baguley B, Marshall S, White VM, Livingston PM, Bell K, Young L, Sabesan S, Swiatek D, Boltong A, Britto JM, Ugalde A. Meaningful consumer involvement in cancer care: a systematic review on co-design methods and processes. JNCI Cancer Spectr 2024; 8:pkae048. [PMID: 38897655 PMCID: PMC11240760 DOI: 10.1093/jncics/pkae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/30/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE Although the benefits of consumer involvement in research and health care initiatives are known, there is a need to optimize this for all people with cancer. This systematic review aimed to synthesize and evaluate the application of co-design in the oncology literature and develop recommendations to guide the application of optimal co-design processes and reporting in oncology research, practice, and policy. METHODS A systematic review of co-design studies in adults with cancer was conducted, searching MEDLINE, CINAHL, Embase, and PsycINFO databases and included studies focused on 2 concepts, co-design and oncology. RESULTS A total of 5652 titles and abstracts were screened, resulting in 66 eligible publications reporting on 51 unique studies. Four frameworks were applied to describe the co-design initiatives. Most co-design initiatives were designed for use in an outpatient setting (n = 38; 74%) and were predominantly digital resources (n = 14; 27%) or apps (n = 12; 23%). Most studies (n = 25; 49%) used a co-production approach to consumer engagement. Although some studies presented strong co-design methodology, most (n = 36; 70%) did not report the co-design approach, and 14% used no framework. Reporting was poor for the participant level of involvement, the frequency, and time commitment of co-design sessions. Consumer participation level was predominantly collaborate (n = 25; 49%). CONCLUSIONS There are opportunities to improve the application of co-design in oncology research. This review has generated recommendations to guide 1) methodology and frameworks, 2) recruitment and engagement of co-design participants, and 3) evaluation of the co-design process. These recommendations can help drive appropriate, meaningful, and equitable co-design, leading to better cancer research and care.
Collapse
Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Hannah Jongebloed
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Brenton Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Skye Marshall
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Victoria M White
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Patricia M Livingston
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Kathy Bell
- Clinical Oncology Society of Australia, Sydney, NSW, Australia
| | - Leonie Young
- Clinical Oncology Society of Australia, Sydney, NSW, Australia
| | - Sabe Sabesan
- Clinical Oncology Society of Australia, Sydney, NSW, Australia
- Department of Medical Oncology, Townsville Cancer Centre, Townsville, QLD, Australia
| | - Dayna Swiatek
- Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Anna Boltong
- Kirby Institute, University of New South Wales, NSW 2052, Australia
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton 3800, Victoria, Australia
| | - Joanne M Britto
- Victorian Comprehensive Cancer Centre Alliance, Parkville, VIC, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
2
|
Leske M, Koczwara B, Blunt J, Morris J, Eakin E, Short CE, Daly A, Degner J, Beatty L. Co-designing Healthy Living after Cancer Online: an online nutrition, physical activity, and psychosocial intervention for post-treatment cancer survivors. J Cancer Surviv 2024; 18:606-616. [PMID: 36374435 PMCID: PMC9660094 DOI: 10.1007/s11764-022-01284-y] [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: 05/26/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of the present study was to co-design Healthy Living after Cancer Online (HLaC Online), an online intervention supporting cancer survivors to set and meet their healthy living goals. METHODS Adapted from an initial telephone-delivered Healthy Living after Cancer program, wireframes (PDF black and white mock-ups) of the proposed online program were presented in a series of focus groups and interviews to our stakeholder group, which consisted of cancer survivors, oncology healthcare professionals, and representatives from cancer support organisations. Stakeholders were prompted for feedback on the wireframe and given end-user scenarios to encourage deeper engagement with the co-design process. Transcriptions underwent thematic analysis to determine which features of the program needed change or expansion. RESULTS 27 participants took part in one of 8 focus groups or 10 interviews. Five themes were identified relating to (a) website design elements, (b) promoting and maintaining long-term engagement, (c) relatability and relevance, (d) navigating professional support, and (e) family and peer support. Recommended changes, such as simple activities and guidance videos, were integrated into the HLaC Online prototype. CONCLUSIONS Involving end-users in the co-design process ensured the intervention's relevance and specificity to the needs of cancer survivors. Next steps include feasibility testing the prototype, prior to commencing a national randomised control trial of HLaC Online. IMPLICATIONS FOR CANCER SURVIVORS HLaC Online aims to support cancer survivors to improve their quality of life by making healthy lifestyle changes in their physical activity, healthy eating, weight management, mental health, and fatigue management.
Collapse
Affiliation(s)
- Morgan Leske
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia.
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Medical Oncology, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | | | | | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Jon Degner
- Cancer Voices South Australia, Kensington Park, SA, Australia
| | - Lisa Beatty
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
3
|
Cwintal M, Ranjbar H, Bandamiri P, Guadagno E, Osmanlliu E, Poenaru D. A rapid review for developing a co-design framework for a pediatric surgical communication application. J Pediatr Surg 2023; 58:879-890. [PMID: 36805140 DOI: 10.1016/j.jpedsurg.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The exponential growth in the use of mobile health (mHealth) applications in patient care has highlighted the importance of understanding end-users' needs for successful interventions, achievable through the process of co-design. This review aims to summarize previously published uses of co-design in mHealth applications. It will inform the development of a local mHealth tool in pediatric surgery. METHODS The rapid review was conducted following Cochrane Rapid Review guidelines. We searched four databases from inception until August 2021 for collaborative design in mHealth apps. Two reviewers independently screened titles and abstracts using Rayyan, with a third reviewer resolving any conflicts. Studies were excluded if they were non-empirical or in other languages than English. RESULTS Out of 984 records screened, 175 were included for full-text screening, and 27 met all eligibility criteria. The purpose of the studies related to care support, communication, self-management or information management. All interventions involved their target audience in the co-design process, and 85% included healthcare professionals for expert opinion. Stakeholder participation was solicited via interviews, surveys, focus groups, design sessions, and prototype evaluation. To initiate the process, 15 studies included needs identification, 8 did background research, and 7 performed literature reviews. CONCLUSION Co-design has a positive impact on mHealth development, research processes and outcomes. Its success relies on a clearly identified framework of terminology, activities involved, and evaluation techniques. The findings of this review will be integrated into a novel co-design framework, which will be used to inform the development of a pediatric surgery mHealth application. LEVEL OF EVIDENCE This review uses manuscripts that are rated level III-V.
Collapse
Affiliation(s)
- Michelle Cwintal
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, 2001 McGill College Ave, Montreal, Quebec, H3A 1G1, Canada
| | - Hamed Ranjbar
- Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de La Montagne, Montréal, Quebec, H3G 2M1, Canada
| | - Parsa Bandamiri
- Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de La Montagne, Montréal, Quebec, H3G 2M1, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, Room B04.2028, Montreal, Quebec H4A 3J1, Canada
| | - Esli Osmanlliu
- Department of Pediatrics, Division of Emergency Medicine, Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada
| | - Dan Poenaru
- Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de La Montagne, Montréal, Quebec, H3G 2M1, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, Room B04.2028, Montreal, Quebec H4A 3J1, Canada.
| |
Collapse
|
4
|
Neff M, Storf H, Vasseur J, Scheidt J, Zerr T, Khouri A, Schaaf J. Identifying project topics and requirements in a citizen science project in rare diseases: a participative study. Orphanet J Rare Dis 2022; 17:357. [PMID: 36104743 PMCID: PMC9476337 DOI: 10.1186/s13023-022-02514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Due to their low prevalence (< 5 in 10,000), rare diseases are an important area of research, with the active participation of those affected being a key factor. In the Citizen Science project “SelEe” (Researching rare diseases in a citizen science approach), citizens collaborate with researchers using a digital application, developed as part of the project together with those affected, to answer research questions on rare diseases. The aim of this study was to define the rare diseases to be considered, the project topics and the initial requirements for the implementation in a digital application. Methods To address our research questions, we took several steps to engage citizens, especially those affected by rare diseases. This approach included the following methods: pre- and post-survey (questionnaire), two workshops with focus group discussion and a requirements analysis workshop (with user stories). Results In the pre-survey, citizens suggested 45 different rare diseases and many different disease groups to be considered in the project. Two main project topics (A) “Patient-guided documentation and data collection” (20 votes) and (B) “Exchange of experience and networking” (13 votes) were identified as priorities in the workshops and ranked in the post-survey. The requirements workshop resulted in ten user stories and six initial requirements to be implemented in the digital application. Conclusion Qualitative, citizen science research can be used to collectively identify stakeholder needs, project topics and requirements for a digital application in specific areas, such as rare diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02514-3.
Collapse
|
5
|
Kennedy AB, Riyad CNY, Ellis R, Fleming PR, Gainey M, Templeton K, Nourse A, Hardaway V, Brown A, Evans P, Natafgi N. Evaluating a Global Assessment Measure Created by Standardized Patients for the Multiple Mini Interview in Medical School Admissions: Mixed Methods Study. J Particip Med 2022; 14:e38209. [PMID: 36040776 PMCID: PMC9472042 DOI: 10.2196/38209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Standardized patients (SPs) are essential stakeholders in the multiple mini interviews (MMIs) that are increasingly used to assess medical school applicants’ interpersonal skills. However, there is little evidence for their inclusion in the development of instruments. Objective This study aimed to describe the process and evaluate the impact of having SPs co-design and cocreate a global measurement question that assesses medical school applicants’ readiness for medical school and acceptance status. Methods This study used an exploratory, sequential, and mixed methods study design. First, we evaluated the initial MMI program and determined the next quality improvement steps. Second, we held a collaborative workshop with SPs to codevelop the assessment question and response options. Third, we evaluated the created question and the additional MMI rubric items through statistical tests based on 1084 applicants’ data from 3 cohorts of applicants starting in the 2018-2019 academic year. The internal reliability of the MMI was measured using a Cronbach α test, and its prediction of admission status was tested using a forward stepwise binary logistic regression. Results Program evaluation indicated the need for an additional quantitative question to assess applicant readiness for medical school. In total, 3 simulation specialists, 2 researchers, and 21 SPs participated in a workshop leading to a final global assessment question and responses. The Cronbach α’s were >0.8 overall and in each cohort year. The final stepwise logistic model for all cohorts combined was statistically significant (P<.001), explained 9.2% (R2) of the variance in acceptance status, and correctly classified 65.5% (637/972) of cases. The final model consisted of 3 variables: empathy, rank of readiness, and opening the encounter. Conclusions The collaborative nature of this project between stakeholders, including nonacademics and researchers, was vital for the success of this project. The SP-created question had a significant impact on the final model predicting acceptance to medical school. This finding indicates that SPs bring a critical perspective that can improve the process of evaluating medical school applicants.
Collapse
Affiliation(s)
- Ann Blair Kennedy
- Biomedical Sciences Department, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- Family Medicine Department, Prisma Health, Greenville, SC, United States
| | - Cindy Nessim Youssef Riyad
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Hospital Based Accreditation, Accreditation Council of Graduate Medical Education, Chicago, IL, United States
| | - Ryan Ellis
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Perry R Fleming
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Mallorie Gainey
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Kara Templeton
- Prisma Health-Upstate Simulation Center, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Anna Nourse
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
| | - Virginia Hardaway
- Admissions and Registration, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - April Brown
- Prisma Health-Upstate Simulation Center, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Pam Evans
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- Prisma Health-Upstate Simulation Center, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Nabil Natafgi
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- Health Services, Policy, Management Department, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
6
|
Partogi M, Gaviria-Valencia S, Alzate Aguirre M, Pick NJ, Bhopalwala HM, Barry BA, Kaggal VC, Scott CG, Kessler ME, Moore MM, Mitchell JD, Chaudhry R, Bonacci RP, Arruda-Olson AM. Sociotechnical Intervention for Improved Delivery of Preventive Cardiovascular Care to Rural Communities: Participatory Design Approach. J Med Internet Res 2022; 24:e27333. [PMID: 35994324 PMCID: PMC9446142 DOI: 10.2196/27333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 12/30/2021] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Clinical practice guidelines recommend antiplatelet and statin therapies as well as blood pressure control and tobacco cessation for secondary prevention in patients with established atherosclerotic cardiovascular diseases (ASCVDs). However, these strategies for risk modification are underused, especially in rural communities. Moreover, resources to support the delivery of preventive care to rural patients are fewer than those for their urban counterparts. Transformative interventions for the delivery of tailored preventive cardiovascular care to rural patients are needed. Objective A multidisciplinary team developed a rural-specific, team-based model of care intervention assisted by clinical decision support (CDS) technology using participatory design in a sociotechnical conceptual framework. The model of care intervention included redesigned workflows and a novel CDS technology for the coordination and delivery of guideline recommendations by primary care teams in a rural clinic. Methods The design of the model of care intervention comprised 3 phases: problem identification, experimentation, and testing. Input from team members (n=35) required 150 hours, including observations of clinical encounters, provider workshops, and interviews with patients and health care professionals. The intervention was prototyped, iteratively refined, and tested with user feedback. In a 3-month pilot trial, 369 patients with ASCVDs were randomized into the control or intervention arm. Results New workflows and a novel CDS tool were created to identify patients with ASCVDs who had gaps in preventive care and assign the right care team member for delivery of tailored recommendations. During the pilot, the intervention prototype was iteratively refined and tested. The pilot demonstrated feasibility for successful implementation of the sociotechnical intervention as the proportion of patients who had encounters with advanced practice providers (nurse practitioners and physician assistants), pharmacists, or tobacco cessation coaches for the delivery of guideline recommendations in the intervention arm was greater than that in the control arm. Conclusions Participatory design and a sociotechnical conceptual framework enabled the development of a rural-specific, team-based model of care intervention assisted by CDS technology for the transformation of preventive health care delivery for ASCVDs.
Collapse
|
7
|
Hyatt A, Lipson-Smith R, Gough K, Butow P, Jefford M, Hack TF, Hale S, Zucchi E, White S, Ozolins U, Schofield P. Including migrant oncology patients in research: A multisite pilot randomised controlled trial testing consultation audio-recordings and question prompt lists. Contemp Clin Trials Commun 2022; 28:100932. [PMID: 35677588 PMCID: PMC9167883 DOI: 10.1016/j.conctc.2022.100932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/21/2022] [Accepted: 05/24/2022] [Indexed: 01/06/2023] Open
Abstract
Background Oncology patients who are migrants or refugees face worse outcomes due to language and communication barriers impacting care. Interventions such as consultation audio-recordings and question prompt lists may prove beneficial in mediating communication challenges. However, designing robust research inclusive of patients who do not speak English is challenging. This study therefore aimed to: a) pilot test and assess the appropriateness of the proposed research design and methods for engaging migrant populations, and b) determine whether a multi-site RCT efficacy assessment of the communication intervention utilising these methods is feasible. Methods This study is a mixed-methods parallel-group, randomised controlled feasibility pilot trial. Feasibility outcomes comprised assessment of: i) screening and recruitment processes, ii) design and procedures, and iii) research time and costing. The communication intervention comprised audio-recordings of a key medical consultation with an interpreter, and question prompt lists and cancer information translated into Arabic, Greek, Traditional, and Simplified Chinese. Results Assessment of feasibility parameters revealed that despite barriers, methods utilised in this study supported the inclusion of migrant oncology patients in research. A future multi-site RCT efficacy assessment of the INFORM communication intervention using these methods is feasible if recommendations to strengthen screening and recruitment are adopted. Importantly, hiring of bilingual research assistants, and engagement with community and consumer advocates is essential. Early involvement of clinical and interpreting staff as key stakeholders is likewise recommended. Conclusion Results from this feasibility RCT help us better understand and overcome the challenges and misconceptions about including migrant patients in clinical research. Migrant oncology patients face worse health outcomes due to language barriers. Consultation recording and question prompt lists are effective communication interventions. Designing robust research methods which overcome language barriers is important and achievable. Engaging with community advocates and hiring of bilingual staff are research design strategies.
Collapse
|
8
|
Ryan L, Weir K, Maskell J, Le Brocque R. Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter. BMJ Open 2022; 12:e056214. [PMID: 35459670 PMCID: PMC9036419 DOI: 10.1136/bmjopen-2021-056214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patients are initiating recordings of their clinical encounters using a smartphone. While this is an important, universal issue, little is known about the clinician viewpoint. Understanding clinician perspectives and behaviours is key to ensuring the protection of patient and clinician interests. This study aimed to gain a deep understanding of clinician attitudes and behaviours to patient-led recordings of hospital clinical encounters. DESIGN Semistructured interviews were conducted with 20 hospital clinicians. Participants were recruited using a combination of purposive and snowball sampling. Interviews were digitally recorded and transcribed. Transcripts were analysed using thematic analysis. SETTING This study took place at two hospitals in the metropolitan area of Gold Coast, Australia. PARTICIPANTS Participants included clinicians with varying levels of experience, or clinical managers in the roles of: medical, nursing and midwifery, and allied health staff. RESULTS The 20 participants interviewed were from a range of health disciplines and clinical areas and most had experienced a patient-led recording. Three themes emerged when exploring participant attitudes. First, that recording was a significant and controversial topic. Second, that experiences often informed clinician attitudes and many clinicians held conflicting views. Finally, a perceived loss of control was a significant stressor. A further three themes emerged relating to clinician behaviours when a patient asks to record. Decision-making involved balancing multiple factors often in pressurised situations. Shared decision-making was shaped by power dynamics and, finally, decision-making was not informed by hospital policy. CONCLUSIONS While patient-led recordings were viewed as beneficial, clinician welfare and patient safety may be at risk when a patient records a clinical encounter. Current safeguards, such as hospital policies, are not used and may not meet the needs of clinicians when decision-making is complicated by power dynamics. More research is needed to better understand how clinicians can be supported in this critical domain.
Collapse
Affiliation(s)
- Laura Ryan
- Social Work, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Kelly Weir
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Griffith Health, Griffith University, Gold Coast, Queensland, Australia
| | - Jessica Maskell
- Social Work, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| |
Collapse
|
9
|
Nørlev J, Derosche C, Sondrup K, Hejlesen O, Hangaard S. Using Distance Communication for the User-Centered Development of a Smartphone-Based Serious Game for Children With Type 1 Diabetes: Participatory Design Approach. JMIR Serious Games 2022; 10:e33955. [PMID: 35348466 PMCID: PMC9006140 DOI: 10.2196/33955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background The complications of type 1 diabetes (T1D) can be delayed or prevented in children with T1D who receive proper self-management education. Smartphone-based serious games are increasingly being used as an effective tool for teaching self-management. When developing a serious game, it is important that the development process be user-centered. Traditionally, different face-to-face methods have been used when children participate in the development process. However, face-to-face data collection is not always feasible. In such situations, distance communication can be used when developing a serious game. Objective The objective of this study is to develop a user-centered smartphone-based serious game that teaches self-management focused on carbohydrate intake in children aged 8-14 years with T1D using distance communication in both the development and evaluation of the game. Methods The development and evaluation of a smartphone-based serious game prototype was inspired by the Lean principles, and a user-centered approach was applied. The development process included 1 expert interview and design workshops with children with T1D. On the basis of the interview and design workshop results, a serious game prototype was developed using Microsoft PowerPoint. The evaluation of the serious game prototype included an interview with a dietitian and a playtest with children with T1D. All data were collected using distance communication. Results A user-centered smartphone-based serious game prototype was developed and evaluated. The expert interview with the dietitian formed the basis for the learning outcomes in the game. Four children and their parents contributed to the preferences, needs, requirements, and ideas for selected parts of the game design. The dietitian evaluated the prototype positively and validated its content and accuracy. The serious game prototype was well-received by the children and their parents during the playtest. The serious game prototype was perceived as a useful and engaging way to learn. However, the difficulty level was not appropriate, and the information was too basic for participants who had been diagnosed over a year ago. The use of digital communication platforms did not cause any problems. Conclusions The smartphone-based serious game prototype has the potential to be a useful and attractive tool for teaching disease self-management. The use of distance communication proved to be a useful approach in the development of a serious game.
Collapse
Affiliation(s)
- Jannie Nørlev
- Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
| | - Christina Derosche
- Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
| | - Katrine Sondrup
- Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| |
Collapse
|
10
|
Smith SM, Stelmar J, Lee G, Carroll PR, Garcia MM. Use of Voice Recordings in the Consultation of Patients Seeking Genital Gender-Affirming Surgery: An Opportunity for Broader Application Throughout Surgery? JOURNAL OF SURGERY AND RESEARCH 2022; 5:618-625. [PMID: 36643404 PMCID: PMC9836232 DOI: 10.26502/jsr.10020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction It has been demonstrated that patient memory for medical information is often poor and inaccurate. The use of audio recordings for patient consultation has been described; however, to our knowledge this is the first reported use of audio recordings in consultation for gender-affirming surgery. Our aim was to determine whether, and specifically how, audio recording the consultation of patients presenting for genital gender-affirming surgery would be of benefit to patients. Materials and Methods We began to offer all new patients the opportunity to have their consultations recorded. At the end of the consultation the recording was uploaded to a USB, which was given to the patient to keep. We then surveyed all patients who had received a copy of their recorded consultation to query the utility of having access to an audio recording of their consultation. Results 71/72 (98.6%) patients who were given the option to have their consultation recorded chose to do so. 50/71 (70%) of patients who had their consultation recorded responded to our survey. Patients reported that having access to a voice recording of their consultation was beneficial and was viewed overwhelmingly positively. Conclusions Routine audio recording of patient consultations is highly beneficial to patients, with little cost to providers, and should be considered as a valuable addition to the new patient consultation. This approach may have applications in broader clinical contexts where patients face numerous, complex, and nuanced management options. The study would benefit from continued application and a larger (multi-center, international) sample.
Collapse
Affiliation(s)
- Shannon M Smith
- Cedars-Sinai Medical Center, Los Angeles, Division of Urology; Los Angeles, CA, USA
- Cedars-Sinai Transgender Surgery and Health Program; Los Angeles, CA, USA
| | - Jenna Stelmar
- Cedars-Sinai Medical Center, Los Angeles, Division of Urology; Los Angeles, CA, USA
| | - Grace Lee
- Cedars-Sinai Medical Center, Los Angeles, Division of Urology; Los Angeles, CA, USA
- Cedars-Sinai Transgender Surgery and Health Program; Los Angeles, CA, USA
| | - Peter R Carroll
- University of California San Francisco; Department of Urology; San Francisco, CA, USA
| | - Maurice M Garcia
- Cedars-Sinai Medical Center, Los Angeles, Division of Urology; Los Angeles, CA, USA
- Cedars-Sinai Transgender Surgery and Health Program; Los Angeles, CA, USA
- University of California San Francisco; Department of Urology; San Francisco, CA, USA
- University of California San Francisco; Department of Anatomy; San Francisco, CA, USA
| |
Collapse
|
11
|
Noorbergen TJ, Adam MTP, Teubner T, Collins CE. Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development. JMIR Mhealth Uhealth 2021; 9:e27896. [PMID: 34757323 PMCID: PMC8663505 DOI: 10.2196/27896] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/22/2021] [Accepted: 09/03/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. OBJECTIVE Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. METHODS Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. RESULTS The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. CONCLUSIONS System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.
Collapse
Affiliation(s)
- Tyler J Noorbergen
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia
| | - Marc T P Adam
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia
| | | | - Clare E Collins
- Hunter Medical Research Institute, New Lambton, Australia.,School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Callaghan, Australia
| |
Collapse
|
12
|
Petric J, Sadri B, van Essen P, Dean NR. Improving preoperative breast reconstruction consultations: a qualitative study on the impact of personalised audio-recordings. BMC WOMENS HEALTH 2021; 21:389. [PMID: 34742266 PMCID: PMC8571820 DOI: 10.1186/s12905-021-01534-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022]
Abstract
Background To investigate the value of audio-recordings in aiding patient understanding and recall of preoperative breast reconstruction information. Methods This was a prospective cohort study. Participants were randomly allocated into either a recording group who were offered the opportunity to record their breast reconstruction explanation of surgery, or a standard information package group who received standard care. The value of having an audio-recording was assessed by semi-structured interviews and analysis of recurring themes. Results Between 21/2/19 and 19/3/20, 32 women attending consultations for breast reconstruction consented to participate in the study, 17 were randomly assigned to the recording group and 15 the standard information package group. Twenty-eight of the 32 participants completed qualitative interviews. All participants agreed that audio-recordings were a beneficial resource which allowed them to have a better understanding of the concepts discussed. Commonly reported themes included the ability to listen to the recording multiple times to refresh memory, as well as usefulness in helping to inform other family members. Participants also reported increased levels of trust in their clinician for allowing the audio-recordings. Very few participants raised any medico-legal implications of the recordings, their focus was more on the potential of the audio-recordings to alleviate the overwhelming nature of a pre-operative breast reconstruction consultation. Conclusions There was a positive response from participants to the use of audio-recordings in the setting of breast reconstruction consultations. These types of recordings could potentially be used in other complex appointments where detailed information is discussed, with similar success. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01534-8.
Collapse
Affiliation(s)
- Josipa Petric
- Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Bahara Sadri
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Phillipa van Essen
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
| | - Nicola Ruth Dean
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia.,Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| |
Collapse
|
13
|
Barr PJ, Haslett W, Dannenberg MD, Oh L, Elwyn G, Hassanpour S, Bonasia KL, Finora JC, Schoonmaker JA, Onsando WM, Ryan J, Bruce ML, Das AK, Arend R, Piper S, Ganoe CH. An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach. J Med Internet Res 2021; 23:e25512. [PMID: 34677131 PMCID: PMC8727051 DOI: 10.2196/25512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients’ primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one’s own recordings and others’ recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans.
Collapse
Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - William Haslett
- The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa Oh
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States.,Department of Epidemiology, Dartmouth College, Hanover, NH, United States
| | - Kyra L Bonasia
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - James C Finora
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jesse A Schoonmaker
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - W Moraa Onsando
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - James Ryan
- Ryan Family Practice, Ludington, MI, United States
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Amar K Das
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States
| | | | | | - Craig H Ganoe
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States
| |
Collapse
|
14
|
Jimenez RB, Johnson AE, Horick NK, Hlubocky FJ, Lei Y, Matsen CB, Mayer EL, Collyar DE, LeBlanc TW, Donelan K, Mello MM, Peppercorn JM. Do you mind if I record?: Perceptions and practice regarding patient requests to record clinic visits in oncology. Cancer 2021; 128:275-283. [PMID: 34633655 DOI: 10.1002/cncr.33910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/22/2021] [Accepted: 08/06/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Audio recordings of oncology clinic discussions can help patients retain and understand information about their disease and treatment decisions. Access to this tool relies on acceptance of recordings by oncologists. This is the first study to evaluate experience and attitudes of oncologists toward patients recording clinic visits. METHODS Medical, radiation, and surgical oncologists from 5 US cancer centers and community affiliates were surveyed to evaluate clinicians' experience, beliefs, and practices regarding patient-initiated recordings. RESULTS Among 360 oncologists (69% response rate), virtually all (93%) have experienced patients seeking to record visits. Although 75% are comfortable with recording, 25% are uncomfortable and 56% report concerns ranging from less thorough discussions to legal liability. Most (85%) always agree when patients ask to record, but 15% never or selectively allow recording. Although 51% believe recording is positive for the patient-physician relationship, a sizable minority report that it can lead to less detailed conversations (28%) or avoidance of difficult topics, including prognosis (33%). Views did not vary based on subspecialty, practice setting, or geographic region, but older age and years in practice were associated with more positive views of recording. The majority of clinicians (72%) desire institutional policies to govern guidelines about recordings. CONCLUSIONS Most oncologists are comfortable with patient requests to record visits, but a sizable minority remain uncomfortable, and access to recording varies solely on physician preference. This difference in care delivery may benefit from institutional policies that promote access while addressing legitimate physician concerns over privacy and appropriate use of recordings.
Collapse
Affiliation(s)
- Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew E Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nora K Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Fay J Hlubocky
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Yvonne Lei
- Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Cindy B Matsen
- Department of Surgery, Division of Surgical Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | - Erica L Mayer
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle M Mello
- Stanford Health Policy and the Department of Medicine, Stanford University School of Medicine, Stanford, California.,Stanford Law School, Stanford, California.,Freeman-Spogli Institute for International Studies, Stanford, California
| | - Jeffrey M Peppercorn
- Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
15
|
Jake-Schoffman DE, McVay MA. Using the Design Sprint process to enhance and accelerate behavioral medicine progress: a case study and guidance. Transl Behav Med 2021; 11:1099-1106. [PMID: 33057685 DOI: 10.1093/tbm/ibaa100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While challenges in the translation of behavioral medicine knowledge from academic settings to real-world use are well documented, they could potentially be reduced through the use of the Design Sprint process, a roadmap that facilitates progression from an idea to a product in 5 days via agile design and user-centered design principles. The Design Sprint is well aligned with several priorities of and methods common in behavioral medicine, including obtaining end-user feedback and thinking about implementation during intervention development. The Design Sprint could be used by behavioral medicine researchers for the development of research tools, implementation strategies, and behavior change interventions. The process may encourage creative and focused thinking, speed product development, and facilitate early user input. However, translating the Design Sprint to behavioral medicine research may present challenges, such as difficulty getting buy-in from team members, inconsistencies between the Design Sprint timeline, the need to obtain institutional review board approval for user testing, and the lack of traditional research processes (e.g., incorporating scientific research into intervention design). Several solutions and adaptations are possible to overcome these challenges while still maintaining the core features of the Design Sprint process. To demonstrate the use of the Design Sprint and potential adaptations, we present a case study of the development of a patient-facing digital tool for weight management and an accompanying implementation strategy. In conclusion, the Design Sprint offers behavioral medicine researchers an approach to developing new products with numerous potential benefits to researchers and to the individuals and communities we seek to impact.
Collapse
Affiliation(s)
- Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| |
Collapse
|
16
|
Ashley L, Kelley R, Griffiths A, Cowdell F, Henry A, Inman H, Hennell J, Ogden M, Walsh M, Jones L, Mason E, Collinson M, Farrin A, Surr C. Understanding and identifying ways to improve hospital-based cancer care and treatment for people with dementia: an ethnographic study. Age Ageing 2021; 50:233-241. [PMID: 33156901 PMCID: PMC7793597 DOI: 10.1093/ageing/afaa210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Providing cancer care and treatment for ageing populations with complicating comorbidities like dementia is a growing global challenge. This study aimed to examine the hospital-based cancer care and treatment challenges and support needs of people with dementia, and identify potential ways to address these. Methods A two-site ethnographic study in England involving semi-structured interviews, observations and accompanying conversations, and medical record review. Participants (N = 58) were people with dementia and comorbid cancer (n = 17), informal caregivers (n = 22) and hospital staff (n = 19). Ethnographically informed thematic analysis was conducted. Results There was an accumulated complexity of living with both illnesses simultaneously. People with dementia and families could feel confused and uninformed due to difficulties understanding, retaining and using cancer information, which impacted their informed treatment decision-making. Dementia increased the complexity and burden of travelling to and navigating unfamiliar hospital environments, frequent lengthy periods of waiting in hospital, and self-managing symptoms and side-effects at home. Oncology staff were often working without the full picture, due to variable documenting of dementia in medical records, dementia training was limited, and time and resource pressures impeded the highly individualised, flexible cancer care required by people with dementia. Supportive family carers were crucial in enabling people with dementia to access, navigate and undergo cancer treatment and care. Conclusions Dementia complicates cancer care in a range of ways accumulating across the cancer pathway. Our findings suggest there are several strategies and interventions, which we list here, with potential to improve cancer care and treatment for people with dementia and their families.
Collapse
Affiliation(s)
- Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Alys Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Ann Henry
- Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Hayley Inman
- Oncology Services, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | | | | | | | - Ellen Mason
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| |
Collapse
|
17
|
Prictor M, Johnston C, Hyatt A. Overt and covert recordings of health care consultations in Australia: some legal considerations. Med J Aust 2020; 214:119-123.e1. [PMID: 33131072 DOI: 10.5694/mja2.50838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Megan Prictor
- Melbourne Law School, University of Melbourne, Melbourne, VIC
| | | | - Amelia Hyatt
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC
| |
Collapse
|
18
|
Cunningham-Erves J, Barajas C, Mayo-Gamble TL, McAfee CR, Hull PC, Sanderson M, Canedo J, Beard K, Wilkins CH. Formative research to design a culturally-appropriate cancer clinical trial education program to increase participation of African American and Latino communities. BMC Public Health 2020; 20:840. [PMID: 32493245 PMCID: PMC7268329 DOI: 10.1186/s12889-020-08939-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program. Methods We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An iterative-deductive approach was used to analyze focus group data. Qualitative data from advisory groups and community members were compiled and used to finalize the program. Results Focus group themes were: 1) Community Perspectives on Overall Presentation; 2) Community Opinions and Questions on the Content of the Presentation; 3) Culturally Specific Issues to Participation in Cancer Clinical Trials; 4) Barriers to Clinical Trial Participation; and 5) Perspectives of Community Health Educators. Feedback was documented during reviews by scientific experts and community members with suggestions to ensure cultural appropriateness using peripheral, evidential, linguistic, sociocultural strategies, and constituent-involving. The final program consisted of two versions (English and Spanish) of a culturally-appropriate slide presentation with speaker notes and videos representing community member and researcher testimonials. Conclusions Incorporating multiple community engagement approaches into formative research processes can facilitate the inclusion of multiple community perspectives and enhance the cultural-appropriateness of the programs designed to promote cancer clinical trial participation among African Americans and Latinos.
Collapse
Affiliation(s)
- Jennifer Cunningham-Erves
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN, 37208, USA.
| | - Claudia Barajas
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tilicia L Mayo-Gamble
- Department of Health Policy and Community Health, Georgia Southern University, Statesboro, GA, USA
| | - Caree R McAfee
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pamela C Hull
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
| | - Juan Canedo
- Progreso Community Center, Nashville, TN, USA.,School of Graduate Research Studies, Meharry Medical College, Nashville, TN, USA
| | - Katina Beard
- Matthew Walker Community Health Center, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN, 37208, USA.,Meharry Vanderbilt Alliance, Nashville, TN, USA.,VUMC Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
19
|
Hyatt A, Lipson-Smith R, Morkunas B, Krishnasamy M, Jefford M, Baxter K, Gough K, Murphy D, Drosdowsky A, Phipps-Nelson J, White F, White A, Serong L, McDonald G, Milne D. Testing Consultation Recordings in a Clinical Setting With the SecondEars Smartphone App: Mixed Methods Implementation Study. JMIR Mhealth Uhealth 2020; 8:e15593. [PMID: 31961333 PMCID: PMC7001044 DOI: 10.2196/15593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/30/2019] [Accepted: 10/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health care systems are increasingly looking to mobile device technologies (mobile health) to improve patient experience and health outcomes. SecondEars is a smartphone app designed to allow patients to audio-record medical consultations to improve recall, understanding, and health care self-management. Novel health interventions such as SecondEars often fail to be implemented post pilot-testing owing to inadequate user experience (UX) assessment, a key component of a comprehensive implementation strategy. OBJECTIVE This study aimed to pilot the SecondEars app within an active clinical setting to identify factors necessary for optimal implementation. Objectives were to (1) investigate patient UX and acceptability, utility, and satisfaction with the SecondEars app, and (2) understand health professional perspectives on issues, solutions, and strategies for effective implementation of SecondEars. METHODS A mixed methods implementation study was employed. Patients were invited to test the app to record consultations with participating oncology health professionals. Follow-up interviews were conducted with all participating patients (or carers) and health professionals, regarding uptake and extent of app use. Responses to the Mobile App Rating Scale (MARS) were also collected. Interviews were analyzed using interpretive descriptive methodology; all quantitative data were analyzed descriptively. RESULTS A total of 24 patients used SecondEars to record consultations with 10 multidisciplinary health professionals. In all, 22 of these patients used SecondEars to listen to all or part of the recording, either alone or with family. All 100% of patient participants reported in the MARS that they would use SecondEars again and recommend it to others. A total of 3 themes were identified from the patient interviews relating to the UX of SecondEars: empowerment, facilitating support in cancer care, and usability. Further, 5 themes were identified from the health professional interviews relating to implementation of SecondEars: changing hospital culture, mitigating medico-legal concerns, improving patient care, communication, and practical implementation solutions. CONCLUSIONS Data collected during pilot testing regarding recording use, UX, and health professional and patient perspectives will be important for designing an effective implementation strategy for SecondEars. Those testing the app found it useful and felt that it could facilitate the benefits of consultation recordings, along with providing patient empowerment and support. Potential issues regarding implementation were discussed, and solutions were generated. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12618000730202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373915&isClinicalTrial=False.
Collapse
Affiliation(s)
- Amelia Hyatt
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ruby Lipson-Smith
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Bryce Morkunas
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Meinir Krishnasamy
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Nursing, University of Melbourne, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Centre for Cancer Research, The University of Melbourne, Melbourne, Australia
| | - Michael Jefford
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Kathryn Baxter
- Health Information Management, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Karla Gough
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Declan Murphy
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Allison Drosdowsky
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jo Phipps-Nelson
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Fiona White
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alan White
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lesley Serong
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Geraldine McDonald
- Prevention and Wellbeing, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Donna Milne
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| |
Collapse
|