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Grosman-Rimon L, Wegier P. With advancement in health technology comes great responsibility - Ethical and safety considerations for using digital health technology: A narrative review. Medicine (Baltimore) 2024; 103:e39136. [PMID: 39151529 PMCID: PMC11332755 DOI: 10.1097/md.0000000000039136] [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: 03/06/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 08/19/2024] Open
Abstract
The accelerated adoption of digital health technologies in the last decades has raised important ethical and safety concerns. Despite the potency and usefulness of digital health technologies, addressing safety, and ethical considerations needs to take greater prominence. This review paper focuses on ethical and safety facets, including health technology-related risks, users' safety and well-being risks, security and privacy concerns, and risks to transparency and diminished accountability associated with the utilization of digital health technologies. In order to maximize the potential of health technology benefits, awareness of safety risks, and ethical concerns should be increased, and the use of appropriate strategies and measures should be considered.
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Affiliation(s)
- Liza Grosman-Rimon
- Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
- Research Institute, Humber River Health, Toronto, ON, Canada
| | - Pete Wegier
- Research Institute, Humber River Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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2
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Mao S, Liu L, Miao C, Wang T, Chen Y, Jiang Z, Hua C, Li C, Cao Y. Electronic symptom monitoring for home-based palliative care: A systematic review. Palliat Med 2024:2692163241257578. [PMID: 38835179 DOI: 10.1177/02692163241257578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Coordination and communication challenges in home-based palliative care complicate transitions from hospital care. Electronic symptom monitoring enables real-time data collection, enhancing patient-provider communication. However, a systematic evaluation of its effectiveness in home-based palliative care is lacking. AIM To analyze the feasibility, effectiveness, and limitations of electronic symptom monitoring in home-based palliative care, assess the evidence quality, identify the evidence gap, and suggest implications for future research and practice. DESIGN This study uses systematic review, meta-analysis, and narrative synthesis (CRD42023457977) to analyze relevant studies until September 2023. DATA SOURCES Electronic searches in MEDLINE, CENTRAL, and Embase until September 2023, complemented by hand-searching of references and citations. RESULTS This study included twenty studies. The majority of patients positively engage in electronic symptom monitoring, which could improve their quality of life, physical and emotional well-being, and symptom scores without a significant increase in costs. However, firm conclusions about the effects of electronic symptom monitoring on outcomes like survival, hospital admissions, length of stay, emergency visits, and adverse events were limited due to significant variability in the reported data or inadequate statistical power. CONCLUSION Introducing electronic symptom monitoring in home-based palliative care holds potential for enhancing patient-reported outcomes, potentially decreasing hospital visits and costs. However, inconsistency in current studies arising from diverse monitoring systems obstructs comparability. To advance, future high-quality research should employ standardized follow-up periods and established scales to better grasp the benefits of electronic symptom monitoring in home-based palliative care.
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Affiliation(s)
- Suning Mao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Cheng Miao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianyi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yue Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhishen Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chengge Hua
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Dental Emergency and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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3
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Lau-Min KS, Marini J, Shah NK, Pucci D, Blauch AN, Cambareri C, Mooney B, Agarwal P, Johnston C, Schumacher RP, White K, Gabriel PE, Rosin R, Jacobs LA, Shulman LN. Pilot Study of a Mobile Phone Chatbot for Medication Adherence and Toxicity Management Among Patients With GI Cancers on Capecitabine. JCO Oncol Pract 2024; 20:483-490. [PMID: 38237102 DOI: 10.1200/op.23.00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Capecitabine is an oral chemotherapy used to treat many gastrointestinal cancers. Its complex dosing and narrow therapeutic index make medication adherence and toxicity management crucial for quality care. METHODS We conducted a pilot study of PENNY-GI, a mobile phone text messaging-based chatbot that leverages algorithmic surveys and natural language processing to promote medication adherence and toxicity management among patients with gastrointestinal cancers on capecitabine. Eligibility initially included all capecitabine-containing regimens but was subsequently restricted to capecitabine monotherapy because of challenges in integrating PENNY-GI with radiation and intravenous chemotherapy schedules. We used design thinking principles and real-time data on safety, accuracy, and usefulness to make iterative refinements to PENNY-GI with the goal of minimizing the proportion of text messaging exchanges with incorrect medication or symptom management recommendations. All patients were invited to participate in structured exit interviews to provide feedback on PENNY-GI. RESULTS We enrolled 40 patients (median age 64.5 years, 52.5% male, 62.5% White, 55.0% with colorectal cancer, 50.0% on capecitabine monotherapy). We identified 284 of 3,895 (7.3%) medication-related and 13 of 527 (2.5%) symptom-related text messaging exchanges with incorrect recommendations. In exit interviews with 24 patients, participants reported finding the medication reminders reliable and user-friendly, but the symptom management tool was too simplistic to be helpful. CONCLUSION Although PENNY-GI provided accurate recommendations in >90% of text messaging exchanges, we identified multiple limitations with respect to the intervention's generalizability, usefulness, and scalability. Lessons from this pilot study should inform future efforts to develop and implement digital health interventions in oncology.
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Affiliation(s)
- Kelsey S Lau-Min
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jessica Marini
- Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA
| | - Nishant K Shah
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Donna Pucci
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abigail N Blauch
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Bethany Mooney
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Parul Agarwal
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Peter E Gabriel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Roy Rosin
- Center for Health Care Innovation, Penn Medicine, Philadelphia, PA
| | - Linda A Jacobs
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Galiti D, Linardou H, Agelaki S, Karampeazis A, Tsoukalas N, Psyrri A, Karamouzis M, Syrigos KN, Ardavanis A, Athanasiadis I, Arvanitou E, Sgourou S, Mala A, Vallilas C, Boukovinas I. Exploring the Use of a Digital Platform for Cancer Patients to Report Their Demographics, Disease and Therapy Characteristics, Age, and Educational Disparities: An Early-Stage Feasibility Study. Curr Oncol 2023; 30:7608-7619. [PMID: 37623032 PMCID: PMC10453047 DOI: 10.3390/curroncol30080551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The increasing burden of cancer, the development of novel therapies, and the COVID-19 pandemic have made cancer care more complex. Digital innovation was then pushed toward developing platforms to facilitate access to cancer care. Age, education, and other disparities were, however, shown to limit the use of the digital health innovation. The aim of this early-stage feasibility study was to assess whether Greek cancer patients would register at CureCancer and self-report their demographics, disease and therapy characteristics, and socioeconomic issues. The study was organized by the Hellenic Society of Medical Oncology. METHODS Patients from nine cancer centers were invited to register on the CureCancer platform and complete an anonymous questionnaire on demographics, disease and therapy characteristics, and socioeconomic issues. Patients were also encouraged to upload, in a secure area for them, their medical files and share them with their physicians. They were then asked to comment on their experience of registration and how easy it was to upload their medical files. RESULTS Of the 159 patients enrolled, 144 (90.56%) registered, and 114 of those (79.16%) completed the questionnaire, suggesting that the study is feasible. Users' median age was 54.5 years, and 86.8% of them were university and high school graduates. Most patients (79.8%) reported their specific type of cancer diagnosis, and all reported their therapy characteristics. Breast and lung cancers were the most common. A total of 87 patients (76.3%) reported being on active cancer therapy, 46 (40.4%) had metastatic disease, and 51 (44.7%) received supportive care medications. Eighty-one (71.05%) patients received prior cancer therapies, and twenty-seven recalled prior supportive care medications. All patients reported visiting non-oncology Health Care Professionals during the study. Nineteen of 72 (26.39%) patients who worked prior to cancer diagnosis changed work status; 49 (42.98) patients had children under 24 years; and 16 (14%) patients lived alone. Nine (7.9%) patients were members of patient associations. Registration was "much/very much" easy for 98 (86.0%) patients, while 67 (58.8%) had difficulties uploading their files. Patients commented on the well-organized data access, improved communication, feeling safe, medication adherence, interventions from a distance, and saving time and money. Over 80% of patients "preferred the digital way". DISCUSSION A total of 114 patients succeeded in registering on the digital platform and reporting their demographics, disease and therapy characteristics, and socioeconomic issues. Age and educational disparities were disclosed and highlighted the need for educational programs to help older people and people of lower education use digital innovation. Health care policy measures would support patients' financial burden associated with work changes, living alone, and children under 24 years old at school or college. Policy actions would motivate patients to increase their participation in patient associations. According to the evidence DEFINED framework, the number of patients, and the focus on enrollment, engagement, and user experience, the study fulfills actionability level criterion 1.
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Affiliation(s)
- Dimitra Galiti
- Clinic of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | | | - Sofia Agelaki
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
| | | | | | - Amanda Psyrri
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
| | | | | | | | | | | | | | - Anastasia Mala
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
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5
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Casà C, Dinapoli L, Marconi E, Chiesa S, Cornacchione P, Beghella Bartoli F, Bracci S, Salvati A, Scalise S, Colloca GF, Chieffo DPR, Gambacorta MA, Valentini V, Tagliaferri L. Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives. Front Public Health 2023; 11:1056307. [PMID: 36755901 PMCID: PMC9901799 DOI: 10.3389/fpubh.2023.1056307] [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: 09/28/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.
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Affiliation(s)
- Calogero Casà
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Marconi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,*Correspondence: Elisa Marconi ✉
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Cornacchione
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Scalise
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
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Rincones O, Bamgboje-Ayodele A, Arnold A, Delaney GP, Durcinoska I, Avery S, Sandell T, Della-Fiorentina SA, Pearson J, Girgis A. Cancer Care Team's Management of Clinical Alerts Generated by Electronically Collected Patient Reported Outcomes: We Could Do Better. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2001. [PMID: 36767367 PMCID: PMC9915302 DOI: 10.3390/ijerph20032001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Electronically administered patient-reported outcome measures (ePROMs) are effective digital health tools for informing clinicians about cancer patients' symptoms and facilitating timely patient-centred care. This paper describes the delivery of healthcare activities supported by the PROMPT-Care model, including ePROMs generated clinical alerts, cancer care team (CCT) response to alerts, and patients' perceptions of the CCT response and ePROMs system. This mixed-methods study includes cancer patients from four cancer therapy centres in New South Wales, Australia. Quantitative and qualitative data were collected regarding clinical alert activity, CCT response, and patient perceptions of the CCT responses and ePROMs system. Qualitative data were thematically analysed. Of the 328 participants whose care was informed by the digital health tool, 70.8% (n = 233) generated at least one alert during the trial period, with 877 alerts generated in total. Although 43.7% (n = 383) were actioned by the CCT, at least 80% of participants found follow-up CCT phone calls beneficial, with multiple benefits confirmed in interviews. The cancer care delivery arm of the PROMPT-Care trial involving clinical alerts to the CCT was positively perceived by most participants, resulting in a diverse range of benefits. However, further work is required, informed by implementation science, to improve the percentage of actioned clinical alerts.
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Affiliation(s)
- Orlando Rincones
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW 2170, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Anthony Arnold
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | - Geoff P. Delaney
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW 2170, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Ivana Durcinoska
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Sandra Avery
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Tiffany Sandell
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
| | - Stephen A. Della-Fiorentina
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW 2116, Australia
| | - Joanne Pearson
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - The PROMPT-Care Co-Authorship Group
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW 2170, Australia
- Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW 2116, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW 2170, Australia
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Chagani J, Li D, Keating B, Chasen M. Experiences and Lessons Learned from Implementing the RELIEF Digital Symptom Self-Reporting App in a Palliative Home Care Setting. Curr Oncol 2022; 29:9401-9406. [PMID: 36547152 PMCID: PMC9777421 DOI: 10.3390/curroncol29120738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
The majority of Canadians agree they have the right to end-of-life care in their own homes. While a palliative approach to care in the home setting has been demonstrated to be beneficial for patients and the healthcare system, it has rarely been well-integrated through an eHealth approach. Thus, in 2018, we piloted the RELIEF app, a digital symptom self-reporting tool for patients with palliative care needs. This was followed by the initiation of an extension phase of RELIEF in the home care setting. In this commentary, we share the implementation perspectives and experiences of the researchers and healthcare workers involved in this home care phase. It was mainly expressed that there were challenges with nurses feeling involved, supporting the research program, and using the technology, while patients and family caregivers had challenges using the app and cooperating with staff. We describe our lessons learned from these experiences and future changes to be enacted. A detailed report of this trial will be made available in future publications.
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Affiliation(s)
- Jehanara Chagani
- Central West Local Health Integration Network, Brampton, ON L6W 4P3, Canada
| | - Donny Li
- Department of Palliative and Supportive Care, William Osler Health System, Brampton, ON L6R 3J7, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L7, Canada
- Department of Research, Humber River Hospital, Toronto, ON M3M 0B2, Canada
- Correspondence:
| | | | - Martin Chasen
- Department of Palliative and Supportive Care, William Osler Health System, Brampton, ON L6R 3J7, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 4L7, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5S 1A4, Canada
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Lundereng ED, Nes AAG, Holmen H, Winger A, Thygesen H, Jøranson N, Borge CR, Dajani O, Mariussen KL, Steindal SA. Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: A Scoping Review (Preprint). J Med Internet Res 2022; 25:e43429. [PMID: 36989024 PMCID: PMC10131609 DOI: 10.2196/43429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. OBJECTIVE The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. METHODS A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. RESULTS This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. CONCLUSIONS Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33305.
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Affiliation(s)
- Elias David Lundereng
- Lovisenberg Diaconal University College, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hilde Thygesen
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Christine Råheim Borge
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Consolo L, Castellini G, Cilluffo S, Basile I, Lusignani M. Electronic patient-reported outcomes (e-PROMs) in palliative cancer care: a scoping review. J Patient Rep Outcomes 2022; 6:102. [PMID: 36138279 PMCID: PMC9500127 DOI: 10.1186/s41687-022-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In palliative oncology settings, electronic patient-reported outcome (PRO) assessment can play an important role in supporting clinical activities for clinicians and patients. This scoping review aims to map the technological innovation of electronic patient-reported outcome measures (e-PROMs) in cancer palliative care and how PRO data collected through e-PROMs can influence the monitoring and management of symptoms and enable better communication between health professionals and patients.
Methods
A scoping review study was designed according to the Arksey and O'Malley framework. Medline, Embase, Web of Science, SCOPUS, PsycINFO and CINAHL and gray literature sources were consulted. The inclusion criteria were people over 18 years old receiving palliative and/or end-of-life care using e-PROMs.
Results
Thirteen primary studies were included: nine quantitative studies, two qualitative studies, and two mixed-method studies. The recently developed software that supports e-PROMs allows patients to receive feedback on their symptoms, helps clinicians prioritize care needs and monitors patients’ conditions as their symptoms change. Electronic PRO data prompt difficult, end-of-life communication between clinicians and patients to better organize care in the last phase of life.
Conclusion
This work shows that electronic PRO data assessment provides valuable tools for patients’ well-being and the management of symptoms; only one study reported conflicting results. However, with studies lacking on how clinicians can use these tools to improve communication with patients, more research is needed.
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