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Verweij L, Metsemakers SJJPM, Ector GICG, Rademaker P, Bekker CL, van Vlijmen B, van der Reijden BA, Blijlevens NMA, Hermens RPMG. Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach. J Med Internet Res 2023; 25:e45259. [PMID: 37713242 PMCID: PMC10541637 DOI: 10.2196/45259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/16/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1. OBJECTIVE The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment. METHODS The study used iterative cycles of planning, action, and reflection, whereby participants' experiences (patients, health care providers, the CMyLife team, and app suppliers) with the platform determined next actions. Co-design workshops were the foundation of this cyclic process. Moreover, patients filled in 2 sets of questionnaires for assessing experiences with CMyLife, the actual use of the platform, and the influence of the platform after 3 and at least 6 months. Data collected during the workshops were analyzed using content analysis, which is often used for making a practical guide to action. Descriptive statistics were used to characterize the study population in terms of information related to chronic myeloid leukemia and sociodemographics, and to describe experiences with the CMyLife digital care platform and the actual use of this platform. RESULTS The co-design workshops provided insights that contributed to the improvement, implementation, and evaluation of CMyLife and empowered patients with chronic myeloid leukemia (for example, simplification of language, and improvement of the user friendliness of functionalities). The results of the questionnaires indicated that (1) the platform improved information provision on chronic myeloid leukemia in 67% (33/49) of patients, (2) the use of the medication app improved medication compliance in 42% (16/38) of patients, (3) the use of the guideline app improved guideline adherence in 44% (11/25) of patients, and (4) the use of the platform caused patients to feel more empowered. CONCLUSIONS A participatory action research approach is suited to scientifically evaluate digital care platforms in daily clinical practice in terms of improvement, implementation, and patient empowerment. Systematic iterative evaluation of users' needs and wishes is needed to keep care centered on patients and keep the innovation up-to-date and valuable for users.
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Affiliation(s)
- Lynn Verweij
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Peter Rademaker
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert A van der Reijden
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
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Verweij L, Ector GICG, Smit Y, van Vlijmen B, van der Reijden BA, Hermens RPMG, Blijlevens NMA. Effectiveness of digital care platform CMyLife for patients with chronic myeloid leukemia: results of a patient-preference trial. BMC Health Serv Res 2023; 23:228. [PMID: 36890512 PMCID: PMC9994406 DOI: 10.1186/s12913-023-09153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Two most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring albeit still being suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients, aiming to improve their care, leading to an increased quality of life and the opportunity of hospital-free care. OBJECTIVE To explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life. METHODS Effectiveness of CMyLife was explored using a patient-preference trial. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least 6 months, after which they completed the post-intervention questionnaire. Scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models. RESULTS At baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. Self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these. CONCLUSIONS Since hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable. TRIAL REGISTRATION ClinicalTrials.gov NCT04595955 , 22/10/2020.
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Affiliation(s)
- Lynn Verweij
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Geneviève I C G Ector
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yolba Smit
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert A van der Reijden
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Ector GICG, Geelen IGP, Dinmohamed AG, Hoogendoorn M, Westerweel PE, Hermens RPMG, Blijlevens NMA. Adherence to quality indicators in chronic myeloid leukemia care: results from a population-based study in The Netherlands. Leuk Lymphoma 2023; 64:424-432. [PMID: 36369821 DOI: 10.1080/10428194.2022.2142055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suboptimal guideline adherence in chronic myeloid leukemia (CML) care is associated with worse treatment outcomes. Current study focused on adherence to seven quality indicators (QIs) based on the European Leukemia Network guideline (one diagnostic, one therapeutic, and five monitoring indicators). Data were obtained from population-based registries in the Netherlands of 405 newly diagnosed chronic phase CML patients between January 2008 and April 2013. Compliance rates regarding diagnostic and therapeutic indicator were 83% and 78%, respectively. Monitoring indicators rates were lower: 21-27% for indicators concerning the first year and 58% and 62% for the second and third year, respectively. Noncompliance occurred mostly due to non-timely monitoring. Twenty cases did not comply with any indicator, 6% complied with all indicators. After adjustment for age, overall survival rates did not differ significantly between the groups. Adherence to guideline-based QIs was suboptimal. This demonstrates the evidence-practice gap, shows room for improvement and underscores the need for real-world data.
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Affiliation(s)
| | - Inge G P Geelen
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, on behalf of the HemoBase Population Registry Consortium, Leeuwarden, Netherlands
| | - Peter E Westerweel
- Department of Hematology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Healthcare Sciences (RIHS), Radboud University Medical Center, Nijmegen, Netherlands
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Maas CCHM, van Klaveren D, Ector GICG, Posthuma EFM, Visser O, Westerweel PE, Janssen JJWM, Blijlevens NMA, Dinmohamed AG. The evolution of the loss of life expectancy in patients with chronic myeloid leukaemia: a population-based study in the Netherlands, 1989-2018. Br J Haematol 2021; 196:1219-1224. [PMID: 34865221 PMCID: PMC9300106 DOI: 10.1111/bjh.17989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 10/27/2022]
Abstract
Studies on the conditional life expectancy of patients with chronic myeloid leukaemia (CML) are lacking. Using data from the Netherlands Cancer Registry, we examined the life expectancy of patients with CML in the Netherlands diagnosed during 1989-2018. As of the early 2010s, the life expectancy of patients with CML who survived several years after diagnosis came narrowly close to the general population's life expectancy, regardless of age. This finding can essentially be ascribed to the introduction and broader application of tyrosine kinase inhibitors (TKIs) and provide optimism to patients with CML who can look forward to a near-normal life expectancy in a modern TKI era.
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Affiliation(s)
- Carolien C H M Maas
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jeroen J W M Janssen
- Amsterdam UMC, Location VUmc, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Avinash G Dinmohamed
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Amsterdam UMC, Location VUmc, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Hematology, Cancer Center Amsterdam, Universiteit van Amsterdam, Amsterdam, the Netherlands
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Ector GICG, Huijskens EGW, Blijlevens NMA, Westerweel PE. Prevalence of COVID-19 diagnosis in Dutch CML patients during the 2020 SARS-CoV2 pandemic. A prospective cohort study. Leukemia 2020; 34:2533-2535. [PMID: 32641732 PMCID: PMC7341464 DOI: 10.1038/s41375-020-0964-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Geneviève I C G Ector
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | | | - Nicole M A Blijlevens
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter E Westerweel
- Department of Haematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Abstract
PURPOSE OF REVIEW This review describes the gaps in cancer patient information and comprehension and provides examples of interventions aimed at filling the gaps. RECENT FINDINGS Despite the technologically advanced era, unmet information needs remain a challenge in current cancer care, even though the beneficial effects of adequate information provision are well described.It starts with the basics of patient-physician communication and information exchange. Barriers are described both patient and physician-specific. For patients to comprehend and recall information correctly, information provision should be tailored to the specific patient in content, as well as in readability level. Tailored content based on bidirectional and iterative information exchange (i.e., patients reported outcomes, followed by specific/personalized feedback) is of focus in the current development of interventions aimed at meeting the gaps. However, the effects of such interventions are not overwhelming and the explanation could be multifactorial. SUMMARY Unmet informational needs are still a gap in current cancer care. The effect of eHealth interventions is not yet well established. Key is to educate patients and (future) healthcare professionals in eHealth. Future research should focus on identifying what kind of interventions are able to fill the gaps.
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Affiliation(s)
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
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Ector GICG, Visser O, Westerweel PE, Janssen JJWM, Blijlevens NMA, Dinmohamed AG. Primary therapy and relative survival among elderly patients with chronic myeloid leukemia: a population-based study in the Netherlands, 1989–2017. Leukemia 2020; 34:3408-3412. [DOI: 10.1038/s41375-020-0902-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 11/09/2022]
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Ector GICG, Govers TM, Westerweel PE, Grutters JPC, Blijlevens NMA. The potential health gain and cost savings of improving adherence in chronic myeloid leukemia. Leuk Lymphoma 2019; 60:1485-1492. [PMID: 30668187 DOI: 10.1080/10428194.2018.1535113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Healthcare costs are rising due to an increase in chronic diseases, including chronic myeloid leukemia (CML) due to improved survival. In CML care, patient adherence and physician adherence are key elements. We assessed the potential health gain and cost savings when both are improved, using a decision analytic model that integrated various sources of evidence. The current situation was compared to a theoretical situation in which either patient or physician adherence is improved, in terms of costs and quality-adjusted life years (QALYs). Current patient adherence rate is 74%, improvement to 100% resulted in 0.1031 QALYs gained and a saving of €17,509 per patient over a 25-year period. Improving physician adherence from 72% to 100%, resulted in 0.0380 QALYs and €7606. Enhancement of either adherence results in substantial health gain and cost savings. Regarding the rising healthcare costs, new strategies should focus on improving adherence to keep healthcare affordable in the future.
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Affiliation(s)
- Geneviève I C G Ector
- a Department of Hematology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tim M Govers
- a Department of Hematology , Radboud University Medical Center , Nijmegen , The Netherlands.,b MedValue , Nijmegen , The Netherlands
| | - Peter E Westerweel
- c Department of Hematology , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - Janneke P C Grutters
- d Department for Health Evidence , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nicole M A Blijlevens
- a Department of Hematology , Radboud University Medical Center , Nijmegen , The Netherlands
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van den Brand M, van der Velden WJFM, Diets IJ, Ector GICG, de Haan AFJ, Stevens WBC, Hebeda KM, Groenen PJTA, van Krieken HJM. Clinical features of patients with nodal marginal zone lymphoma compared to follicular lymphoma: similar presentation, but differences in prognostic factors and rate of transformation. Leuk Lymphoma 2015; 57:1649-56. [DOI: 10.3109/10428194.2015.1106535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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