1
|
Abdelmutti N, Powis M, Macedo A, Liu Z, Bender JL, Papadakos J, Hack S, Rajnish N, Rana P, Kittuppanantharajah S, Lovas M, Melwani S, Moody L, Elliot M, Ashfaq I, Avery L, Mohammed H, Berlin A, Krzyzanowska MK. Virtual Cancer Care Beyond the COVID-19 Pandemic: Patient and Staff Perspectives and Recommendations. JCO Oncol Pract 2024; 20:643-656. [PMID: 38266201 DOI: 10.1200/op.23.00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 01/26/2024] Open
Abstract
PURPOSE COVID-19 catalyzed rapid implementation of virtual cancer care (VC); however, work is needed to inform long-term adoption. We evaluated patient and staff experiences with VC at a large urban, tertiary cancer center to inform recommendations for postpandemic sustainment. METHODS All physicians who had provided VC during the pandemic and all patients who had a valid e-mail address on file and at least one visit to the Princess Margaret Cancer Centre in Toronto, Canada, in the preceding year were invited to complete a survey. Interviews and focus groups with patients and staff across the cancer center were analyzed using qualitative descriptive analysis and triangulated with survey findings. RESULTS Response rates for patients and physicians were 15% (2,343 of 15,169) and 41% (100 of 246), respectively. A greater proportion of patients than physicians were satisfied with VC (80.1 v 53.4%; P < .01). In addition, fewer patients than physicians felt that virtual visits were worse than those conducted in person (28.0 v 43.4%; P < .01) and that telephone and video visits negatively affected the human interaction that they valued (59.8% v 82.0%; P < .01). Major barriers to VC for patients were respect for care preferences and personal boundaries, accessibility, and equitable access. For staff, major barriers included a lack of role clarity, dedicated resources (space and technology), integration of nursing and allied health, support (administrative, clinical, and technical), and guidance on appropriateness of use. CONCLUSION Patient and staff perceptions and barriers to virtual care are different. Moving forward, we need to pay attention to both staff and patient experiences with virtual care since this will have major implications for long-term adoption into clinical practice.
Collapse
Affiliation(s)
- Nazek Abdelmutti
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Melanie Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Alyssa Macedo
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Radiation Oncology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Jackie L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Cancer Education, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Saidah Hack
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Nikki Rajnish
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Palwasha Rana
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Shay Kittuppanantharajah
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Mike Lovas
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Sheena Melwani
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Lesley Moody
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Mary Elliot
- Department of Supportive Care, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Iqra Ashfaq
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Lisa Avery
- Biostatistics Research Unit, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
| | - Hiba Mohammed
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Cancer Digital Intelligence, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre- University Health Network, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| |
Collapse
|
2
|
Howell D, Bryant Lukosius D, Avery J, Santaguida A, Powis M, Papadakos T, Addario V, Lovas M, Kukreti V, Haase K, Mayo SJ, Papadakos J, Moradian S, Krzyzanowska MK. A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing. JMIR Cancer 2023; 9:e44914. [PMID: 37477968 PMCID: PMC10403801 DOI: 10.2196/44914] [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: 12/09/2022] [Revised: 03/26/2023] [Accepted: 05/23/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. OBJECTIVE We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). METHODS We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). RESULTS In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed "chapters"), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. CONCLUSIONS The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial.
Collapse
Affiliation(s)
- Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Research Institute, Toronto, ON, Canada
| | - Denise Bryant Lukosius
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Department of Medical Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, ON, Canada
| | - Athina Santaguida
- Ontario College of Art and Design, University of Toronto, Toronto, ON, Canada
| | - Melanie Powis
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tina Papadakos
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Mike Lovas
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Vishal Kukreti
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, ON, Canada
| | - Samantha J Mayo
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Janet Papadakos
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Saeed Moradian
- Faculty of Nursing, York University, Toronto, ON, Canada
| | | |
Collapse
|
3
|
Handler L, Jaloul P, Clancy J, Cuypers B, Muir J, Hemphill J, Janaudis-Ferreira T, Gottesman C, Wickerson L, Lovas M, Cafazzo JA, Mathur S. A Qualitative Study of the Perspectives of Healthcare Professionals on Features of Digital Health Interventions to Support Physical Activity in Solid Organ Transplant Recipients. Prog Transplant 2023; 33:43-49. [PMID: 36537126 PMCID: PMC9968994 DOI: 10.1177/15269248221145039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Digital health interventions may support physical activity among solid organ transplant recipients. These interventions should be designed with users in mind, including healthcare professionals who counsel transplant recipients on physical activity to ensure acceptance and to promote an optimal user experience. The purpose of this study was to explore the perspectives of health care providers on the features of digital health interventions that would be useful in the promotion, implementation, and maintenance of physical activity among solid organ transplant recipients. Methods: This qualitative, cross-sectional study used semistructured interviews that were conducted remotely, via videoconferencing software, with providers who worked with transplant recipients. Interviews were transcribed, and an iterative-inductive, thematic analysis was used to identify common themes. Data were coded using NVivo software. Findings: Thirteen providers participated in this study. Four main themes were identified: (a) physical activity and exercise features (eg, physical activity guidelines, and exercise instructions); (b) credibility; (c) self-management; and (d) user engagement. Potential barriers to using digital health interventions included staffing requirements, professional regulatory issues, cost, perceived low patient motivation to use, and lack of technological literacy or access. Discussion: Digital health interventions were perceived to be a potential adjunct to current physical activity counseling practices, and part of an innovative strategy to address identified barriers to physical activity participation in solid organ transplant recipients.
Collapse
Affiliation(s)
- Lauren Handler
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Paula Jaloul
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jessica Clancy
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Brittany Cuypers
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Jayme Muir
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Julia Hemphill
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada
| | - Tania Janaudis-Ferreira
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Chaya Gottesman
- Toronto Lung Transplant Program, 33540Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Lisa Wickerson
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada.,Toronto Lung Transplant Program, 33540Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada
| | - Mike Lovas
- Centre for Global eHealth Innovation, 7989University Health Network, Toronto, Ontario, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, 7989University Health Network, Toronto, Ontario, Canada
| | - Sunita Mathur
- Department of Physical Therapy, 7938University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada.,School of Rehabilitation Therapy, 4257Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
4
|
Safavi AH, Lovas M, Liu ZA, Melwani S, Truong T, Devonish S, Abdelmutti N, Sayani A, Rodin D, Berlin A. Virtual Care and Electronic Patient Communication During COVID-19: Cross-sectional Study of Inequities Across a Canadian Tertiary Cancer Center. J Med Internet Res 2022; 24:e39728. [DOI: 10.2196/39728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background
Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent.
Objective
We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic.
Methods
We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD≥0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance.
Results
Among the 42,194 patients who had outpatient visits, 62.65% (n=26,435) had at least one VC visit and 31.15% (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84% (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4% received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95% CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95% CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95% CI 0.68-0.97) and emotional (OR 0.86, 95% CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95% CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95% CI 1.11-2.44; P=.01).
Conclusions
Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience.
Collapse
|
5
|
Abdelmutti N, Berlin A, Macedo A, Bender J, Liu Z(A, Papadakos J, Lovas M, Melwani S, Elliott M, Moody L, Ashfaq I, Powis ML, Krzyzanowska MK. Virtual care beyond COVID-19: Patient and physician perspectives. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
389 Background: The COVID-19 pandemic catalyzed rapid implementation of virtual care (VC), resulting in new opportunities to integrate technology and a need to evaluate patient and provider experiences. To inform sustainment beyond COVID-19, we evaluated perceptions of VC at a comprehensive cancer centre in Toronto, Canada. Methods: Physicians who provided VC during the pandemic, and patients with a valid email address on file and at least one visit with centre in the preceding 12 months were eligible to participate. Survey invitations were disseminated between May and July 2021 via email using a modified Dillman approach. The survey examined the implementation outcomes of acceptability, adoption, and appropriateness. Unadjusted associations between patient demographic variables and preference for in-person visits were evaluated using univariate logistic regression models. Results: 41% (100/246) of physicians and 15% (2,343/15,169) of patients completed the survey. The majority of patients were Caucasian (77%), college or university educated (78%), had solid malignancies (73%), and were in the follow-up phase (47%); 50% were male. The median age was 66 (IQR: 58-74). A greater proportion of patients expressed satisfaction with VC than providers (81% and 53%). Conversely, a greater proportion of providers felt that care delivered virtually was worse than care delivered in-person (45% vs 26%). Interestingly, many patients (69%) and physicians (40%) reported feeling they could maintain a good relationship through VC while at the same time reporting concerns that VC would detract from the human interaction they value as part of care (patients: 60%; providers: 82%). Patients expressed relatively equal preference for phone vs video visits (40% vs 31%), but indicated concerns about wait times for VC visits. The majority of physicians (37%) estimated that 10-29% of their practice would remain virtual post-COVID, however physicians expressed concerns with increased workload (72%), decreased efficiency (40%), and increased worry about missing relevant clinical information (61%). The majority of patients and physicians reported that VC was not appropriate for first consultations and discussions of prognosis, and most appropriate for long-term follow-up. Being born outside of Canada, primary language other than English, lower income, lower functional health literacy, and greater physical mobility were associated with preferring in-person over VC visits. Conclusions: Patients and physicians were satisfied with VC but expressed concerns with the impacts on care quality and experience and highlighted the need for guidelines on appropriate use. Providers expressed greater concerns with VC than patients. More research is needed to formally evaluate the impact of VC on quality performance and clinical outcomes as well as investigate the patient, disease and system factors that are associated with effective virtual cancer care.
Collapse
Affiliation(s)
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alyssa Macedo
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jackie Bender
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zhihui (Amy) Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Mike Lovas
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sheena Melwani
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mary Elliott
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Iqra Ashfaq
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Melanie Lynn Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | |
Collapse
|
6
|
Lau KPL, Agarwal P, Parente L, Marcello O, Lovas M, Van J, Vigod SN, Champagne T, Mohan T, Arents BW, Burton T, Flohr C, Drucker AM. Development of a Website for a Living Network Meta-analysis of Atopic Dermatitis Treatments Using a User-Centered Design: Multimethod Study. JMIR Dermatol 2022; 5:e41201. [PMID: 37632894 PMCID: PMC10334921 DOI: 10.2196/41201] [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: 07/18/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A rapid expansion of systemic immunological treatment options for atopic dermatitis (AD) has created a need for clinically relevant and understandable comparative efficacy and safety information for patients and clinicians. Given the scarcity of head-to-head trials, network meta-analysis (NMA) is an alternative way to enable robust comparisons among treatment options; however, NMA results are often complex and difficult to directly implement in shared decision-making. OBJECTIVE The aim of this study is to develop a website that effectively presents the results of a living systematic review and NMA on AD treatments to patient and clinician users. METHODS We conducted a multimethod study using iterative feedback from adults with AD, adult caregivers of children with AD, dermatologists, and allergists within a user-centered design framework. We used questionnaires followed by workshops among patients and clinicians to develop and improve the website interface. Usability testing was done with a caregiver of a patient with eczema. RESULTS Questionnaires were completed by 31 adults with AD or caregivers and 94 clinicians. Patients and caregivers felt it was very important to know about new treatments (20/31, 65%). Clinicians felt the lack of evidence-based comparisons between treatments was a barrier to care (55/93, 59%). "Avoiding dangerous side effects" was ranked as the most important priority for patients (weighted ranking 5.2/7, with higher ranking being more important), and "improving patients' overall symptoms" was the most important priority for clinicians (weighted ranking 5.0/6). A total of 4 patients and 7 clinicians participated in workshops; they appreciated visualizations of the NMA results and found the website valuable for comparing different treatments. The patients suggested changes to simplify the interface and clarify terminology related to comparative efficacy. The user in the usability testing found the website intuitive to navigate. CONCLUSIONS We developed a website, "eczematherapies.com," with a user-centered design approach. Visualizations of NMA results enable users to compare treatments as part of their shared decision-making process.
Collapse
Affiliation(s)
- Karen P L Lau
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Parente
- Healthcare Human Factors, University Health Network, Toronto, ON, Canada
| | - Olivia Marcello
- Healthcare Human Factors, University Health Network, Toronto, ON, Canada
| | - Mike Lovas
- Cancer Digital Intelligence, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Simone N Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Trevor Champagne
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Dermatology Division, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tanya Mohan
- Specialty Health Network, Shoppers Drug Mart, Toronto, ON, Canada
| | - Bernd Wm Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, Netherlands
| | | | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Aaron M Drucker
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Ribeiro MFFSA, Gregorio N, Somji F, Melwani S, Lovas M, Macedo A, Gray D, Singh R, Giovannetti E, Lee S, Chong S, Berlin A, Saibil S, Spreafico A, Hogg D, Butler MO. Development of a remote monitoring program for melanoma/skin oncology patients at Princess Margaret Cancer Centre. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18630 Background: The Melanoma/Skin Oncology (MSO) clinic supports > 200 patients on active treatment at any given time. In September 2018, the MSO clinic implemented a nurse-led proactive management program (IMBRASE) to support the monitoring of adverse events (AEs) in patients receiving immunotherapy (IO). Nurses conducted telephone calls at a pre-determined frequency to identify those who required immediate in-person assessment. Despite an initial 40% drop in emergency department visits in the first few months of implementation, insufficient human resources and lack of prioritization of assessments impacted the clinic’s ability to sustain this program. We sought to overcome this limitation by employing digital health technology to monitor and triage on-treatment patients for assessment (eIMBRASE program). Methods: MSO team worked alongside an internal innovation team (Cancer Digital Intelligence) to develop a remote assessment program with an algorithm able to prioritize patients by combining real-time biometrics and automatically scheduled electronic patient-reported outcomes (ePROs) data of individuals undergoing targeted-therapy and IO. This new digital tool will be accessible via smartphone/computer. It will enable patients to send their data to the clinical team and establish priorities based on patients’ complexity of symptoms. Results: eIMBRASE algorithm requires four data points to be displayed for the clinical team: overall priority, cumulative score (CS), biometric alert, and no response alert. The first two points are based on ePROs, for which we established a set of symptoms of interest for each treatment modality. Each symptom can be categorized in 1 of the 6 priority levels. Each priority is associated with a number of complexity points on a logarithmic scale from 0 - 400. After a questionnaire is submitted, a CS is generated for clinicians to determine which patient may be the most complex and deserve priority assessment. Regarding the third data point, oxygen saturation (SpO2) and temperature (T) measures are collected throughout the day and patients are flagged according to the following predefined thresholds: T - red alert > 38.5C, orange 38.1-38.4C, yellow 37.5-38C; and SpO2 - red alert £93%. Patients under the highest risk of AEs, for instance those on anti-CTLA4 + anti-PD1, are required to complete ePROs daily during the first 12 weeks. Patients under low-risk therapies are required to complete ePROs 1x/week. The tool triggers priority-oriented timeframe for medical contact. To minimize the influence of poor electronic literacy, patients will have their apps set up at clinic before treatment initiation. Conclusions: eIMBRASE development presents an alternative way to use digital health tools to potentially improve quality of care for MSO patients. A pilot study will be conducted to assess its feasibility, the impact in patients’ outcomes and satisfaction.
Collapse
Affiliation(s)
| | | | - Faiza Somji
- Cancer Digital Intelligence, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sheena Melwani
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mike Lovas
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Alyssa Macedo
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Diana Gray
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | - Suheon Lee
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Samuel Saibil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Hogg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marcus O. Butler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
8
|
Perlis N, Finelli A, Lovas M, Lund A, Di Meo A, Lajkosz K, Berlin A, Papadakos J, Ghai S, Dennifel D, Meng E, Wiljer D, Alibhai S, Bakas V, Badzynski A, Lee O, Cafazzo J, Haider MA. Exploring the value of using patient-oriented MRI reports in clinical practice - a pilot study. Support Care Cancer 2022; 30:6857-6876. [PMID: 35534628 DOI: 10.1007/s00520-022-07108-0] [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: 11/09/2021] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Standard radiology reports (SRR) are designed to communicate information between doctors. With many patients having instantaneous access to SRRs on patient portals, interpretation without guidance from doctors can cause anxiety and panic. In this pilot study, we designed a patient-centred prostate MRI template report (PACERR) to address some of these challenges and tested whether PACERRs improve patient knowledge and experience. MATERIALS AND METHODS Patients booked for clinical prostate MRI were randomly assigned to SRR or SRR + PACERR. Questionnaires included multiple-choice that targeted 4 domains (understanding, usefulness, next steps, emotional experience) hypothesized to improve with patient-centred reports and short answer questions, testing knowledge regarding MRI results. Clinical encounters were observed and recorded to explore whether adding PACERR improved communication. Likert scaled-responses and short-answer questions were compared using Mann-Whitney U test and Kruskal-Wallis test. RESULTS Of the 40 participants, the majority were MRI naïve (70%). Patients receiving a PACERR had higher scores in the categories of patient understanding (mean: 4.17 vs. 3.39, p=0.006), usefulness (mean: 4.58 vs. 3.07, p<0.001), and identifying next steps (mean: 1.89 vs. 3.03, p=0.003) but not emotional experience (mean: 4.18 vs. 3.79, p=0.22). PACERR participants found the layout and design more patient friendly (mean: 4.47 vs. 2.61, p<0.001) and easier to understand (mean: 4.37 vs. 2.38, p<0.001). In the knowledge section, overall, the PACERR arm scored better (87% vs. 56%, p=0.004). CONCLUSION With the addition of prostate MRI PACERR, participants had better understanding of their results and felt more prepared to involve themselves in discussions with their doctor.
Collapse
Affiliation(s)
- Nathan Perlis
- University Health Network: Princess Margaret Cancer Centre - Department of Surgical Oncology, Toronto General Hospital - Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada.
| | - Antonio Finelli
- University Health Network: Princess Margaret Cancer Centre - Department of Surgical Oncology, Toronto General Hospital - Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Mike Lovas
- University Health Network - Toronto General Hospital, Healthcare Human Factors, Toronto, Canada.,University Health Network - Princess Margaret Cancer Centre, Smart Cancer Care, Toronto, Canada
| | - Alexis Lund
- University Health Network: Princess Margaret Cancer Centre - Department of Surgical Oncology, Toronto General Hospital - Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Amelia Di Meo
- University Health Network: Princess Margaret Cancer Centre - Department of Surgical Oncology, Toronto General Hospital - Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Katherine Lajkosz
- University Health Network: Princess Margaret Cancer Centre - Department of Surgical Oncology, Toronto General Hospital - Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - Alejandro Berlin
- University Health Network - Princess Margaret Cancer Centre, Smart Cancer Care, Toronto, Canada.,University Health Network - Princess Margaret Cancer Centre, Radiation Oncology, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- University Health Network - Princess Margaret Cancer Centre: Cancer Education, Toronto, Canada
| | - Sangeet Ghai
- University Health Network and Sinai Health System - Joint Department of Medical Imaging (JDMI), University of Toronto, Toronto, Canada
| | - Dominic Dennifel
- University Health Network and Sinai Health System - Joint Department of Medical Imaging (JDMI), University of Toronto, Toronto, Canada
| | - Eric Meng
- University Health Network: Princess Margaret Cancer Centre - Department of Surgical Oncology, Toronto General Hospital - Sprott Department of Surgery, Division of Urology, University of Toronto, Toronto, Canada
| | - David Wiljer
- University Health Network - Toronto General Hospital, Education Technology Innovation at UHN Digital, Toronto, Canada
| | - Shabbir Alibhai
- University Health Network - Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Vasiliki Bakas
- University Health Network - myUHN Patient Portal, Patient Experience, Toronto, Canada
| | - Adam Badzynski
- University Health Network - Centre for Global eHealth Innovation, University of Toronto, Toronto, Canada
| | - Odelia Lee
- University Health Network - Centre for Global eHealth Innovation, University of Toronto, Toronto, Canada
| | - Joseph Cafazzo
- University Health Network - Princess Margaret Cancer Centre, Smart Cancer Care, Toronto, Canada.,University Health Network - Centre for Global eHealth Innovation, University of Toronto, Toronto, Canada
| | - Masoom A Haider
- University Health Network and Sinai Health System - Joint Department of Medical Imaging (JDMI), University of Toronto, Toronto, Canada
| |
Collapse
|
9
|
Perlis N, Finelli A, Lovas M, Lund A, Di Meo A, Lajkosz K, Berlin A, Papadakos J, Ghai S, Deniffel D, Meng E, Wiljer D, Alibhai S, Bakas V, Badzynski A, Lee O, Cafazzo J, Haider M. Exploring the value of using patient-oriented mri reports in clinical practice. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
Mathur S, Janaudis-Ferreira T, Hemphill J, Cafazzo JA, Hart D, Holdsworth S, Lovas M, Wickerson L. User-centered design features for digital health applications to support physical activity behaviors in solid organ transplant recipients: A qualitative study. Clin Transplant 2021; 35:e14472. [PMID: 34510558 DOI: 10.1111/ctr.14472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2020] [Revised: 05/30/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Digital health tools may be effective in engaging solid organ transplant (SOT) recipients in physical activity (PA). This study examined the perspectives of SOT recipients regarding PA, and desired features for digital health tools. METHODS Semi-structured interviews were used to explore perspectives of SOT recipients about barriers and motivators to physical activity, and core features of a digital health tool to support PA. Interviews were analyzed via thematic analysis. RESULTS Participants included 21 SOT recipients (11 men, 10 women, 21-78 years, 1.5-16 years post-transplant) from various organ groups (four heart, five kidney, five liver, three lung, and four multi-organ). Barriers to PA included risk aversion, managing non-linear health trajectories, physical limitations and lack of access to appropriate fitness training. Facilitators of PA included desire to live long and healthy lives, renewed physical capabilities, access to appropriate fitness guidelines and facilities. Desired features of a digital health tool included a reward system, affordability, integration of multiple functions, and the ability to selectively share information with healthcare professionals and peers. CONCLUSIONS SOT recipients identified the desired features of a digital health tool, which may be incorporated into future designs of digital and mobile health applications to support PA in SOT recipients.
Collapse
Affiliation(s)
- Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada
| | - Tania Janaudis-Ferreira
- Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada.,School of Physical and Occupational Therapy, McGill University, Quebec, Canada.,Research Institute of the McGill University Health Centre, Quebec, Canada
| | - Julia Hemphill
- School of Rehabilitation Therapy, Queen's University, Ontario, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Ontario, Canada
| | - Donna Hart
- Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada
| | - Mike Lovas
- Healthcare Human Factors, University Health Network, Ontario, Canada
| | - Lisa Wickerson
- School of Rehabilitation Therapy, Queen's University, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada.,Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, Ontario, Canada
| |
Collapse
|
11
|
Safavi A, Lovas M, Liu Z(A, Melwani S, Truong T, Devonish S, Abdelmutti N, Rodin DL, Berlin A. Your voice matters during COVID-19: Evaluation of digital divides across a tertiary cancer center. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18768 Background: Virtual care (VC) and electronic patient-reported experience measures (ePREM) have been systemically adopted during the COVID-19 pandemic to facilitate continuity of cancer care and quality improvement. Digital divides, defined as differential access and benefit from these tools, may exacerbate existing health inequities among patients. We aimed to evaluate digital divides through ePREM access, use, and responses during the pandemic. Methods: Your Voice Matters (YVM), a provincially-mandated ePREM survey, was adapted to an online platform in September 2020 and emailed to patients after outpatient VC and in-person clinic visits at a tertiary cancer centre in Ontario. Age, gender, postal codes, and completed surveys from September-December 2020 were collated. Income was estimated using area-level averages from Statistics Canada 2016 census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation: residential instability (RI), economic dependency, ethnocultural composition (EC), situational vulnerability (SV). Higher factor scores per dimension correspond to greater marginalization. Two-sided Chi-squared and t-tests were used to compare demographics between VC and in-person patients with a significance threshold of p < 0.001. Generalized estimating equations logistic regression models were used to assess associations between patient satisfaction and visit type, as well as demographics. Results: YVM was emailed to 28% (10625/37835) of patients with a response rate of 21.8% (2321/10625). Mean and minimum income (x $10,000) were highest among responders (6.6, 1.5) compared to non-responders (6.3, 1.3) and those without email (6.2, 1.1). Comparing responders with VC (n = 549) and in-person (n = 1719) visits, the former had higher mean income (6.9 vs 6.5, p < 0.001) and lower mean EC factor score (0.2 vs 0.4, p < 0.001). Satisfaction with care received was not associated with visit type and satisfaction with VC logistics was not associated with demographics. Patients with higher EC scores were more likely to rate low satisfaction in “culturally appropriate” (OR 0.69, 95% CI: 0.57-0.85) and “respect” (OR 0.69, 95% CI: 0.57-0.85) domains. Patients with higher SV scores were more likely to rate low satisfaction in the “physical symptoms” (OR 0.69, 95% CI: 0.51-0.94) domain, while patients with higher RI scores were more likely to rate low satisfaction in the “physical” (OR 0.82, 95% CI: 0.69-0.98) and “emotional symptoms” (OR 0.88, 95% CI: 0.79-0.98) domains. Conclusions: VC patients had positive experiences with visit logistics across demographics and their satisfaction with care was comparable to that of in-person patients. However, VC use and YVM access, use, and responses were associated with income and socioeconomic status. Identifying populations vulnerable to digital health inequities will guide strategies to bridge the divides.
Collapse
Affiliation(s)
- Amir Safavi
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Mike Lovas
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zhihui (Amy) Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sheena Melwani
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Tran Truong
- University Health Network, Toronto, ON, Canada
| | - Shayla Devonish
- Smart Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
12
|
Berlin A, Lovas M, Truong T, Melwani S, Liu J, Liu ZA, Badzynski A, Carpenter MB, Virtanen C, Morley L, Bhattacharyya O, Escaf M, Moody L, Goldfarb A, Brzozowski L, Cafazzo J, Chua MLK, Stewart AK, Krzyzanowska MK. Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19. JAMA Oncol 2021; 7:597-602. [PMID: 33410867 PMCID: PMC7791400 DOI: 10.1001/jamaoncol.2020.6982] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Question Can virtual care (VC) be rapidly implemented across a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic, and what are service capacity and quality outcomes? Findings This cohort study of 22 085 VC visits at a single cancer center suggests feasibility of an agile service design process for implementation of VC at scale. This approach preserved outpatient caseloads and maintained care quality in all 6 care-quality domains of care quality laid out by the Institute of Medicine while rendering high patient and practitioner satisfaction. Meaning These data support the value proposition of VC to safeguard system capacity, while minimizing the disruption to patient care during a pandemic. Importance The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. Objective To examine the outcomes of a cancer center–wide virtual care program in response to the COVID-19 pandemic. Design, Setting, and Participants This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020. Main Outcomes and Measures Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients. Results The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946. Conclusions and Relevance These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.
Collapse
Affiliation(s)
- Alejandro Berlin
- Smart Cancer Care Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Data Science Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Techna Institute, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mike Lovas
- Smart Cancer Care Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada
| | - Tran Truong
- Data Science Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Sheena Melwani
- Smart Cancer Care Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Justin Liu
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Zhihui Amy Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adam Badzynski
- Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada
| | - Mary Beth Carpenter
- University Health Network Digital, University Health Network, Toronto, Ontario, Canada
| | - Carl Virtanen
- University Health Network Digital, University Health Network, Toronto, Ontario, Canada
| | - Lyndon Morley
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Marnie Escaf
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lesley Moody
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Avi Goldfarb
- Rotman School of Management, University of Toronto, Toronto, Ontario, Canada
| | - Luke Brzozowski
- Data Science Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Joseph Cafazzo
- Techna Institute, University Health Network, Toronto, Ontario, Canada.,Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada.,eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - A Keith Stewart
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Ontario Health, Cancer Care Ontario, Ontario, Canada
| | - Monika K Krzyzanowska
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,The Cancer Quality Lab, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Perlis N, Finelli A, Lovas M, Berlin A, Papadakos J, Ghai S, Bakas V, Alibhai S, Lee O, Badzynski A, Wiljer D, Lund A, Di Meo A, Cafazzo J, Haider M. Creating patient-centered radiology reports to empower patients undergoing prostate magnetic resonance imaging. Can Urol Assoc J 2020; 15:108-113. [PMID: 33007175 DOI: 10.5489/cuaj.6585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION As we progress to an era when patient autonomy and shared decision-making are highly valued, there is a need to also have effective patient-centered communication tools. Radiology reports are designed for clinicians and can be very technical and difficult for patients to understand. It is important for patients to understand their magnetic resonance imaging (MRI) report in order to make an informed treatment decision with their physician. Therefore, we aimed to create a patient-centered prostate MRI report to give our patients a better understanding of their clinical condition. METHODS A prototype patient-centered radiology report (PACERR) was created by identifying items to include based on opinions sought from a group of patients undergoing prostate MRI and medical experts. Data was collected in semi-structured interviews using a salient belief question. A prototype PACERR was created in collaboration with human factors engineering and design, medical imaging, biomedical informatics, and cancer patient education groups. RESULTS Fifteen patients and eight experts from urology, radiation oncology, radiology, and nursing participated in this study. Patients were particularly interested to have a report with laymen terms, concise language, contextualization of values, definitions of medical terms, and next course of action. Everyone believed the report should include the risk of MRI findings actually being cancer in the subsequent biopsy. CONCLUSIONS A prostate MRI PACERR has been developed to communicate the most important findings relevant to decision-making in prostate cancer using patient-oriented design principles. The ability of this tool to improve patient knowledge and communication will be explored.
Collapse
Affiliation(s)
- Nathan Perlis
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mike Lovas
- Healthcare Human Factors, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Patient Education, Cancer Care Ontario; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vasiliki Bakas
- Operations, myUHN Portal, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shabbir Alibhai
- Division of General Internal Medicine and Geriatrics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Odelia Lee
- Healthcare Human Factors, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adam Badzynski
- Healthcare Human Factors, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Wiljer
- Education Technology and Innovation, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexis Lund
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Amelia Di Meo
- Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Joseph Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Masoom Haider
- Joint Department of Medical Imaging, Sinai Health System, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Parry M, Dhukai A, Clarke H, Bjørnnes AK, Cafazzo JA, Cooper L, Harvey P, Katz J, Lalloo C, Leegaard M, Légaré F, Lovas M, McFetridge-Durdle J, McGillion M, Norris C, Parente L, Patterson R, Pilote L, Pink L, Price J, Stinson J, Uddin A, Victor JC, Watt-Watson J, Auld C, Faubert C, Park D, Park M, Rickard B, DeBonis VS. Development and usability testing of HEARTPA♀N: protocol for a mixed methods strategy to develop an integrated smartphone and web-based intervention for women with cardiac pain. BMJ Open 2020; 10:e033092. [PMID: 32156763 PMCID: PMC7064127 DOI: 10.1136/bmjopen-2019-033092] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION More women experience cardiac pain related to coronary artery disease and cardiac procedures compared with men. The overall goal of this programme of research is to develop an integrated smartphone and web-based intervention (HEARTPA♀N) to help women recognise and self-manage cardiac pain. METHODS AND ANALYSIS This protocol outlines the mixed methods strategy used for the development of the HEARTPA♀N content/core feature set (phase 2A), usability testing (phase 2B) and evaluation with a pilot randomised controlled trial (RCT) (phase 3). We are using the individual and family self-management theory, mobile device functionality and pervasive information architecture of mHealth interventions, and following a sequential phased approach recommended by the Medical Research Council to develop HEARTPA♀N. The phase 3 pilot RCT will enable us to refine the prototype, inform the methodology and calculate the sample size for a larger multisite RCT (phase 4, future work). Patient partners have been actively involved in setting the HEARTPA♀N research agenda, including defining patient-reported outcome measures for the pilot RCT: pain and health-related quality of life (HRQoL). As such, the guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols (SPIRIT-PRO) are used to report the protocol for the pilot RCT (phase 3). Quantitative data (eg, demographic and clinical information) will be summarised using descriptive statistics (phases 2AB and 3) and a content analysis will be used to identify themes (phase 2AB). A process evaluation will be used to assess the feasibility of the implementation of the intervention and a preliminary efficacy evaluation will be undertaken focusing on the outcomes of pain and HRQoL (phase 3). ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Toronto (36415; 26 November 2018). We will disseminate knowledge of HEARTPA♀N through publication, conference presentation and national public forums (Café Scientifique), and through fact sheets, tweets and webinars. TRIAL REGISTRATION NUMBER NCT03800082.
Collapse
Affiliation(s)
- Monica Parry
- University of Toronto Lawrence S Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Abida Dhukai
- University of Toronto Lawrence S Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Hance Clarke
- Pain Research Unit, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Joseph A Cafazzo
- University of Toronto, Toronto, Ontario, Canada
- Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada
| | | | - Paula Harvey
- University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Joel Katz
- Faculty of Health - Department of Psychology, York University, Toronto, Ontario, Canada
| | - Chitra Lalloo
- The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Marit Leegaard
- Institute of Nursing, Oslo Metropolitan University, Oslo, Akershus, Norway
| | - France Légaré
- Médecine Familiale, Université Laval, Quebec, Quebec, Canada
| | - Mike Lovas
- Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada
| | | | - Michael McGillion
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Parente
- Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada
| | | | - Louise Pilote
- Medicine, McGill University, Montreal, Quebec, Canada
| | - Leah Pink
- Wasser Pain Management Centre, Sinai Health System, Toronto, Ontario, Canada
| | | | - Jennifer Stinson
- The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Akib Uddin
- Healthcare Human Factors, University Health Network, Toronto, Ontario, Canada
| | | | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Carol Auld
- Patient Advisor, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
15
|
|