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. 2023 Dec 22:7:e50550.
doi: 10.2196/50550.

Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study

Nanna Fridriksdottir #  1   2 , Brynja Ingadottir #  1   2 , Kristin Skuladottir #  1 , Sigridur Zoëga #  1   2 , Sigridur Gunnarsdottir #  1   2   3
Affiliations

Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study

Nanna Fridriksdottir et al. JMIR Form Res. .

Abstract

Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging.

Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes.

Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility.

Results: The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=-.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=-.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up.

Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.

Keywords: acceptability; digital health service; electronic health records; feasibility; health engagement; mobile phone; patient education; patient portal; patient-reported outcomes; self-management support; supportive digital health service; symptom monitoring; usability; web portal for patients with cancer.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Overview of the timeline and main actions in the 4 developmental phases of the cancer portal. DT&PL: Distress Thermometer and Problem List; EMR: electronic medical record; ESASr: Edmonton Symptom Assessment System–Revised; HCP: health care professional.
Figure 2
Figure 2
An overview of the portal interface and functions. DT&PL: Distress Thermometer and Problem List; EMR: electronic medical record; ESASr: Edmonton Symptom Assessment System–Revised; PRO: patient-reported outcome.
Figure 3
Figure 3
Study flow diagram.
See this image and copyright information in PMC

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