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. 2025 Jan 3:27:e65148.
doi: 10.2196/65148.

Optimizing Virtual Follow-Up Care: Realist Evaluation of Experiences and Perspectives of Patients With Breast and Prostate Cancer

Sarah Scruton  1 , Geoff Wong  2 , Stephanie Babinski  1 , Lauren R Squires  1   3 , Alejandro Berlin  4   5   6 , Julie Easley  7 , Sharon McGee  8 , Ken Noel  9 , Danielle Rodin  4   5 , Jonathan Sussman  10 , Robin Urquhart  11 , Jacqueline L Bender  1   3   12
Affiliations

Optimizing Virtual Follow-Up Care: Realist Evaluation of Experiences and Perspectives of Patients With Breast and Prostate Cancer

Sarah Scruton et al. J Med Internet Res. .

Abstract

Background: Virtual follow-up (VFU) has the potential to enhance cancer survivorship care. However, a greater understanding is needed of how VFU can be optimized.

Objective: This study aims to examine how, for whom, and in what contexts VFU works for cancer survivorship care.

Methods: We conducted a realist evaluation of VFU among patients with breast cancer and prostate cancer at an urban cancer center during the COVID-19 pandemic. Realist evaluations examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). Semistructured interviews were conducted with a purposive sample of patients ≤5 years after diagnosis. Interviews were audio-recorded and analyzed using a realist logic of analysis.

Results: Participants (N=24; n=12, 50% with breast cancer and n=12, 50% with prostate cancer) had an average age of 59.6 (SD 10.7) years. Most participants (20/24, 83%) were satisfied with VFU and wanted VFU options to continue after the COVID-19 pandemic. However, VFU impacted patient perceptions of the quality of their care, particularly in terms of its effectiveness and patient centeredness. Whether VFU worked well for patients depended on patient factors (eg, needs, psychosocial well-being, and technological competence), care provider factors (eg, socioemotional behaviors and technological competence), and virtual care system factors (eg, modality, functionality, usability, virtual process of care, and communication workflows). Key mechanisms that interacted with contexts to produce positive outcomes (eg, satisfaction) were visual cues, effective and empathetic communication, and a trusting relationship with their provider.

Conclusions: Patients value VFU; however, VFU is not working as well as it could for patients. To optimize VFU, it is critical to consider contexts and mechanisms that impact patient perceptions of the patient centeredness and effectiveness of their care. Offering patients the choice of in-person, telephone, or video visits when possible, coupled with streamlined access to in-person care when required, is important. Prioritizing and addressing patient needs; enhancing physician virtual socioemotional behaviors and technology competency; and enhancing VFU functionality, usability, and processes of care and communication workflows will improve patient perceptions of the patient centeredness and effectiveness of virtual care.

Keywords: cancer; follow-up; outcomes; realist evaluation; survivorship; virtual.

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Conflict of interest statement

Conflicts of Interest: JLB is the Associate Editor for JMIR Cancer. All other authors have no conflicts to declare.

Figures

Figure 1
Figure 1
Refined program theory.
See this image and copyright information in PMC

References

    1. Canadian cancer statistics 2023. Canadian Cancer Society. 2023. [2024-03-19]. https://cancer.ca/en/cancer-information/resources/publications/canadian-... .
    1. Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2005.
    1. Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin. 2013 Sep;63(5):295–317. doi: 10.3322/caac.21186. https://onlinelibrary.wiley.com/doi/10.3322/caac.21186 - DOI - PubMed
    1. Cheville AL, Mustian K, Winters-Stone K, Zucker DS, Gamble GL, Alfano CM. Cancer rehabilitation: an overview of current need, delivery models, and levels of care. Phys Med Rehabil Clin N Am. 2017 Feb;28(1):1–17. doi: 10.1016/j.pmr.2016.08.001.S1047-9651(16)30063-8 - DOI - PubMed
    1. Urquhart R, Cordoba W, Bender J, Cuthbert C, Easley J, Howell D, Kaal J, Kendell C, Radford S, Sussman J. Risk stratification and cancer follow-up: towards more personalized post-treatment care in Canada. Curr Oncol. 2022 May 03;29(5):3215–23. doi: 10.3390/curroncol29050261. https://www.mdpi.com/resolver?pii=curroncol29050261 curroncol29050261 - DOI - PMC - PubMed

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