Feasibility of a Personal Health Network Technology for Cancer Care Coordination
Our primary aims were to: 1) Assess the acceptance and use of the PHN among multidisciplinary oncology clinicians (medical oncologist, nurse, dietician, social worker); 2) Assess the acceptance and use of the PHN among patients with cancer; 3) Develop a fully functional PHN that reflects patient care and clinic workflow needs.
Rationale/Background: Cancer care is complex and often requires multiple providers in diverse clinical settings. As the population of newly diagnosed cancer patients and cancer survivors continue to grow, particularly among older adults, engaging patients and their families, in addition to the multidisciplinary care team is critical in achieving high-quality cancer care. Despite the Institute of Medicine’s call to address quality in cancer care fifteen years ago, including use of evidence-based care and care recommendations, considerable gaps remain. Health technology offers opportunities to address rising costs, fragmented and disorganized care, and the utilization of evidence-based care. The use of technology to coordinate cancer care is an understudied field.
Methods: Key elements of a PHN and care coordination in cancer were identified and have been described elsewhere. Fundamental to an integrated and useable PHN is the engagement of patients and the multidisciplinary care team. We recruited 4 cancer survivors and 6 multidisciplinary health care professionals (medical oncologists, nurses, social workers, dieticians) to participate in individual demonstrations followed by a semi-structured interview. We developed a demonstration and interview script prior to interviews that oriented patients and clinicians to key features within the PHN. Staff testing was conducted on either a website version and/or tablet application, while patients used the tablet application.
Outcomes Achieved/Documented: Overall, patients and members of the multidisciplinary care team thought the PHN provided value and was easy to use. Both groups were able to navigate the technology within the first demonstration. Patient usability challenges included the order of the information presented within the application and lack of a clear “home screen”. Staff challenges included integration with clinic workflow, the timeliness and management of communication. For example, alerts and notifications were automated and there was significant concern about overload. This input was incorporated into a final version of the PHN.
Conclusions: We successfully developed a PHN for cancer care coordination that reflects complex workflow and care demands for both care teams and patients. The PHN offers a novel and innovative solution to addressing quality issues in cancer care coordination. Optimizing the usability and acceptance of the PHN required an iterative process with all partners (multidisciplinary care team, patients, technology developers) for successful development and implementation. The PHN will be tested in a small, randomized control trial with 60 newly diagnosed adult cancer patients initiating chemotherapy.