1
|
Heneka N, Chambers SK, Schaefer I, Carmont K, Parcell M, Wallis S, Walker S, Tuffaha H, Steele M, Dunn J. Acceptability of a virtual prostate cancer survivorship care model in rural Australia: A multi-methods, single-centre feasibility pilot. Aust J Rural Health 2024; 32:815-826. [PMID: 38853378 DOI: 10.1111/ajr.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 04/22/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Abstract
DESIGN A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study. SETTING A rural Australian hospital and health service. PARTICIPANTS Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. INTERVENTION The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting. MAIN OUTCOME MEASURES Primary outcome: program acceptability. SECONDARY OUTCOMES quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3). RESULTS Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. CONCLUSIONS This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.
Collapse
Affiliation(s)
- Nicole Heneka
- University of Southern Queensland, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne K Chambers
- Australian Catholic University, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Isabelle Schaefer
- University of Southern Queensland, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | | | - Michael Steele
- Australian Catholic University, Sydney, New South Wales, Australia
| | - Jeff Dunn
- University of Southern Queensland, Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Silva DJ, Nelson BE, Rodon J. Decentralized Clinical Trials in Early Drug Development-A Framework Proposal. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2024; 7:190-200. [PMID: 39219999 PMCID: PMC11361338 DOI: 10.36401/jipo-23-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 09/04/2024]
Abstract
The COVID-19 pandemic has led to a rethinking of clinical trial design to maintain clinical research activity, with regulatory changes allowing for the wider implementation and development of decentralized design models. Evidence of the feasibility and benefits associated with a remote design comes mainly from observational studies or phase 2 and 3 clinical trials, in which implementation is easier with a better-established safety profile. Early drug development is a slow and expensive process in which accrual and safety are key aspects of success. Applying a decentralized model to phase 1 clinical trials could improve patient accrual by removing geographic barriers, improving patient population diversity, strengthening evidence for rare tumors, and reducing patients' financial and logistical burdens. However, safety monitoring, data quality, shipment, and administration of the investigational product are challenges to its implementation. Based on published data for decentralized clinical trials, we propose an exploratory framework of solutions to enable the conceptualization of a decentralized model for phase 1 clinical trials.
Collapse
Affiliation(s)
- Diogo J. Silva
- Local Health Unity of Matosinhos – Hospital Pedro Hispano, Matosinhos, Portugal
| | - Blessie Elizabeth Nelson
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
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] [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
|
4
|
Toni E, Ayatollahi H. An insight into the use of telemedicine technology for cancer patients during the Covid-19 pandemic: a scoping review. BMC Med Inform Decis Mak 2024; 24:104. [PMID: 38641567 PMCID: PMC11027268 DOI: 10.1186/s12911-024-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/12/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic. METHODS This was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively. RESULTS A total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates. CONCLUSION The findings provided valuable insights into the various telemedicine technologies, services, users' perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users' satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.
Collapse
Affiliation(s)
- Esmaeel Toni
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Johnston EA, Collins KE, Vicario JN, Sibthorpe C, Ireland MJ, Goodwin BC. Changes in rural caregivers' health behaviors while supporting someone with cancer: A qualitative study. Cancer Med 2024; 13:e7157. [PMID: 38572938 PMCID: PMC10993705 DOI: 10.1002/cam4.7157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Caring for someone with cancer has a significant impact on usual routines, including caregivers' ability to maintain their own health and wellbeing. Caregivers living in rural areas face additional challenges in supporting someone with cancer, and little is known about the impact of caregiving on the health behaviors of rural caregivers. Therefore, this study explored how caring for someone with cancer affected rural caregivers' health behaviors. METHODS Through semi-structured interviews, 20 rural caregivers described changes in their health behaviors while caring for someone with cancer and the factors underlying these changes. Specific prompts were provided for diet, physical activity, alcohol, smoking, sleep, social connection and leisure, and accessing health care when needed. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to identify changes in health behaviors and the factors underlying these changes. The factors identified were mapped to the socioecological framework, identifying areas for intervention across multiple levels (individual, interpersonal, organizational, community, and policy). RESULTS Rural caregivers reported both positive and negative changes to their diet, physical activity, alcohol, and smoking. Sleep, social connection and leisure, and accessing health care were negatively impacted since becoming a caregiver. CONCLUSIONS Designing interventions to address rural caregivers' coping strategies, reduce carer burden and fatigue, improve access to cooking and exercise facilities and social support while away from home, reduce the need to travel for treatment, and increase the financial support available could yield widespread benefits for supporting the health and wellbeing of rural caregivers.
Collapse
Affiliation(s)
- Elizabeth A. Johnston
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
- School of Exercise and Nutrition SciencesQueensland University of TechnologyKelvin GroveQueenslandAustralia
- Population Health ProgramQIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Katelyn E. Collins
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
- School of Psychology and WellbeingUniversity of Southern QueenslandSpringfieldQueenslandAustralia
| | | | - Chris Sibthorpe
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
| | - Michael J. Ireland
- School of Psychology and WellbeingUniversity of Southern QueenslandSpringfieldQueenslandAustralia
- Centre for Health ResearchUniversity of Southern QueenslandSpringfieldQueenslandAustralia
| | - Belinda C. Goodwin
- Cancer Council QueenslandFortitude ValleyQueenslandAustralia
- Centre for Health ResearchUniversity of Southern QueenslandSpringfieldQueenslandAustralia
- School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
6
|
van Schalkwijk D, Lodder P, Everaert J, Widdershoven J, Habibović M. Latent profiles of telehealth care satisfaction during the COVID-19 pandemic among patients with cardiac conditions in an outpatient setting. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:85-95. [PMID: 38765625 PMCID: PMC11096653 DOI: 10.1016/j.cvdhj.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background During the COVID-19 pandemic, telemedicine was advocated and rapidly scaled up worldwide. However, little is known about for whom this type of care is acceptable. Objective To examine which patient characteristics (demographic, medical, psychosocial) are associated with telehealth care satisfaction, attitude toward telehealth, and preference regarding telehealth over time in a cardiac patient population. Methods In total, 317 patients were recruited at the Elisabeth-TweeSteden Hospital in The Netherlands. All patients who had received telehealth care (telephone and video) in the previous 2 months were approached for participation. Baseline, 3-month, and 6-month questionnaires were administered online. A 3-step latent class analysis was conducted to identify trajectories of telehealth use over time and the possible association of the found trajectories with external variables. Results Five trajectories (classes) were identified for satisfaction with telehealth and 4 for attitude toward telehealth. Patients with higher distress, lower physical and mental health, higher scores on pessimism, and negative affectivity were more likely to be less satisfied. Patients with no partner, more comorbidities, higher distress, lower physical and mental health, and higher scores on pessimism were more likely to hold a negative attitude toward telehealth. For the future application of telehealth, marital status, comorbidities, digital health literacy, and pessimism were significantly related. Conclusion Results show that patients' profiles should be considered when offering telehealth care and that the "one size fits all" approach does not apply. Results can inform clinical practice on how to better implement remote health care in the future while considering a personalized approach.
Collapse
Affiliation(s)
- Dinah van Schalkwijk
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|