Utility, barriers and facilitators to the use of connected health to support families impacted by paediatric cancer: a qualitative analysis

Barriers and facilitators to the implementation of a new European eHealth solution (SurPass v2.0): the PanCareSurPass Open Space study

PURPOSE

To identify barriers and facilitators for implementing the Survivorship Passport (SurPass) v2.0 in six long-term follow-up (LTFU) care centres in Europe.

METHODS

Stakeholders including childhood cancer survivors (CCSs), healthcare providers (HCPs), managers, information and technology (IT) specialists, and others, participated in six online Open Space meetings. Topics related to Care, Ethical, Legal, Social, Economic, and Information & IT-related aspects of implementing SurPass were evaluated.

RESULTS

The study identified 115 barriers and 159 facilitators. The main barriers included the lack of standardised LTFU care in centres and network cooperation, uncertainty about SurPass accessibility, and uncertainty about how to integrate SurPass into electronic health information systems. The main facilitators included standardised and coordinated LTFU care in centres, allowing CCSs to conceal sensitive information in SurPass and (semi)automatic data transfer and filing.

CONCLUSIONS

Key barriers to SurPass implementation were identified in the areas of care, ethical considerations, and information & IT. To address these barriers and facilitate the implementation on SurPass, we have formulated 27 recommendations. Key recommendations include using the internationally developed protocols and guidelines to implement LTFU care, making clear decisions about which parties have access to SurPass data in accordance with CCSs, and facilitating (semi)automated data transfer and filing using Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR).

IMPLICATIONS FOR CANCER SURVIVORS

The findings of this study can help to implement SurPass and to ensure that cancer survivors receive high-quality LTFU care with access to the necessary information to manage their health effectively.

Connected health in cancer survivorship: Evaluating the usability and utility of the cancer thriving and surviving programme in Ireland

BACKGROUND

Cancer survivorship care has become increasingly complex, with a growing population of people living with and beyond the disease requiring holistic support and follow-up. Connected health (CH) offer a promising solution to enhance care delivery.

AIM

This study evaluated the usability and effectiveness of CH, and motivations of participants in the Cancer Thriving and Surviving (CTS) programme in Ireland.

METHODS

A cross-sectional survey of persons living with and beyond cancer (PLWBC) who completed the CH-delivered CTS was conducted between December 2022 and April 2023. Closed and open-ended questions captured participants experiences and motivations. Telehealth Usability Questionnaire (TUQ) assessed the CH usability. Qualitative content analysis examined recurring themes in participant responses.

RESULTS

Forty-four participants who engaged in CTS completed the survey. Participants were predominantly female (88%), diagnosed with breast cancer (76%), and had third-level education or higher (86%). Slightly over one third (36%) were in full time employment. Motivations for engaging in CTS included seeking peer support, psychosocial assistance, and practical self-management tools. Most respondents agreed that the programme improved their psychological wellbeing (90%), quality of life (76%) and helped them take more control of their health (83%). TUQ scores indicated high usability of the CH systems.

CONCLUSION

Findings suggest that the CH-delivered CTS programme effectively benefits PLWBC, improving psychological well-being and quality of life. The high CH system usability and positive user experiences highlight its potential to complement in-person care, supporting the continued development and evaluation of CH systems to enhance cancer survivorship, particularly within Irish digital health initiatives.

Using AI to Predict Patients' Length of Stay: PACU Staff's Needs and Expectations for Developing and Implementing an AI System

Introduction: The need for innovative technology in healthcare is apparent due to challenges posed by the lack of resources. This study investigates the adoption of AI-based systems, specifically within the postanesthesia care unit (PACU). The aim of the study was to explore staff needs and expectations concerning the development and implementation of a digital patient flow system based on ML predictions. Methods: A qualitative approach was employed, gathering insights through interviews with 20 healthcare professionals, including nurse managers and staff involved in planning patient flows and patient care. The interview data were analyzed using reflexive thematic analysis, following steps of data familiarization, coding, and theme generation. The resulting themes were then assessed for their alignment with the modified technology acceptance model (TAM2). Results: The respondents discussed the benefits and drawbacks of the proposed ML system versus current manual planning. They emphasized the need for controlling PACU throughput and expected the ML system to improve the length of stay predictions and provide a comprehensive patient flow overview for staff. Prioritizing the patient was deemed important, with the ML system potentially allowing for more patient interaction time. However, concerns were raised regarding potential breaches of patient confidentiality in the new ML system. The respondents suggested new communication strategies might emerge with effective digital information use, possibly freeing up time for more human interaction. While most respondents were optimistic about adapting to the new technology, they recognized not all colleagues might be as convinced. Conclusion: This study showed that respondents were largely favorable toward implementing the proposed ML system, highlighting the critical role of nurse managers in patient workflow and safety, and noting that digitization could offer substantial assistance. Furthermore, the findings underscore the importance of strong leadership and effective communication as key factors for the successful implementation of such systems.

The development of an augmented reality application for exercise prescription within paediatric oncology: App design and protocol of a pilot study

Background: Children and young people with cancer face barriers when engaging with exercise, such as treatment-related side effects, psychosocial burdens and lack of individualised provisions. Digital health tools, such as smartphone applications, have emerged as a promising driver to support healthcare provisions in exercise prescription among patients. It is vital to explore how such technologies can be developed more effectively in order to strengthen the evidence supporting their use and for more appropriate implementation within healthcare. This study aims to explore user experiences, preferences and suggested improvements from healthy children and young people aged 9-21 years. Methods: An augmented reality (AR) application was specifically developed for children and young people aged 9-21 years undergoing cancer treatment and a protocol for a pilot study was designed. The target sample of this pilot study is 90 healthy children and young people aged 9-21 years. Practical 30-min workshops will be conducted encouraging participants to engage with the smartphone app. Focus groups will explore participant experiences, preferences, and suggested improvements. Data will be analysed deductively with apriori themes derived from the semi-structured interviews. Discussion: Obtaining user experiences, preferences and suggested improvements is especially important for the development of novel apps, such as those prescribing exercise and using algorithms and augmented reality software. Results from this study will directly influence the development of an augmented reality application, which will also be applied within a long-term trial in paediatric oncology.

Exploring the perspectives of health care professionals on digital health technologies in pediatric care and rehabilitation

BACKGROUND

Digital health technologies are increasingly used by healthcare professionals working in pediatric hospital and rehabilitation settings. Multiple factors may affect the implementation and use of digital health technologies in these settings. However, such factors have not been identified in a multidisciplinary, pediatric context. The objective of this study was to describe actual use and to identify the factors that promote or hinder the intention to use digital health technologies (mobile learning applications, virtual/augmented reality, serious games, robotic devices, telehealth applications, computerized assessment tools, and wearables) among pediatric healthcare professionals.

METHODS

An online survey evaluating opinions, current use, and future intentions to use digital health technologies was completed by 108 professionals at one of Canada's largest pediatric institutes. Mann-Whitney U tests were used to compare the attitudes of healthcare professionals who intend to increase their use of digital health technologies and those who do not. Linear regression analyses were used to determine predictors of usage success.

RESULTS

Healthcare professionals reported mostly using mobile and tablet learning applications (n = 43, 38.1%), telehealth applications (n = 49, 43.4%), and computerized assessment tools (n = 33, 29.2%). Attitudes promoting the intention to increase the use of digital health technologies varied according to technology type. Healthcare professionals who wished to increase their use of digital health technologies reported a more positive attitude regarding benefits in clinical practice and patient care, but were also more critical of potential negative impacts on patient-professional relationships. Ease of use (β = 0.374; p = 0.020) was a significant predictor of more favorable usage success. The range of obstacles encountered was also a significant predictor (β = 0.342; p = 0.032) of less favorable evaluation of usage success. Specific factors that hinder successful usage are lack of training (β = 0.303; p = 0.033) and inadequate infrastructure (β = 0.342; p = 0.032).

CONCLUSIONS

When working with children, incorporating digital health technologies can be effective for motivation and adherence. However, it is crucial to ensure these tools are implemented properly. The findings of this study underscore the importance of addressing training and infrastructure needs when elaborating technology-specific strategies for multidisciplinary adoption of digital health technologies in pediatric settings.

Healthcare personnel's perspectives on health technology in home-based pediatric palliative care: a qualitative study

BACKGROUND

In the context of pediatric palliative care, where the quality of life of children with life-limiting or life-threatening conditions is of utmost importance, the integration of health technology must support the provision of care. Research has highlighted the role of healthcare personnel when utilizing health technology in home-based pediatric palliative care, but specific knowledge of healthcare personnel's views on the technological relevance remains limited. Therefore, our study has explored potentials and limitations of health technology in home-based pediatric palliative care from the perspectives of healthcare personnel.

METHODS

Our study utilized a qualitative, descriptive, and exploratory design, including five focus groups with a total of 22 healthcare personnel. The participants were selected from various health regions in Norway and were experienced in providing home-based pediatric palliative care. Using reflexive thematic analysis, we interpreted data obtained from focus groups, identified patterns, and developed themes.

RESULTS

The analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care. The healthcare personnel acknowledged difficulties in fully replacing in-person interaction with health technology. However, they also emphasized potentials of health technology to facilitate information sharing and the ability to access a child's health record within interdisciplinary teams.

CONCLUSION

The results underscored that technology can support pediatric palliative care but must be thoughtfully integrated to ensure an individualized patient-centered approach. To maximize the benefits of health technology in enhancing home-based pediatric palliative care, future research should address the limitations of current health technology and consider the opinions for information sharing between relevant healthcare team members, the child, and their family.

Efficiency of the Technology-Based "HomeCARE-Family EmPow" for Children with Cancer and Their Parents: A Study Protocol for a Randomized Controlled Trial

OBJECTIVES

Home-based pediatric cancer care requires addressing both physical and psychosocial care needs for children and their parents Currently, there is a notable gap in intervention programs that evaluate technology-based psychosocial empowerment for children and parents in home-based pediatric cancer care. The study protocol was to assess the efficiency of a technology-based psychosocial empowerment intervention for home-based care for children with cancer and their parents.

METHODS

This study was planned as a single-blinded parallel-group randomized controlled experimental design. The study was intended to include 64 children and parents in the research sample. The HomeCare-Family EmPow is a technology-based intervention based on the Psychological Empowerment Theory. This 4-week program, delivered via the website, consists of four modules for parents and two for children. The descriptive form, Self-Efficacy Scale- for children and adolescents with cancer, State-Trait Anxiety Inventory, and Pediatric Cancer Coping Scale will be used in the data collection for children. The descriptive form, Self-Efficacy Scale, Problem-Solving Inventory, and Psychological Resilience Scale will be used for parents. Repeated measures analysis of variance and linear mixed-effects models will be applied for intragroup and intergroup comparisons. Outcome measures will be assessed before randomization, 1 week after the intervention, and 1 month after.

RESULTS

The possible differences between the intervention and control groups will be evaluated after the implementation of the intervention. Our proposed hypotheses will report the findings.

CONCLUSIONS

This research may provide a more comprehensive and evidence-based approach to pediatric cancer management at home-based pediatric cancer management by improving children's and parents' self-efficacy and coping by providing feasible, accessible, and innovative support.

IMPLICATIONS FOR NURSING PRACTICE

The study outcomes are expected to enrich the understanding and management of the psychosocial well-being of children and their parents and empower them to cope with the treatment process more effectively during home-based care.

Moving Forward With Telehealth in Cancer Rehabilitation: Patient Perspectives From a Mixed Methods Study

BACKGROUND

The COVID-19 pandemic accelerated the use of telehealth in cancer care and highlighted the potential of telehealth as a means of delivering the much-needed rehabilitation services for patients living with the side effects of cancer and its treatments.

OBJECTIVE

This mixed methods study aims to explore patients' experiences of telehealth and their preferences regarding the use of telehealth for cancer rehabilitation to inform service development.

METHODS

The study was completed in 2 phases from October 2020 to November 2021. In phase 1, an anonymous survey (web- and paper-based) exploring the need, benefits, barriers, facilitators, and preferences for telehealth cancer rehabilitation was distributed to survivors of cancer in Ireland. In phase 2, survivors of cancer were invited to participate in semistructured interviews exploring their experiences of telehealth and its role in cancer rehabilitation. Interviews were conducted via telephone or video call following an interview guide informed by the results of the survey and transcribed verbatim, and reflexive thematic analysis was performed using a qualitative descriptive approach.

RESULTS

A total of 48 valid responses were received. The respondents were at a median of 26 (range 3-256) months after diagnosis, and 23 (48%) of the 48 participants had completed treatment. Of the 48 respondents, 31 (65%) reported using telehealth since the start of the pandemic, 15 (31%) reported having experience with web-based cancer rehabilitation, and 43 (90%) reported a willingness for web-based cancer rehabilitation. A total of 26 (54%) of the 48 respondents reported that their views on telehealth had changed positively since the start of the pandemic. Semistructured interviews were held with 18 survivors of cancer. The mean age of the participants was 58.9 (SD 8.24) years, 56% (10/18) of the participants were female, and 44% (8/18) of the participants were male. Reflexive thematic analysis identified 5 key themes: telehealth improves accessibility to cancer rehabilitation for some but is a barrier for others, lived experiences of the benefits of telehealth in survivorship, the value of in-person health care, telehealth in cancer care and COVID-19 (from novelty to normality), and the future of telehealth in cancer rehabilitation.

CONCLUSIONS

Telehealth is broadly welcomed as a mode of cancer rehabilitation for patients living with and beyond cancer in Ireland. However, issues regarding accessibility and the importance of in-person care must be acknowledged. Factors of convenience, time savings, and cost savings indicate that telehealth interventions are a desirable patient-centered method of delivering care when performed in suitable clinical contexts and with appropriate populations.

Evaluating the Usefulness and Ease of Use of a Next-Generation-Connected Drug Delivery Device for Growth Hormone Therapy: Qualitative Study of Health Care Professionals' Perceptions

BACKGROUND

Digital solutions targeting children's health have become an increasingly important element in the provision of integrated health care. For the treatment of growth hormone deficiency (GHD), a unique connected device is available to facilitate the delivery of recombinant human growth hormone (r-hGH) by automating the daily injection process and collecting injection data such that accurate adherence information is available to health care professionals (HCPs), caregivers, and patients. The adoption of such digital solutions requires a good understanding of the perspectives of HCPs as key stakeholders because they leverage data collection and prescribe these solutions to their patients.

OBJECTIVE

This study aimed to evaluate the third generation of the easypod device (EP3) for the delivery of r-hGH treatment from the HCP perspective, with a focus on perceived usefulness and ease of use.

METHODS

A qualitative study was conducted, based on a participatory workshop conducted in Zaragoza, Spain, with 10 HCPs experienced in the management of pediatric GHD from 7 reference hospitals in Spain. Several activities were designed to promote discussion among participants about predefined topics based on the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology to provide their perceptions about the new device.

RESULTS

Participants reported 2 key advantages of EP3 over previous easypod generations: the touch screen interface and the real-time data transmission functionality. All participants (10/10, 100%) agreed that the new device should be part of a digital health ecosystem that provides complementary functionalities including data analysis.

CONCLUSIONS

This study explored the perceived value of the EP3 autoinjector device for the treatment of GHD by HCPs. HCPs rated the new capabilities of the device as having substantial improvements and concluded that it was highly recommendable for clinical practice. EP3 will enhance decision-making and allow for more personalized care of patients receiving r-hGH.