Older cancer survivors' perspectives and use of telehealth in their cancer survivorship care in the United States: A ResearchMatch® sample

Social Media and eHealth Literacy Among Older Adults: Systematic Literature Review

BACKGROUND

The advent of social media has significantly transformed health communication and the health-related actions of older adults, offering both obstacles and prospects for this generation to embrace eHealth developments.

OBJECTIVE

We aimed to investigate the correlation between social media and eHealth literacy in older individuals and answer four research questions: (1) What are the specific social media behaviors (including general use behaviors and health behaviors) of older adults on social media? (2) How do these behaviors impact their eHealth literacy? (3) How does eHealth literacy influence older adults' social media behaviors? and (4) What factors influence older adults' use of social media for health-related purposes?

METHODS

Using predetermined keywords and inclusion criteria, we searched Scopus, Web of Science, and PubMed databases for English-language journal articles published from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. The initial search identified 1591 publications, and after removing duplicates, 48.21% (767/1591) of publications remained. Ultimately, 1% (16/1591) of studies met the inclusion criteria. A research question-driven manual qualitative thematic analysis was conducted, guided by the categorization of social media use behaviors, the definition of eHealth literacy, and the social-ecological model to provide direction for coding and thematic analysis. In addition, attention was given to identifying unanticipated behaviors or phenomena during the coding process, and these were subsequently incorporated into the analytical framework.

RESULTS

The results indicated that older adults' general social media use behaviors are primarily characterized by social media preferences, with 2 subthemes identified. Their social media health behaviors revealed 5 main themes and 14 subthemes. Among the primary themes, health information behavior appeared most frequently (12/16, 75%), followed by self-management (8/16, 50%). Other themes included health decision-making (4/16, 25%), telemedicine (3/16, 19%), and health interventions (2/16, 13%). Cross-thematic analysis confirmed that older adults' social media use behaviors and their eHealth literacy had a reciprocal relationship. Finally, the study revealed that the use of social media to improve eHealth literacy among older adults was influenced by individual, interpersonal, institutional or organizational, and social factors.

CONCLUSIONS

The reciprocal relationship between older adults' social media use and eHealth literacy highlights the importance of establishing a long-term positive mechanism that mutually reinforces social media health practices and eHealth literacy. Based on the findings, this review proposes key directions for efforts to achieve this goal: (1) leveraging postpandemic momentum to enhance eHealth literacy among older adults through social media, (2) reconsidering the dimensions of eHealth literacy among older adults in the context of Web 2.0, (3) actively developing age-friendly integrated social media health service platforms, (4) optimizing social media for engaging and reliable health information for older adults, and (5) integrating social support systems to foster lifelong eHealth learning for older adults.

Exploring Older Adult Cancer Survivors' Digital Information Needs: Qualitative Pilot Study

Background

Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults' transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns.

Objective

This pilot study, which examined older adult cancer survivors' use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors' perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers.

Methods

A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (#21-0421) was obtained. Interpretive description inquiry-a practice-based approach suitable for generating applied knowledge-supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes).

Results

Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors.

Conclusions

Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve.

COVID-19 and beyond: A systematic review of adaptations to psychosocial support in oncology

AIMS

To understand the strategies used to continue providing psychosocial support to cancer patients during the pandemic, including outcomes and implications beyond the pandemic.

DESIGN

A systematic review of original research.

DATA SOURCES

ProQuest Health & Medicine, CINAHL Complete (via EBSCOhost), Scopus, and PubMed were searched for original work published between January 2020 and December 2022.

METHODS

Abstract and title screening identified eligible articles for full-text review. Following a full-text review, data were extracted from eligible articles, and a risk of bias assessment was conducted. A synthesis without meta-analysis was performed.

RESULTS

Thirty-four articles met the selection criteria. These articles provide evidence that systematic adaptations during the pandemic improved the assessment and screening of psychological needs and/or increased the number of clients accessing services. Additionally, while the pandemic was associated with decreased psychosocial well-being for cancer patients, five intervention studies reported improvements in psychosocial well-being. Barriers, strategies, and recommendations were described.

CONCLUSION

Adapting psychosocial support during a pandemic can be successful, achieved relatively quickly, and can increase the uptake of support for people experiencing cancer.

IMPLICATIONS FOR PATIENT CARE

It is imperative that these adaptations continue beyond the pandemic to maximize adaptive psychosocial outcomes for a group vulnerable to ongoing mental health concerns.

IMPACT

While the COVID-19 pandemic was associated with increased psychosocial need for cancer patients, evidence in the review suggested that adaptations made to service delivery facilitated increased access for patients who may not previously have been able to access support. Additionally, improvements in psychosocial well-being were achieved. These findings are relevant for clinicians and decision-makers who fund and design psychosocial support services for cancer patients.

REPORTING METHOD

The review was guided by PRISMA Guidelines and the SWiM Reporting Guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Telemedicine in geriatric oncology - lessons learned from the COVID-19 experience

PURPOSE OF REVIEW

Telemedicine quickly became integrated into healthcare caused by the Coronavirus 19 (COVID-19) pandemic. Rapid use of telemedicine into healthcare systems was supported by the World Health Organization and other prominent national organizations to reduce transmission of the virus while continuing to provide access to care. In this review, we explored the effect of this swift change in care and its impact on older adults with cancer.

RECENT FINDINGS

Older adults are susceptible to the COVID-19 virus caused by various risk factors, such as comorbidity, frailty, decreased immunity, and cancer increases vulnerability to infection, hospitalization, and mortality. We found three major themes emerged in the literature published in the past 18 months, including access to care, telemedicine modes of communication, and the use of technology by older adults with cancer. These findings have brought insight into issues regarding healthcare disparities.

SUMMARY

The utilization of telemedicine by older adults with cancer has potential future benefits with the integration of technology preparation prior to the patient's initial visit and addressing known health disparities. The hybrid model of care provides in-person and or remote access to clinicians which may allow older adults with cancer the flexibility needed to obtain quality cancer care.

Experiences participating in a telehealth exercise program among older adults with cancer: a qualitative study

PURPOSE

Telehealth delivery of exercise programs has rapidly increased in recent years; yet, little is known regarding older cancer survivors' (OCS) experiences participating in telehealth exercise. The purpose of this study was to determine OCS barriers and facilitators to participation in telehealth-delivered exercise.

METHODS

OCS who participated in a 12-week, one-on-one telehealth exercise program were recruited to participate in one of three focus groups. Focus groups were conducted virtually using a semi-structured interview guide. Focus groups were audio recorded, transcribed verbatim, and analyzed utilizing thematic analysis with Atlas.ti.

RESULTS

Fourteen OCS (age range 65-79 years) participated in the focus groups, five (35.7%) of which had not completed a telehealth follow-up assessment. The most common cancer type was breast (n = 6, 42.9%), and all cancer stages were represented. Three overall themes were identified: having adequate space to exercise, meeting OCS physical and psychosocial needs, and OCS learning throughout the exercise program. Within these themes, five facilitators and two barriers were identified. Facilitators included the individualization of the exercise program, no travel, accountability, learning to exercise, and support from staff and family. The barriers identified were having limited space to exercise and a learning curve with technology.

CONCLUSION

OCS viewed telehealth exercise positively. Identified barriers aligned with those in younger cancer survivors (≥18 years), indicating that OCS are able to engage with telehealth exercise programs alongside their younger counterparts.

IMPLICATIONS FOR CANCER SURVIVORS

Telehealth exercise mitigates exercise barriers in OCS and should be used as a strategy to support exercise participation among cancer survivors, regardless of age.

Personalization in digital health interventions for older adults with cancer: A scoping review

INTRODUCTION

Digital health interventions (DHIs) are promising to support older adults with cancer in managing their conditions and improving their health outcomes. However, there is a lack of overall understanding of various DHIs for the aging population with cancer. Specifically, it is unclear how personalization components are included in those DHIs to promote engagement in the interventions among older adults with cancer. This study aimed to provide a comprehensive overview of existing DHIs for older adults with cancer and identify the intervention components, especially personalized features, and effectiveness of these DHIs for improving self-management and psychosocial health.

MATERIALS AND METHODS

A scoping review was conducted following Joanna Briggs Institute guidelines, focusing on older adults diagnosed with cancer who participated in DHIs to improve self-management and psychosocial health. Studies using an experimental design and published from 2000 to January 2023 were retrieved from four databases: PubMed, Embase, CINAHL, and Scopus. After primary data extraction of study characteristics, participants, interventions, and outcomes, DHIs were categorized according to personalized features.

RESULTS

Out of 9,750 articles, 20 were eligible for this scoping review. The main personalized features of DHIs were categorized into four domains: goal setting, adjusting the plan, data-driven approaches, and motivating behavioral changes. Self-management outcomes were focused on physical activity, diet, and symptom management. Quality of life, depression, and anxiety were addressed as psychosocial health-related outcomes. Although no consistent results were reported on the effectiveness, DHIs with a combination of multiple personalized features, more than three domains, were likely to be more effective in improving self-management outcomes.

DISCUSSION

This review enhances the understanding of personalized DHIs for older adults with cancer by identifying intervention components, personalized features, and effectiveness on self-management and psychosocial health. Several gaps were identified, including the absence of targeted studies exclusively focusing on older adults, a relative scarcity of personalized features for improving patient engagement, a lack of understanding of the mechanism of effective personalized features, and the necessity for more experimental studies. Addressing these gaps can contribute to improving health outcomes and the quality of care for older adults with cancer by providing the direction for developing effective DHIs.

Digital health in geriatric oncology: A Young International Society of Geriatric Oncology review

The integration of digital health technologies in geriatric oncology has the potential to enhance patient care and self-management. This review article discusses the applications of these technologies, including teleassessment, telemonitoring, and teleintervention, within geriatric oncology, and evaluates their potential to improve cancer care and patient outcomes. We also review challenges to the implementation of digital health technologies among populations of older patients with cancer. The article provides a perspective for clinicians, researchers, policymakers, and patients on the integration and utilisation of digital health technologies in current geriatric oncology practice.

Cancer nursing research priorities: A rapid review

PURPOSE

Identifying cancer nursing research priorities is central to influencing the direction of cancer care research. The aim of this rapid review was to explore research priorities identified by oncology nurses for cancer care delivery between 2019 and 2022.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis informed the design of the rapid review. MEDLINE, CINAHL, PUBMED, Web of Science, and Cochrane databases were searched for studies published between December 1st, 2018, and September 30th^, 2022. This timeframe was chosen to account for the latest relevant evidence synthesis, as well as changes in cancer care necessitated by the COVID-19 pandemic. The Quality Assessment of Diverse Studies tool was used to appraise quality.

RESULTS

Four studies met the inclusion criteria. Many of the research priorities identified were influenced by the COVID-19 pandemic. The top cancer nursing research priority identified was the role of technology in improving patient and caregiver symptoms and health outcomes. Other most prevalent research priorities were focused on symptom management, culturally sensitive palliative and psychosocial care, early/integrated palliative care, financial toxicity, modifiable risk factors related to social determinants of health, public and patient involvement in research, and oncology nurses' well-being and scope of practice.

CONCLUSION

The findings indicate a need to steer a strategic programme of cancer nursing research towards digitalisation in cancer care to meet the current needs of people living with cancer and their caregivers. However, cancer nurses' burnout, staff shortages and disparities in specialist education will hinder the implementation of certain models of care.