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Payne S, Begovic D, Salifu Y, Nelson A, Payne C, Downing J, Natsiavas P, Ling J. Applying Digital Health in Cancer and Palliative Care in Europe: Policy Recommendations from an International Expert Workshop (MyPal Project). J Palliat Med 2024; 27:216-223. [PMID: 37738323 DOI: 10.1089/jpm.2023.0309] [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] [Indexed: 09/24/2023] Open
Abstract
Background: Digital health interventions are becoming increasingly important for adults, children, and young people with cancer and palliative care needs, but there is little research to guide policy and practice. Objectives: To identify recommendations for policy development of digital health interventions in cancer and palliative care. Design: Expert elicitation workshop. Setting: European clinical (cancer and palliative care, adult and pediatric), policy, technical, and research experts attended a one-day workshop in London, England, in October 2022, along with MyPal research consortium members. Methods: As part of the European Commission-funded MyPal project, we elicited experts' views on global, national, and institutional policies within structured facilitated groups, and conducted qualitative analysis on these discussions. Results/Implementation: Thirty-two experts from eight countries attended. Key policy drivers and levers in digital health were highlighted. Global level: global technology regulation, definitions, access to information technology, standardizing citizens' rights and data safety, digital infrastructure and implementation guidance, and incorporation of technology into existing health systems. National level: country-specific policy, compatibility of health apps, access to digital infrastructure including vulnerable groups and settings, development of guidelines, and promoting digital literacy. Institutional level: undertaking a needs assessment of service users and clinicians, identifying best practice guidelines, providing education and training for clinicians on digital health and safe digital data sharing, implementing plans to minimize barriers to accessing digital health care, minimizing bureaucracy, and providing technical support. Conclusions: Developers and regulators of digital health interventions may find the identified recommendations useful in guiding policy making and future research initiatives. MyPal child study Clinical Trial Registration NCT04381221; MyPal adult study Clinical Trial Registration NCT04370457.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dunja Begovic
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Yakubu Salifu
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Anna Nelson
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Cathy Payne
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, United Kingdom
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thermi Thessaloniki, Greece
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
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Tanzi S, Martucci G. Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances. Front Oncol 2023; 13:991791. [PMID: 37051541 PMCID: PMC10083487 DOI: 10.3389/fonc.2023.991791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundResearch in PC (Palliative Care) is frequently challenging for patient’s frailty, study design, professional misconceptions, and so on. Little is known about specificity in PC research on Hematologic cancer patients, who have distinct characteristics that might influence the enrollment process.AimsWhat works, how and for whom, in increasing enrollment in studies in PC on patients with hematologic malignancies?MethodsRealist review: a qualitative review whose goal is to identify and explain the interaction between Contexts, Mechanisms, and Outcomes (CMOs). The theory was informed by a narrative, theory-based literature research, including an initialsystematic research, and the addition of papers suggested by experts of the field. We also used 7 interviews with experts in PC about patients with hematologic malignancies research and our own experience from a PC pilot study on patients with hematologic malignancies to refine the initial theory.ResultsIn our initial theory we hypothesize that: - Access to palliative care could be beneficial to hematologic patients, even in early stages - Hematologists tend to under-use palliative care services in general, due to unpredictable disease trajectories and cultural barriers. - These factors may negatively impact the patients’ enrollment in PC researchWe included secondary literature as narrative reviews, if they presented interesting propositions useful for our theoretical construction. 23 papers met our inclusion criteria.We also searched for relevant CMOs impacting referral in palliative care, and we selected a list of CMOs that could be relevant also in hematology. We accordingly theorized a group of interventions that could increase the enrollment in PC research and presented them using “social exchange theory” (SET) as a theoretical framework.Prominent researchers in PC in hematologic malignancies were interviewed on their opinion on our results, and additional CMOs.ConclusionsBefore conducting research in PC on patients with hematologic malignancies, it’s probably advisable to assess: - The perception of the different actors (physicians, nurses, other professionals involved), in particular the hematologists, in terms of pros and cons of referral to PC and enrollment in PC trials - The existing relationship between PC and the Hematology departmentAccordingly, it’s possible to tailor different interventions on the various actors and choose a model of trial to increase the perception of benefits from PC and, consequently, enrollment.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Gianfranco Martucci
- Palliative Care Local Program, Local Health Unit of Modena, Modena, Italy
- *Correspondence: Gianfranco Martucci,
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Burner-Fritsch I, Bolzani A, Hriskova K, Kolmhuber S, Bausewein C, Hodiamont F. Challenges developing an electronic patient-reported outcome measurement for palliative home care: A qualitative interview and focus group study. Palliat Med 2023; 37:265-274. [PMID: 36600402 DOI: 10.1177/02692163221141487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patient-reported outcome measures have the potential to improve outcomes, quality, and effectiveness of care. Digital use of patient-reported outcome measures could be an option to foster implementation in palliative care. The Palli-MONITOR study focused on developing and testing an electronic patient-reported outcome measure in specialised palliative home care. As part of this study, we examined setting-specific challenges for the development of the measure. AIM We aimed to identify and explore challenges for the development of electronic patient-reported outcome measures as standardised assessment in specialised palliative home care. DESIGN Qualitative approach with semi-structured interviews and focus groups. Data were thematically analysed using the framework method. SETTING/PARTICIPANTS Patients and professionals from five German palliative home care teams. RESULTS Patients described potential problems in using electronic questionnaires due to their deteriorating health. Answering the electronic questionnaire encouraged patients to reflect on their current palliative situation, which was partly perceived as burdensome. Identified concerns and questions regarding the future roll-out of electronic patient-reported outcome measurement addressed the process of receiving and using the provided information in clinical care routine. Challenging factors on organisational and structural level were the potential undermining of the established 24-h emergency call system and the potential use for patients. CONCLUSIONS Our results provide a multifaceted picture of challenges developing electronic systems for patient-reported outcome measurement in palliative home care on the individual and organisational level. The study underpins the benefit of stakeholder involvement creating digital health innovations and emphasises the importance to therefore mind setting specific culture.
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Affiliation(s)
- Isabel Burner-Fritsch
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Bolzani
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Kolmhuber
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
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Garani-Papadatos T, Natsiavas P, Meyerheim M, Hoffmann S, Karamanidou C, Payne SA. Ethical Principles in Digital Palliative Care for Children: The MyPal Project and Experiences Made in Designing a Trustworthy Approach. Front Digit Health 2022; 4:730430. [PMID: 35373180 PMCID: PMC8971573 DOI: 10.3389/fdgth.2022.730430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
This paper explores the ethical dimension of the opportunity to offer improved electronic patient-reported outcome (ePRO) systems addressing personal needs of pediatric cancer patients, their parents and caregivers, with regard to technological advance of digital health. This opportunity has been explored in the MyPal research project, which aims to assess a patient-centered service for palliative care relying on the adaptation and extension of digital health tools and concepts available from previous projects. Development and implementation of ePROs need to take place in a safe, secure and responsible manner, preventing any possible harm and safeguarding the integrity of humans. To that end, although the final results will be published at the end of the project, this paper aims to increase awareness of the ethical ramifications we had to address in the design and testing of new technologies and to show the essentiality of protection and promotion of privacy, safety and ethical standards. We have thus reached a final design complying with the following principles: (a) respect for the autonomy of participants, especially children, (b) data protection and transparency, (c) fairness and non-discrimination, (d) individual wellbeing of participants in relation to their physical and psychological health status and e) accessibility and acceptability of digital health technologies for better user-engagement. These principles are adapted from the Ethics Guidelines for a trustworthy Artificial Intelligence (AI) which provide the framework for similar interventions to be lawful, complying with all applicable laws and regulations, ethical, ensuring compliance to ethical principles and values and robust, both from a technical and social perspective.
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Affiliation(s)
- Tina Garani-Papadatos
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | | | - Marcel Meyerheim
- Faculty of Medicine, Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University, Homburg, Germany
| | - Stefan Hoffmann
- Serious Games Solutions, a Division of Promotion Software GmbH, Tuebingen, Germany
| | | | - Sheila A Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Meyerheim M, Burns-Gebhart A, Mirzaie K, Garani-Papadatos T, Braun Y, Graf N. Challenges and Pitfalls for Implementing Digital Health Solutions in Clinical Studies in Europe. Front Digit Health 2021; 3:730680. [PMID: 34713200 PMCID: PMC8521796 DOI: 10.3389/fdgth.2021.730680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
The increasing number of digital solutions developed for use in clinical health care settings is accompanied by new challenges to develop and conduct clinical studies that include eHealth technologies. Clinical study implementation plans often disregard or underestimate the necessity of additional administrative and logistic tasks required at clinical sites as well as ethical aspects to test digital solutions. Experiences made in the run-up of an observational clinical feasibility study at three international clinical sites in the framework of the MyPal project (https://mypal-project.eu/) result in recommendations to avoid delays and barriers in the planning of such prospective studies in clinical and also palliative care for increased efficiency.
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Affiliation(s)
- Marcel Meyerheim
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University Hospital and Saarland University, Homburg, Germany
| | - Anna Burns-Gebhart
- Clinic for Pediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany
| | - Kasra Mirzaie
- Clinic for Pediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany
| | - Tina Garani-Papadatos
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Yvonne Braun
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University Hospital and Saarland University, Homburg, Germany
| | - Norbert Graf
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University Hospital and Saarland University, Homburg, Germany
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