1
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Dağdelen D, Zincir H. Effects of dependent care theory-based post-surgical home care intervention on self-care, symptoms, and caregiver burden in patients with primary brain tumor and their caregivers: a randomized controlled trial. Support Care Cancer 2024; 32:296. [PMID: 38635060 PMCID: PMC11026272 DOI: 10.1007/s00520-024-08488-1] [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: 11/22/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE This study aimed to examine the effect of dependent care theory-based post-surgical home care intervention on self-care, symptoms, and caregiver burden in primary brain tumor patients and their caregivers. METHODS A parallel-group randomized controlled trial was conducted with patients who underwent surgery for a primary brain tumor between March 2019 and January 2020 in a tertiary hospital and with caregivers who cared for them at home. Eligible patients and caregivers were determined by block randomization. Outcome measures included validated measures of self-care agency (Self-Care Agency Scale), symptoms and interference by symptoms (MD Anderson Symptom Inventory Brain Tumor-Turkish Form), and caregiver burden (Caregiver Burden Scale). Two-way analysis of variance was used in repeated measurements from general linear models compared to scale scores. RESULTS Self-care agency was significantly higher in the intervention group than in the control group in the first and sixth months after surgery (p < 0.05). The severity of the patients' emotional, focal neurologic, and cognitive symptoms and interference by symptoms were significantly lower in the intervention group than in the control group (p < 0.05). Caregiver burden was significantly lower in the intervention group in the first, third, and sixth months after surgery (p < 0.05). CONCLUSION Dependent care theory-based post-surgical home care intervention increased patients' self-care and reduced symptoms and their effects. It also reduced the caregiver burden. Dependent care theory can guide the nursing practices of nurses who provide institutional and/or home care services to patients with chronic diseases and their caregivers. TRIAL REGISTRATION NCT05328739 on April 14, 2022 (retrospectively registered).
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Affiliation(s)
- Derya Dağdelen
- Department of Public Health Nursing, Faculty of Health Sciences, Erciyes University, 38280, Kayseri, Turkey.
| | - Handan Zincir
- Department of Public Health Nursing, Faculty of Health Sciences, Erciyes University, 38280, Kayseri, Turkey
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2
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Quach KT, Dirven L, Vingerhoed AM, de Bresser J, Dammers R, Bos EM, Moojen WA, Peul WC, Taphoorn MJB, Zamanipoor Najafabadi AH, van Furth WR. The prevalence and severity of fatigue in meningioma patients and its association with patient-, tumor- and treatment-related factors. Neurooncol Adv 2023; 5:vdad056. [PMID: 37293257 PMCID: PMC10246586 DOI: 10.1093/noajnl/vdad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Background Fatigue is a commonly reported and severe symptom in primary brain tumor patients, but the exact occurrence in meningioma patients is unknown. This study aimed to determine the frequency and severity of fatigue in meningioma patients as well as associations between the level of fatigue and patient-, tumor-, and treatment-related factors. Methods In this multicenter cross-sectional study, meningioma patients completed questionnaires on fatigue (MFI-20), sleep (PSQI), anxiety and depression (HADS), tumor-related symptoms (MDASI-BT), and cognitive functioning (MOS-CFS). Multivariable regression models were used to evaluate the independent association between fatigue and each patient-, tumor-, and treatment-related factor separately, corrected for relevant confounders. Results Based on predetermined in- and exclusion criteria, 275 patients, on average 5.3 (SD = 2.0) year since diagnosis, were recruited. Most patients had undergone resection (92%). Meningioma patients reported higher scores on all fatigue subscales compared to normative data and 26% were classified as fatigued. Having experienced a complication due to resection (OR 3.6, 95% CI: 1.8-7.0), having received radiotherapy (OR 2.4, 95% CI: 1.2-4.8), a higher number of comorbidities (OR 1.6, 95% CI: 1.3-1.9) and lower educational level (low level as reference; high level OR 0.3, 95% CI: 0.2-0.7) were independently associated with more fatigue. Conclusions Fatigue is a frequent problem in meningioma patients even many years after treatment. Both patient- and treatment-related factors were determinants of fatigue, with the treatment-related factors being the most likely target for intervention in this patient population.
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Affiliation(s)
- Kwong T Quach
- Corresponding Authors: Kwong Tack Quach, MD, Department of Neurosurgery, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, the Netherlands()
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, the Hague, the Netherlands
| | - Aliede M Vingerhoed
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wouter A Moojen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, the Hague, the Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, the Hague, the Netherlands
| | | | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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3
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Mavragani A, Gouw SC, Beestrum M, Cronin RM, Fijnvandraat K, Badawy SM. Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review. J Med Internet Res 2022; 24:e43086. [PMID: 36548034 PMCID: PMC9816956 DOI: 10.2196/43086] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes. OBJECTIVE We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use. METHODS We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired. RESULTS Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the "use of recommended care services" (10/13, 77%), on the patient-reported outcomes "disease knowledge" (7/10, 70%), "patient engagement" (13/28, 56%), "treatment adherence" (10/18, 56%), and "self-management and self-efficacy" (10/19, 53%), and on the clinical outcome "laboratory parameters," including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on "health-related quality of life" were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed. CONCLUSIONS The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285.
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Affiliation(s)
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Molly Beestrum
- Galter Health Sciences Library at Northwestern University, Chicago, IL, United States
| | - Robert M Cronin
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.,Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Division of Hematology, Oncology, and Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
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4
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Hong S, Lee J, Lee J, Chang JH, Park CG, Kim TH. What we need to know about uncertainty in illness among people with primary malignant brain tumours: A mixed-methods systematic review. J Clin Nurs 2022. [PMID: 36071659 DOI: 10.1111/jocn.16499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the characteristics of uncertainty in illness (UI) among people with primary malignant brain tumours (PMBT). BACKGROUND High recurrence rates and complex symptoms cause uncertainty in people with PMBT. Given the characteristics of PMBT, reviewing UI among people with PMBT will benefit future research and clinical intervention development. DESIGN A mixed-methods systematic review. METHODS We performed a mixed-methods systematic review (PubMed, CINAHL, Embase, PsycINFO, Scopus and Cochrane Library), including studies on UI among people with PMBT, searched from the databases' inception to the search date. The initial search was conducted in July 2021, with an additional search in March 2022. The major search terms were PMBT and UI, and no limitations were placed on the study design. The Cochrane tool was used to evaluate the risk of bias in randomised controlled trials, and JBI checklists were used to evaluate quasi-experimental studies, survey methodology studies and a case study. This review was reported using the PRISMA 2020 checklist. Both quantitative and qualitative research data were extracted, analysed and then integrated in three stages of a mixed-methods systematic review. RESULTS Eleven studies were included. Due to physical, psychological and social risk factors, the UI progression of people with PMBT was complex and ambiguous, although they adapted to the PMBT diagnosis and treatment process. Subsequently, we proposed a model of UI among people with PMBT. CONCLUSIONS UI has multidimensional characteristics, and healthcare providers need to consider these aspects for people with PMBT. RELEVANCE TO CLINICAL PRACTICE The proposed model provides directions for nursing practice and future research. Nurses caring for people with PMBT should comprehend their UI and intervene accordingly. PATIENT OR PUBLIC CONTRIBUTION This review incorporated data including people with PMBT in hospitals and communities. This analysis contributes to the clinical-to-community nursing transition process for people with PMBT.
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Affiliation(s)
- Soomin Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - JuHee Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea.,Yonsei Evidence Based Nursing Centre of Korea: A JBI Affiliated Group, Seoul, Korea
| | - Jiyeon Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | | | - Tae Hee Kim
- Office of Administration and Education, Division of Nursing, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
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Abd-Alrazaq A, Safi Z, Bewick BM, Househ M, Gardner PH. Patients' Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis. J Med Internet Res 2021; 23:e17500. [PMID: 33439126 PMCID: PMC7840286 DOI: 10.2196/17500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/22/2020] [Accepted: 05/14/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients' adoption and implementation success of the system, it is important to understand the factors affecting their use of the system. OBJECTIVE The aim of this study is to explore patients' perspectives of factors affecting their use of ePHRs in England. METHODS A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis. RESULTS Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants' responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online. CONCLUSIONS The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Zeineb Safi
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Bridgette M Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Peter H Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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6
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Ownsworth T, Chan RJ, Jones S, Robertson J, Pinkham MB. Use of telehealth platforms for delivering supportive care to adults with primary brain tumors and their family caregivers: A systematic review. Psychooncology 2020; 30:16-26. [PMID: 32915517 DOI: 10.1002/pon.5549] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Telehealth platforms have potential utility for providing remote access to supportive care to people with brain tumour. This systematic review aimed to evaluate the feasibility, acceptability and efficacy of delivering supportive care via telehealth platforms to adults with primary brain tumour and family caregivers. METHODS A systematic search of PsycINFO, MEDLINE, CINAHL, Embase, Scopus and Cochrane Library was conducted from 1980 to 1st June 2020 to identify eligible studies. Methodological quality was assessed by two independent reviewers. RESULTS Seventeen articles, reporting on 16 studies, evaluated telephone-based support (5 studies), videoconferencing (3 studies), web-based programs and resources (7 studies) or combined use of videoconferencing and web-based modules (1 study) to deliver supportive care remotely. Caregivers were involved in 31% of interventions. Mean rates of accrual (68%) and adherence (74%) were moderate, whereas acceptability or satisfaction for those completing the interventions was typically high (M satisfied or very satisfied = 81%). Adherence rates were generally higher and clinical gains were more evident for interventions involving real-time interaction as opposed to self-guided interventions. CONCLUSIONS Telehealth delivery of supportive care is feasible and acceptable to a high proportion of individuals with primary brain tumour and their caregivers. It is recommended that future research focuses on implementation outcomes, including factors influencing the uptake and sustainability of telehealth platforms in practice.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Raymond J Chan
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital, Woolloongabba, Australia
| | - Stephanie Jones
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Julia Robertson
- School of Medicine, Griffith University, South Port, Australia
| | - Mark B Pinkham
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital, Woolloongabba, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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7
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Abd-alrazaq A, Safi Z, Bewick BM, Househ M, Gardner PH. Patients’ Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis (Preprint).. [DOI: 10.2196/preprints.17500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients’ adoption and implementation success of the system, it is important to understand the factors affecting their use of the system.
OBJECTIVE
The aim of this study is to explore patients’ perspectives of factors affecting their use of ePHRs in England.
METHODS
A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis.
RESULTS
Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants’ responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online.
CONCLUSIONS
The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.
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8
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Abd-Alrazaq A, Bewick BM, Farragher T, Gardner P. Factors Affecting Patients' Use of Electronic Personal Health Records in England: Cross-Sectional Study. J Med Internet Res 2019; 21:e12373. [PMID: 31368442 PMCID: PMC6693305 DOI: 10.2196/12373] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/26/2019] [Accepted: 05/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs. Objective This study aimed to examine factors associated with patients’ use of ePHRs in England. Methods The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling. Results Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB. Conclusions This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, London, United Kingdom.,Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Bridgette M Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, London, United Kingdom
| | - Tracey Farragher
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, London, United Kingdom
| | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, United Kingdom
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9
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Abd-alrazaq AA, Bewick B, Farragher T, Gardner P. (Preprint).. [DOI: 10.2196/preprints.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
Electronic Personal Health Records (ePHRs) are secure web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ use of ePHRs is important to increase adoption rates and improve the implementation success of ePHRs.
OBJECTIVE
This study aims to examine factors associated with patients’ use of ePHRs in England.
METHODS
The Unified Theory of Acceptance and Use of Technology (UTAUT) was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in four general practices in West Yorkshire, England. Factors associated with use of ePHRs were explored using Structural Equation Modelling (SEM).
RESULTS
Of 800 eligible patients invited to take part in the survey, 624 (78%) participants returned a valid questionnaire. Behavioural intention was significantly influenced by performance expectancy (β=0.57, P<0.001), effort expectancy (β=0.16, P<0.001), and perceived privacy and security (β=0.24, P<0.001). The path from social influence to behavioural intention was not significant (β=0.03, P=0.183). Facilitating conditions and behavioural intention significantly influenced use behaviour (β=0.25, P<0.001; β=0.53, P<0.001, respectively). Performance expectancy significantly mediated the effect of effort expectancy and perceived privacy and security on behavioural intention (β=0.19, P<0.001; β=0.28, P=0.001, respectively). Age significantly moderated three paths; PEBI, EEBI, and FCUB. Sex significantly moderated only the relationship between performance expectancy and behavioural intention. Two paths were significantly moderated by education and internet access: EEBI and FCUB. Income moderated the relationship between facilitating conditions and use behaviour. The adapted model accounted for 51% of the variance in performance expectancy, 76% of the variance in behavioural intention, and 48% of the variance in use behaviour.
CONCLUSIONS
This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills, thereby, create a useful and easy to use system. The proposed model accounted for 48% of the variance in use behaviour, indicating the existence of other, as yet unidentified, factors that influence adoption of ePHRs. Future studies should confirm the effect of the factors included in the current model and to identify additional factors.
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10
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Aljabri D, Dumitrascu A, Burton MC, White L, Khan M, Xirasagar S, Horner R, Naessens J. Patient portal adoption and use by hospitalized cancer patients: a retrospective study of its impact on adverse events, utilization, and patient satisfaction. BMC Med Inform Decis Mak 2018; 18:70. [PMID: 30053809 PMCID: PMC6062873 DOI: 10.1186/s12911-018-0644-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 06/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized cancer patients and investigates associations with selected safety, utilization, and satisfaction measures. METHODS A retrospective review of 4594 adult hospitalized cancer patients was conducted between 2012 and 2014 at Mayo Clinic in Jacksonville, Florida, comparing portal adopters, who registered for a portal account prior to hospitalization, with nonadopters. Adopters were classified by their portal activity during hospitalization as active or inactive inpatient users. Univariate and several logistic and linear regression models were used for analysis. RESULTS Of total patients, 2352 (51.2%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Portal adoption was associated with patients who were young, female, married, with higher income, and had more frequent hospitalizations (P < .05). Active inpatient use was associated with patients who were young, married, nonlocals, with higher disease severity, and were hospitalized for medical treatment (P < .05). In univariate analyses, self-management knowledge scores were higher among adopters vs nonadopters (84.3 and 80.0, respectively; P = .01) and among active vs inactive inpatient users (87.0 and 83.3, respectively; P = .04). In regression models adjusted for age and disease severity, the association between portal behaviors and majority of measures were not significant (P > .05). CONCLUSIONS Over half of our cancer inpatients adopted a portal prior to hospitalization, with increased adoption associated with predisposing and enabling determinants (eg: age, sex, marital status, income), and increased inpatient use associated with need (eg: nonlocal residence and disease severity). Additional research and greater effort to expand the portal functionality is needed to impact inpatient outcomes.
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Affiliation(s)
- Duaa Aljabri
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL USA
| | - Adrian Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - Launia White
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL USA
| | - Mahmud Khan
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - James Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
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Cooley ME, Nayak MM, Abrahm JL, Braun IM, Rabin MS, Brzozowski J, Lathan C, Berry DL. Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth. Psychooncology 2017; 26:1105-1112. [PMID: 28430396 DOI: 10.1002/pon.4442] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 03/03/2017] [Accepted: 04/14/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Adequate symptom and quality-of-life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient-engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. METHODS Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. RESULTS Face-to-face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self-manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non-eHealth options for decision support. Core components for both eHealth and non-eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. CONCLUSIONS Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self-manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide.
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Affiliation(s)
| | | | | | | | | | - Jane Brzozowski
- Independent Clinical Informatics Consultant, Boston, MA, USA
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Laccetti AL, Chen B, Cai J, Gates S, Xie Y, Lee SJC, Gerber DE. Increase in Cancer Center Staff Effort Related to Electronic Patient Portal Use. J Oncol Pract 2016; 12:e981-e990. [PMID: 27601511 DOI: 10.1200/jop.2016.011817] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Electronic portals provide patients with real-time access to personal health records. Use of this technology by individuals with cancer is particularly intensive. We therefore examined patterns of use of electronic portals by clinic staff at a National Cancer Institute-designated comprehensive cancer center. METHODS We identified and characterized cancer center providers and clinic staff who performed electronic activities related to MyChart, the institution's personal health records portal, from 2009 to 2014. Total MyChart actions and messages received were quantified and characterized according to type, timing, and staff category. RESULTS Two hundred eighty-nine employees were included in our analysis: 85 nurses (29%), 79 ancillary staff (27%), 49 clerical/managerial staff (17%), 47 physicians (16%), and 29 advanced practice providers (10%). These individuals performed 740,613 MyChart actions and received 117,799 messages. Seventy-seven percent of actions were performed by nurses, 11% by ancillary staff, 6% by advanced practice providers, 5% by physicians, and 1% by clerical/managerial staff. From 2011 to 2014, staff MyChart activity increased approximately 10-fold. On average, 6.3 staff MyChart actions were performed per patient-initiated message. In 2014, nurses performed an average of 3,838 MyChart actions and received an average of 589 messages, compared with 591 actions and 87 messages in 2011 ( P < .001). Sixteen percent of all actions occurred outside clinic hours. CONCLUSION Cancer center employee effort related to an electronic patient portal has increased markedly over time, particularly among nursing staff. Because further uptake of this technology is expected, it is critical to consider potential effects on clinical resources, employee and patient satisfaction, and patient safety.
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Affiliation(s)
| | - Beibei Chen
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jennifer Cai
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Samantha Gates
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Yang Xie
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - David E Gerber
- University of Texas Southwestern Medical Center, Dallas, TX
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