The meaning of web-based communication for support: from the patients' perspective within a hematological healthcare setting

Racial Differences in Patient-Reported Access to Telehealth: An Important and Unmeasured Social Determinant of Health

PURPOSE

The COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify barriers that might limit access to telehealth video services.

METHODS

First, retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center during the pandemic (March 2020 to April 2022). Second, a prospective, cross-sectional study was conducted of patients with known or suspected malignancy over a 6-month period (November 2021 to April 2022). A survey regarding video telehealth accessibility was verbally administered to patients at their clinic visit.

RESULTS

Administrative data demonstrated that although Black patients comprised 43% (n = 9,021) of all patient visits (n = 20,953), the proportion of telehealth visits conducted among Black patients was significantly lower compared with White patients (29% v 71%; P < .0001). Of the prospective, cross-sectional study cohort (n = 148), 51.4% of patients (n = 76) were Black, 38.5% (n = 57) resided in a rural county, and 8.1% (n = 12) were Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% v 90.4%; P < .01) and were less likely to report having access to or actively using a patient portal (29.0% v 47.2%; P < .001) compared with White patients. The independent association of race and internet access (P < .05) and patient portal use (P = .001) persisted after multivariable analysis.

CONCLUSION

Black patients disproportionately underparticipated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal compared with White patients. Ensuring equal internet access and digital literacy will be critical to reduce disparities in cancer care among racial minorities.

People with cancer and their family caregivers' personal experience of using supportive eHealth technology: A narrative review

PURPOSE

To synthesise existing qualitative evidence regarding the experiences of people living with cancer and their family caregivers using eHealth technology in their home setting.

METHOD

A narrative review using a systematic approach was utilised. Five databases (PubMed, CINAHL, EMBASE, PsycINFO and the Cochrane Library) were searched using a tailored search strategy to identify primary research articles published between January 2005 and May 2021. Studies were quality appraised using the Critical Appraisal Skills Programme's Qualitative Studies Checklist and the Mixed Method Appraisal Tool, where relevant. Identified studies were appraised by three reviewers and data were extracted for analysis. Key themes were identified and agreed upon by the authors.

RESULTS

28 empirical studies were included in the review. Five major themes emerged: (i) understanding of cancer and its care (ii) alignment and integration of eHealth technology into daily life (iii) connection and collaboration with healthcare professionals, family and peers (iii) reassurance and sense of safety (iv) and the psychosocial impact on the self during the cancer experience.

CONCLUSIONS

eHealth technology can have positive role in the lives of people with cancer and their family caregivers, beyond the intended health outcomes of the intervention. Individual preferences amongst people with cancer and their family caregivers using eHealth technology must be considered, especially regarding cancer information delivery, content and support methods. This review underlines a critical need for further in-depth evidence on the personal meaning and relationships people with cancer and their family caregivers develop with eHealth technology in an ambulatory care setting.

Experiences of adult cancer patients receiving counseling from nurses: a qualitative systematic review

INTRODUCTION

Counseling is a brief psycho-educational intervention that is useful in facilitating personal growth and adaptive resolution of life stresses. With increased recognition on the psycho-emotional needs of patients with cancer, it is prudent to consider the possibility of expanding the role of nurses in the provision of counseling.

OBJECTIVE

This qualitative systematic review aimed to establish the best available evidence on the experiences of adult cancer patients receiving counseling provided by nurses.

INCLUSION CRITERIA

This review included studies on adult cancer patients of at least 18 years of age who were diagnosed with oncological malignancies of any type and staging. The phenomena of interest were the experiences of adult cancer patients who received nurse counseling (patient education, psycho-education and/or supportive counseling) that was conducted face-to-face or via other communication modes. The review included studies done in institutional and community settings. Qualitative data including, but not limited to, designs of phenomenology, grounded theory, ethnography, action research, feminist research and mixed methods research were considered.

SEARCH STRATEGY

A three-step search strategy was utilized to find both published and unpublished studies in the English language. Databases searched included CINAHL, MEDLINE, Embase, JSTOR, PsycINFO, Scopus, ScienceDirect, Wiley Online Library and ProQuest Dissertations and Theses Global. Two reviewers independently appraised the 14 included studies using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. The studies were of moderate to high quality, mostly, falling short in quality due to lack of statements locating the researchers and their influence on the research. Data were extracted from included papers using the standardized JBI data extraction tool.

DATA SYNTHESIS

Two reviewers independently reviewed and pooled similar findings into categories. All three reviewers then collaborated in finalizing these derived categories to generate a meta-synthesis.

RESULTS

Five synthesized findings were generated during the meta-synthesis: (1) Nurses provide tailored information and teaching to enhance patients' coping; (2) Nurses attend to patients' emotional needs; (3) Nurses assume the role of a significant person in the patients' journey; (4) Patients feel valued as a whole person and the ready availability of nursing interactions; and (5) Nursing role ambiguity and time constraints limit nurse counseling.

CONCLUSION

Overall, cancer patients' experiences with nurse counseling are positive and beneficial to them. Despite some nursing role ambiguity and time constraints impeding nurse counseling, this review has established the diverse instrumental roles nurses have played in enhancing adaptive coping in patients across their illness trajectory. In particular, the nurses' presence and availability, a trusting nurse-patient relationship, use of psychotherapy techniques, a holistic approach, human touch and continuity of care were highlighted as key factors in enhancing healing. The role of the nurse navigator and the use of expressive writing warrant more attention when tending to patients' psycho-emotional distress.

Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis

BACKGROUND

Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors-individuals living with and beyond cancer-to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are "complex," and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized.

OBJECTIVE

To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group.

METHODS

Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies.

RESULTS

Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance-a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors' lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden.

CONCLUSIONS

Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit.

Caring Through Web-Based Communication: A Qualitative Evaluation of a Nursing Intervention to Create Holistic Well-Being Among Patients With Hematological Disease

Purpose: To examine how written communication between patients with hematological diseases and a nurse within a web-based communication service can be caring. Design: The study is based on qualitative deductive content analysis of 109 written messages between 10 patients and a responding nurse. The evaluated nursing intervention is a web-based communication service where patients could request support from a responding nurse during 2 months of use. A structured theoretical matrix based on Swanson’s theory of caring including compassion, competence, and upholding trust is used for the analysis. Findings: Nursing compassion emerges when patients share personal matters and the nurse has an opportunity to explicitly display genuine interest and understanding. Nursing competence is required when patients ask for or are in need of information, advice, and emotional support. The nurse can uphold trust when compassion and competence are exhibited and patients share their innermost feelings. Conclusions: Web-based communication has the potential to contribute to holistic well-being according to Swanson’s theory of caring. The written word lasts, can be read repeatedly, and in connection with writing there is time for reflection. However, the lack of nonverbal cues makes it important that the nurse answers in a fully accurate and explicitly caring way.