Home Telemonitoring Improved Pain Registration in Patients With Cancer

Assessing Telehealth in Palliative Care: A Systematic Review of the Effectiveness and Challenges in Rural and Underserved Areas

The integration of telehealth into palliative care has garnered significant attention due to its potential to enhance both access and quality of care, particularly for patients in rural and underserved areas. This interest stems from the need to address geographical and logistical barriers that traditionally hinder palliative care delivery. Despite its potential benefits, the effectiveness of telehealth and the challenges associated with its implementation remain underexplored, necessitating further investigation. This study aims to critically evaluate the effectiveness of telehealth in palliative care by focusing on several key areas: its impact on access to care, symptom management, patient satisfaction, and cost-effectiveness. To achieve this, a systematic review was conducted, synthesizing data from various studies that investigated telehealth interventions within palliative care settings. The review employed a comprehensive search strategy across electronic databases, concentrating on randomized controlled trials (RTCs) published between 2014 and 2024. To ensure the reliability of the findings, low-quality and unrelated studies were excluded, and the remaining studies were meticulously analyzed for bias and methodological quality. The review's findings indicate that telehealth significantly enhances access to palliative care, allowing patients to receive timely and appropriate care without the need for extensive travel. It also improves symptom management and patient satisfaction, aligning to provide patient-centered care. Additionally, telehealth is cost-effective by reducing expenses associated with travel and in-person visits. These benefits highlight telehealth's potential to address some of the critical challenges in palliative care delivery. Despite its advantages, implementing telehealth in palliative care is not without challenges. Technological barriers, such as inadequate infrastructure and device limitations, pose significant hurdles. Integration issues, including the need for seamless incorporation into existing care systems, and varying levels of digital literacy among patients and caregivers, also impact the effectiveness of telehealth. Addressing these challenges is crucial for optimizing telehealth's implementation. Ensuring that telehealth solutions are accessible, user-friendly, and well-integrated into care practices is essential for fully leveraging its potential benefits.

Effects on Quality of Life of a Telemonitoring Platform amongst Patients with Cancer (EQUALITE): A Randomized Trial Protocol

Cancer, a pervasive global health challenge, necessitates chemotherapy or radiotherapy treatments for many prevalent forms. However, traditional follow-up approaches encounter limitations, exacerbated by the recent COVID-19 pandemic. Consequently, telemonitoring has emerged as a promising solution, although its clinical implementation lacks comprehensive evidence. This report depicts the methodology of a randomized trial which aims to investigate whether leveraging a smartphone app called Contigo for disease monitoring enhances self-reported quality of life among patients with various solid cancers compared to standard care. Secondary objectives encompass evaluating the app's impact on depressive symptoms and assessing adherence to in-person appointments. Randomization will be performed independently using an allocation sequence that will be kept concealed from clinical investigators. Contigo offers two primary functions: monitoring cancer patients' progress and providing educational content to assist patients in managing common clinical situations related to their disease. The study will assess outcomes such as quality of life changes and depressive symptom development using validated scales, and adherence to in-person appointments. Specific scales include the EuroQol Group's EQ-5D questionnaire and the Patient Health Questionnaire (PHQ-9). We hypothesize that the use of Contigo will assist and empower patients receiving cancer treatment, which will translate to better quality of life scores and a reduced incidence of depressive symptoms. All analyses will be undertaken with the intention-to-treat principle by a statistician unaware of treatment allocation. This trial is registered in ClinicalTrials under the registration number NCT06086990.

Effects of internet-based telemonitoring platforms on the quality of life of oncologic patients: A systematic literature review protocol

INTRODUCTION

Telemonitoring involves the transmission of clinical information through digital means, including internet-connected devices such as smartphones, health tracking apps and video conferencing platforms. This strategy could provide a viable alternative to facilitate follow-up in several conditions, including cancer.

OBJECTIVES

To synthesise the available evidence on the effectiveness of internet-based telemonitoring platforms amongst oncological patients. Relevant endpoints include overall quality of life, the ability to detect postoperative complications, severe toxicity reactions attributable to chemotherapy, reducing the frequency of hospitalisations, emergency department visits and mortality.

METHODS

A systematic review of published and unpublished randomised and controlled studies will be carried out. Iterative searches in PubMED/MEDLINE, EMBASE, Epistemonikos, LILACS, and Cochrane CENTRAL repositories from January 2000 to January 2023 will be conducted. Grey literature repositories, such as Clinicaltrials, BioRxiv and MedRxiv will be searched as well. The Cochrane risk of bias tool will be used to assess the quality of the eligible studies. If possible, a meta-analysis based on the random-effects model will be conducted to evaluate changes in any of the aforementioned outcomes. Heterogeneity will be assessed with Cochrane's Q and I2 statistics. Its exploration will be carried out using subgroup and sensitivity analyses. Relevant subgroups include the proportion of elderly patients in each study, characteristics of each platform, study type, type of funding and moment of conduction (i.e. before or after the COVID-19 pandemic). Publication bias will be assessed using funnel plots and Egger's test.

REGISTRATION

This systematic review protocol is registered in PROSPERO. Its registration number is CRD42023412705.

Satisfaction with Telemedicine for Cancer Pain Management: A Model of Care and Cross-Sectional Patient Satisfaction Study

Background: Since cancer pain requires complex modalities of care, the proper strategy for addressing its telemedicine-based management should be better defined. This study aimed to trace a pathway for a progressive implementation of the telemedicine process for the treatment of pain in the setting of cancer patients. Methods: The features of the model were investigated to dissect the dropout from the telemedicine pathway. A cross-sectional patient satisfaction study was conducted. The degree of satisfaction was evaluated through a developed 22-item questionnaire (Likert scale 0−7). Results: A total of 375 video consultations for 164 patients (mean age 62.9 years) were performed through remote consultations for cancer pain management between March 2021 and February 2022. After the exclusion of 72 patients, 92 (56.1%) were included in the analysis. The dropout ratio was 8.7%. The number of visits and pharmacological therapies for neuropathic pain correlated with the risk for readmission (p < 0.05). Overall, the satisfaction was very high (mean > 5.5 for all items). Conclusion: Feedback from patients reflected high satisfaction rates with the care provided. A methodological approach based on the degree of satisfaction combined with the analysis of the pathways can help to implement the quality of a service provided through telemedicine. While not without limitations, our hybrid protocol can be useful for addressing cancer pain through a patient-centered approach.

eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens

BACKGROUND

Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors.

OBJECTIVE

The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains).

METHODS

The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework.

RESULTS

A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease.

CONCLUSIONS

eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual.

How technology can improve communication and health outcomes in patients with advanced cancer: an integrative review

OBJECTIVE

Patients facing an advanced cancer diagnosis require clear communication with their clinicians. Technology has been utilized in many different capacities to navigate communication in cancer care, but few authors examine the specific areas of communication from a theoretical perspective. The purpose of this literature review was to (1) identify articles focused on technology-based communication strategies to improve health outcomes in individuals with advanced cancer, and (2) using Epstein and Street's framework, identify areas in which technology-based communication has been used to improve health outcomes, and (3) identify gaps that exist in technology-based communication care in patients with advanced cancer.

METHODS

A systematic search was conducted which returned 446 articles. Using Epstein and Street's 2007 framework, the final sample was 39.

RESULTS

Nine clinical trials, 29 observational studies, and 1 case study were identified. The articles were categorized into one area within Epstein and Street's areas of communication. Many of the articles examined the patient's and provider's acceptability and feasibility of technology-based methods of communication, while other articles examined their efficacy.

CONCLUSIONS

While research studies were identified in each of the areas of communication, the majority of technology-based communication strategies were focused on the exchange of information between patients and their providers. Further research and the development of technology-based communication interventions assessed through clinical trials are needed in the areas of healing relationships and making decisions in cancer care. Additionally, the communication strategies found effective at improving health outcomes in advanced cancer should begin implementation into clinical practice, therefore reaching more patients.

Pain assessment and registration in medical oncology clinics: operationalised through the lens of health care professionals and patients

Background: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain, due to fear that reporting pain will distract the healthcare professional from their cancer treatment. Methods: This study adopted an explanatory sequential mixed-methods design. Data collection incorporated three strands. The first strand involved a quantitative enquiry in which medical chart reviews of patients (n=100) attending the medical oncology outpatient clinic were examined. The second qualitative strand comprised of semi-structured interviews with patients (n=10) attending that service. The third strand was qualitative and consisted of focus group discussions with healthcare professionals (n=12). Results: All 100 patients had cancer. The quantitative findings confirmed the suboptimum assessment and subsequent recording of patient's pain, that seemed to afford a reality check for all healthcare professionals. For patients, the outcomes of the anti-cancer treatment were their priority, and pain was perceived as inevitable, being associated with a cancer diagnosis. There were multifaceted complexities voiced amongst healthcare professionals associated with balancing the benefits and harms aligned with treating cancer pain. Conclusions: Pain assessment in medical records was not systematically recorded by healthcare professionals. Patients were reluctant to self-report pain during their medical oncology outpatient review. The expectation that patients will self-report pain can be accommodated by healthcare professionals if a personalized pain goal is part of the cancer pain management plan during each clinical encounter. Healthcare professionals reported a need to take distinct responsibility for supplementing their dearth of knowledge, skills and beliefs regarding assessing and managing patients' cancer pain. Optimal pain management stems from an interprofessional approach that was applied in this study design.

What to Do and What Not to Do in the Management of Cancer Pain: A Physician Survey and Expert Recommendations

BACKGROUND

Despite the prevalence of pain among patients with cancer and the availability of pertinent guidelines, the clinical management of oncological pain is decisively insufficient. To address this issue, we evaluated current trends in clinical practice and subsequently generated a list of ten corrective actions-five things to do and five things not to do-for the diagnosis, management, and monitoring of cancer pain.

METHODS

The survey included 18 questions about clinical practice surrounding background pain and breakthrough cancer pain (BTcP). Survey questions were developed by a scientific board of 10 physician experts and communicated via email to an expanded panel of physicians in Italy. Responses were tabulated descriptively for analysis.

RESULTS

Of 51 invited physicians, 32 (63%) provided complete survey responses. The responses revealed several incongruencies with current guideline recommendations: physicians did not always diagnose or monitor pain using diagnostically validated or disease-specific instruments; frequently based clinical decision-making on time availability or convenience; and pharmacological therapy was often inappropriate (eg, prescribing NSAIDs or corticosteroids for BTcP). The list of corrective actions generated by the scientific board favored a guideline-oriented approach that systematically characterizes oncological pain and implements treatment based on pain characteristics (eg, fast-acting transmucosal opioids for BTcP) and evidence-based recommendations.

CONCLUSION

Oncologists require better education and training about the diagnosis, treatment, and monitoring of oncological pain. Physicians should be aware of current guideline recommendations as well as available pharmacological tools for BTcP.

Satisfaction With an Interactive Voice Response System and Symptom Management Toolkit Intervention to Improve Adherence in Patients Prescribed an Oral Anticancer Agent

OBJECTIVES

To describe patient satisfaction with an interactive voice response (IVR) system to assess adherence and symptom management in patients newly prescribed an oral anticancer agent (OAA).

SAMPLE & SETTING

Patients prescribed a new OAA were recruited from six comprehensive cancer centers in the United States.

METHODS & VARIABLES

Cross-sectional analysis and descriptive statistics were used to summarize patient demographics and satisfaction with the IVR system and symptom management toolkit.

RESULTS

Participants had a mean age of 61.82 years, and gastrointestinal cancer was most prevalent. Participants were either "very" or "highly" satisfied with the IVR weekly calling system to assess symptoms, the IVR system daily OAA adherence reminders, and the symptom management toolkit.

IMPLICATIONS FOR NURSING

Nurses often triage patient-reported issues with OAAs. Nurses are well positioned to lead IVR system symptom management interventions and to be actively involved in the development, implementation, and dissemination of IVR technologies through research and practice.