The impact of digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care: A systematic review and narrative synthesis

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.

Maintaining High-Touch in High-Tech Digital Health Monitoring and Multi-Omics Prognostication: Ethical, Equity, and Societal Considerations in Precision Health for Palliative Care

Advances in digital health, systems biology, environmental monitoring, and artificial intelligence (AI) continue to revolutionize health care, ushering a precision health future. More than disease treatment and prevention, precision health aims at maintaining good health throughout the lifespan. However, how can precision health impact care for people with a terminal or life-limiting condition? We examine here the ethical, equity, and societal/relational implications of two precision health modalities, (1) integrated systems biology/multi-omics analysis for disease prognostication and (2) digital health technologies for health status monitoring and communication. We focus on three main ethical and societal considerations: benefits and risks associated with integration of these modalities into the palliative care system; inclusion of underrepresented and marginalized groups in technology development and deployment; and the impact of high-tech modalities on palliative care's highly personalized and "high-touch" practice. We conclude with 10 recommendations for ensuring that precision health technologies, such as multi-omics prognostication and digital health monitoring, for palliative care are developed, tested, and implemented ethically, inclusively, and equitably.

Parent and Provider Perspectives of a Hospital-Based Bereavement Support Program in Pediatric Palliative Care

CONTEXT

Bereavement is an individuated, nuanced experience, and its expression is different for each parent who has cared for a dying child. Evidence highlights support is valuable to navigate this loss.

OBJECTIVES

To evaluate a Bereavement Support Program from the perspectives of both families and service providers.

METHODS

A cross-sectional study design explored the experiences and perspectives of the benefits of various program components. Respondents were asked about accessing program components, their expectations, and parents were asked to rate the impact of program components on their grief on a scale from one, (no impact) to 100 (positive impact). Space for free text was provided throughout for additional feedback.

SETTING/ PARTICIPANTS

The survey was distributed through mailing lists of parents known to the service, referring service providers, and advertised in the program newsletter.

RESULTS

One hundred two respondents completed the survey and provided detailed comments about their experiences. Most interactions and program components were reported helpful by both parents and service providers. Parents (N = 60) reported a positive impact on grief across all program components (median impact on grief range 81-98, Interquartile range 68.5-99). There were, however, a considerable number of respondents who were unaware of some components.

CONCLUSION

Bereavement care to navigate the devastating loss of a child is of paramount importance and can offer significant and beneficial resources for families. Findings have supported service development in a major tertiary paediatric hospital facilitating improved access for families, particularly for those in regional and rural locations.

Digital Health Interventions for Adult Patients With Cancer Evaluated in Randomized Controlled Trials: Scoping Review

BACKGROUND

Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements.

OBJECTIVE

The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer.

METHODS

A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions.

RESULTS

A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9%), followed by those with the self-manage function (67/231, 29%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6%) or patients with advanced or metastatic cancer (22/231, 9.5%).

CONCLUSIONS

This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research.

Ethical Principles in Digital Palliative Care for Children: The MyPal Project and Experiences Made in Designing a Trustworthy Approach

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.

Challenges and Pitfalls for Implementing Digital Health Solutions in Clinical Studies in Europe

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.