Abstract
BackgroundTelehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear.ObjectiveThe aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature.MethodsThis systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological s, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies.ResultsOf the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery.ConclusionsUnderstanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care.Trial RegistrationPROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117232
Highlights
BackgroundCancer ranks as a leading cause of death worldwide and is a leading cause of premature death in most countries [1]
Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care
JMIR Cancer 2022 | vol 8 | iss. 1 | e33355 | p. 1 and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care
Summary
BackgroundCancer ranks as a leading cause of death worldwide and is a leading cause of premature death in most countries [1]. Common symptoms include pain, experienced in approximately two-thirds (66.4%) of patients with advanced disease [3], alongside breathlessness, nausea and vomiting, and fatigue [4]. Individuals experience more than one symptom, with an average of 14 symptoms for those with advanced cancer [5]. Such physical symptoms often exist alongside deterioration across physical, psychological, social, spiritual, and overall quality of life (QOL) trajectories [6]. There remain gaps in supporting care delivery for patients with cancer, including barriers in health communication with health care providers, lack of care coordination, and challenges in accessing care [7]. Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; the extent of and factors influencing patient engagement remain unclear
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