The Potential of E-Health in Patients after Allogeneic Stem Cell Transplantation

Abstract

Introduction Modern information and communication technologies (ICT) have become increasingly important in daily life as well as in patient-physician interaction, health monitoring and health related information (E-Health). Progress in allogeneic stem cell transplantation (allo-SCT) has led to improved survival and increasing numbers of patients. However, with a multitude of potential complications, follow-up of allo-SCT patients remains complex requiring close monitoring, support and treatment with a plethora of medical fields involved. Early studies have shown that E-Health can benefit caretaking of these patients. So far, only little information is known about the patients’ current use of E-Health and their perspective on its potential. Yet, this knowledge is of particular importance for re-structurization of follow-up after allo-SCT including the standardized use of E-Health and its comprehensive acceptance. This multicenter study aims to close this knowledge gap by investigating the patients’ view towards E-Health and use of telemedicine after allo-SCT. The results will help to facilitate the implementation of E-Health in standard follow-up after allo-SCT and other cellular therapies with a focus on patients’ perspective. Methods and Results Between May 2021 and June 2022, 237 patients after allo-SCT were asked to answer a structured questionnaire at the university hospitals Aachen, Bonn, Cologne and Duesseldorf (Center for Integrated Oncology, CIO ABCD) in Germany. Overall, 219 patients returned the questionnaire leading to a response rate of 92%. Of these, 34% were female and 66% were male with a median age of 59 years (range 18-81). In our patient cohort, the current distribution of internet-enabled computers/smartphones is over 90% and the electronic devices are mainly used for daily life activities. Nevertheless, the use of ICT in medical monitoring and patient-physician interaction is still limited. Only a minority of patients have digitized medication plans, use digital monitoring of health data/fitness-apps or own wearables for health monitoring such as smartwatches. In contrast, the majority of patients favors additional online patient-physician interaction such as scheduling and transmission of medical reports and 65% of the patients support real-time transmission of health data through wearables to the physician for a limited time period. Of note, 40-50% of patients have concerns regarding data safety, even more when using messenger services (67%). The majority of patients considers online chats or video calls with their physician to be beneficial and expects an improvement of the treatment quality through increased use of E-Health. Additionally, most patients favor local treatment with online correspondence between their local practitioner and a specialized center, especially if the patients are present during the online communication or with intermittent personal patient contact to the center. Subgroup analyses revealed that in most areas there is no gender difference in use and perspective on E-Health. However, male patients consider online chats more beneficial and expect an improved patient-physician interaction through increased use of ICT compared to females. Age and educational attainment are very significant factors in patients’ view on E-Health. Younger (<60 years) as well as higher educated patients favor increased use of online communication, applications and devices in almost all regards and expect benefits of patient-physician interaction and treatment quality, which is in significant contrast to the views of older or less educated patients. Hometown size or distance to a specialized center does not show a relevant impact on the view on E-Health. This is also true for time after allo-SCT or frequency of outpatient visits at the time of questioning. Conclusions Dissemination of internet-enabled devices is wide and the potential of E-Health is high in patients after allo-SCT. The majority of patients favors further standardized implementation of E-Health technologies and telemedically supported caretaking post allo-SCT and potentially other cellular therapies to improve patient-physician interaction and cross-sectoral care. Future research should focus on patients’ needs in the context of data safety and exchange of medical information in interdisciplinary care processes to successfully integrate new E-Health technologies.