Abstract

BackgroundCancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population.ObjectiveThis study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities.MethodsUser needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users.ResultsOverarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information.ConclusionsWeb-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption.

Highlights

  • Cancer patients receiving chemotherapy have high symptom burden, which is reflected in their frequent utilization of the emergency department (ED) and high rates of hospitalization during treatment [1,2,3,4]

  • Between December 2014 and November 2015, 49 patients, caregivers, and health care providers (HCPs) participated in the study

  • 8 patients and 8 HCPs participated in ethnographic field studies; 6 patients, 1 caregiver, and 4 HCPs participated in focus groups; and 11 patients and 11 HCPs participated in usability testing (Figure 1)

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Summary

Introduction

Cancer patients receiving chemotherapy have high symptom burden, which is reflected in their frequent utilization of the emergency department (ED) and high rates of hospitalization during treatment [1,2,3,4]. Unplanned acute care visits among patients receiving systemic therapy in routine practice are likely a reflection of suboptimal management of these toxicities due to inadequate use of preventative strategies or lack of timely access to advice and assessment by the health care team. The design of an effective Web-based chemotherapy toxicity management tool requires an understanding of factors associated with the interaction between humans, technology, and care context to ensure uptake by end users and integration into existing clinical workflows [11]. Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population

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