@Article{info:doi/10.2196/50550,
author="Fridriksdottir, Nanna
and Ingadottir, Brynja
and Skuladottir, Kristin
and Zo{\"e}ga, Sigridur
and Gunnarsdottir, Sigridur",
title="Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="22",
volume="7",
pages="e50550",
keywords="web portal for patients with cancer; supportive digital health service; symptom monitoring; self-management support; feasibility; usability; acceptability; patient education; health engagement; patient-reported outcomes; digital health service; patient portal; electronic health records; mobile phone",
abstract="Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System--Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT{\&}PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT{\&}PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. Results: The portal adoption rate was 72{\%} (103/143), and the portal use rate was 76.7{\%} (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67{\%} (69/103). The combined completion rate of the ESASr and DT{\&}PL was 78.4{\%} (685/874). Patients received a mean 41 (SD 13) information leaflets; 33{\%} (26/79) initiated messaging, 73{\%} (58/79) received messages, and 85{\%} (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age ($\beta$=−.45), ESASr engagement ($\beta$=.5), symptom interference ($\beta$=.4), and received knowledge ($\beta$=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age ($\beta$=−.31), ESASr engagement ($\beta$=.37), symptom interference ($\beta$=.60), self-care self-efficacy ($\beta$=.37), and received knowledge ($\beta$=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted. ",
issn="2561-326X",
doi="10.2196/50550",
url="https://formative.jmir.org/2023/1/e50550",
url="https://doi.org/10.2196/50550",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015268"
}