Abstract
Cancer is a very dangerous disease with exceptionally high morbidity and mortality rates. Early detection and treatment of cancer are paramount to reducing mortality rates and increasing the effectiveness of treatment. Various electronic devices and the Internet could also be used to help monitor cancer symptoms and help the patients, and the doctors maintain contact with one another, in order to provide better treatment. In the course of this literature research, it was discovered that although electronic communication shows promise in empowering oncology patients, there is not enough clinical evidence to accurately measure its effectiveness.
Introduction
Cancer is one of the primary causes of death across the world, right next to heart diseases and heavy respiratory failures (Lennon et al., 2014). Cancer is typically treated with chemotherapy, which is dangerous to the body in the long-term and does not guarantee 100 percent effectiveness (Lennon et al., 2014). One of the complications that cancer brings is that at later stages of the disease, the effectiveness of any treatment drops considerably. According to the American Cancer Society (2017) [ACS], an estimated 1.7 million new cases of cancer will be diagnosed in 2017. The Centers for Disease Control state that the mortality rate of cancer is 591,686 people for the last year surveyed (U.S. Cancer Statistics Working Group, 2017).
One out of every four deaths in the United States can be attributed to cancer (U.S. Cancer Statistics Working Group, 2017). Early detection and treatment of cancer are paramount to reducing the mortality rates and increasing the effectiveness of treatment. As it stands, the most frequently used channels of communication are the telephone and personal contact during visits to the hospital. However, as modern technologies are being actively implemented and incorporated in hospital practices, various electronic devices, and the Internet could also be used to help monitor cancer symptoms and help patients and doctors maintain contact with one another, in order to provide better treatment. Improving communication between patients and their health providers could provide improved outcomes and enhance the life of patients.
Question: Does the use of an electronic communication health portal compared with standard communication methods improve outcomes in oncology patients?
- P: Adult oncology patients
- I: Electronic health communication portal
- C: Standard communication
- O: Improve patient outcomes by reducing the daily symptoms of cardiovascular diseases
Literature Search Methods
PubMed and CINAHL databases were used to locate and retrieve data for this research. These databases possess a large number of peer-reviewed medical articles that were published in various accredited medical journals. In order to ensure the accuracy of the research, only the articles published in the last 6 years were accepted for review. The keywords used in the literature search are as follows: Electronic health communication, oncology, cancer, self-care support, e-mail communication, electronic self-report, early detection of cancer. All searches used several keywords in order to narrow down the potential search pool, as the topics represented by every individual keyword are too broad to effectively conduct any kind of literature research. The total number of studies retrieved and examined is 30, out of which ten were chosen to be included in the literature summary/discussion section, 5 were chosen to be used as supportive evidence, and 20 were rejected due to containing repetitive evidence, or due to the fact that the keywords were mentioned only briefly, while the actual research contained no valuable information on the selected subject.
Literature Review
This section is dedicated to the analysis of the literature retrieved from PubMed and CINAHL, which provides important information on electronic health communication in adult oncology patients. The provided literature is reviewed based on the topic of the research, type of research, methodology, research sample, strengths, and weaknesses of the research design, findings, and discussion.
Electronic Self-Report Assessment for Cancer and Self-Care Support: Results of a Multicenter Randomized Trial
This quantitative research was published in the Journal of Clinical Oncology in 2014. Its purpose was to evaluate the effects of a web-based self-report assessment on symptom distress during oncological treatments. The research sample constituted 752 adult patients, which were separated into 2 groups – the test group and the control group (Berry et al., 2011). The control group was assigned symptom screenings at 4 points in time, whereas the test group utilized self-care training and electronic self-report assessments. The research found a significant decrease in symptom distress, particularly among patients aged 50 and older (Berry et al., 2011). The research design is strong because it uses multivariate analyses and has a large and diverse sample size.
Patient-Physician E-Mail Communication: The Kaiser Permanente Experience
This research was published in 2011, in the Journal of Oncology Practice. It studies the use of a private e-mail communication system between patients and doctors between 2004 and 2011, and its effect on measurable quality outcomes, patient satisfaction, and a decrease in in-office visits. In 7 years since the implementation of the system, over 5.6 million messages were sent to 7.000 physicians that participated in the program (Baer, 2011). In logistical regression modeling, the use of the Kaiser Permanente e-mail system was an independent factor that enhanced patient satisfaction and quality outcomes. In addition, in the period between 2003 and 2007, there was a marked drop in-office visit, by 3.7 percent in the control group, and by 10.7 percent in the test group (Baer, 2011).
Enhancing Patient-Provider Communication with the Electronic Self-Report Assessment for Cancer: A Randomized Trial
This randomized trial was published in 2011 in the Journal of Clinical Oncology. The study concerns itself with providing the means of electronic self-report systems in order to enhance patients’ ability for self-assessment. The research sample consisted of 660 individuals, who were separated into two groups of approximately 330 participants, to serve as the test group and the control group (Berry et al., 2014). The test group was provided with the means of electronic self-report assessments that were to be displayed to clinicians during hospital visits. The control group was given none. The results of this quantitative research were analyzed using a logistical regression model. The research found that the ESRA-C was useful for clinicians and enabled them to focus on the actual health issues of the patient. The weakness of this research is that the majority of the sample were white middle-class individuals with the knowledge and skill of using computer technology, which does not represent any variables coming from racial and social backgrounds (Berry et al., 2014).
Feasibility of Long-Term Patient Self-Reporting of Toxicities from Home via the Internet during Routine Chemotherapy
This article was published in 2013 in the Journal of Clinical Oncology. Its purpose is to provide long-term longitudinal data to establish the effectiveness of long-term patient self-reporting systems during chemotherapy sessions. The research involved 286 patients who were tasked to utilize electronic self-report systems for the duration of their chemotherapy (Judson et al., 2013). Weekly compliance rates were at 60 percent, while more than 75 percent of patients were reporting their toxicity levels at least once a month (Judson et al., 2013). Increased levels of compliance were detected during the initial 12 weeks. The research concludes that compliance with the self-reporting system diminishes as the time goes on, and suggests the development of strategies to encourage weekly compliance with self-reporting procedures on a weekly basis. Limitations of the study lie in the area of variety, as it was conducted in a single hospital, on the patients who were predominantly white, well-educated, and computer-literate.
Improving the Care of Children with Advanced Cancer by Using an Electronic Patient-Reported Feedback Intervention: Results from the PediQUEST Randomized Controlled Trial
This study was published in the Journal of Clinical Oncology in 2014 and is aimed to research the effects of an electronic patient-reporting feedback system on symptom distress and health-related quality of life in children. 104 child patients took part in the research; the participants were divided into two groups. The test group implemented the computer-based Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST), whereas the control group followed the standard procedures and checkups (Wolfe et al., 2014). The research found that the use of the self-report system did not dramatically affect the symptoms of cancer or the patients’ quality of life. However, both patients and healthcare practitioners found the self-care reports to be valuable and informative for their practice, as well as to provide an improvement to the emotional spectrum of health-related quality of life (Wolfe et al., 2014).
Discussion and Implications for Practice
The findings of the research articles reviewed above provide several implications for medical practice. To summarize, implementing means of electronic self-assessment and communication with healthcare providers would achieve several goals:
- Improve symptoms in adult patients and patients over 50 years of age.
- Reduce the number of hospital visits, thus reducing the workload on physicians.
- Provide helpful information to patients and physicians during routine visits.
- Provide emotional support for parents and children.
However, these implications are made based on the assessment of the 5 articles reviewed in the literature section. A systematic review of controlled trials by Eysenbach (2012) states that the current number of randomized controlled trials is low and that making any general conclusions based on them alone is insufficient. Still, despite that statement, all the materials related to the use of electronic communication and self-assessment have stated that the practice would empower patients and allow them to participate and contribute to their own medical outcomes. Bennett, Jensen, and Bach (2012) have also found the practice useful and easily implemented in the current hospital system.
One particular trend observed during the data analysis was that many types of research were performed on white middle-class individuals, which could have contributed to the effectiveness of the interventions. According to Lustria, Smith, and Hinnant (2011), there is a lack of studies on the subject aimed specifically at the poor, underserved, and disadvantaged groups. One of the articles on electronic care plans in breast cancer survivorship, however, indicated that there are no significant differences in the use of the provided information between the residents of urban and city areas (Smith, Singh-Carlson, Downie, Payeur, & Wai, 2011). The reasons why the disadvantaged groups may be underrepresented in research could be connected to the fact that long-term cancer treatment is expensive. Therefore, the only eligible candidates to participate in research would be those who could afford it, which limits a potential sample pool and obscures results.
Conclusions
Despite the presence of certain gaps found in the currently available data pool, there is evidence to suggest that electronic communication, particularly in the form of self-care reports, has a positive effect on health-related quality of life and patient outcomes. The use of these systems, considering the computerization of all hospital services, would be relatively easy to integrate into standard oncology practice. Additional research is required in order to determine the effectiveness of the intervention among the poor and disadvantaged groups. In addition, there is a need for strategies to ensure patients’ long-term commitment to electronic communication. These measurements have the potential to improve oncology healthcare and warrant further study.
References
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Bennett, A. V., Jensen, R. E., & Bach, E. (2012). Electronic patient-reported outcome systems in oncology clinical practice. CA: A Cancer Journal for Clinicians, 62(5), 336-347.
Berry, D.L., Blumenstein, B. A., Halpenny, B., Wolpin, S., Fann, J. R., & Austin- Seymour, M. (2011). Enhancing patient-provider communication with the electronic self-report assessment for cancer: A randomized trial. Journal of Clinical Oncology, 29(8), 1029-1035.
Berry, D. L., Hong, F., Halpenny, B., Partridge, A. H., Fann, J. R., & Wolpin, S. (2014). Electronic self-report assessment for cancer and self-care support: Results of a multicenter randomized trial. Journal of Clinical Oncology, 32(3), 199-205.
Eysenbach, G. (2012). The impact of electronic patient portals on patient care: A systematic review of controlled trials. Journal of Medical Internet Research, 14(6), 162-167.
Judson, T. J., Bennett, A. V., Rogak, L. J., Sit, L., Barz, A., & Kris, M. G. (2013). Feasibility of long-term patient self-reporting of toxicities from home via the internet during routine chemotherapy. Journal of Clinical Oncology, 31(20), 2580-2585.
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Smith, S. L., Singh-Carlson, S., Downie, L., Payeur, N., & Wai, E. S. (2011). Survivors of breast cancer: Patient perspectives on survivorship care planning. Journal of Cancer Survivorship, 5(4), 337-344.
U.S. Cancer Statistics Working Group. (2017). Leading cancer cases and deaths 2014. In Centers for Disease Control and Prevention. Web.
Wolfe, J., Orellana, L., Cook, E. F., Ullrich, C., Kang, T., & Geyer, J. R. (2014). Improving the care of children with advanced cancer by using an electronic patient-reported feedback intervention: Results from the PediQUEST randomized controlled trial. Journal of Clinical Oncology 32(11), 1119-1126.