PDF herunterladen
CC BY 4.0 · ACI open 2019; 03(02): e78-e87
DOI: 10.1055/s-0039-1696732
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Oncologists' Perceptions of a Digital Tool to Improve Cancer Survivors' Cardiovascular Health

Marjorie Kelley
1   Department of Biomedical Informatics, The Ohio State University, College of Medicine, Columbus, Ohio, United States
2   College of Nursing, The Ohio State University, Columbus, Ohio, United States
,
Randi Foraker
3   Division of General Medicine, Washington University St. Louis, St. Louis, Missouri, United States
4   Institute for Informatics, Institute for Public Health, Washington University, St. Louis, United States
,
En-Ju Deborah Lin
5   Nationwide Children's Hospital, Columbus, Ohio, United States
,
Manjusha Kulkarni
6   Ohio State University Wexner Medical Center—Health and Rehabilitation Sciences, Columbus, Ohio, United States
,
Maryam Lustberg
7   Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Kathryn E. Weaver
8   Wake Forest School of Medicine—Social Sciences and Health Policy, Office of Women in Medicine and Science, Winstom-Salem, North Carolina, United States
› Institutsangaben Funding This project was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002733. This work was partially supported by a grant from the National Institute of Health, NCI R01 CA226078.
Weitere Informationen

Publikationsverlauf

21. Juni 2018

18. Juli 2019

Publikationsdatum:
03. Oktober 2019 (online)

   Lizenzen und Reprints

Abstract

Background Cardiovascular (CV) disease continues to be a leading cause of morbidity and mortality with higher rates among cancer survivors than in the general population.

Objective This study was aimed to understand oncology providers' attitudes toward a digital CV health tool, delivered via a tablet, to promote CV health in cancer survivors.

Methods Using qualitative methods, 14 oncologists, from community and academic practice sites, were interviewed while they used the tool. Interviews were videotaped then analyzed using NVivo 11 software. Themes were inductively developed from the interviews.

Results Three major themes emerged from the interviews as follows: (1) system functionality, (2) facilitators and barriers to integration, and (3) appropriate end-users. Oncologists recognized the critical role of CV health promotion among cancer survivors and identified features about the tool that would be helpful for CV health promotion. Workflow (subtheme) was a barrier to tool use. This feedback enabled tool redesign for further testing in the context of survivorship care.

Conclusion Our findings emphasized the importance of identifying appropriate End-users which may include other survivorship care providers, patients, and primary care providers.

Implications Our research addresses the knowledge gap in the use of digital tools in cancer survivorship care, specifically digital tools to promote CV health. Future research is needed to evaluate digital tools in cancer survivorship care. Research investigating patients as users of digital tools may provide additional insight.

Keywords

cancer survivors - medical informatics - cardiovascular disease - lifestyle - patient participation

Protection of Human and Animal Subjects

This study was performed in compliance with the ethical standards of the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the Institutional Review Boards of Wake Forest University and the Ohio State University.


Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the NLM.


Supplementary Material

 

  • References

  • 1 American Cancer Society. Cancer Facts & Figures 2019. Available at: http://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019 . Accessed September 2019
    PubMed
  • 2 de Moor JS, Mariotto AB, Parry C. , et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev 2013; 22 (04) 561-570
    CrossrefPubMedGoogle Scholar
  • 3 Fung C, Fossa SD, Milano MT, Sahasrabudhe DM, Peterson DR, Travis LB. Cardiovascular disease mortality after chemotherapy or surgery for testicular nonseminoma: a population-based study. J Clin Oncol 2015; 33 (28) 3105-3115
    CrossrefPubMedGoogle Scholar
  • 4 Youn P, Milano MT, Constine LS, Travis LB. Long-term cause-specific mortality in survivors of adolescent and young adult bone and soft tissue sarcoma: a population-based study of 28,844 patients. Cancer 2014; 120 (15) 2334-2342
    CrossrefPubMedGoogle Scholar
  • 5 Daher IN, Daigle TR, Bhatia N, Durand JB. The prevention of cardiovascular disease in cancer survivors. Tex Heart Inst J 2012; 39 (02) 190-198
    PubMedGoogle Scholar
  • 6 Lipshultz SE, Adams MJ, Colan SD. , et al; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Radiolo. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation 2013; 128 (17) 1927-1995
    CrossrefPubMedGoogle Scholar
  • 7 Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC. Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol 2012; 126 (02) 176-179
    CrossrefPubMedGoogle Scholar
  • 8 Weaver KE, Foraker RE, Alfano CM. , et al. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?. J Cancer Surviv 2013; 7 (02) 253-261
    CrossrefPubMedGoogle Scholar
  • 9 Adams MJ, Lipshultz SE. Pathophysiology of anthracycline- and radiation-associated cardiomyopathies: implications for screening and prevention. Pediatr Blood Cancer 2005; 44 (07) 600-606
    CrossrefPubMedGoogle Scholar
  • 10 Mertens AC, Liu Q, Neglia JP. , et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst 2008; 100 (19) 1368-1379
    CrossrefPubMedGoogle Scholar
  • 11 Coughlin SS, Smith SA. The insulin-like growth factor axis, adipokines, physical activity, and obesity in relation to breast cancer incidence and recurrence. Cancer Clin Oncol 2015; 4 (02) 24-31
    PubMedGoogle Scholar
  • 12 Greenfield DM, Blewitt A, Coleman RE. , et al. Evaluation of adipocytokines and traditional cardiometabolic risk factors in young male cancer survivors: an age-matched control study. Clin Endocrinol (Oxf) 2016; 84 (02) 296-304
    CrossrefPubMedGoogle Scholar
  • 13 Wethal T, Haugnes HS, Kjekshus J. , et al. C-reactive protein; a potential marker of second cancer and cardiovascular disease in testicular cancer survivors?. Eur J Cancer 2010; 46 (18) 3425-3433
    CrossrefPubMedGoogle Scholar
  • 14 Oeffinger KC, Mertens AC, Sklar CA. , et al; Childhood Cancer Survivor Study. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006; 355 (15) 1572-1582
    CrossrefPubMedGoogle Scholar
  • 15 Pavon JM, Zhao Y, McConnell E, Hastings SN. Identifying risk of readmission in hospitalized elderly adults through inpatient medication exposure. J Am Geriatr Soc 2014; 62 (06) 1116-1121
    CrossrefPubMedGoogle Scholar
  • 16 van Dorp W, Mulder RL, Kremer LC. , et al. Recommendations for premature ovarian insufficiency surveillance for female survivors of childhood, adolescent, and young adult cancer: A report from the international late effects of childhood cancer guideline harmonization group in collaboration with the pancaresurfup consortium. J Clin Oncol 2016; 34 (28) 3440-3450
    CrossrefPubMedGoogle Scholar
  • 17 ASCO. Cancer survivorship. 2015 ; Available at: https://www.cancer.net/survivorship . Accessed September 10, 2015
    PubMed
  • 18 The National Academics of Science, Engineering, Medicine: health and medicine Division.. National cancer policy forum. 2013 ; Available at: http://iom.nationalacademies.org/activities/disease/ncpf/2013-jul-15/day%202/session%205/25-freyer.aspx . Accessed October 1, 2015
    PubMed
  • 19 Hewitt M, Ganz PA. A National Coalition for Cancer Survivorship and Institute of Medicine National Cancer Policy Forum Workshop. 2006 . Available at: http://www.nap.edu/read//11739/chapter/1 . Accessed September 2019
    PubMedGoogle Scholar
  • 20 Institute of Medicine. From cancer patient to cancer survivor: Lost in Transition. 2005. Available at: http://www.nationalacademies.org/hmd/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx . Accessed September 2019
    PubMed
  • 21 Hewitt M, Greenfield S, Stovall E. , eds.; Institute of Medicine; National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, D.C. : The National Academies Press; 2006
    Google Scholar
  • 22 Levit LA, Balogh EP, Nass SJ, Ganz PA. , eds.; IOM. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, D.C.: The National Academies Press; 2013
    Google Scholar
  • 23 Birken SA, Deal AM, Mayer DK, Weiner BJ. Following through: the consistency of survivorship care plan use in United States cancer programs. J Cancer Educ 2014; 29 (04) 689-697
    CrossrefPubMedGoogle Scholar
  • 24 Ammon M, Arenja N, Leibundgut G. , et al. Cardiovascular management of cancer patients with chemotherapy-associated left ventricular systolic dysfunction in real-world clinical practice. J Card Fail 2013; 19 (09) 629-634
    CrossrefPubMedGoogle Scholar
  • 25 Clauser SB, Wagner EH, Aiello Bowles EJ, Tuzzio L, Greene SM. Improving modern cancer care through information technology. Am J Prev Med 2011; 40 (05) (Suppl. 02) S198-S207
    CrossrefPubMedGoogle Scholar
  • 26 Foraker RE, Shoben AB, Lopetegui MA. , et al. Assessment of life's simple 7 in the primary care setting: The stroke prevention in healthcare delivery environments (sphere) study. Contemp Clin Trials 2014; 38 (02) 182-189
    CrossrefPubMedGoogle Scholar
  • 27 Foraker RE, Kite B, Kelley MM. , et al. Ehr-based visualization tool: adoption rates, satisfaction, and patient outcomes. EGEMS (Wash DC) 2015; 3 (02) 1159
    PubMedGoogle Scholar
  • 28 FDA. Digital health. 2018 ; Available at: https://www.fda.gov/MedicalDevices/DigitalHealth/default.htm . Accessed October 23, 2018
    PubMed
  • 29 WHO. Classification of digital health interventions v1.0. 2018 ; Available at: http://apps.who.int/iris/bitstream/handle/10665/260480/WHO-RHR-18.06-eng.pdf;jsessionid=B42D38F5B9967374443366ED1CE122D0?sequence=1 . Accessed October 23, 2018
    PubMed
  • 30 Sharifi M, Adams WG, Winickoff JP, Guo J, Reid M, Boynton-Jarrett R. Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke. Acad Pediatr 2014; 14 (05) 478-484
    CrossrefPubMedGoogle Scholar
  • 31 Chrimes D, Kitos NR, Kushniruk A, Mann DM. Usability testing of avoiding diabetes thru action plan targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record. Int J Med Inform 2014; 83 (09) 636-647
    CrossrefPubMedGoogle Scholar
  • 32 Zamora A, Fernández de Bobadilla F, Carrion C. , et al; VALIDA Study Group; Network of Lipid Units of Catalonia (XULA). Pilot study to validate a computer-based clinical decision support system for dyslipidemia treatment (HTE-DLP). Atherosclerosis 2013; 231 (02) 401-404
    CrossrefPubMedGoogle Scholar
  • 33 Litvin CB, Ornstein SM, Wessell AM, Nemeth LS, Nietert PJ. Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study. J Gen Intern Med 2013; 28 (06) 810-816
    CrossrefPubMedGoogle Scholar
  • 34 Razavi SA, Carter AB, Puskas JD, Gregg SR, Aziz IF, Buchman TG. Reduced red blood cell transfusion in cardiothoracic surgery after implementation of a novel clinical decision support tool. J Am Coll Surg 2014; 219 (05) 1028-1036
    CrossrefPubMedGoogle Scholar
  • 35 Robbins GK, Lester W, Johnson KL. , et al. Efficacy of a clinical decision-support system in an HIV practice: a randomized trial. Ann Intern Med 2012; 157 (11) 757-766
    PubMedGoogle Scholar
  • 36 Slev VN, Mistiaen P, Pasman HR, Verdonck-de Leeuw IM, van Uden-Kraan CF, Francke AL. Effects of eHealth for patients and informal caregivers confronted with cancer: A meta-review. Int J Med Inform 2016; 87: 54-67
    CrossrefPubMedGoogle Scholar
  • 37 Berry DL, Hong F, Halpenny B. , et al. Electronic self-report assessment for cancer and self-care support: results of a multicenter randomized trial. J Clin Oncol 2014; 32 (03) 199-205
    PubMedGoogle Scholar
  • 38 Jaatun EAA, Fallon M, Kofod-Petersen A, Halvorsen K, Haugen DF. Users' perceptions on digital visualization of neuropathic cancer-related pain. Health Informatics J 2019; 25 (03) 683-700
    CrossrefPubMedGoogle Scholar
  • 39 Roberts AL, Fisher A, Smith L, Heinrich M, Potts HWW. Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2017; 11 (06) 704-719
    CrossrefPubMedGoogle Scholar
  • 40 Belden J, Plaisant C, Johnson T. , et al. Inspired EHRs: Designing for Clinicians. St. Louis, MO: The Curators of the University of Missouri; 2014
    Google Scholar
  • 41 Nielsen J. The usability engineering lifecycle. In: Usability Engineering. San Diego, CA: Academic Press Inc.; 1993: 71-114
    CrossrefGoogle Scholar
  • 42 Foraker RE, Shoben AB, Kelley MM. , et al. Electronic health record-based assessment of cardiovascular health: the stroke prevention in healthcare delivery environments (SPHERE) study. Prev Med Rep 2016; 4: 303-308
    PubMedGoogle Scholar
  • 43 Lloyd-Jones DM, Hong Y, Labarthe D. , et al; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121 (04) 586-613
    CrossrefPubMedGoogle Scholar
  • 44 Shneiderman B, Plaisant C. Designing the user interface. 5th ed. Boston, MA: Pearson; 2010
    Google Scholar
  • 45 Li AC, Kannry JL, Kushniruk A. , et al. Integrating usability testing and think-aloud protocol analysis with “near-live” clinical simulations in evaluating clinical decision support. Int J Med Inform 2012; 81 (11) 761-772
    CrossrefPubMedGoogle Scholar
  • 46 Washington KT, Oliver DP, Gage LA, Albright DL, Demiris G. A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers. Palliat Med 2016; 30 (03) 270-278
    CrossrefPubMedGoogle Scholar
  • 47 Alpert JM, Krist AH, Aycock RA, Kreps GL. Applying multiple methods to comprehensively evaluate a patient portal's effectiveness to convey information to patients. J Med Internet Res 2016; 18 (05) e112
    CrossrefPubMedGoogle Scholar
  • 48 Menon S, Smith MW, Sittig DF. , et al. How context affects electronic health record-based test result follow-up: a mixed-methods evaluation. BMJ Open 2014; 4 (11) e005985
    CrossrefPubMedGoogle Scholar
  • 49 Bender JL, Yue RY, To MJ, Deacken L, Jadad AR. A lot of action, but not in the right direction: systematic review and content analysis of smartphone applications for the prevention, detection, and management of cancer. J Med Internet Res 2013; 15 (12) e287
    CrossrefPubMedGoogle Scholar
  • 50 Sandelowski M. Qualitative analysis: what it is and how to begin. Res Nurs Health 1995; 18 (04) 371-375
    CrossrefPubMedGoogle Scholar
  • 51 Schwandt TA, Lincoln YS, Guba EG. Judging interpretations: but is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Eval 2007; 2007 (114) 11-25
    CrossrefPubMedGoogle Scholar
  • 52 Guba E, Lincoln Y. Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS. , eds. Handbook of Qualitative Research. Thousand Oaks, CA: SAGE Publications, Inc.; 1994
    Google Scholar
  • 53 Krippendorff K. Content Analysis: An introduction to Its Methodology. Thousand Oaks, CA: SAGE Publications, Inc.; 2004
    Google Scholar
  • 54 Sittig DF, Singh H. A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care 2010; 19 (Suppl. 03) i68-i74
    CrossrefPubMedGoogle Scholar
  • 55 Shay CM, Gooding HS, Murillo R, Foraker R. Understanding and improving cardiovascular health: An update on the american heart association's concept of cardiovascular health. Prog Cardiovasc Dis 2015; 58 (01) 41-49
    CrossrefPubMedGoogle Scholar
  • 56 Sittig DF, Krall M, Kaalaas-Sittig J, Ash JS. Emotional aspects of computer-based provider order entry: a qualitative study. J Am Med Inform Assoc 2005; 12 (05) 561-567
    CrossrefPubMedGoogle Scholar
  • 57 Henriksen K, Joseph A, Zayas-Cabán T. The human factors of home health care: a conceptual model for examining safety and quality concerns. J Patient Saf 2009; 5 (04) 229-236
    CrossrefPubMedGoogle Scholar
  • 58 NSAI. Ergonomic Human-System Interaction–Part 11: Usability: Definitions and Concepts. 2nd ed. Geneva, Switzerland: European Committee for Standardization; 2018
    Google Scholar
  • 59 West P, Van Kleek M, Giordano R, Weal M, Shadbolt N. Information quality challenges of patient-generated data in clinical practice. Front Public Health 2017; 5: 284
    CrossrefPubMedGoogle Scholar
  • 60 Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol 2009; 27 (15) 2489-2495
    CrossrefPubMedGoogle Scholar
  • 61 Cheung WY, Aziz N, Noone AM. , et al. Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 2013; 7 (03) 343-354
    CrossrefPubMedGoogle Scholar
  • 62 Blanch-Hartigan D, Forsythe LP, Alfano CM. , et al. Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians. J Clin Oncol 2014; 32 (15) 1578-1585
    CrossrefPubMedGoogle Scholar
  • 63 Meiklejohn JA, Mimery A, Martin JH. , et al. The role of the GP in follow-up cancer care: a systematic literature review. J Cancer Surviv 2016; 10 (06) 990-1011
    CrossrefPubMedGoogle Scholar
  • 64 Singer S, Gianinazzi ME, Hohn A, Kuehni CE, Michel G. General practitioner involvement in follow-up of childhood cancer survivors: a systematic review. Pediatr Blood Cancer 2013; 60 (10) 1565-1573
    CrossrefPubMedGoogle Scholar
  • 65 Berry DL, Nayak MM, Abrahm JL, Braun I, Rabin MS, Cooley ME. Clinician perspectives on symptom and quality of life experiences of patients during cancer therapies: Implications for eHealth. Psychooncology 2017; 26 (08) 1113-1119
    CrossrefPubMedGoogle Scholar
  • 66 Puszkiewicz P, Roberts AL, Smith L, Wardle J, Fisher A. Assessment of cancer survivors' experiences of using a publicly available physical activity mobile application. JMIR Cancer 2016; 2 (01) e7
    CrossrefPubMedGoogle Scholar
  • 67 Robertson MC, Tsai E, Lyons EJ. , et al. Mobile health physical activity intervention preferences in cancer survivors: A qualitative study. JMIR Mhealth Uhealth 2017; 5 (01) e3
    CrossrefPubMedGoogle Scholar
  • 68 Pugh G, Hough RE, Gravestock HL, Jackson SE, Fisher A. The health behavior information needs and preferences of teenage and young adult cancer survivors. J Adolesc Young Adult Oncol 2017; 6 (02) 318-326
    CrossrefPubMedGoogle Scholar
  • 69 Smith SK, Kuhn E, O'Donnell J. , et al. Cancer distress coach: Pilot study of a mobile app for managing posttraumatic stress. Psychooncology 2018; 27 (01) 350-353
    CrossrefPubMedGoogle Scholar
  • 70 McCarroll ML, Armbruster S, Pohle-Krauza RJ. , et al. Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. Gynecol Oncol 2015; 137 (03) 508-515
    CrossrefPubMedGoogle Scholar
  • 71 Henriksen PA. Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention. Heart 2018; 104 (12) 971-977
    CrossrefPubMedGoogle Scholar
  • 72 Leong SL, Chaiyakunapruk N, Tassaneeyakul W, Arunmanakul P, Nathisuwan S, Lee SWH. Roles of pharmacogenomics in non-anthracycline antineoplastic-induced cardiovascular toxicities: A systematic review and meta-analysis of genotypes effect. Int J Cardiol 2019; 280: 190-197
    CrossrefPubMedGoogle Scholar
  • 73 Darby SC, Ewertz M, McGale P. , et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368 (11) 987-998
    CrossrefPubMedGoogle Scholar
  • 74 Armenian SH, Lacchetti C, Barac A. , et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American society of clinical oncology clinical practice guideline. J Clin Oncol 2017; 35 (08) 893-911
    CrossrefPubMedGoogle Scholar
  • 75 Zamorano JL, Lancellotti P, Rodriguez Muñoz D. , et al; ESC Scientific Document Group. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 2016; 37 (36) 2768-2801
    CrossrefPubMedGoogle Scholar
  • 76 Ammenwerth E, Mansmann U, Iller C, Eichstädter R. Factors affecting and affected by user acceptance of computer-based nursing documentation: results of a two-year study. J Am Med Inform Assoc 2003; 10 (01) 69-84
    CrossrefPubMedGoogle Scholar
  • 77 Hersh W. Health care information technology: progress and barriers. JAMA 2004; 292 (18) 2273-2274
    CrossrefPubMedGoogle Scholar
  • 78 Shanahan CW, Sorensen-Alawad A, Carney BL. , et al. The implementation of an integrated information system for substance use screening in general medical settings. Appl Clin Inform 2014; 5 (04) 878-894
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 79 Kirkovits T, Schinkoethe T, Drewes C. , et al. Ehealth in modern patient-caregiver communication: High rate of acceptance among physicians for additional support of breast cancer patients during long-term therapy. JMIR Cancer 2016; 2 (02) e14
    CrossrefPubMedGoogle Scholar