Subscribe to RSS
How a Digital Case Management Platform Affects Community-Based Palliative Care of Sub-Saharan African Cancer Patients: Clinician-Users' PerspectivesFunding This work was supported by the Fogarty International Center (R21TW010190).
Background Symptom control among cancer patients is a Tanzanian public health priority impacted by limited access to palliative care (PC) specialists and resources. Mobile Palliative Care Link (mPCL), a mobile/web application, aims to extend specialist access via shared care with local health workers (LHWs) with the African Palliative care Outcome Scale (POS) adapted for regular, automated symptom assessment as a core feature.
Objective The aim of the study is to assess clinicians' attitudes, beliefs, and perceptions regarding mPCL usability and utility with their patients within a government-supported, urban Tanzanian cancer hospital setting.
Methods We used a mixed methods approach including surveys, qualitative interviews, and system usage data to assess clinicians' experience with mPCL in a field study where discharged, untreatable cancer patients were randomized to mPCL or phone-contact POS collection.
Results All six specialists and 10 LHWs expressed overall satisfaction with mPCL among 49 intervention arm patients. They perceived mPCL as a way to stay connected with patients and support remote symptom control. Timely access to POS responses and medical records were identified as key benefits. Some differences in perceptions of mPCL use and utility were seen between clinician groups; however, both expressed strong interest in continuing app use, recommending it to colleagues, and extending use throughout Tanzania. Primary use was for clinical status communication and care coordination. Pain and other symptom progression were the most frequently reported reasons for provider–patient interactions accounting for 34% (n = 44) and 12% (n = 15) of reasons, respectively. Usage barriers included time required to create a new clinical record, perceived need for response to non-urgent reminders or alerts, and training. necessary for competent use. System-level implementation barriers included variable patient access to smartphones and SIM cards and unreliable Internet access.
Conclusion This work demonstrates broad clinician desire for digital health tools to support remote community-based PC among cancer patients, particularly pain management.
Protection of Human and Animal Subjects
All study activities were approved by the MUHAS Institutional Review Board. Informed consent was required and obtained from all study participants.
Received: 11 May 2022
Accepted: 16 September 2022
Article published online:
16 November 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
- 2 Jemal A, Bray F, Forman D. et al. Cancer burden in Africa and opportunities for prevention. Cancer 2012; 118 (18) 4372-4384
- 3 Parkin DM, Bray F, Ferlay J, Jemal A. Cancer in Africa 2012. Cancer Epidemiol Biomarkers Prev 2014; 23 (06) 953-966
- 4 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70 (01) 7-30
- 5 Rebbeck TR. Cancer in sub-Saharan Africa. Science 2020; 367 (6473): 27-28
- 6 Chen Z, Xu L, Shi W. et al. Trends of female and male breast cancer incidence at the global, regional, and national levels, 1990-2017. Breast Cancer Res Treat 2020; 180 (02) 481-490
- 7 Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3 (11) e442
- 8 Harding R, Selman L, Agupio G. et al. Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale. Health Qual Life Outcomes 2010; 8 (01) 10
- 9 El-Jawahri A, Greer JA, Temel JS. Does palliative care improve outcomes for patients with incurable illness? A review of the evidence. J Support Oncol 2011; 9 (03) 87-94
- 10 Temel JS, Greer JA, Muzikansky A. et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363 (08) 733-742
- 11 Harding R, Selman L, Powell RA. et al. Research into palliative care in sub-Saharan Africa. Lancet Oncol 2013; 14 (04) e183-e188
- 12 Bates MJ, Namisango E, Tomeny E, Muula A, Squire SB, Niessen L. Palliative care within universal health coverage: the Malawi Patient-and-Carer Cancer Cost Survey. BMJ Support Palliat Care 2019:bmjspcare-2019-001945
- 13 Ochieng W. Advanced cancer palliative care economics in sub-Saharan Africa: an important start. Lancet Glob Health 2021; 9 (12) e1638-e1639
- 14 District Health Information Software 2 (DHIS2). Accessed April 29, 2022 at: https://www.dhis2.org
- 15 Holst C, Sukums F, Radovanovic D, Ngowi B, Noll J, Winkler AS. Sub-Saharan Africa-the new breeding ground for global digital health. Lancet Digit Health 2020; 2 (04) e160-e162
- 16 World Health Organization. Global Status Report on Noncommunicable Diseases 2014. World Health Organization. 2014 . Accessed January 31, 2022 at: https://apps.who.int/iris/handle/10665/148114
- 17 Rural population (% of total population) - Tanzania | Data. Accessed September 20, 2021 at: https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?locations=TZ
- 18 Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. J Biomed Inform 2010; 43 (01) 159-172
- 19 Marangunić N, Granić A. Technology acceptance model: a literature review from 1986 to 2013. Univers Access Inf Soc 2015; 14 (01) 81-95
- 20 Nguyen M, Fujioka J, Wentlandt K. et al. Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care. BMC Palliat Care 2020; 19 (01) 138
- 21 Yarbrough AK, Smith TB. Technology acceptance among physicians: a new take on TAM. Med Care Res Rev 2007; 64 (06) 650-672
- 22 Zakerabasali S, Ayyoubzadeh SM, Baniasadi T, Yazdani A, Abhari S. Mobile health technology and healthcare providers: systemic barriers to adoption. Healthc Inform Res 2021; 27 (04) 267-278
- 23 Morse RS, Lambden K, Quinn E. et al. A mobile app to improve symptom control and information exchange among specialists and local health workers treating Tanzanian cancer patients: human-centered design approach. JMIR Cancer 2021; 7 (01) e24062
- 24 Ngoma M, Mushi B, Morse RS. et al. mPalliative care link: examination of a mobile solution to palliative care coordination among Tanzanian patients with cancer. JCO Glob Oncol 2021; 7 (07) 1306-1315
- 25 Dimagi, Inc. (2002). CommCare (version 2.42.2) [Mobile/Web application software]. Available at http://commcarehq.org
- 26 Skype | Stay connected with free video calls worldwide. Accessed April 29, 2022 at: https://www.skype.com/en//
- 27 Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15 (09) 1277-1288
- 28 Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther 2009; 89 (02) 125-135
- 29 Charmaz K. Constructing Grounded Theory: A practical guide through qualitative analysis Kathy Charmaz Constructing Grounded Theory: A practical guide through qualitative analysis Sage 224 £19.99 0761973532 0761973532. Nurse Res 2006; 13 (04) 84
- 30 Cohen DJ, Crabtree BF. Evaluative criteria for qualitative research in health care: controversies and recommendations. Ann Fam Med 2008; 6 (04) 331-339
- 31 Prater L, Sanchez A, Modan G. et al. Electronic health record documentation patterns of recorded primary care visits focused on complex communication: a qualitative study. Appl Clin Inform 2019; 10 (02) 247-253
- 32 Project ECHO. Bridging the Gap in Health Care for Rural and Underserved Communities. RWJF. Published April 24, 2014. Accessed March 7, 2022 at: https://www.rwjf.org/en/library/research/2014/04/project-echo–bridging-the-gap-in-health-care-for-rural-and-unde.html
- 33 Reichheld FF. The one number you need to grow. Harv Bus Rev 2003; 81 (12) 46-54 , 124