TY - JOUR AU - Yung, Alan AU - Shaw, Tim AU - Kay, Judy AU - Janssen, Anna PY - 2025/6/11 TI - Examining How Technology Supports Shared Decision-Making in Oncology Consultations: Qualitative Thematic Analysis JO - JMIR Cancer SP - e70827 VL - 11 KW - digital health KW - patient-centered care KW - person-centered care KW - shared decision-making KW - cancer care KW - oncology KW - artificial intelligence KW - AI N2 - Background: Commonly used digital health technologies, such as electronic health record systems and patient portals as well as custom-built digital decision aids, have the potential to enhance person-centered shared decision-making (SDM) in cancer care. SDM is a 2-way exchange of information between at least a clinician and the patient and a shared commitment to make informed decisions. However, there is little evidence in the literature on how technologies are used for SDM or how best they can be designed and integrated into workflows and practice. This may be due to the nature of SDM, which is fundamentally human interactions and conversations that produce desired human outcomes. Therefore, technology must be nonintrusive while supporting the human decision-making process. Objective: This study examined how digital technologies can help cancer care professionals improve SDM in oncology consultations. Methods: Health care professionals who treat patients with cancer were invited to participate in online co-design focus group meetings. During these sessions, they shared their experiences using digital technologies for SDM and provided suggestions to improve their use of digital technologies. The session recordings were transcribed and then analyzed using qualitative thematic analysis. The 3-talk SDM model, which consists of 3 steps?team talk, option talk, and decision talk?was used as the guiding framework. This approach was chosen because the 3-talk SDM model has been adopted in Australia. The researchers walked the participants through the SDM model and discussed their routine clinical workflows. Results: In total, 9 health care professionals with experience treating patients with cancer and using technologies participated in the study. Two focus groups and 2 interviews were conducted in 2024. Three themes and 7 subthemes were generated from the thematic analysis. The findings indicated that various digital technologies, such as electronic health record systems, mobile devices, and patient portals, are used by cancer care professionals to help improve patients? understanding of their disease and available care options. Digital technologies can both improve and undermine SDM. Current systems are generally not designed to support SDM. Key issues such as data integration and interoperability between systems negatively impact the ability of digital technologies to support SDM. Emerging technologies such as generative artificial intelligence were discussed as potential facilitators of SDM by automating information gathering and sharing with patients and between health professionals. Conclusions: This research indicates that digital technologies have the potential to impact SDM in oncology consultations. However, this potential has not yet been fully realized, and significant modifications are required to optimize their usefulness in person-centered SDM. Although technology can facilitate information sharing and improve the efficiency of consultation workflows, it is only part of a complex human communication process that needs support from multiple sources, including the broader multidisciplinary cancer team. UR - https://cancer.jmir.org/2025/1/e70827 UR - http://dx.doi.org/10.2196/70827 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/70827 ER - TY - JOUR AU - Heudel, Pierre AU - Ahmed, Mashal AU - Renard, Felix AU - Attye, Arnaud PY - 2025/5/23 TI - Leveraging Digital Twins for Stratification of Patients with Breast Cancer and Treatment Optimization in Geriatric Oncology: Multivariate Clustering Analysis JO - JMIR Cancer SP - e64000 VL - 11 KW - digital twins KW - artificial intelligence KW - breast cancer KW - older adult patients with cancer KW - treatment KW - geriatric oncology KW - geriatric KW - oncology KW - cancer KW - clustering analysis KW - therapeutic KW - older adult KW - elder KW - old KW - patients with cancer KW - decision-making tools KW - decision-making KW - manifold learning model KW - chemotherapy KW - comorbidities KW - comorbidity KW - health care N2 - Background: Defining optimal adjuvant therapeutic strategies for older adult patients with breast cancer remains a challenge, given that this population is often overlooked and underserved in clinical research and decision-making tools. Objectives: This study aimed to develop a prognostic and treatment guidance tool tailored to older adult patients using artificial intelligence (AI) and a combination of clinical and biological features. Methods: A retrospective analysis was conducted on data from women aged 70+ years with HER2-negative early-stage breast cancer treated at the French Léon Bérard Cancer Center between 1997 and 2016. Manifold learning and machine learning algorithms were applied to uncover complex data relationships and develop predictive models. Predictors included age, BMI, comorbidities, hemoglobin levels, lymphocyte counts, hormone receptor status, Scarff-Bloom-Richardson grade, tumor size, and lymph node involvement. The dimension reduction technique PaCMAP was used to map patient profiles into a 3D space, allowing comparison with similar cases to estimate prognoses and potential treatment benefits. Results: Out of 1229 initial patients, 793 were included after data refinement. The selected predictors demonstrated high predictive efficacy for 5-year mortality, with mean area under the curve scores of 0.81 for Random Forest Classification and 0.76 for Support Vector Classifier. The tool categorized patients into prognostic clusters and enabled the estimation of treatment outcomes, such as chemotherapy benefits. Unlike traditional models that focus on isolated factors, this AI-based approach integrates multiple clinical and biological features to generate a comprehensive biomedical profile. Conclusions: This study introduces a novel AI-driven prognostic tool for older adult patients with breast cancer, enhancing treatment guidance by leveraging advanced machine learning techniques. The model provides a more nuanced understanding of disease dynamics and therapeutic strategies, emphasizing the importance of personalized oncology care. UR - https://cancer.jmir.org/2025/1/e64000 UR - http://dx.doi.org/10.2196/64000 ID - info:doi/10.2196/64000 ER - TY - JOUR AU - Bai, Xuexue AU - Wang, Shiyong AU - Zhao, Yuanli AU - Feng, Ming AU - Ma, Wenbin AU - Liu, Xiaomin PY - 2025/5/21 TI - Application of AI Chatbot in Responding to Asynchronous Text-Based Messages From Patients With Cancer: Comparative Study JO - J Med Internet Res SP - e67462 VL - 27 KW - artificial intelligence, chatbot, telemedicine KW - oncology KW - comparative study N2 - Background: Telemedicine, which incorporates artificial intelligence such as chatbots, offers significant potential for enhancing health care delivery. However, the efficacy of artificial intelligence chatbots compared to human physicians in clinical settings remains underexplored, particularly in complex scenarios involving patients with cancer and asynchronous text-based interactions. Objective: This study aimed to evaluate the performance of the GPT-4 (OpenAI) chatbot in responding to asynchronous text-based medical messages from patients with cancer by comparing its responses with those of physicians across two clinical scenarios: patient education and medical decision-making. Methods: We collected 4257 deidentified asynchronous text-based medical consultation records from 17 oncologists across China between January 1, 2020, and March 31, 2024. Each record included patient questions, demographic data, and disease-related details. The records were categorized into two scenarios: patient education (eg, symptom explanations and test interpretations) and medical decision-making (eg, treatment planning). The GPT-4 chatbot was used to simulate physician responses to these records, with each session conducted in a new conversation to avoid cross-session interference. The chatbot responses, along with the original physician responses, were evaluated by a medical review panel (3 oncologists) and a patient panel (20 patients with cancer). The medical panel assessed completeness, accuracy, and safety using a 3-level scale, whereas the patient panel rated completeness, trustworthiness, and empathy on a 5-point ordinal scale. Statistical analyses included chi-square tests for categorical variables and Wilcoxon signed-rank tests for ordinal ratings. Results: In the patient education scenario (n=2364), the chatbot scored higher than physicians in completeness (n=2301, 97.34% vs n=2213, 93.61% for fully complete responses; P=.002), with no significant differences in accuracy or safety (P>.05). In the medical decision-making scenario (n=1893), the chatbot exhibited lower accuracy (n=1834, 96.88% vs n=1855, 97.99% for fully accurate responses; P<.001) and trustworthiness (n=860, 50.71% vs n=1766, 93.29% rated as ?Moderately trustworthy? or higher; P<.001) compared with physicians. Regarding empathy, the medical review panel rated the chatbot as demonstrating higher empathy scores across both scenarios, whereas the patient review panel reached the opposite conclusion, consistently favoring physicians in empathetic communication. Errors in chatbot responses were primarily due to misinterpretations of medical terminology or the lack of updated guidelines, with 3.12% (59/1893) of its responses potentially leading to adverse outcomes, compared with 2.01% (38/1893) for physicians. Conclusions: The GPT-4 chatbot performs comparably to physicians in patient education by providing comprehensive and empathetic responses. However, its reliability in medical decision-making remains limited, particularly in complex scenarios requiring nuanced clinical judgment. These findings underscore the chatbot?s potential as a supplementary tool in telemedicine while highlighting the need for physician oversight to ensure patient safety and accuracy. UR - https://www.jmir.org/2025/1/e67462 UR - http://dx.doi.org/10.2196/67462 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67462 ER - TY - JOUR AU - Le Dû, Katell AU - Chauchet, Adrien AU - Sadot-Lebouvier, Sophie AU - Fitoussi, Olivier AU - Fontanet, Bijou AU - Saint-Lezer, Arnaud AU - Maloisel, Frédéric AU - Rossi, Cédric AU - Carras, Sylvain AU - Parcelier, Anne AU - Balavoine, Magali AU - Septans, Anne-Lise PY - 2025/5/6 TI - Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma) JO - JMIR Cancer SP - e65960 VL - 11 KW - patient-reported outcome measures KW - lymphoma KW - risk of relapse KW - relapse KW - randomized trial KW - web-based KW - quality of life KW - survival KW - detection KW - progression KW - T-cell lymphoma KW - Hodgkin lymphoma N2 - Background: Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse. Objective: This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire. Methods: We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90% to detect a 30% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis. Results: A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3?25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7%) compared with 30.2% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8?20.6) months and 6.7 (range 1.9?16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled. Conclusions: The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines. Trial Registration: ClinicalTrials.gov NCT03154710; https://clinicaltrials.gov/ct2/show/NCT03154710 UR - https://cancer.jmir.org/2025/1/e65960 UR - http://dx.doi.org/10.2196/65960 ID - info:doi/10.2196/65960 ER - TY - JOUR AU - Lin, Ching-Hsiung AU - Wang, Bing-Yen AU - Lin, Sheng-Hao AU - Shih, Hsuan Pei AU - Lee, Chin-Jing AU - Huang, Ting Yung AU - Chen, Chieh Shih AU - Pan, Mei-Lien PY - 2025/5/5 TI - Process Re-Engineering and Data Integration Using Fast Healthcare Interoperability Resources for the Multidisciplinary Treatment of Lung Cancer JO - JMIR Cancer SP - e53887 VL - 11 KW - multidisciplinary team meetings KW - process re-engineering KW - multidisciplinary cancer care KW - Fast Healthcare Interoperability Resources KW - tumor board KW - multidisciplinary team KW - cancer KW - lung cancer KW - treatment KW - lung KW - health care professionals KW - health care KW - MDT KW - digitize KW - API KW - hospital KW - information system KW - HIS KW - medical data KW - platform KW - data integration KW - information and communication technology KW - ICT KW - decision support KW - eHealth KW - digital tools KW - clinic KW - patient care KW - application programming interface KW - hospital information system UR - https://cancer.jmir.org/2025/1/e53887 UR - http://dx.doi.org/10.2196/53887 ID - info:doi/10.2196/53887 ER - TY - JOUR AU - Battistuzzi, Linda AU - Giannubilo, Irene AU - Bighin, Claudia PY - 2025/4/29 TI - Prognostic Disclosure in Metastatic Breast Cancer: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e57256 VL - 14 KW - scoping review KW - protocol KW - metastatic breast cancer KW - advanced breast cancer KW - prognostic disclosure KW - prognosis KW - communication KW - truth-telling KW - ethics KW - shared decision-making N2 - Background: Prognostic disclosure enables shared decision-making by keeping patients informed about their health and involved in treatment-related choices. In metastatic cancer, patients who understand their prognosis are better placed to evaluate their health situation, have more realistic expectations about treatment, and better end-of-life (EoL) care. However, many oncologists feel uncomfortable discussing prognoses with their patients, as they worry about causing psychological distress and diminishing hope. Other barriers to prognostic disclosure are associated with the inherent uncertainty of prognostication, which is especially prominent in metastatic breast cancer (mBC), as are a lack of timely discussions about EoL care and poor quality of care at EoL. Despite this background, a preliminary literature search has shown that, to date, knowledge about prognostic disclosure in mBC has not been systematically mapped. Objective: The overall aim of this scoping review will be to comprehensively explore the existing literature pertaining to prognostic disclosure in mBC. Methods: This scoping review will follow Arksey and O?Malley?s expanded framework. We will systematically search electronic databases for peer-reviewed, published journal articles to identify appropriate studies. First, 2 members of the research team will independently review titles and abstracts. Then, they will review full texts to establish whether articles meet inclusion criteria. A data chart for collecting and sorting information will be developed. Results will be reported following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and summarized quantitatively and qualitatively. Results: We expect to present the results in a scoping review in 2025. Conclusions: To our knowledge, this scoping review will be the first systematic effort aimed at mapping existing literature on prognostic disclosure in mBC, in which rapidly developing therapeutic approaches and changing disease trajectories generate new uncertainties and place new communicative demands on oncologists. The insights gained from this scoping review will inform the development of an interview schedule with oncologists, oncology residents, oncology nurses, and patients with mBC to explore their experiences, views, and perceptions about prognostic disclosure. International Registered Report Identifier (IRRID): PRR1-10.2196/57256 UR - https://www.researchprotocols.org/2025/1/e57256 UR - http://dx.doi.org/10.2196/57256 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57256 ER - TY - JOUR AU - Weisman, Dan AU - Sugarman, Alanna AU - Huang, Ming Yue AU - Gelberg, Lillian AU - Ganz, A. Patricia AU - Comulada, Scott Warren PY - 2025/4/17 TI - Development of a GPT-4?Powered Virtual Simulated Patient and Communication Training Platform for Medical Students to Practice Discussing Abnormal Mammogram Results With Patients: Multiphase Study JO - JMIR Form Res SP - e65670 VL - 9 KW - standardized patient KW - virtual simulated patient KW - artificial intelligence KW - AI KW - large language model KW - LLM KW - GPT-4 KW - agent KW - communication skills training KW - abnormal mammography results KW - biopsy N2 - Background: Standardized patients (SPs) prepare medical students for difficult conversations with patients. Despite their value, SP-based simulation training is constrained by available resources and competing clinical demands. Researchers are turning to artificial intelligence and large language models, such as generative pretrained transformers, to create communication training that incorporates virtual simulated patients (VSPs). GPT-4 is a large language model advance allowing developers to design virtual simulation scenarios using text-based prompts instead of relying on branching path simulations with prescripted dialogue. These nascent developmental practices have not taken root in the literature to guide other researchers in developing their own simulations. Objective: This study aims to describe our developmental process and lessons learned for creating a GPT-4?driven VSP. We designed the VSP to help medical student learners rehearse discussing abnormal mammography results with a patient as a primary care physician (PCP). We aimed to assess GPT-4?s ability to generate appropriate VSP responses to learners during spoken conversations and provide appropriate feedback on learner performance. Methods: A research team comprised of physicians, a medical student, an educator, an SP program director, a learning experience designer, and a health care researcher conducted the study. A formative phase with in-depth knowledge user interviews informed development, followed by a development phase to create the virtual training module. The team conducted interviews with 5 medical students, 5 PCPs, and 5 breast cancer survivors. They then developed a VSP using simulation authoring software and provided the GPT-4?enabled VSP with an initial prompt consisting of a scenario description, emotional state, and expectations for learner dialogue. It was iteratively refined through an agile design process involving repeated cycles of testing, documenting issues, and revising the prompt. As an exploratory feature, the simulation used GPT-4 to provide written feedback to learners about their performance communicating with the VSP and their adherence to guidelines for difficult conversations. Results: In-depth interviews helped establish the appropriate timing, mode of communication, and protocol for conversations between PCPs and patients during the breast cancer screening process. The scenario simulated a telephone call between a physician and patient to discuss the abnormal results of a diagnostic mammogram that that indicated a need for a biopsy. Preliminary testing was promising. The VSP asked sensible questions about their mammography results and responded to learner inquiries using a voice replete with appropriate emotional inflections. GPT-4 generated performance feedback that successfully identified strengths and areas for improvement using relevant quotes from the learner-VSP conversation, but it occasionally misidentified learner adherence to communication protocols. Conclusions: GPT-4 streamlined development and facilitated more dynamic, humanlike interactions between learners and the VSP compared to branching path simulations. For the next steps, we will pilot-test the VSP with medical students to evaluate its feasibility and acceptability. UR - https://formative.jmir.org/2025/1/e65670 UR - http://dx.doi.org/10.2196/65670 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65670 ER - TY - JOUR AU - Yang, Xiongwen AU - Xiao, Yi AU - Liu, Di AU - Shi, Huiyou AU - Deng, Huiyin AU - Huang, Jian AU - Zhang, Yun AU - Liu, Dan AU - Liang, Maoli AU - Jin, Xing AU - Sun, Yongpan AU - Yao, Jing AU - Zhou, XiaoJiang AU - Guo, Wankai AU - He, Yang AU - Tang, Weijuan AU - Xu, Chuan PY - 2025/4/17 TI - Enhancing Physician-Patient Communication in Oncology Using GPT-4 Through Simplified Radiology Reports: Multicenter Quantitative Study JO - J Med Internet Res SP - e63786 VL - 27 KW - radiology reports KW - doctor-patient communication KW - large language models KW - oncology KW - GPT-4 N2 - Background: Effective physician-patient communication is essential in clinical practice, especially in oncology, where radiology reports play a crucial role. These reports are often filled with technical jargon, making them challenging for patients to understand and affecting their engagement and decision-making. Large language models, such as GPT-4, offer a novel approach to simplifying these reports and potentially enhancing communication and patient outcomes. Objective: We aimed to assess the feasibility and effectiveness of using GPT-4 to simplify oncological radiology reports to improve physician-patient communication. Methods: In a retrospective study approved by the ethics review committees of multiple hospitals, 698 radiology reports for malignant tumors produced between October 2023 and December 2023 were analyzed. In total, 70 (10%) reports were selected to develop templates and scoring scales for GPT-4 to create simplified interpretative radiology reports (IRRs). Radiologists checked the consistency between the original radiology reports and the IRRs, while volunteer family members of patients, all of whom had at least a junior high school education and no medical background, assessed readability. Doctors evaluated communication efficiency through simulated consultations. Results: Transforming original radiology reports into IRRs resulted in clearer reports, with word count increasing from 818.74 to 1025.82 (P<.001), volunteers? reading time decreasing from 674.86 seconds to 589.92 seconds (P<.001), and reading rate increasing from 72.15 words per minute to 104.70 words per minute (P<.001). Physician-patient communication time significantly decreased, from 1116.11 seconds to 745.30 seconds (P<.001), and patient comprehension scores improved from 5.51 to 7.83 (P<.001). Conclusions: This study demonstrates the significant potential of large language models, specifically GPT-4, to facilitate medical communication by simplifying oncological radiology reports. Simplified reports enhance patient understanding and the efficiency of doctor-patient interactions, suggesting a valuable application of artificial intelligence in clinical practice to improve patient outcomes and health care communication. UR - https://www.jmir.org/2025/1/e63786 UR - http://dx.doi.org/10.2196/63786 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63786 ER - TY - JOUR AU - Baygi, Fereshteh AU - Bitz Trabjerg, Theis AU - Jensen, Henrik Lars AU - Munch Storsveen, Maria AU - Wehberg, Sonja AU - Sisler, James Jeffrey AU - Søndergaard, Jens AU - Gilså Hansen, Dorte PY - 2025/2/11 TI - Challenges of Cross-Sectoral Video Consultation in Cancer Care on Patients? Perceived Coordination: Randomized Controlled Trial JO - JMIR Cancer SP - e60158 VL - 11 KW - randomized controlled trials KW - video consultations KW - outcome assessment KW - patients? satisfaction KW - patients? care coordination KW - interprofessional relations KW - cancer N2 - Background: Patients with cancer need coordinated care for both treatment and concurrent health conditions. This requires collaboration among specialists when using telemedicine services, emphasizing the importance of care continuity. Objective: This study aimed to explore the effects of cross-sectorial video consultation involving oncologists, general practitioners, and patients with cancer on patients? perceived coordination of care, compared with usual care. Methods: This study describes the primary outcomes from a 7-month follow-up of patients in the Partnership Project, a randomized clinical trial. Patients in the intervention group were randomized to receive a ?partnership consultation,? a shared video consultation with an oncologist, general practitioners, and the patient, in addition to their usual care. Questionnaires were completed for both groups at baseline and 7 months to assess the primary outcome, ?global assessment of inter-sectorial cooperation,? from the Danish questionnaire ?Patients? attitude to the health care service.? The questionnaire also included 2 single items and 5 index scales, examining patients? attitude toward cooperation in the health care system. Change in perceived global coordination from baseline to 7 months was compared between intention-to-treat groups using generalized estimating equations in a linear regression model. Results: A total of 278 participants were randomized with 1:1 allocation, with 80 patients receiving the intervention. Further, 210 patients completed the questionnaire at baseline, while 118 responded at 7-month follow-up. The estimated difference in the primary outcome between usual care (?0.13, 95% CI ?0.38 to 0.12) and intervention (0.11, 95% CI ?0.11 to 0.34) was 0.24 (95% CI ?0.09 to 0.58) and not statistically significant (P=.15). Conclusions: Low rates of intervention completion and high levels of missing data compromised the interpretability of our study. While we observed a high level of global assessment of coordination, the estimated intervention effect was smaller than anticipated, with no significant difference in perceived coordination between control and intervention groups. Future studies should explore strategies like patient incentives to increase response rate and improve the evaluation of this innovative health care model. Trial Registration: ClinicalTrials.gov NCT02716168; https://clinicaltrials.gov/study/NCT02716168 International Registered Report Identifier (IRRID): RR2-10.1186/s12875-019-0978-8 UR - https://cancer.jmir.org/2025/1/e60158 UR - http://dx.doi.org/10.2196/60158 ID - info:doi/10.2196/60158 ER - TY - JOUR AU - Wu, Xingyue AU - Lam, Sing Chun AU - Hui, Ho Ka AU - Loong, Ho-fung Herbert AU - Zhou, Rui Keary AU - Ngan, Chun-Kit AU - Cheung, Ting Yin PY - 2025/2/10 TI - Perceptions in 3.6 Million Web-Based Posts of Online Communities on the Use of Cancer Immunotherapy: Data Mining Using BERTopic JO - J Med Internet Res SP - e60948 VL - 27 KW - social media KW - cancer KW - immunotherapy KW - perceptions KW - data mining KW - oncology KW - web-based KW - lifestyle KW - therapeutic intervention KW - leukemia KW - lymphoma KW - survival KW - treatment KW - health information KW - decision-making KW - online community KW - machine learning N2 - Background: Immunotherapy has become a game changer in cancer treatment. The internet has been used by patients as a platform to share personal experiences and seek medical guidance. Despite the increased utilization of immunotherapy in clinical practice, few studies have investigated the perceptions about its use by analyzing social media data. Objective: This study aims to use BERTopic (a topic modeling technique that is an extension of the Bidirectional Encoder Representation from Transformers machine learning model) to explore the perceptions of online cancer communities regarding immunotherapy. Methods: A total of 4.9 million posts were extracted from Facebook, Twitter, Reddit, and 16 online cancer-related forums. The textual data were preprocessed by natural language processing. BERTopic modeling was performed to identify topics from the posts. The effectiveness of isolating topics from the posts was evaluated using 3 metrics: topic diversity, coherence, and quality. Sentiment analysis was performed to determine the polarity of each topic and categorize them as positive or negative. Based on the topics generated through topic modeling, thematic analysis was conducted to identify themes associated with immunotherapy. Results: After data cleaning, 3.6 million posts remained for modeling. The highest overall topic quality achieved by BERTopic was 70.47% (topic diversity: 87.86%; topic coherence: 80.21%). BERTopic generated 14 topics related to the perceptions of immunotherapy. The sentiment score of around 0.3 across the 14 topics suggested generally positive sentiments toward immunotherapy within the online communities. Six themes were identified, primarily covering (1) hopeful prospects offered by immunotherapy, (2) perceived effectiveness of immunotherapy, (3) complementary therapies or self-treatments, (4) financial and mental impact of undergoing immunotherapy, (5) impact on lifestyle and time schedules, and (6) side effects due to treatment. Conclusions: This study provides an overview of the multifaceted considerations essential for the application of immunotherapy as a therapeutic intervention. The topics and themes identified can serve as supporting information to facilitate physician-patient communication and the decision-making process. Furthermore, this study also demonstrates the effectiveness of BERTopic in analyzing large amounts of data to identify perceptions underlying social media and online communities. UR - https://www.jmir.org/2025/1/e60948 UR - http://dx.doi.org/10.2196/60948 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60948 ER - TY - JOUR AU - Mazzella-Ebstein, Marie Ann AU - Daly, Robert AU - Huang, Jennie AU - Bernal, Camila AU - Wilhelm, Clare AU - Panageas, S. Katherine AU - Holland, Jessie AU - Salvaggio, Rori AU - Ackerman, Jill AU - Cracchiolo, Jennifer AU - Kuperman, Gilad AU - Mao, Jun AU - Begue, Aaron AU - Barton-Burke, Margaret PY - 2025/1/24 TI - Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach JO - JMIR Hum Factors SP - e60585 VL - 12 KW - cancer KW - oncology KW - clinician end users KW - remote patient monitoring KW - digital health KW - implementation science KW - patient monitoring KW - patient access KW - care KW - communication KW - usability KW - functionality KW - survey KW - interview KW - efficiency KW - workflow KW - user KW - clinician support N2 - Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians? workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program?s utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. UR - https://humanfactors.jmir.org/2025/1/e60585 UR - http://dx.doi.org/10.2196/60585 ID - info:doi/10.2196/60585 ER - TY - JOUR AU - Hashtarkhani, Soheil AU - Zhou, Yiwang AU - Kumsa, Asefa Fekede AU - White-Means, Shelley AU - Schwartz, L. David AU - Shaban-Nejad, Arash PY - 2025/1/16 TI - Analyzing Geospatial and Socioeconomic Disparities in Breast Cancer Screening Among Populations in the United States: Machine Learning Approach JO - JMIR Cancer SP - e59882 VL - 11 KW - mammography KW - breast neoplasms KW - social determinants of health KW - geographic information systems KW - machine learning N2 - Background: Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates. Objective: This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates. Methods: Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large-scale dataset of social determinants of health, comprising 13 variables for 72,337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence. Results: Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06, compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor?s degree were the most influential variables, all positively associated with mammography screening rates. Conclusions: These findings underscore the significance of social determinants and the accessibility of mammography services in explaining the variability of breast cancer screening rates in the United States, emphasizing the need for targeted policy interventions in areas with relatively lower screening rates. UR - https://cancer.jmir.org/2025/1/e59882 UR - http://dx.doi.org/10.2196/59882 ID - info:doi/10.2196/59882 ER - TY - JOUR AU - Hemler, R. Jennifer AU - Wagner, B. Rachel AU - Sullivan, Brittany AU - Macenat, Myneka AU - Tagai, K. Erin AU - Vega, L. Jazmarie AU - Hernandez, Enrique AU - Miller, M. Suzanne AU - Wen, Kuang-Yi AU - Ayers, A. Charletta AU - Einstein, H. Mark AU - Hudson, V. Shawna AU - Kohler, E. Racquel PY - 2025/1/14 TI - A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives JO - JMIR Form Res SP - e55043 VL - 9 KW - cervical cancer screening KW - colposcopy KW - HPV KW - human papillomavirus KW - mHealth KW - health communication KW - qualitative research KW - cancer screening KW - cancer KW - cervical cancer KW - screening KW - women KW - clinic staff KW - barrier KW - messaging KW - privacy KW - text message KW - qualitative KW - colposcopic KW - mhealth intervention KW - mobile phone N2 - Background: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. Objective: This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Methods: Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Results: Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Conclusions: Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial. UR - https://formative.jmir.org/2025/1/e55043 UR - http://dx.doi.org/10.2196/55043 UR - http://www.ncbi.nlm.nih.gov/pubmed/39808485 ID - info:doi/10.2196/55043 ER - TY - JOUR AU - Davis, Alexis AU - Martin, Joshua AU - Cooks, Eric AU - Vilaro, Melissa AU - Wilson-Howard, Danyell AU - Tang, Kevin AU - Raup Krieger, Janice PY - 2024/12/19 TI - From English to ?Englishes?: A Process Perspective on Enhancing the Linguistic Responsiveness of Culturally Tailored Cancer Prevention Interventions JO - J Particip Med SP - e57528 VL - 16 KW - behavior change KW - community-engaged research KW - cancer screening KW - colorectal cancers KW - communication KW - communication accommodation KW - linguistics UR - https://jopm.jmir.org/2024/1/e57528 UR - http://dx.doi.org/10.2196/57528 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57528 ER - TY - JOUR AU - Baxter-King, Ryan AU - Naeim, Arash AU - Huang, Q. Tina AU - Sepucha, Karen AU - Stanton, Annette AU - Rudkin, Aaron AU - Ryu, Rita AU - Sabacan, Leah AU - Vavreck, Lynn AU - Esserman, Laura AU - Stover Fiscalini, Allison AU - Wenger, S. Neil PY - 2024/12/2 TI - Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study JO - JMIR Cancer SP - e47856 VL - 10 KW - breast cancer KW - COVID-19 risk perception KW - cancer screening KW - anxiety KW - cancer KW - COVID-19 KW - prevention KW - medical care KW - screening KW - survey N2 - Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women?s breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI ?0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. UR - https://cancer.jmir.org/2024/1/e47856 UR - http://dx.doi.org/10.2196/47856 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47856 ER - TY - JOUR AU - Gong, Jie AU - Gu, Dandan AU - Dong, Suyun AU - Shen, Wangqin AU - Yan, Haiou AU - Xie, Juan PY - 2024/11/7 TI - Effects of Message Framing on Human Papillomavirus Vaccination: Systematic Review JO - J Med Internet Res SP - e52738 VL - 26 KW - message framing KW - gain-loss framing KW - human papillomavirus KW - vaccination KW - attitude KW - intention KW - behavior KW - systematic review KW - PRISMA N2 - Background: With the advancement of cervical cancer elimination strategies, promoting human papillomavirus (HPV) vaccination is essential to achieving this goal. The issue of how to structure and develop message content to promote HPV vaccination is a debatable issue. Objective: The efficacy of gain-loss framing in vaccination contexts is disputed. Our study aimed to elucidate the consequences of message framing on attitudes, intentions, and behavioral tendencies toward HPV vaccination, with the objective of refining message framing strategies and their elements. Methods: This systematic review adhered strictly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline reporting standards to comprehensively retrieve, extract, and integrate data. We searched databases, including PubMed, Embase, Scopus, and Web of Science, for literature published from database construction to August 15, 2023. Literature screening, data extraction, and quality evaluation were performed by 2 researchers. Intervention studies published in English, conducted with populations with children eligible for HPV vaccination, and involving message framing were included. Attitudes, intentions, and behaviors served as outcome evaluation criteria. Results: A total of 19 intervention studies were included. Gain-loss framing had no clear effect on vaccination attitudes nor intentions. Loss framing showed a weak advantage at improving HPV vaccination attitudes or intentions, but the evidence was not strong enough to draw definitive conclusions. The impact of gain-loss framing on HPV vaccination behaviors could not be determined due to the limited number of studies and the qualitative nature of the analysis. Conclusions: Combining gain-loss framing with other message framing approaches may be an effective way to enhance the effect of message framing. More high-quality message framing content and exploring alternative moderator or mediator variables are required to support the conclusion. Trial Registration: CRD42023451612; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=451612 UR - https://www.jmir.org/2024/1/e52738 UR - http://dx.doi.org/10.2196/52738 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52738 ER - TY - JOUR AU - Owens-Jasey, Constance AU - Chen, Jinying AU - Xu, Ran AU - Angier, Heather AU - Huebschmann, G. Amy AU - Ito Fukunaga, Mayuko AU - Chaiyachati, H. Krisda AU - Rendle, A. Katharine AU - Robien, Kim AU - DiMartino, Lisa AU - Amante, J. Daniel AU - Faro, M. Jamie AU - Kepper, M. Maura AU - Ramsey, T. Alex AU - Bressman, Eric AU - Gold, Rachel PY - 2024/4/30 TI - Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review JO - JMIR Cancer SP - e49002 VL - 10 KW - cancer prevention KW - health information technology KW - implementation KW - implementation strategies KW - scoping review N2 - Background: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. Objective: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. Methods: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record?based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer?relevant studies; 9/14, 64% of breast cancer?relevant studies; and 7/10, 70% of cervical cancer?relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. Conclusions: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations. UR - https://cancer.jmir.org/2024/1/e49002 UR - http://dx.doi.org/10.2196/49002 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687595 ID - info:doi/10.2196/49002 ER - TY - JOUR AU - Ow, Tsai-Wing AU - Sukocheva, Olga AU - Bampton, Peter AU - Iyngkaran, Guruparan AU - Rayner, K. Christopher AU - Tse, Edmund PY - 2024/2/22 TI - Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study JO - JMIR Cancer SP - e46625 VL - 10 KW - colorectal cancer KW - guidelines KW - colorectal cancer screening KW - digital application KW - questionnaire KW - application KW - cancer prevention KW - prevention KW - cancer KW - bowel cancer KW - surveillance KW - clinical vignette quiz KW - usability KW - Australia N2 - Background: Australia?s bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. Objective: This study aims to assess whether a DA could increase clinician adherence to Australia?s new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. Methods: As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA?s usability using the System Usability Scale. Results: Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants? adherence improved by 40% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). Conclusions: DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further. UR - https://cancer.jmir.org/2024/1/e46625 UR - http://dx.doi.org/10.2196/46625 UR - http://www.ncbi.nlm.nih.gov/pubmed/38238256 ID - info:doi/10.2196/46625 ER - TY - JOUR AU - Young, Karen AU - Xiong, Ting AU - Lee, Rachel AU - Banerjee, Tina Ananya AU - Leslie, Myles AU - Ko, Yu Wellam AU - Guo, Jia Julia Yu AU - Pham, Quynh PY - 2023/12/28 TI - Honoring the Care Experiences of Chinese Canadian Survivors of Prostate Cancer to Cultivate Cultural Safety and Relationality in Digital Health: Exploratory-Descriptive Qualitative Study JO - J Med Internet Res SP - e49349 VL - 25 KW - digital health KW - virtual care KW - digital therapeutics KW - prostate cancer KW - cancer survivorship KW - social determinants of health KW - structural determinants of health KW - supportive care KW - cultural adaptation KW - Chinese Canadians N2 - Background: Prostate cancer (PCa) is the most commonly diagnosed nonskin cancer for Canadian men and has one of the highest 5-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors? care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities. Objective: This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care app, the Ned (no evidence of disease) Clinic. Methods: An axiology of relational accountability and a relational paradigm underpinned our phenomenologically informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centered design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analyzed to explore their unmet needs, common experiences, and levels of digital literacy. Results: Unmet needs and technology preferences were similar to broader trends within the wider community of PCa survivors. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally informed coping mechanisms, such as ?eating bitterness,? and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as ?better than nothing;? it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and well-being rather than the cultural adaptation of Ned for Chinese Canadians. Participants? desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians. Conclusions: Chinese Canadian survivors are seeking to strengthen their connections in a health care system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing ?trickle-up? adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions. UR - https://www.jmir.org/2023/1/e49349 UR - http://dx.doi.org/10.2196/49349 UR - http://www.ncbi.nlm.nih.gov/pubmed/38153784 ID - info:doi/10.2196/49349 ER - TY - JOUR AU - Elkefi, Safa AU - Asan, Onur PY - 2023/8/18 TI - Perceived Patient Workload and Its Impact on Outcomes During New Cancer Patient Visits: Analysis of a Convenience Sample JO - JMIR Hum Factors SP - e49490 VL - 10 KW - health care KW - cancer patients? workload KW - trust KW - satisfaction KW - health information technology N2 - Background: Studies exploring the workload in health care focus on the doctors? perspectives. The ecology of the health care environment is critical and different for doctors and patients. Objective: In this study, we explore the patient workload among newly diagnosed patients with cancer during their first visit and its impact on the patient?s perceptions of the quality of care (their trust in their doctors, their satisfaction with the care visits, their perception of technology use). Methods: We collected data from the Hackensack Meridian Health, John Theurer Cancer Center between February 2021 and May 2022. The technology use considered during the visit is related to doctors? use of electronic health records. A total of 135 participants were included in the study. Most participants were 50-64 years old (n=91, 67.41%). A majority (n=81, 60%) of them were White, and only (n=16, 11.85%) went to graduate schools. Results: The findings captured the significant effect of overall workload on trust in doctors and perception of health IT use within the visits. On the other hand, the overall workload did not impact patients? satisfaction during the visit. A total of 80% (n=108) of patients experienced an overall high level of workload. Despite almost 55% (n=75) of them experiencing a high mental load, 71.1% (n=96) reported low levels of effort, 89% (n=120) experienced low time pressure, 85.2% (n=115) experienced low frustration levels, and 69.6% (n=94) experienced low physical activity. The more overall workload patients felt, the less they trusted their doctors (odds ratio [OR] 0.059, 95% CI 0.001-2.34; P=.007). Low trust was also associated with the demanding mental tasks in the visits (OR 0.055, 95% CI 0.002-2.64; P<.001), the physical load (OR 0.194, 95% CI 0.004-4.23; P<.001), the time load (OR 0.183, 95% CI 0.02-2.35; P=.046) the effort needed to cope with the environment (OR 0.163, 95% CI 0.05-1.69; P<.001), and the frustration levels (OR 0.323, 95% CI 0.04-2.55; P=.03). The patients? perceptions of electronic health record use during the visit were negatively impacted by the overall workload experienced by the patients (OR 0.315, 95% CI 0.08-6.35; P=.01) and the high frustration level experienced (OR 0.111, 95% CI 0.015-3.75; P<.001). Conclusions: The study?s findings established pathways for future research and have implications for cancer patients? workload. Better technology design and use can minimize perceived workload, which might contribute to the trust relationship between doctors and patients in this critical environment. Future human factors work needs to explore the workload and driving factors in longitudinal studies and assess whether these workloads might contribute to unintended patient outcomes and medical errors. UR - https://humanfactors.jmir.org/2023/1/e49490 UR - http://dx.doi.org/10.2196/49490 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594798 ID - info:doi/10.2196/49490 ER - TY - JOUR AU - Acoba, D. Jared AU - Yin, Chelsea AU - Meno, Michael AU - Abe, Justin AU - Pagano, Ian AU - Tamashiro, Sharon AU - Fujinaga, Kristy AU - Braun-Inglis, Christa AU - Fukui, Jami PY - 2022/12/9 TI - Racial Disparities in Patient-Provider Communication During Telehealth Visits Versus Face-to-face Visits Among Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer: Cross-sectional Analysis JO - JMIR Cancer SP - e37272 VL - 8 IS - 4 KW - cancer KW - telemedicine KW - telehealth KW - eHealth KW - racial disparities KW - race KW - racial KW - Asia KW - Asian KW - Hawaii KW - Hawaiian KW - Native Hawaiian KW - Pacific Islander KW - cross-sectional KW - satisfaction KW - oncology KW - racially diverse KW - patient-physician communication N2 - Background: Telehealth visits increase patients? access to care and are often rated as ?just as good? as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups. Objective: Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients. Methods: We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors. Results: Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree ?[y]our physician listened carefully to you?). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits. Conclusions: Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration. UR - https://cancer.jmir.org/2022/4/e37272 UR - http://dx.doi.org/10.2196/37272 UR - http://www.ncbi.nlm.nih.gov/pubmed/36485021 ID - info:doi/10.2196/37272 ER - TY - JOUR AU - Darville-Sanders, Gabrielle AU - Reinoso, Humberto AU - MacInnes, Jann AU - Corluyan, Emilie AU - Munroe, Dominique AU - Mathis, W. Mary AU - Madden, Lamarca Suzie AU - Hamrick, Johnathan AU - Dickerson, Lisa AU - Gaddis, Cheryl PY - 2022/11/4 TI - HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study JO - JMIR Form Res SP - e38164 VL - 6 IS - 11 KW - human papillomavirus KW - HPV KW - HPV vaccine KW - provider communication KW - medical trainees KW - immunization KW - vaccine KW - communication KW - student KW - sexually transmitted infection KW - STI KW - United States of America KW - USA KW - young adult KW - teen KW - patient KW - parent KW - mobile phone N2 - Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. Objective: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. Methods: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. Results: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach ? indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport (?=.796), patient respect or empathy (?=.737), provider interview or intake (?=.9), patient counseling or education (?=.935), provider communication closure (?=.896), and provider knowledge (?=.824). Conclusions: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee?s individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates. UR - https://formative.jmir.org/2022/11/e38164 UR - http://dx.doi.org/10.2196/38164 UR - http://www.ncbi.nlm.nih.gov/pubmed/36331545 ID - info:doi/10.2196/38164 ER - TY - JOUR AU - Nanton, Veronica AU - Appleton, Rebecca AU - Ahmed, Nisar AU - Loew, Joelle AU - Roscoe, Julia AU - Muthuswamy, Radha AU - Patel, Prashant AU - Dale, Jeremy AU - Ahmedzai, H. Sam PY - 2022/10/19 TI - A Web-Based Prostate Cancer?Specific Holistic Needs Assessment (CHAT-P): Multimethod Study From Concept to Clinical Practice JO - JMIR Cancer SP - e32153 VL - 8 IS - 4 KW - Holistic Needs Assessment KW - prostate cancer KW - survivorship KW - cancer follow-up KW - coproduction KW - web-based communication KW - care planning N2 - Background: Men with prostate cancer experience immediate and long-term consequences of the disease and its treatment. They require both long-term monitoring for recurrence or progression and follow-up to identify and help manage psychosocial and physical impacts. Holistic Needs Assessment aims to ensure patient-centered continuing cancer care. However, paper-based generic tools have had limited uptake within cancer services, and there is little evidence of their impact. With the expansion of remote methods of care delivery and to enhance the value of generic tools, we developed a web-based Composite Holistic Needs Assessment Adaptive Tool-Prostate (CHAT-P) specifically for prostate cancer. Objective: This paper described the context, conceptual underpinning, and approach to design that informed the development of CHAT-P, starting from the initial concept to readiness for deployment. Through this narrative, we sought to contribute to the expanding body of knowledge regarding the coproduction process of innovative digital systems with potential for enhanced cancer care delivery. Methods: The development of CHAT-P was guided by the principles of coproduction. Men with prostate cancer and health care professionals contributed to each stage of the process. Testing was conducted iteratively over a 5-year period. An initial rapid review of patient-reported outcome measures identified candidate items for inclusion. These items were categorized and allocated to overarching domains. After the first round of user testing, further items were added, improvements were made to the adaptive branching system, and response categories were refined. A functioning version of CHAT-P was tested with 16 patients recruited from 3 outpatient clinics, with interviewers adopting the think-aloud technique. Interview transcripts were analyzed using a framework approach. Interviews and informal discussions with health care professionals informed the development of a linked care plan and clinician-facing platform, which were incorporated into a separate feasibility study of digitally enhanced integrated cancer care. Results: The findings from the interview study demonstrated the usability, acceptability, and potential value of CHAT-P. Men recognized the benefits of a personalized approach and the importance of a holistic understanding of their needs. Preparation for the consultation by the completion of CHAT-P was also recognized as empowering. The possible limitations identified were related to the importance of care teams responding to the issues selected in the assessment. The subsequent feasibility study highlighted the need for attention to men?s psychological concerns and demonstrated the ability of CHAT-P to capture red flag symptoms requiring urgent investigation. Conclusions: CHAT-P offers an innovative means by which men can communicate their concerns to their health care teams before a physical or remote consultation. There is now a need for a full evaluation of the implementation process and outcomes where CHAT-P is introduced into the clinical pathway. There is also scope for adapting the CHAT-P model to other cancers. UR - https://cancer.jmir.org/2022/4/e32153 UR - http://dx.doi.org/10.2196/32153 UR - http://www.ncbi.nlm.nih.gov/pubmed/36260380 ID - info:doi/10.2196/32153 ER - TY - JOUR AU - Spector-Bagdady, Kayte AU - Kent, Madison AU - Krenz, D. Chris AU - Brummel, Collin AU - Swiecicki, L. Paul AU - Brenner, Chad J. AU - Shuman, G. Andrew PY - 2022/5/3 TI - Patient and Provider Perspectives on Enrollment in Precision Oncology Research: Qualitative Ethical Analysis JO - JMIR Cancer SP - e35033 VL - 8 IS - 2 KW - oncology research platform KW - precision oncology KW - head and neck oncology KW - academic cancer center KW - semistructured interview KW - patient-provider dyads KW - oncology KW - interview KW - ethical analysis KW - patient KW - provider N2 - Background: The genomic frontier continues to revolutionize the practice of oncology. Advances in cancer biology from tumorigenesis to treatment resistance are driven by the molecular underpinnings of malignancy. The framing of precision oncology as both a clinical and research tool is constantly evolving and directly influences conversations between oncologists and their patients. Prior research has shown that patient-participants often have unmet or unrealistic expectations regarding the clinical utility of oncology research and genomic sequencing. This indicates the need for more in-depth investigation of how and why patients choose to participate in such research. Objective: This study presents a qualitative ethical analysis to better understand patient and provider perspectives on enrollment in precision oncology research. Methods: Paired semistructured interviews were conducted with patient-participants enrolled in a prospective head and neck precision oncology research platform, along with their oncology providers, at a National Cancer Institute?designated academic cancer center. Results: There were three major themes that emerged from the analysis. (1) There are distinct and unique challenges with informed consent to precision medicine, chiefly involving the ability of both patient-participants and providers to effectively understand the science underlying the research. (2) The unique benefits of precision medicine enrollment are of paramount importance to patients considering enrollment. (3) Patient-participants have little concern for the risks of research enrollment, particularly in the context of a low-burden protocol. Conclusions: Patient-participants and their providers offer complementary and nuanced perspectives on their motivation to engage in precision oncology research. This reflects both the inherent promise and enthusiasm within the field, as well as the limitations and challenges of ensuring that both patient-participants and clinicians understand the complexities of the science involved. UR - https://cancer.jmir.org/2022/2/e35033 UR - http://dx.doi.org/10.2196/35033 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503525 ID - info:doi/10.2196/35033 ER - TY - JOUR AU - White, A. Andrew AU - King, M. Ann AU - D?Addario, E. Angelo AU - Brigham, Berg Karen AU - Dintzis, Suzanne AU - Fay, E. Emily AU - Gallagher, H. Thomas AU - Mazor, M. Kathleen PY - 2022/4/29 TI - Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory JO - JMIR Med Educ SP - e30988 VL - 8 IS - 2 KW - medical error disclosure KW - simulation studies KW - communication assessment KW - graduate medical education KW - crowdsourcing KW - patient-centered care KW - generalizability theory KW - medical education KW - medical error KW - communication N2 - Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents? error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates? and crowdsourced laypeople?s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. UR - https://mededu.jmir.org/2022/2/e30988 UR - http://dx.doi.org/10.2196/30988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486423 ID - info:doi/10.2196/30988 ER - TY - JOUR AU - Lama, Yuki AU - Davidoff, J. Amy AU - Vanderpool, C. Robin AU - Jensen, E. Roxanne PY - 2022/1/25 TI - Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic JO - J Med Internet Res SP - e34616 VL - 24 IS - 1 KW - cancer survivor KW - Medicare KW - telehealth KW - COVID-19 KW - availability KW - use KW - elderly KW - older adults KW - cancer KW - sociodemographic KW - internet KW - communication KW - population KW - access N2 - Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53%) of cancer survivors reported using the internet for communication purposes, and 62% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28% vs 46%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29%, 31%, and 44%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53% vs 63%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers? available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. UR - https://www.jmir.org/2022/1/e34616 UR - http://dx.doi.org/10.2196/34616 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978531 ID - info:doi/10.2196/34616 ER - TY - JOUR AU - Turner, Kea AU - Bobonis Babilonia, Margarita AU - Naso, Cristina AU - Nguyen, Oliver AU - Gonzalez, D. Brian AU - Oswald, B. Laura AU - Robinson, Edmondo AU - Elston Lafata, Jennifer AU - Ferguson, J. Robert AU - Alishahi Tabriz, Amir AU - Patel, B. Krupal AU - Hallanger-Johnson, Julie AU - Aldawoodi, Nasrin AU - Hong, Young-Rock AU - Jim, L. Heather S. AU - Spiess, E. Philippe PY - 2022/1/19 TI - Health Care Providers? and Professionals? Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study JO - J Med Internet Res SP - e29635 VL - 24 IS - 1 KW - telehealth KW - telemedicine KW - teleoncology KW - digital health KW - remote monitoring KW - cancer KW - oncology KW - coronavirus disease KW - COVID-19 N2 - Background: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective: The aim of this qualitative study was to explore oncology HPPs? experiences with telehealth implementation during the COVID-19 pandemic. Methods: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results: Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity. UR - https://www.jmir.org/2022/1/e29635 UR - http://dx.doi.org/10.2196/29635 UR - http://www.ncbi.nlm.nih.gov/pubmed/34907900 ID - info:doi/10.2196/29635 ER - TY - JOUR AU - Brédart, Anne AU - Rault, Aude AU - Terrasson, Johanna AU - Seigneur, Etienne AU - De Koning, Leanne AU - Hess, Elisabeth AU - Savignoni, Alexia AU - Cottu, Paul AU - Pierga, Jean-Yves AU - Piperno-Neumann, Sophie AU - Rodrigues, Manuel AU - Bouleuc, Carole AU - Dolbeault, Sylvie PY - 2022/1/12 TI - Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study JO - JMIR Res Protoc SP - e26414 VL - 11 IS - 1 KW - cancer resistance KW - physician-patient communication KW - question prompt list KW - patient participation KW - collaborative research KW - mixed methods N2 - Background: Most cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help. Objective: This study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM). Methods: A sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals? interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group). Results: This study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited. Conclusions: A clinically and culturally tailored QPL is expected to facilitate patients? participation in consultations, improve oncologists? responses to patients? information and support needs, and thus foster patients? psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment. Trial Registration: ClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062 International Registered Report Identifier (IRRID): DERR1-10.2196/26414 UR - https://www.researchprotocols.org/2022/1/e26414 UR - http://dx.doi.org/10.2196/26414 UR - http://www.ncbi.nlm.nih.gov/pubmed/35019850 ID - info:doi/10.2196/26414 ER - TY - JOUR AU - Jones, R. Sarah AU - Vidrine, J. Damon AU - Wetter, W. David AU - Shih, Tina Ya-Chen AU - Sutton, K. Steven AU - Ramondetta, M. Lois AU - Elting, S. Linda AU - Walker, L. Joan AU - Smith, M. Katie AU - Frank-Pearce, G. Summer AU - Li, Yisheng AU - Simmons, N. Vani AU - Vidrine, I. Jennifer PY - 2021/12/30 TI - Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34502 VL - 10 IS - 12 KW - smoking cessation KW - cervical cancer KW - cancer survivor KW - motivation KW - tobacco treatment KW - cancer KW - smoking KW - RCT KW - randomized controlled trial KW - cognitive behavior KW - intervention N2 - Background: The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory?based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Objective: This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. Methods: Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state?s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. Results: This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. Conclusions: This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. Trial Registration: ClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610 International Registered Report Identifier (IRRID): DERR1-10.2196/34502 UR - https://www.researchprotocols.org/2021/12/e34502 UR - http://dx.doi.org/10.2196/34502 UR - http://www.ncbi.nlm.nih.gov/pubmed/34967755 ID - info:doi/10.2196/34502 ER - TY - JOUR AU - Wilson-Howard, Danyell AU - Vilaro, J. Melissa AU - Neil, M. Jordan AU - Cooks, J. Eric AU - Griffin, N. Lauren AU - Ashley, T. Taylor AU - Tavassoli, Fatemeh AU - Zalake, S. Mohan AU - Lok, C. Benjamin AU - Odedina, T. Folakemi AU - Modave, Francois AU - Carek, J. Peter AU - George, J. Thomas AU - Krieger, L. Janice PY - 2021/12/24 TI - Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study JO - JMIR Form Res SP - e28709 VL - 5 IS - 12 KW - telehealth KW - digital health KW - eHealth KW - colorectal cancer KW - Black men KW - virtual human KW - technology KW - cancer screening KW - app KW - cancer KW - prevention KW - development N2 - Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one?s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user?s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as ?brother-doctor,? and participants stated ?wanting to interact with ALEX over their regular doctor.? Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. UR - https://formative.jmir.org/2021/12/e28709 UR - http://dx.doi.org/10.2196/28709 UR - http://www.ncbi.nlm.nih.gov/pubmed/34780346 ID - info:doi/10.2196/28709 ER - TY - JOUR AU - North, Frederick AU - Nelson, M. Elissa AU - Buss, J. Rebecca AU - Majerus, J. Rebecca AU - Thompson, C. Matthew AU - Crum, A. Brian PY - 2021/12/7 TI - The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison JO - JMIR Med Inform SP - e27072 VL - 9 IS - 12 KW - electronic health record KW - schedule KW - patient appointment KW - preventive health service KW - office visit KW - outpatient care KW - mammogram KW - software tool KW - computer software application KW - mobile applications KW - self-schedule KW - app KW - EHR KW - screening KW - diagnostic KW - cancer N2 - Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective: The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods: We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results: For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or ?clean up? self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions: Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends. UR - https://medinform.jmir.org/2021/12/e27072 UR - http://dx.doi.org/10.2196/27072 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878997 ID - info:doi/10.2196/27072 ER - TY - JOUR AU - Lei, Fang AU - Lee, Eunice PY - 2021/11/18 TI - Cross-Cultural Modification Strategies for Instruments Measuring Health Beliefs About Cancer Screening: Systematic Review JO - JMIR Cancer SP - e28393 VL - 7 IS - 4 KW - cancer screening KW - health beliefs KW - instrument modification KW - strategy KW - systematic review N2 - Background: Modification is an important process by which to adapt an instrument to be used for another culture. However, it is not fully understood how best to modify an instrument to be used appropriately in another culture. Objective: This study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening. Methods: A systematic review design was used for conducting this study. Keywords including constructs about instrument modification, health belief, and cancer screening were searched in the PubMed, Google Scholar, CINAHL, and PsycINFO databases. Bowling?s checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach with a narrative method. Results: A total of 1312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts, and texts of the articles, 18 studies met the inclusion criteria for the study. Based on Flaherty?s cultural equivalence model, strategies used in the modification process included rephrasing items and response options to achieve semantic equivalence; changing subjects of items, changing wording of items, adding items, and deleting items to achieve content equivalence; adding subscales and items and deleting subscales and items to achieve criterion equivalence. Solutions used to resolve disagreements in the modification process included consultation with experts or literature search, following the majority, and consultation with the author who developed the scales. Conclusions: This study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially give cross-cultural researchers insight into modification strategies and a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments to achieve cultural equivalence. UR - https://cancer.jmir.org/2021/4/e28393 UR - http://dx.doi.org/10.2196/28393 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792474 ID - info:doi/10.2196/28393 ER - TY - JOUR AU - Mallmann, A. Christoph AU - Domröse, M. Christian AU - Schröder, Lars AU - Engelhardt, David AU - Bach, Frederik AU - Rueckel, Helena AU - Abramian, Alina AU - Kaiser, Christina AU - Mustea, Alexander AU - Faridi, Andree AU - Malter, Wolfram AU - Mallmann, Peter AU - Rudlowski, Christian AU - Zivanovic, Oliver AU - Mallmann, R. Michael PY - 2021/11/18 TI - Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study JO - JMIR Cancer SP - e20964 VL - 7 IS - 4 KW - digitalization KW - eHealth KW - breast cancer KW - internet N2 - Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the <59-year-old group used the internet in 2020, 92% of the 60 to 69-year-old group [11/12] and only 47% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ?2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364 UR - https://cancer.jmir.org/2021/4/e20964 UR - http://dx.doi.org/10.2196/20964 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792468 ID - info:doi/10.2196/20964 ER - TY - JOUR AU - Hopstaken, S. Jana AU - Verweij, Lynn AU - van Laarhoven, M. Cees J. H. AU - Blijlevens, A. Nicole M. AU - Stommel, J. Martijn W. AU - Hermens, G. Rosella P. M. PY - 2021/9/24 TI - Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review JO - J Med Internet Res SP - e28869 VL - 23 IS - 9 KW - digital care platforms KW - cancer care KW - eHealth KW - telemedicine KW - health care services KW - fragmentation of care KW - health care fragmentation KW - oncology KW - quality of care KW - barriers KW - facilitators KW - patient experience N2 - Background: Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider?reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. Objective: The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider?reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. Methods: The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. Results: Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. Conclusions: The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels. UR - https://www.jmir.org/2021/9/e28869 UR - http://dx.doi.org/10.2196/28869 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559057 ID - info:doi/10.2196/28869 ER - TY - JOUR AU - Tomaszewski, Tre AU - Morales, Alex AU - Lourentzou, Ismini AU - Caskey, Rachel AU - Liu, Bing AU - Schwartz, Alan AU - Chin, Jessie PY - 2021/9/9 TI - Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models JO - J Med Internet Res SP - e30451 VL - 23 IS - 9 KW - misinformation KW - disinformation KW - social media KW - HPV KW - human papillomavirus vaccination KW - vaccination KW - causality mining KW - cause KW - effect KW - risk perceptions KW - vaccine KW - perception KW - risk KW - Twitter KW - machine learning KW - natural language processing KW - cervical cancer N2 - Background: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. Objective: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. Methods: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine?related information on Twitter. Results: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine?related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. Conclusions: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media. UR - https://www.jmir.org/2021/9/e30451 UR - http://dx.doi.org/10.2196/30451 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499043 ID - info:doi/10.2196/30451 ER - TY - JOUR AU - Kim, Sue AU - Aceti, Monica AU - Baroutsou, Vasiliki AU - Bürki, Nicole AU - Caiata-Zufferey, Maria AU - Cattaneo, Marco AU - Chappuis, O. Pierre AU - Ciorba, M. Florina AU - Graffeo-Galbiati, Rossella AU - Heinzelmann-Schwarz, Viola AU - Jeong, Joon AU - Jung, M. MiSook AU - Kim, Sung-Won AU - Kim, Jisun AU - Lim, Cheol Myong AU - Ming, Chang AU - Monnerat, Christian AU - Park, Seok Hyung AU - Park, Hyung Sang AU - Pedrazzani, A. Carla AU - Rabaglio, Manuela AU - Ryu, Min Jai AU - Saccilotto, Ramon AU - Wieser, Simon AU - Zürrer-Härdi, Ursina AU - Katapodi, C. Maria PY - 2021/6/11 TI - Using a Tailored Digital Health Intervention for Family Communication and Cascade Genetic Testing in Swiss and Korean Families With Hereditary Breast and Ovarian Cancer: Protocol for the DIALOGUE Study JO - JMIR Res Protoc SP - e26264 VL - 10 IS - 6 KW - HBOC KW - proportion of informed at-risk relatives KW - coping KW - communicating KW - decisional conflict KW - cultural and linguistic adaptation KW - implementation KW - RE-AIM KW - mobile phone N2 - Background: In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. Objective: The aims of this study are to develop the K-CASCADE (Korean?Cancer Predisposition Cascade Genetic Testing) cohort in Korea by expanding an infrastructure developed by the CASCADE (Cancer Predisposition Cascade Genetic Testing) Consortium in Switzerland; develop a digital health intervention to support the communication of cancer predisposition for Swiss and Korean HBOC families, based on linguistic and cultural adaptation of the Family Gene Toolkit; evaluate its efficacy on primary (family communication of genetic results and cascade testing) and secondary (psychological distress, genetic literacy, active coping, and decision making) outcomes; and explore its translatability using the reach, effectiveness, adoption, implementation, and maintenance framework. Methods: The digital health intervention will be available in French, German, Italian, Korean, and English and can be accessed via the web, mobile phone, or tablet (ie, device-agnostic). K-CASCADE cohort of Korean HBOC mutation carriers and relatives will be based on the CASCADE infrastructure. Narrative data collected through individual interviews or mini focus groups from 20 to 24 HBOC family members per linguistic region and 6-10 health care providers involved in genetic services will identify the local cultures and context, and inform the content of the tailored messages. The efficacy of the digital health intervention against a comparison website will be assessed in a randomized trial with 104 HBOC mutation carriers (52 in each study arm). The translatability of the digital health intervention will be assessed using survey data collected from HBOC families and health care providers. Results: Funding was received in October 2019. It is projected that data collection will be completed by January 2023 and results will be published in fall 2023. Conclusions: This study addresses the continuum of translational research, from developing an international research infrastructure and adapting an existing digital health intervention to testing its efficacy in a randomized controlled trial and exploring its translatability using an established framework. Adapting existing interventions, rather than developing new ones, takes advantage of previous valid experiences without duplicating efforts. Culturally sensitive web-based interventions that enhance family communication and understanding of genetic cancer risk are timely. This collaboration creates a research infrastructure between Switzerland and Korea that can be scaled up to cover other hereditary cancer syndromes. Trial Registration: ClinicalTrials.gov NCT04214210; https://clinicaltrials.gov/ct2/show/NCT04214210 and CRiS KCT0005643; https://cris.nih.go.kr/cris/ International Registered Report Identifier (IRRID): PRR1-10.2196/26264 UR - https://www.researchprotocols.org/2021/6/e26264 UR - http://dx.doi.org/10.2196/26264 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114954 ID - info:doi/10.2196/26264 ER - TY - JOUR AU - Efficace, Fabio AU - Breccia, Massimo AU - Fazi, Paola AU - Cottone, Francesco AU - Holzner, Bernhard AU - Vignetti, Marco PY - 2021/6/1 TI - The GIMEMA-ALLIANCE Digital Health Platform for Patients With Hematologic Malignancies in the COVID-19 Pandemic and Postpandemic Era: Protocol for a Multicenter, Prospective, Observational Study JO - JMIR Res Protoc SP - e25271 VL - 10 IS - 6 KW - digital health KW - hematology KW - leukemia KW - lymphoma KW - multiple myeloma KW - patient-reported outcomes KW - quality of life KW - symptoms KW - COVID-19 N2 - Background: The COVID-19 pandemic has raised unprecedented challenges in the management of patients with cancer and has increased the demands for digital health tools that, for example, could facilitate remote monitoring of patients. Based on this, the Gruppo Italiano Malattie Ematologiche dell?Adulto (GIMEMA) has recently developed a digital health tool dedicated to patients with hematologic malignancies: the GIMEMA-ALLIANCE platform. Objective: The main objectives of this web-based platform are to generate relevant data to better understand quality of life, symptoms, and medication adherence during the COVID-19 pandemic and postpandemic era; to develop a prospective real-life registry on outcomes of patients with hematologic cancer, with or without a diagnosis of COVID-19; and to facilitate patient-centered care in routine practice. Methods: The platform consists of physician- and patient-secure portals and enables electronic patient-reported outcome (ePRO) assessments with real-time graphical presentation to physicians of individual patient symptoms and quality-of-life outcomes. Automated alerts are sent to treating hematologists based on the following predetermined criteria: presence of clinically important problems and symptoms, problems with adherence to therapy, and risk of COVID-19 diagnosis. The platform also allows physicians to set up video consultations. Clinical information regarding disease and treatment as well as clinical and survival outcomes are also prospectively collected. Results: Recruitment of participants started in December 2020. As of April 2021, a total of 116 patients have been enrolled in this study. Use of this platform may help to improve patient-physician communication and help hematologists in the early recognition of clinically important problems and symptoms of their patients. More than 20 community and university-based hospitals have currently agreed to participate. In addition to patient-reported outcome data, the prospective collection of disease- and treatment-related information, as well as data on possible COVID-19 diagnosis and COVID-19 vaccination, will allow the development of a large database to also identify subgroups of patients at risk of poor outcomes. Conclusions: Data generated via this platform will help to answer clinically relevant questions for patients with hematologic malignancies during the COVID-19 pandemic and postpandemic era. The use of the GIMEMA-ALLIANCE platform in routine practice may also contribute to enhancing patient-centered care. Trial Registration: ClinicalTrials.gov NCT04581187; https://clinicaltrials.gov/ct2/show/NCT04581187 International Registered Report Identifier (IRRID): PRR1-10.2196/25271 UR - https://www.researchprotocols.org/2021/6/e25271 UR - http://dx.doi.org/10.2196/25271 UR - http://www.ncbi.nlm.nih.gov/pubmed/33890580 ID - info:doi/10.2196/25271 ER - TY - JOUR AU - Peltola, Kristiina Maria AU - Poikonen-Saksela, Paula AU - Mattson, Johanna AU - Parkkari, Timo PY - 2021/5/6 TI - A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability JO - JMIR Form Res SP - e16156 VL - 5 IS - 5 KW - electronic patient-reported outcome KW - adverse events KW - patients with cancer N2 - Background: As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective: In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods: The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona?s suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results: A total of 41/44 (93%) patients and 15/17 (88%) professionals reported that the program was easy or quite easy to use; 38/44 (86%) patients and 11/17 (65%) professionals found Noona reliable, and 38/44 (86%) patients and 10/17 (59%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions: The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient?s symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice. UR - https://formative.jmir.org/2021/5/e16156 UR - http://dx.doi.org/10.2196/16156 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955841 ID - info:doi/10.2196/16156 ER - TY - JOUR AU - O'Cathail, Micheal AU - Aznar-Garcia, Luis AU - Sivanandan, Ananth AU - Diver, Claire AU - Patel, Poulam AU - Tang, Pui-Shan AU - Christian, Judith PY - 2021/2/5 TI - Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study JO - JMIR Form Res SP - e15598 VL - 5 IS - 2 KW - telemedicine KW - teleconsultations KW - brain metastases KW - stereotactic radiosurgery KW - mobile phone N2 - Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. UR - http://formative.jmir.org/2021/2/e15598/ UR - http://dx.doi.org/10.2196/15598 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544082 ID - info:doi/10.2196/15598 ER - TY - JOUR AU - Terra, Lara AU - Hooning, J. Maartje AU - Heemskerk-Gerritsen, M. Bernadette A. AU - van Beurden, Marc AU - Roeters van Lennep, E. Jeanine AU - van Doorn, C. Helena AU - de Hullu, A. Joanne AU - Mom, Constantijne AU - van Dorst, L. Eleonora B. AU - Mourits, E. Marian J. AU - Slangen, M. Brigitte F. AU - Gaarenstroom, N. Katja AU - Zillikens, Carola M. AU - Leiner, Tim AU - van der Kolk, Lizet AU - Collee, Margriet AU - Wevers, Marijke AU - Ausems, M. Margreet G. E. AU - van Engelen, Klaartje AU - Berger, PV Lieke AU - van Asperen, J. Christi AU - Gomez-Garcia, B. Encarna AU - van de Beek, Irma AU - Rookus, A. Matti AU - Hauptmann, Michael AU - Bleiker, M. Eveline AU - Schagen, B. Sanne AU - Aaronson, K. Neil AU - Maas, M. Angela H. E. AU - van Leeuwen, E. Flora PY - 2021/1/22 TI - Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study) JO - JMIR Res Protoc SP - e24414 VL - 10 IS - 1 KW - risk-reducing salpingo-oophorectomy KW - BRCA1/2 KW - cardiovascular disease KW - osteoporosis KW - cognition KW - health-related quality of life N2 - Background: BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective: The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods: We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results: This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions: Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration: ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID): DERR1-10.2196/24414 UR - http://www.researchprotocols.org/2021/1/e24414/ UR - http://dx.doi.org/10.2196/24414 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480862 ID - info:doi/10.2196/24414 ER - TY - JOUR AU - Sandell, Tiffany AU - Schütze, Heike AU - Miller, Andrew PY - 2021/1/19 TI - A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study JO - JMIR Res Protoc SP - e21752 VL - 10 IS - 1 KW - radiation oncology KW - general practice KW - health technology KW - communication KW - cancer KW - shared care KW - follow-up N2 - Background: The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective: The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods: This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results: Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions: Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients? preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID): PRR1-10.2196/21752 UR - http://www.researchprotocols.org/2021/1/e21752/ UR - http://dx.doi.org/10.2196/21752 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464209 ID - info:doi/10.2196/21752 ER - TY - JOUR AU - Greenberg-Worisek, Alexandra AU - Ferede, Liaa AU - Balls-Berry, Joyce AU - Marigi, Ian AU - Valentin Mendez, Emily AU - Bajwa, Numra AU - Ouk, Melody AU - Orellana, Minerva AU - Enders, Felicity PY - 2020/8/10 TI - Differences in Electronic Personal Health Information Tool Use Between Rural and Urban Cancer Patients in the United States: Secondary Data Analysis JO - JMIR Cancer SP - e17352 VL - 6 IS - 2 KW - cancer KW - patient engagement KW - health research KW - digital divide KW - disparities N2 - Background: Studies have previously shown that rural cancer patients are diagnosed at later stages of disease. This delay is felt throughout treatment and follow-up, reflected in the fact that rural patients often have poorer clinical outcomes compared with their urban counterparts. Objective: Few studies have explored whether there is a difference in cancer patients? current use of health information technology tools by residential location. Methods: Data from 7 cycles of the Health Information National Trends Survey (HINTS, 2003-2017) were merged and analyzed to examine whether differences exist in managing electronic personal health information (ePHI) and emailing health care providers among rural and urban cancer patients. Geographic location was categorized using Rural-Urban Continuum Codes (RUCCs). Bivariate analyses and multivariable logistic regression were used to determine whether associations existed between rural/urban residency and use of health information technology among cancer patients. Results: Of the 3031 cancer patients/survivors who responded across the 7 cycles of HINTS, 797 (26.9%) resided in rural areas. No difference was found between rural and urban cancer patients in having managed ePHI in the past 12 months (OR 0.78, 95% CI 0.43-1.40). Rural cancer patients were significantly less likely to email health care providers than their urban counterparts (OR 0.52, 95% CI 0.32-0.84). Conclusions: The digital divide between rural and urban cancer residents does not extend to general ePHI management; however, electronic communication with providers is significantly lower among rural cancer patients than urban cancer patients. Further research is needed to determine whether such disparities extend to other health information technology tools that might benefit rural cancer patients as well as other chronic conditions. UR - http://cancer.jmir.org/2020/2/e17352/ UR - http://dx.doi.org/10.2196/17352 UR - http://www.ncbi.nlm.nih.gov/pubmed/32773369 ID - info:doi/10.2196/17352 ER - TY - JOUR AU - Gilljam, Britt-Mari AU - Nygren, M. Jens AU - Svedberg, Petra AU - Arvidsson, Susann PY - 2020/7/28 TI - Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study JO - J Med Internet Res SP - e17673 VL - 22 IS - 7 KW - cancer KW - child care KW - communication KW - eHealth KW - patient participation N2 - Background: For children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. Objective: The aim of this study was to investigate children?s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. Methods: A quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children?s levels of participation guided by a framework based on Shier?s model of participation. Results: Pediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier?s participation model: children were listened to, children were supported to express their views, and children?s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. Conclusions: This study shows that the eHealth service Sisom can increase children?s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children?s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care. UR - http://www.jmir.org/2020/7/e17673/ UR - http://dx.doi.org/10.2196/17673 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720907 ID - info:doi/10.2196/17673 ER - TY - JOUR AU - Cunningham-Erves, Jennifer AU - Koyama, Tatsuki AU - Huang, Yi AU - Jones, Jessica AU - Wilkins, H. Consuelo AU - Harnack, Lora AU - McAfee, Caree AU - Hull, C. Pamela PY - 2019/07/02 TI - Providers? Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Study JO - JMIR Cancer SP - e13832 VL - 5 IS - 2 KW - neoplasms KW - papillomavirus infections KW - papillomavirus vaccines KW - primary prevention KW - health care provider KW - vaccine hesitancy KW - provider barriers to HPV vaccination N2 - Background: Human papillomavirus (HPV) vaccine hesitancy among parents contributes to low vaccination coverage in adolescents. To improve health care provider communication and vaccine recommendation practices with hesitant parents, it is important to understand how providers perceive parental HPV vaccine hesitancy. Objective: This study aimed to characterize perceived reasons for parental HPV vaccine hesitancy and identify factors associated with perceived parental hesitancy among providers at community-based pediatric clinics. Methods: In 2018, providers in 23 community-based pediatric clinics in Tennessee were invited to complete a Web-based baseline survey as part of a larger quality improvement study focused on HPV vaccine uptake. These survey data were used for a cross-sectional, secondary data analysis. Scale scores ranging from 0 to 100 were calculated for provider self-efficacy (confidence in ability to recommend HPV vaccine), provider outcome expectations (expectations that recommendation will influence parents? decisions), and perceived parental HPV vaccine hesitancy. Provider confidence in HPV vaccine safety and effectiveness were categorized as high versus low. Clinic-level exposures examined were clinic size and rural-urban location. Descriptive analyses were used to characterize perceived parental barriers by provider type. Mixed-effects linear regression models were fit taking one exposure variable at a time, whereas controlling for provider type, age, gender, and race to identify provider- and clinic-level factors associated with perceived parental barriers to HPV vaccination. Results: Of the 187 providers located in the 23 clinics, 137 completed the survey. The majority of physician providers were white and female, with a higher percentage of females among nurse practitioners (NPs) and physician assistants (PAs). The most common parental barriers to HPV vaccination perceived by providers were concerns about HPV vaccine safety (88%), child being too young (78%), low risk of HPV infection for child through sexual activity (70%), and mistrust in vaccines (59%). In adjusted mixed models, perceived parental HPV vaccine hesitancy was significantly associated with several provider-level factors: self-efficacy (P=.001), outcome expectations (P<.001), and confidence in HPV vaccine safety (P=.009). No significant associations were observed between perceived parental HPV vaccine hesitancy and clinic-level factors clinic size nor location. Conclusions: Researchers developing provider-focused interventions to reduce parental HPV vaccine hesitancy should consider addressing providers? self-efficacy, outcome expectations, and confidence in HPV vaccine safety to help providers communicate more effectively with HPV vaccine hesitant parents. UR - https://cancer.jmir.org/2019/2/e13832/ UR - http://dx.doi.org/10.2196/13832 UR - http://www.ncbi.nlm.nih.gov/pubmed/31267976 ID - info:doi/10.2196/13832 ER - TY - JOUR AU - Dodd, H. Rachael AU - Obermair, M. Helena AU - McCaffery, J. Kirsten PY - 2019/04/11 TI - A Thematic Analysis of Attitudes Toward Changes to Cervical Screening in Australia JO - JMIR Cancer SP - e12307 VL - 5 IS - 1 KW - screening KW - attitudes KW - cervical cancer KW - knowledge N2 - Background: In December 2017, the Australian National Cervical Screening Program (NCSP) was changed to encompass a 5-yearly human papillomavirus (HPV) primary test for women aged 25 to 74 years. Public concerns about changes to screening programs has been demonstrated in other countries previously. Objective: The aim of the study was to explore in depth women?s understanding of and concerns about the specific changes to the Australian NCSP implemented in December 2017. Methods: A Web-based petition (Change.org) opposing the changes received over 70,000 signatures and nearly 20,000 comments from February to March 2017. Of 19,633 comments, a random sample of 10% (2000/19,633) were analyzed using content analysis (reported elsewhere). Comments relating directly to the specific changes to the program were further analyzed using qualitative thematic analysis. Results: Around one-third (34.55%; 691/2000) of the total comments were related to concerns about specific changes to the program. The greatest concern was that screening intervals would be too long and that cancer may not be detected in time for successful treatment. Missing cancer in younger women (aged <25 years) was also an important concern, perceiving younger women to remain at significant risk. Notably, concern was rarely expressed about the new test (the HPV test). Conclusions: Gaps in knowledge and understanding about changes to the program and the rationale behind these have caused health concerns among women. Worry about the extended screening interval indicates little understanding of the slow progression of the HPV infection to cervical cancer or the high rates of regression. Identification of these knowledge gaps can inform both deintensification of other cancer screening programs and practitioners, so that they are able to address these concerns with their patients. UR - http://cancer.jmir.org/2019/1/e12307/ UR - http://dx.doi.org/10.2196/12307 UR - http://www.ncbi.nlm.nih.gov/pubmed/30973340 ID - info:doi/10.2196/12307 ER - TY - JOUR AU - Lipson-Smith, Ruby AU - White, Fiona AU - White, Alan AU - Serong, Lesley AU - Cooper, Guy AU - Price-Bell, Georgia AU - Hyatt, Amelia PY - 2019/03/12 TI - Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App JO - JMIR Form Res SP - e11111 VL - 3 IS - 1 KW - referral and consultation KW - adult KW - humans KW - cancer KW - audiovisual aids KW - mobile apps KW - community-based participatory research KW - health behavior KW - psychological theory N2 - Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients? recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient?s medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. UR - http://formative.jmir.org/2019/1/e11111/ UR - http://dx.doi.org/10.2196/11111 UR - http://www.ncbi.nlm.nih.gov/pubmed/30860487 ID - info:doi/10.2196/11111 ER - TY - JOUR AU - Noordman, Janneke AU - Driesenaar, A. Jeanine AU - van Bruinessen, R. Inge AU - Portielje, EA Johanneke AU - van Dulmen, Sandra PY - 2019/01/30 TI - Evaluation and Implementation of ListeningTime: A Web-Based Preparatory Communication Tool for Elderly Patients With Cancer and Their Health Care Providers JO - JMIR Cancer SP - e11556 VL - 5 IS - 1 KW - audio-facility KW - cancer patients KW - communication KW - internet KW - health care providers KW - videos KW - Web-based tool N2 - Background: Effective patient-provider communication is an important condition to deliver optimal care and it supports patients in coping with their disease. The complex and emotionally loaded setting of oncology care challenges both health care providers (HCPs) and patients in reaching effective communication. ListeningTime is developed for elderly patients with cancer and their oncological HCPs to help them (better) prepare the clinical encounter and overcome communication barriers. ListeningTime is a Web-based preparatory communication tool including modeling videos and has an audio-facility to listen back to recorded encounters. Objective: This study aims to evaluate the usability, perceived usefulness, and actual use of ListeningTime, through the eyes of elderly patients with cancer and their oncological HCPs. If highly rated, the ultimate goal is to make ListeningTime publicly available. Methods: First, members of a panel of elderly cancer survivors and patients (age ?65 years) were approached to evaluate ListeningTime through a Web-based questionnaire. The usability and perceived usefulness were assessed. Second, ListeningTime was evaluated in real-life practice through a pilot study in 3 Dutch hospitals. In these hospitals, elderly patients with cancer and their oncological HCPs were approached to evaluate ListeningTime through a similar Web-based questionnaire, measuring the perceived usefulness. In addition, we examined log files and user statistics to get insight into how the program was used. Results: A total of 30 cancer survivors or patients from the patient panel, and 17 patients and 8 HCPs from the hospitals, evaluated ListeningTime. Overall, both panel members and hospital patients were positive about the ListeningTime website, audio-facility, and video fragments. Some patients suggested improvements with respect to the actors? performances in the video fragments and believed that ListeningTime is mainly suitable for non experienced patients. HCPs were also positive about ListeningTime; they valued the video fragments for patients and the audio-facility for patients and themselves. However, providers did not relisten their own recorded encounters. Patients did use the audio-facility to relisten their encounters. Conclusions: ListeningTime was highly rated, both by patients and their oncological HCPs. As a result, the video fragments of ListeningTime are now made publicly available for elderly patients with cancer through the Dutch website ?kanker.nl.? UR - http://cancer.jmir.org/2019/1/e11556/ UR - http://dx.doi.org/10.2196/11556 UR - http://www.ncbi.nlm.nih.gov/pubmed/30698525 ID - info:doi/10.2196/11556 ER - TY - JOUR AU - Lofters, K. Aisha AU - Telner, Deanna AU - Kalia, Sumeet AU - Slater, Morgan PY - 2018/11/01 TI - Association Between Adherence to Cancer Screening and Knowledge of Screening Guidelines: Feasibility Study Linking Self-Reported Survey Data With Medical Records JO - JMIR Cancer SP - e10529 VL - 4 IS - 2 KW - cancer screening KW - electronic medical records KW - electronic survey KW - health literacy KW - self-reported data N2 - Background: It is possible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: The aim of this study was to determine whether screening knowledge was associated with the documented screening participation. We also assessed the feasibility and acceptability of linking electronic survey data with clinical data in the primary care setting. Methods: We conducted an electronic survey at 2 sites in Toronto, Canada. At one site, eligible patients were approached in the waiting room to complete the survey; at the second site, eligible patients were sent an email inviting them to participate. All participants were asked to consent to the linkage of their survey results with their electronic medical record. Results: Overall, 1683 participants responded to the survey?247 responded in the waiting room (response rate, 247/366, 67.5%), whereas 1436 responded through email (response rate, 1436/5779, 24.8%). More than 80% (199/247 and 1245/1436) of participants consented to linking their survey data to their medical record. Knowledge of cancer screening guidelines was generally low. Although the majority of participants were able to identify the recommended tests for breast and cervical screening, very few participants correctly identified the recommended age and frequency of screening, with a maximum of 22% (21/95) of screen-eligible women correctly answering all 3 questions for breast cancer screening. However, this low level of knowledge among patients was not significantly associated with screening uptake, particularly after adjustment for sociodemographic characteristics. Conclusions: Although knowledge of screening guidelines was low among patients in our study, this was not associated with screening participation. Participants were willing to link self-reported data with their medical record data, which has substantial implications for future research. UR - http://cancer.jmir.org/2018/2/e10529/ UR - http://dx.doi.org/10.2196/10529 UR - http://www.ncbi.nlm.nih.gov/pubmed/30389655 ID - info:doi/10.2196/10529 ER - TY - JOUR AU - Subramanian, Sujha AU - Kaganova, Yevgeniya AU - Zhang, Yuying AU - Hoover, Sonja AU - Nyambe, Namakau AU - Pinder, Leeya AU - Chibwesha, Carla AU - Kapambwe, Sharon AU - Parham, Groesbeck PY - 2018/07/25 TI - Patient Preferences and Willingness to Pay for Cervical Cancer Prevention in Zambia: Protocol for a Multi-Cohort Discrete Choice Experiment JO - JMIR Res Protoc SP - e10429 VL - 7 IS - 7 KW - discrete choice experiment KW - cervical cancer prevention KW - economic evaluation N2 - Background: Although most countries in southern Africa have cervical cancer screening programs, these programs generally fail to reach a significant majority of women because they are often implemented as pilot or research projects, and this limits their scope and ability to scale up screening. Some countries have planned larger-scale programs, but these have either never been implemented or have not been successfully scaled up. Most of the global burden of cervical cancer is experienced in countries with limited resources, and mortality from cervical cancer is the most common cause of cancer-related deaths among women in Sub-Saharan Africa. Objective: The purpose of this study is to learn about preferences for cervical cancer screening in Zambia, to identify barriers and facilitators for screening uptake, and to evaluate willingness to pay for screening services to support the scaling up of cervical cancer screening programs. Methods: We will conduct a discrete choice experiment by interviewing women and men and asking them to choose among constructed scenarios with varying combinations of attributes relevant to cervical cancer screening. To inform the discrete choice experiment, we will conduct focus groups and interviews about general knowledge and attitudes about cervical screening, perception about the availability of screening, stigma associated with cancer and HIV, and payment for health care services. For the discrete choice experiment, we will have a maximum design of 120 choice sets divided into 15 sets of 8 tasks each with a sample size of 320-400 respondents. We will use a hierarchical Bayesian estimation procedure to assess attributes at the following two levels: group and individual levels. Results: The model will generate preferences for attributes to assess the most important features and allow for the assessment of differences among cohorts. We will conduct policy simulations reflecting potential changes in the attributes of the screening facilities and calculate the projected changes in preference for choosing to undergo cervical cancer screening. The findings from the discrete choice experiment will be supplemented with interviews, focus groups, and patient surveys to ensure a comprehensive and context-based interpretation of the results. Conclusions: Because willingness to pay for cervical cancer screening has not been previously assessed, this will be a unique and important contribution to the literature. This study will take into account the high HIV prevalence in Sub-Saharan Africa and prevailing gender attitudes to identify an optimal package of interventions to reduce cervical cancer incidence. This simulation of women?s decisions (and men?s support) to undergo screening will lay the foundation for understanding the stated preferences and willingness to pay to help design future screening programs. Registered Report Identifier: RR1-10.2196/10429 UR - http://www.researchprotocols.org/2018/7/e10429/ UR - http://dx.doi.org/10.2196/10429 UR - http://www.ncbi.nlm.nih.gov/pubmed/30045833 ID - info:doi/10.2196/10429 ER - TY - JOUR AU - Rat, Anne-Christine AU - Ricci, Laetitia AU - Guillemin, Francis AU - Ricatte, Camille AU - Pongy, Manon AU - Vieux, Rachel AU - Spitz, Elisabeth AU - Muller, Laurent PY - 2018/07/19 TI - Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET) JO - JMIR Med Educ SP - e17 VL - 4 IS - 2 KW - bad news disclosure KW - health communication KW - physician-patient relationship KW - distance e-learning N2 - Background: Although most physicians in medical settings have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and nonverbal skills, the ability to recognize and respond to patients? emotions and the importance of considering the patient?s environment such as culture and social status. How bad news is delivered can have consequences that may affect patients, sometimes over the long term. Objective: This project aimed to develop a Web-based formative self-assessment tool for physicians to practice delivering bad news to minimize the deleterious effects of poor way of breaking bad news about a disease, whatever the disease. Methods: BReaking bAD NEws Tool (BRADNET) items were developed by reviewing existing protocols and recommendations for delivering bad news. We also examined instruments for assessing patient-physician communications and conducted semistructured interviews with patients and physicians. From this step, we selected specific themes and then pooled these themes before consensus was achieved on a good practices communication framework list. Items were then created from this list. To ensure that physicians found BRADNET acceptable, understandable, and relevant to their patients? condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was used to explore the impact of the items and messages and why and how these messages could change physicians? relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). Results: The good practices communication framework list comprised 70 specific issues related to breaking bad news pooled into 8 main domains: opening, preparing for the delivery of bad news, communication techniques, consultation content, attention, physician emotional management, shared decision making, and the relationship between the physician and the medical team. After constructing the items from this list, the items were extensively refined to make them more useful to the target audience, and one item was added. BRADNET contains 71 items, each including a question, response options, and a corresponding message, which were divided into 8 domains and assessed with 12 self-assessment sessions. The BRADNET Web-based platform was developed according to the cognitive load theory and the cognitive theory of multimedia learning. Conclusions: The objective of this Web-based assessment tool was to create a ?space? for reflection. It contained items leading to self-reflection and messages that introduced recommended communication behaviors. Our approach was innovative as it provided an inexpensive distance-learning self-assessment tool that was manageable and less time-consuming for physicians with often overwhelming schedules. UR - http://mededu.jmir.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/mededu.9551 UR - http://www.ncbi.nlm.nih.gov/pubmed/30026180 ID - info:doi/10.2196/mededu.9551 ER - TY - JOUR AU - Cherrez Ojeda, Ivan AU - Vanegas, Emanuel AU - Torres, Michell AU - Calderón, Carlos Juan AU - Calero, Erick AU - Cherrez, Annia AU - Felix, Miguel AU - Mata, Valeria AU - Cherrez, Sofia AU - Simancas, Daniel PY - 2018/02/20 TI - Ecuadorian Cancer Patients? Preference for Information and Communication Technologies: Cross-Sectional Study JO - J Med Internet Res SP - e50 VL - 20 IS - 2 KW - social media KW - telemedicine KW - cancer KW - Web 2.0 KW - mHealth N2 - Background: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. Objective: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. Methods: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. Results: Of the total, 43.2% (216/500) of participants reported that they had access to the Internet, and 25.4% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5%, 145/218) and short message service (SMS) text messaging (61.0%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0%, 157/218) followed by SMS (63.8%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. Conclusions: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries. UR - http://www.jmir.org/2018/2/e50/ UR - http://dx.doi.org/10.2196/jmir.8485 UR - http://www.ncbi.nlm.nih.gov/pubmed/29463492 ID - info:doi/10.2196/jmir.8485 ER - TY - JOUR AU - Rosen, L. Brittany AU - Bishop, M. James AU - McDonald, L. Skye AU - Kahn, A. Jessica AU - Kreps, L. Gary PY - 2018/02/16 TI - Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment JO - JMIR Cancer SP - e3 VL - 4 IS - 1 KW - papillomavirus vaccines KW - internet KW - program evaluation KW - health personnel N2 - Background: Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. Objective: The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. Methods: Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions? content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. Results: A total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. Conclusions: This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians. UR - http://cancer.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/cancer.9114 UR - http://www.ncbi.nlm.nih.gov/pubmed/29453187 ID - info:doi/10.2196/cancer.9114 ER - TY - JOUR AU - Kurahashi, M. Allison AU - Stinson, N. Jennifer AU - van Wyk, Margaret AU - Luca, Stephanie AU - Jamieson, Trevor AU - Weinstein, Peter AU - Cafazzo, A. Joseph AU - Lokuge, Bhadra AU - Cohen, Eyal AU - Rapoport, Adam AU - Husain, Amna PY - 2018/01/09 TI - The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System JO - JMIR Hum Factors SP - e2 VL - 5 IS - 1 KW - patient-centered care KW - patient participation KW - chronic disease KW - communication KW - internet communication tools KW - usability testing KW - interdisciplinary communication KW - health communication KW - continuity of patient care KW - patient care team KW - inventions N2 - Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system?s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users? perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions?composing, posting, and reading messages?with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. UR - http://humanfactors.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/humanfactors.7882 UR - http://www.ncbi.nlm.nih.gov/pubmed/29317386 ID - info:doi/10.2196/humanfactors.7882 ER - TY - JOUR AU - Belkora, K. Jeffrey AU - Naguit, Marijoyce AU - Stupar, Lauren AU - Wiley, James AU - Volz, Shelley AU - O'Donnell, Sara PY - 2017/8/22 TI - The Effects of Coaching Patients to List Questions Before Visiting Cancer Specialists: Retrospective Evaluation of Visit Preparation in a Rural, Underserved Setting JO - J Participat Med SP - e15 VL - 9 IS - 1 KW - Visit preparation KW - self-efficacy KW - anxiety KW - question list KW - patient support KW - community-based participatory research KW - psycho-oncology. N2 - Background: A community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits. Objective: Was the question-listing intervention effective in reducing anxiety and increasing decision self-efficacy? Methods: The organization surveyed patients on decision self-efficacy (273 respondents, 99% response rate) and anxiety (190, 68%) before and after question-listing interventions delivered from 2006 ? 2011. We analyzed responses using two-sided paired t-tests at 5% significance and conducted linear regression to identify significant predictors of change. We examined predictors related to the patient (location, demographics, disease status and baseline decision self-efficacy and anxiety); the intervention (including interventionist case volume); and the visit (including type of doctor seen). Results: Question-listing was associated with higher mean decision self-efficacy (2.70/3.43 pre/post, 1-4 min-max, P<.001) and lower mean anxiety (7.26/5.87, 1-10 min-max, P<.001). Significant predictors of change in decision self-efficacy included: patient location; interventionist case volume; baseline decision self-efficacy and anxiety. Higher baseline anxiety was also associated with reductions in anxiety. Conclusions: In a sustained community-based implementation, the intervention helped patients prepare for oncology visits. Patients reported higher self-efficacy and lower anxiety. UR - http://jopm.jmir.org/2017/1/e15/ UR - http://dx.doi.org/10.2196/jopm.8949 UR - http://www.ncbi.nlm.nih.gov/pubmed/36262006 ID - info:doi/10.2196/jopm.8949 ER - TY - JOUR AU - Warner, L. Echo AU - Ding, Qian AU - Pappas, Lisa AU - Bodson, Julia AU - Fowler, Brynn AU - Mooney, Ryan AU - Kirchhoff, C. Anne AU - Kepka, Deanna PY - 2017/08/11 TI - Health Care Providers? Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study JO - JMIR Cancer SP - e12 VL - 3 IS - 2 KW - health care provider KW - human papillomavirus KW - human papillomavirus vaccine KW - mixed methods KW - knowledge N2 - Background: Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents. Objective: The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers? perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt. Methods: In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (?10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed. Results: Family practice providers (52.2%, 71/136; P=.001), institutional or university clinics (54.0%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and public health campaigns. Hesitancy to recommend the HPV vaccine to patients persisted among some providers. Conclusions: Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents. UR - http://cancer.jmir.org/2017/2/e12/ UR - http://dx.doi.org/10.2196/cancer.7345 UR - http://www.ncbi.nlm.nih.gov/pubmed/28801303 ID - info:doi/10.2196/cancer.7345 ER - TY - JOUR AU - Dodd, Natalie AU - Carey, Leanne Mariko AU - Mansfield, Elise AU - Oldmeadow, Christopher PY - 2017/05/10 TI - Testing the Effectiveness of a Primary Care Intervention to Improve Uptake of Colorectal Cancer Screening: A Randomized Controlled Trial Protocol JO - JMIR Res Protoc SP - e86 VL - 6 IS - 5 KW - clinical trial KW - colorectal cancer KW - early detection of cancer KW - general practice KW - primary care KW - primary care provider N2 - Background: Screening for colorectal cancer (CRC) significantly reduces mortality associated with this disease. In Australia, the National Bowel Cancer Screening Program provides regular fecal occult blood tests (FOBT) for those aged 50 to 74 years, however, participation rates in the program have plateaued at 36%. Given low uptake in the National Bowel Cancer Screening Program, it is necessary to explore alternate methods to increase CRC screening rates. Primary care is a promising adjunct setting to test methods to increase CRC screening participation. Primary care guidelines support the recommendation and provision of CRC screening to primary care patients. Those in the National Bowel Cancer Screening Program target age range frequently present to their primary care provider. Objective: This study tests the effect that a multicomponent primary care?based intervention has on CRC screening uptake when compared to usual care. Methods: Primary care patients presenting for an appointment with their primary care provider complete a touchscreen survey to determine eligibility for the trial. Those aged 50 to 74 years, at average risk of CRC, with no history of CRC or inflammatory bowel disease, who have not had an FOBT in the past 2 years or a colonoscopy in the past 5 years are eligible to participate in the trial. Trial participants are randomized to the intervention or usual care group by day of attendance at the practice. The intervention consists of provision of an FOBT, printed information sheet, and primary care provider endorsement to complete the FOBT. The usual care group receives no additional care. Results: The primary outcome is completion of CRC screening 6 weeks after recruitment. The proportion of patients completing CRC screening will be compared between trial groups using a logistic regression model. Conclusions: CRC screening rates in Australia are suboptimal and interventions to increase screening participation are urgently required. This protocol describes the process of implementing a multicomponent intervention designed to increase CRC screening uptake in a primary care setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001299493; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371136&isReview=true (Archived by WebCite at http://www.webcitation.org/6pL0VYIj6). Universal Trial Number U1111-1185-6120. UR - http://www.researchprotocols.org/2017/5/e86/ UR - http://dx.doi.org/10.2196/resprot.7432 UR - http://www.ncbi.nlm.nih.gov/pubmed/28490420 ID - info:doi/10.2196/resprot.7432 ER - TY - JOUR AU - Fissler, Tim AU - Bientzle, Martina AU - Cress, Ulrike AU - Kimmerle, Joachim PY - 2015/09/08 TI - The Impact of Advice Seekers? Need Salience and Doctors? Communication Style on Attitude and Decision Making: A Web-Based Mammography Consultation Role Play JO - JMIR Cancer SP - e10 VL - 1 IS - 2 KW - communication style KW - needs KW - need salience KW - attitude KW - decision-making KW - mammography screening KW - online consultation N2 - Background: Patients and advice seekers come to a medical consultation with typical needs, and physicians require adequate communication skills in order to address those needs effectively. It is largely unclear, however, to what extent advice seekers? attitudes toward a medical procedure or their resulting decisions are influenced by a physician?s communication that ignores or explicitly takes these needs into account. Objective: This experimental study tested how advice seekers? salient needs and doctor?s communication styles influenced advice seekers? attitudes toward mammography screening and their decision whether or not to participate in this procedure. Methods: One hundred women (age range 20-47 years, mean 25.22, SD 4.71) participated in an interactive role play of an online consultation. During the consultation, a fictitious, program-controlled physician provided information about advantages and disadvantages of mammography screening. The physician either merely communicated factual medical information or made additional comments using a communication style oriented toward advice seekers? typical needs for clarity and well-being. Orthogonal to this experimental treatment, participants? personal needs for clarity and for well-being were either made salient before or after the consultation with a needs questionnaire. We also measured all participants? attitudes toward mammography screening and their hypothetical decisions whether or not to participate before and after the experiment. Results: As assumed, the participants expressed strong needs for clarity (mean 4.57, SD 0.42) and for well-being (mean 4.21, SD 0.54) on 5-point Likert scales. Making these needs salient or not revealed significant interaction effects with the physician?s communication style regarding participants? attitude change (F1,92=7.23, P=.009, ?2=.073) and decision making (F1,92=4.43, P=.038, ?2=.046). Those participants whose needs were made salient before the consultation responded to the physician?s communication style, while participants without salient needs did not. When the physician used a need-oriented communication style, those participants with salient needs had a more positive attitude toward mammography after the consultation than before (mean 0.13, SD 0.54), while they changed their attitude in a negative direction when confronted with a purely fact-oriented communication style (mean ?0.35, SD 0.80). The same applied to decision modification (need-oriented: mean 0.10, SD 0.99; fact-oriented: mean ?0.30, SD 0.88). Conclusions: The findings underline the importance of communicating in a need-oriented style with patients and advice seekers who are aware of their personal needs. Ignoring the needs of those people appears to be particularly problematic. So physicians? sensitivity for advice seekers? currently relevant needs is essential. UR - http://cancer.jmir.org/2015/2/e10/ UR - http://dx.doi.org/10.2196/cancer.4279 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410160 ID - info:doi/10.2196/cancer.4279 ER -