Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study

Abstract

Background Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors’ attainment or maintenance of cardiovascular health. Objective We sought to evaluate survivors’ awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers. Methods Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability. Results Enrolled breast cancer survivors (84% White race, 4% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92%). Prior to viewing the tool, 65% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45% (range 0%-86%) of survivors’ known cardiovascular health factors were at an ideal level. More than 50% of survivors had ideal smoking status (45/48, 94%) or blood glucose level (29/45, 64%); meanwhile, less than 50% had ideal blood pressure (12/49, 24%), body mass index (12/49, 24%), cholesterol level (17/35, 49%), diet (7/49, 14%), and physical activity (10/49. 20%). More than 90% of survivors thought the tool was easy to understand (46/47, 98%), improved their understanding (43/47, 91%), and was helpful (45/47, 96%); overall, 94% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60%) oncology providers (female: 12/20, 60%; physicians: 14/20, 70%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90%), would help their effectiveness (18/20, 90%), was easy to use (20/20, 100%), and presented information in a useful format (19/20, 95%); and 85% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care. Conclusions These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record–enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes.

Addressing cancer survivors’ cardiovascular health using the automated heart health assessment (AH-HA) EHR tool: Initial protocol and modifications to address COVID-19 challenges

“…The tool renders a visual, interactive display of CVH risk factors, automatically populated from the [ [14] , [15] , [16] ], alongside a tab that indicates the receipt of cancer treatments (yes or no) with cardiotoxic potential. The tool was designed to be relevant to a diverse population of cancer survivors, including those who did and did not received potentially cardiotoxic treatments, and was developed and refined using input from oncology providers and survivors [ 17 ]. The tool does not dictate how oncologists should care for their patients, nor is the AH-HA tool intended to replace primary care management of CV risk factors, intensive behavioral interventions to address weight loss or tobacco use, or specialty management of survivors at high risk for cardiotoxicity.…”

“…Designed to serve as a prompt for health-promoting discussions, this tool is presented to providers via the EHR during an encounter with an eligible patient. We chose to deploy this tool during the post-treatment survivorship period (defined as six months or more post-potentially curative treatment, with no evidence of disease) based on preliminary data from oncology providers indicating greater interest in using the tool while providing survivorship care compared to during initial treatment planning or during active treatment [ 17 ]. The tool was first implemented in primary care and now incorporates EHR data on cancer treatments with cardiotoxic potential [ 15 ].…”

Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives

“…To effectively implement these and similar guidelines to prevent CV morbidity in cancer survivors, it is critical to understand survivors’ current understanding of their heart health, as well as their perspectives on addressing CV risk during routine oncology care. In our pilot work with breast cancer survivors treated at an academic medical center, we uncovered gaps in survivors’ knowledge of heart health, as well as their attainment of ideal cardiovascular health (CVH) [ 29 ]. More than half of these survivors reported not knowing their level for one or more CVH factors, and less than 50% had ideal blood pressure (BP), body mass index (BMI), cholesterol, diet, and physical activity per American Heart Association guidelines [ 30 ].…”

“…We present baseline data from an ongoing hybrid effectiveness-implementation study (WF-1804CD) of a novel electronic health record (EHR)-embedded heart health assessment tool, Automated Heart-Health Assessment (AH-HA) [ 13 , 29 , 32 , 33 ]. The AH-HA trial collects data on CVH factors and care coordination among cancer survivors receiving routine survivorship care in NCI Community Oncology Research Program (NCORP) outpatient oncology practices [ 34 ].…”

Analysis of Epidemiological Characteristics of New Cardiovascular Diseases in Cancer Patients with Cardiovascular Disease

“…Long-term cancer survivorship has continued to climb as cancer medicines have evolved, resulting in substantial advancements in the survival rates of a variety of tumours [ 9 ]. The possibility of a mechanistic overlap in the frequency of cancer and CVD is becoming more widely recognized [ 10 ]. Heart disease and cancer, despite being considered of as two independent disease entities, contribute to half of overall fatalities in the US.…”