Closing the Patient-Provider Gap Along the Surgical Journey One Click at a Time: Results of a Phase I Pilot Trial of a Patient Navigation Tool

Abstract

Background Patients diagnosed with complex hepato-pancreaticobiliary (HPB) conditions experience a complex journey through the health care system. Patient navigation is commonly offered to patients and their caregivers throughout this complex journey. We developed and tested a prototype web-based dual (patient and provider) navigation application ‘PatientNav’. We report on phase I of the study, which evaluated the app in multiple domains: usability, functionality, and reliability. Methods Evidence-based recommendations determined throughout a needs assessment. PatientNav app was designed to be a highly customizable tool based both on needs of the patient, care team and characteristics of the institution. Our phase I pilot trial targeted individuals aged 18 years or older who reported the capacity to use a mobile app or desktop website presenting to our HPB transplant clinic at MedStar Georgetown University Hospital/Lombardi Comprehensive Cancer Center over a 2-month period. Usability, functionality, and reliability testing was conducted by applying multiple strategies that include biometric data analysis, task completion, questionnaires, and interviews. Results The usability rate of PatientNav among patient app users was 95.4%. Out of 22 patients, 18 (81.8%) completed the in-app survey whose responses were included in the analysis. Among patient app users who completed the in-app survey questionnaire, 66.6% reported that content in PatientNav app was relevant. In terms of reliability of the app, none of the patient app users reported issues with technical issues with accessing PatientNav throughout the study period. To further elucidate the characteristics of individuals who exhibited high usage of the PatientNav assigned task functions, we divided our cohort based on median number of tasks used (N = 75 total tasks). Univariable comparison showed that high function users were older with a median (IQR) of 61.5 (57.8, 71.3) compared to 52.2 (34.5, 65.7) years among low function users. No differences were observed based on gender, racial distribution, living condition or occupation. However, 41.7% of low function users had Medicare/Medicaid insurance whereas all high function users had private or combined insurance. Conclusion Our phase I pilot study showed that PatientNav is a feasible, usable and functional technological tool that enables patients with complex HPB diagnoses and their care team to interface in real time using PROMs. PatientNav is a reliable tool that can be used by clinical and support staff to help navigate patients through surgery and aftercare, and by patients to assist in navigation and self-management. Trial Registration: The trial was registered at ClinicalTrials.gov; Registration number: NCT04892927; date of registration: 5/19/2021.