Development and evaluation of a holistic surgical head and neck cancer post-treatment follow-up clinic using touchscreen technology-Feasibility study

Abstract

The efficacy of traditional follow-up care is being challenged, as cancer survivors' supportive and psychological needs are often neither identified, nor addressed. This study's aim was to develop a holistic surgical follow-up clinic for oral and oropharyngeal cancer patients were participants completed a disease-specific health-related quality of life tool (UWQOLv4) and item prompt list (Patient Concern Inventory) on a touchscreen computer. Information generated was used to focus the consultation on patient's identified needs and concerns. By means of a prospective non-randomised, pre-test post-test design, this follow-up clinic was evaluated using the patient enablement instrument (PEI) and patient content checklist (PCC). Feasibility was explored from the patient perspective (satisfaction survey) and clinician perspective (qualitative interview). Forty-four consecutive patients were recruited. Findings demonstrating five of the eight topics (overall QOL, emotions, head and neck symptoms, side-effects of treatment, chronic non-specific) on PCC were discussed more frequently, but changes were not statistically significant. The PEI highlighted a trend towards perceived improvement in four of the six items. Using touchscreen computers to aid communication during routine follow-up was reported as both feasible and beneficial by patients and clinicians. Providing a patient-focused follow-up consultation can facilitate the identification of unmet needs, permitting timely and appropriate intervention being initiated.

What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence

“…Where PROMs were completed prior to a consultation, this could aid HP preparation [27,32,33,36] and promote careful reflection on the part of patients [52,55]. PROMs were also a means to structure consultations and interactions, and aided to prioritise issues of importance [10,29,37,40,42,43,50,57] (see also "Attitudes to the care experience"). Some studies [31,42,48,49] noted that HPs also saw PROMs as prompting patients to identify and prioritise issues from their own perspectives: "Actually, it [using the questionnaire] meant that we talked about issues which we wouldn't otherwise have touched upon because she hadn't thought of it, and I usually don't ask about it / … / it…”

“…Responding PROMs were viewed as generating a range of responses in patient management. Response strategies included: intervention where issues were identified [26,27,32,35,46]; adoption of a more holistic management approach [40,42,45,50]; modification of communication approaches [30,32,39,47,54,56]; and the promotion of patient self-management [44,53]. Study findings also raised the fear that PROMs could bring up issues for which no adequate response existed, particularly in relation to financial difficulties, psychological issues and fatigue [10,28,34,37]: I find it very hard to discuss finances with patients, especially when it comes to, "they say I'm not entitled to any benefits", and I'm thinking, "well I can't do anything about that unfortunately".…”

“…Interaction between HP and patient An often-cited benefit of PROMs was that it facilitated communication between the HP and the patient [29,46,50,56,57], allowing staff to get to know patients better [10,34,46,50,55]. For example:…”

“…Patient engagement PROMs are perceived as a means through which patients may more actively direct their own care [34,37,50]. HPs in some studies (n = 7) described the "empowering" facets of PROMs-supported engagement, noting it could promote the "voice" of patients in their care [29,34,37,45,48,50,56]. A few studies (n = 3) also noted the potential for PROMs to bring patients back into care when they had unresolved issues [10,53,54].…”

“…Feasibility Studies highlighted the importance of how PROMs were integrated with existing systems and practice. Where PROMs were electronic, integration within the existing management system was viewed to enhance feasibility [34,36,40,46,[50][51][52], but it was important that the PROMs were easy to navigate and that professionals were equipped with the computer access, knowledge and skills they would need [10,37,39,41,45,47,54]. The introduction of PROMs also represented a shift in practice which needed to be carefully integrated in relation to the setting culture and as was noted as a key concern of staff, "alongside clinical priorities" [26,33,43,44,53,57,58]: "The participants indicated that there are 'at least a hundred other priorities that compete with SFD [PROM] and these priorities have the potential to threaten the sustainability of the program' and that SFD could fall off over time as other priorities emerge" [34] (p145).…”