Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial

Abstract

Background Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists. Objective This study aimed to examine whether a web- and text-based asynchronous system (eOncoNote) could facilitate communication between PCPs and cancer specialists (oncologists and oncology nurses) to improve patient-reported continuity of care among patients receiving treatment or posttreatment survivorship care. Methods In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to either the intervention group (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or a control group (usual communication only), including 104 (60.1%) patients in the survivorship phase (breast and colorectal cancer) and 69 (39.9%) patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team and cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression, and Picker Patient Experience Questionnaire. Patients completed the questionnaires at baseline and at 2 points following randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month and at either 4 months (patients with prostate cancer) or 6 months following randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months and at 12 months following randomization. Results The results did not show an intervention effect on the primary outcome of team and cross-boundary continuity of care or on the secondary outcomes of depression and patient experience with their health care. However, there was an intervention effect on anxiety. In the treatment phase, there was a statistically significant difference in the change score from baseline to the 1-month follow-up for GAD-7 (mean difference −2.3; P=.03). In the survivorship phase, there was a statistically significant difference in the change score for GAD-7 between baseline and the 6-month follow-up (mean difference −1.7; P=.03) and between baseline and the 12-month follow-up (mean difference −2.4; P=.004). Conclusions PCPs’ and cancer specialists’ access to eOncoNote is not significantly associated with patient-reported continuity of care. However, PCPs’ and cancer specialists’ access to the eOncoNote intervention may be a factor in reducing patient anxiety. Trial Registration ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785

Implementation of a Web-Based Communication System for Primary Care Providers and Cancer Specialists

“…Healthcare providers reported that PCPs were more likely to contact cancer specialists by telephone or fax after the patient completed treatment, in instances where a patient had more complex needs, or if the patient lived far away from the cancer center [ 18 ]. Results from the pRCT demonstrated that patients randomized to the intervention group had an average of three comorbid conditions in the treatment phase, and an average of two comorbid conditions in the survivorship phase [ 17 ], so there may have been less of a need for communication regarding patients who did not have as many illnesses.…”

“…During this study, PCPs were still able to communicate with cancer specialists via usual channels while the eOncoNote intervention was active. We abstracted hospital EMR data on PCP and cancer specialist communication via the usual channels, which indicated that there were few calls made by PCPs or faxes sent to the cancer center during the treatment and survivorship phases [ 17 ]. Taken together, these results indicate that PCPs were not communicating with cancer specialists via usual channels instead of using eOncoNote, rather there was limited communication beyond the faxed consult notes from the specialist.…”

“…The implementation aim was addressed through qualitative interviews, analysis of eOncoNote system usage metrics, and data abstracted from the hospital EMR. Results from the pRCT [ 17 ] and qualitative interviews [ 18 ] have been reported separately. This paper focuses on the findings from the PCP survey and eOncoNote system usage data.…”

“…Participants were PCPs and cancer specialists of patients who participated in the pRCT [ 17 ]. Patients were eligible to participate in the pRCT if they were receiving adjuvant chemotherapy for early-stage breast cancer, or radical or adjuvant radiation therapy for localized prostate cancer; or completed adjuvant therapy for breast or colorectal cancer with the intent of being discharged for survivorship follow-up care to their PCP.…”

“…Patients were recruited from a cancer center at an academic hospital in Ottawa, Ontario, Canada. The patient recruitment process has been described elsewhere [ 17 ]. Patient recruitment took place between February 2018 and March 2020.…”