ABSTRACT
[This corrects the article DOI: 10.2196/32153.].
ABSTRACT
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.
ABSTRACT
PURPOSE: This study assessed the feasibility of implementing a novel model of integrated prostate cancer care involving an online prostate cancer-specific holistic needs assessment (sHNA) and shared digital communication between patients and their healthcare professionals (HCPs). The sHNA produces a semi-automated care plan that is finalised in consultation between the patient and their practice nurse. METHODS: Men living with and beyond prostate cancer were invited to participate in a 9-month non-randomised cluster controlled feasibility study. The intervention group was asked to complete the sHNA on three occasions. Data were collected using Patient Reported Outcome Measures (PROMs) at baseline, 10 and 24 weeks, and 9 months. Outcomes included recruitment, retention, acceptability, and engagement with the sHNA and PROMs. RESULTS: Fourteen general practices (8 intervention and 6 control), and 41 men (29 intervention and 12 control) participated. Initial patient engagement with the sHNA was high, with all but one receiving practice nurse-led follow-up and an individualised care plan. The sHNA proved useful in identifying 'red flag' symptoms, and helping practice nurses decide when to seek further medical care for the patients. There was a high level of acceptability for patients and HCPs. However, integration of care did not occur as intended because of problems linking hospital and general practice IT systems. CONCLUSION: While the study demonstrated the feasibility of implementing the sHNA, it did not meet the a priori progression criteria; as such, undertaking a definitive randomised controlled trial is not appropriate until the identified methodological and technical issues have been addressed.
Subject(s)
Delivery of Health Care, Integrated/methods , Delivery of Health Care, Integrated/organization & administration , Holistic Health , Needs Assessment , Primary Health Care , Prostatic Neoplasms/therapy , Telemedicine , Aged , Aged, 80 and over , Delivery of Health Care, Integrated/standards , Feasibility Studies , Health Personnel/organization & administration , Health Personnel/standards , Health Promotion/methods , Holistic Health/standards , Humans , Male , Middle Aged , Online Systems , Patient Care Planning/organization & administration , Patient Care Planning/standards , Patient-Centered Care/methods , Patient-Centered Care/organization & administration , Patient-Centered Care/standards , Primary Health Care/methods , Primary Health Care/organization & administration , Primary Health Care/standards , Professional-Patient Relations , Quality of Life , Referral and Consultation/organization & administration , Referral and Consultation/standards , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/standardsABSTRACT
The simulated surgery examination is one of the tripos of entry assessments for the Induction and Refresher (I&R) Scheme. It is used to assess the clinical and consulting skills of GPs prior to a period of supervised practice. The assessment involves observing candidates consulting with simulated patients played by role-players presenting standardised cases. Additionally, this assessment provides an 'educational prescription' for both passing and failing candidates as well as evidence of linguistic competency for overseas candidates. A feedback questionnaire is administered to candidates immediately after the examination, to seek their views and to evaluate their experience of the exam. Between July 2015 and July 2018, 401 candidates completed the examination and questionnaire. Quantitative and qualitative data has been collected and analysed with the findings reported in this paper. Overall candidates are satisfied with the examination, and regard it as a valid assessment of their GP consulting skills. However, there are still concerns regarding the I&R application process although there is evidence that there has been a trajectory of improvement over the past three years. Candidate feedback obtained has been used in an iterative manner to ensure quality control of the examination as well as for prompting improvements in the process.
