Providers' Perspectives on Adherence to Hormonal Therapy in Breast Cancer Survivors. Is there a Role for the Digital Health Feedback System?

OBJECTIVE: Despite the benefits of hormonal therapy (HT) adherence remains suboptimal in ER positive breast cancer patients. Medication adherence is challenging to assess and tends to be overestimated. The Digital Health Feedback System (DHFS) consists of an ingestible sensor attached to a pill that sends intake date and time to a smart phone or computer. Patients can share this information with health care providers and other persons. The DHFS can also send reminders. This mixed methods study examined providers' perceptions of HT medication adherence. The potential role of the DHFS in enhancing medication tracking and adherence was also explored. METHODS: We conducted semi-structured interviews with key informants (N=10). Questions examined perceptions about adherence barriers and facilitators, challenges tracking adherence, and views on the DHFS. Findings informed the development of a survey that was administered online (N=19). RESULTS: Providers emphasized the importance of fostering open and trustful communication around adherence. The most mentioned challenges to assessing adherence were the patient not disclosing discontinuation immediately (78.9%) and over-reporting adherence (57.9%). The perceived potential benefits of DHFS were the ability to track adherence better (94.7%) and reminders to take the medication (68.4%). Safety to ingest a sensor was as a major perceived barrier (8 4.2%). CONCLUSION: Interventions that target providers and doctor-patient communication are warranted to enhance adherence and reduce communication delays around HT discontinuation. PRACTICE IMPLICATIONS: DHFS has the potential to enhance HT adherence by directly targeting barriers. Future studies should also examine the feasibility of adopting the DHFS with cancer patients.

The Relationship between Emotional and Esteem Social Support Messages and Health.

The purpose of this investigation is to determine the relative contribution of five types of social support to improved patient health. This analysis suggests that emotional and esteem social support messages are associated with improved patient health as measured by a decrease in average blood glucose levels among diabetic patients. In addition, when two system feature variables, two system use variables, two measures of learning, one measure of self-efficacy, and one measure of affect toward their HCP were added to the baseline model, a third significant factor emerged. Perceptions about learning about diabetes from reading the digital messages sent by their HCP also predicted improved patient health. Cognitive-Emotional Theory of Esteem Support Messages suggests a combination of esteem social support and emotional social support messages enhanced our ability to predict improved patient health by change in patient hemoglobin A1c (HbA1c) scores. While a nonrandomized prospective study, this investigation provides support for the notion that provider-patient interaction is related to improved patient health and that both emotional and esteem social support messages play a role in that process. Finally, the study suggests some types of social support are and other types are not associated with improved patient health; this is consistent with the optimal matching hypothesis.

Sentiment Analysis of an Online Breast Cancer Support Group: Communicating about Tamoxifen.

A better understanding of the breast cancer online narrative is important for a clearer conceptualizing of the role of online platforms in mediating health-related support. Sentiment analysis was conducted on a breast cancer online support group regarding Tamoxifen to understand users' emotions and opinions. This analysis was then contextualized within online social support literature. Out of the 498 users, the most active users were 80% more positive than least active users, while least active users were 48% more negative than most active ones; both differences were statistically significant. The higher the stage of cancer a user had, the less likelihood that she would have posted, and if she were to post, the post would have focused on her side effects and the anxiety/sadness that tailgates those side effects. The lower the stage of cancer a user had, the more likelihood that she would have posted, additionally remained active on the forum, and encouraged more (online) social support. This finding suggests that the online support platform may provide a context that exacerbates support for like-minded users where stronger ties are created around a specific sentiment within the community with less connection from those with dissimilar sentiments to the dominant group.

What Residents Say About Communicating with Patients: A Preliminary Examination of Doctor-to-Doctor Interaction.

This article describes the implementation and initial assessment of a training blog created within a family medicine department and used as a feedback mechanism for residents. First-year residents (n = 7) at a large private East Coast university hospital had an interaction with a patient recorded and posted to a training blog. The residents then watched this, and posted a reaction to their interaction with the patient. Within this reaction the residents offered self-reflection on the experience and were provided an opportunity to solicit advice from their colleagues to improve their communicative strategies and style. Once the reaction was posted to the blog, other residents watched the videotaped interaction, read the self-assessment written by the resident, and responded as part of their communication training. Content analysis of the messages suggests that the residents are socially skilled. They offer each other advice, provide each other with emotional and esteem social support, and use techniques such as self-deprecation in what appears to be a strategic manner. Perhaps most interesting is that they tend to identify the problems and difficulties they experience during patient-physician interactions in an apparent effort to deflect responsibility from the practicing physician. Patient challenges raised by residents included talkativeness, noncompliance, health literacy, and situational constraints.

Patient Perceptions of Acute Care Telemedicine: A Pilot Investigation.

This investigation focuses on the patient perceptions of the interaction that occurs during acute telemedical care in an emergency department and the effectiveness of this technology. Data indicate 95% of the patients were seen by a specialist within 15 minutes of arriving at the emergency room and fewer than 12% reported experiencing a technical problem (n = 150). Further, 80% of the patients indicated that they were satisfied with level of concern communicated to them by the specialist and 80% were satisfied with the explanation of their medical condition. Finally, 80% of the patients believed the use of telemedicine was a positive factor in the diagnostic process and 80% were reported being satisfied with their overall treatment.