Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach

Abstract

Background Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.

Caring for older culturally and linguistically diverse patients with Cancer: Healthcare Providers' perceived barriers to communication

“…These findings are in line with previous studies which have shown that one of the strongest impediments to good quality medical communication with CALD patients is the language barrier, which is often inadequately solved by means of family interpreters [36][37][38]. Additionally, not knowing the extent of patients' informational needs was as an influential barrier for all healthcare provider groups, which can be explained by the finding that CALD patients often behave in a passive manner during medical consultations and are disinclined to express their needs, as well as due to lack of understandable communication initiated by professionals [39]. Note.…”

“…Indeed, the inefficiency of using family members as interpreters became apparent in the present study. Therefore, we recommend that the language barriers should be bridged by communication strategies other than using family interpreters, such as by utilization of professional interpreters and digital translation tools [39]. Combining professional interpreters with inexpensive digital applications and translation tools could eliminate serious health consequences by reducing the risk of incorrect translations, empowering patients, and enabling both patients and providers to stay fully informed during consultations and treatment processes.…”

“…To this end, an easy to understand and short standardized questionnaire can be administered via professional interpreters or via translation applications to determine patients' choices. An example of such a tool is the recently developed "Conversation Starter" application targeted at older CALD patients with cancer and their healthcare providers in the Netherlands [39]. This application can provide auditory information in the patients' mother tongue and let them choose among simple options to show their preferences to their healthcare providers about the extent to which they want to be informed about their health (e.g., choose to be informed about all aspects of their health, or leave out negative news), as well as the role they would like to attribute to their family members with regards to the decision-making process [38].…”

“…Determining patients' preference before their consultation provides clarity to healthcare providers and enables them to share information more confidently, as well as experience less decision-making related conflict by knowing the patient's preferred role of family members. Given that this patient group tend to have low health literacy skills, which is an important barrier on its own [45,46], incorporating user friendly digital tools that employ easy to understand narrative videos, images (i.e., simple representations of health situations) and auditory support have shown to be beneficial for patients [39].…”

Language and cultural discordance between practitioners and refugees in mental healthcare consultations: Developing a promising European intervention to break down barriers

“…For instance, the Health Communicator is a semi-automated translation tool that enables patients with low Dutch language proficiency to indicate what they would like to communicate about with their healthcare provider. A previous intervention study has shown this tool to increase both patients' and providers' participation levels during the consultation [11].…”