Development and Implementation of a Clinician Reporting System for Advanced Stage Cancer: Initial Lessons Learned

DuBenske, Lori L.; Chih, Ming‐Yuan; Dinauer, Susan; Gustafson, David H.; Cleary, James F.

doi:10.1197/jamia.m2532

Cited by 32 publications

(55 citation statements)

References 46 publications

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“…64 Some clinicians indicated that the assessed symptoms were already frequently monitored at clinic visits, therefore limiting the usefulness of the CR. Accordingly, systems need to be designed around the needs of those they plan to serve, offering functionality that clearly fulfills a need.…”

Section: Case Example: Chessmentioning

confidence: 99%

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

et al. 2010

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Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS—the Comprehensive Health Enhancement Support System (CHESS)—for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS. An interactive health communication system (IHCS) offers one platform for providing the information, communication, and coaching resources that cancer patients and their families need to understand the disease, find support, and develop decision-making and coping skills. One such IHCS—the Comprehensive Health Enhancement Support System (CHESS)—has evolved over the past 20 years. Based on our recent experience creating and testing a new version of CHESS—“Coping with Lung Cancer: A Network of Support”—this article outlines the issues faced in developing and implementing such a system within the cancer context.

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Section: Case Example: Chessmentioning

confidence: 99%

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

et al. 2010

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“…CHESS is distinguished by the quality and depth of its information and resources and by ease of use. CHESS is an extensively studied eHealth system, having been (over its evolutions) the subject of numerous needs assessments (DuBenske et al, 2008a; DuBenske et al, 2008b; Wen & Gustafson, 2004) randomized clinical trials (Gustafson et al, 2001, 2008), and field tests (Gustafson et al, 2005; Gustafson, McTavish, Schubert, & Johnson, 2012). These studies demonstrated that CHESS can be widely accepted and used, improve patient quality of life and information competence, and in some cases lead to more efficient use of health services (Gustafson et al, 2001; Shaw et al, 2007; Shaw, McTavish, Hawkins, Gustafson, & Pingree, 2000).…”

Section: Introductionmentioning

confidence: 99%

CHESS improves cancer caregivers’ burden and mood: Results of an eHealth RCT.

DuBenske¹,

Gustafson²,

Namkoong³

et al. 2014

Health Psychology

130

246

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Objective Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. CHESS (Comprehensive Health Enhancement Support System) is a web-based lung cancer information, communication and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites. Methods 285 informal caregivers of patients with advanced non-small cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS. Caregivers were provided a computer and Internet service if needed. Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months. ANCOVA analyses compared the intervention’s effect on caregivers’ disruptiveness and burden (CQOLI-C), and negative mood (combined Anxiety, Depression, and Anger scales of the POMS) at six months, controlling for blocking variables (site, caregiver’s race, and relationship to patient) and the given outcome at pretest. Results Caregivers randomized to CHESS reported lower burden [t (84) = 2.36, p = .021, d= .39] and negative mood [t (86) = 2.82, p = .006, d= .44] than those in the Internet group. The effect on disruptiveness was not significant. Conclusions Although caring for someone with a terminal illness will always exact a toll on caregivers, eHealth interventions like CHESS may improve caregivers’ understanding and coping skills and, as a result, ease their burden and mood.

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“…For example, a study done at a palliative unit where an electronic assessment tool was being implemented reported perceived difficulties related to establishing new routines, increased workload, technology issues, increased burden for patients, and ethical issues due to concerns about whether or not the system would actually benefit the patients [21]. Functional and technological issues, the users' desire for more in-depth information, user privacy concerns, and limited patient use are other challenges noted when implementing new systems in clinical practice [23]. However, while a number of studies have addressed aspects of system implementation, less research has examined the challenges that may emerge over time or the impact of new interventions after they have been implemented [24].…”

Section: The Choice Applicationmentioning

confidence: 99%

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

Børøsund

Ruland

Moore

et al. 2014

International Journal of Medical Informatics

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Please cite this article in press as: E. Børøsund, et al., Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation, Int. J. No. of Pages 12 i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s x x x ( 2 0 1 3 ) xxx-xxx j o u r n a l h o m e p a g e : w w w . i j m i j o u r n a l . c o m Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation Objective: To explore nurses' experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation. ARTICLE IN PRESSMethods: This investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.Results: Three themes and nine sub-themes emerged: (1) "Choice as facilitator for shared understanding and engagement in patients' own care," with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) "enhancing the patients' strengths," with two sub-themes: releasing patient's internal strengths and confirming "normalcy" for the patient; and (3) "new challenges for the nurse," with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges. Conclusions: Findings suggest that, from nurses' perspectives, integration of ITPAs suchas Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses' professional roles and created dilemmas such as nurses' ambivalence regarding patients' levels of disclosure of sensitive issues and the nurses' ability to respond to

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Development and Implementation of a Clinician Reporting System for Advanced Stage Cancer: Initial Lessons Learned

Abstract: Though in its early implementation stages, the CR demonstrates the potential to positively impact care delivery in the cancer clinic setting, particularly by facilitating earlier interventions and improving patient-caregiver-clinician communication both during and between clinic visits.

Cited by 32 publications

References 46 publications

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

CHESS improves cancer caregivers’ burden and mood: Results of an eHealth RCT.

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

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