Virtual care for prostate cancer survivorship: protocol for an evaluation of a nurse-led algorithm-enhanced virtual clinic implemented at five cancer centres across Canada

Abstract

IntroductionProstate cancer (PCa) is the most common cancer in Canadian men. Current models of survivorship care are no longer adequate to address the chronic and complex survivorship needs of patients today. Virtual care models for cancer survivorship have recently been associated with comparable clinical outcomes and lower costs to traditional follow-up care, with patients favouring off-site and on-demand visits. Building on their viability, our research group conceived the Ned Clinic—a virtual PCa survivorship model that provides patients with access to lab results, collects patient-reported outcomes, alerts clinicians to emerging issues, and promotes patient self-care. Despite the promise of the Ned Clinic, the model remains limited by its dependence on oncology specialists, lack of an autonomous triage algorithm, and has only been implemented among PCa survivors living in Ontario.Methods and analysisOur programme of research comprises two main research objectives: (1) to evaluate the process and cost of implementing and sustaining five nurse-led virtual PCa survivorship clinics in three provinces across Canada and identify barriers and facilitators to implementation success and (2) to assess the impact of these virtual clinics on implementation and effectiveness outcomes of enrolled PCa survivors. The design phase will involve developing an autonomous triage algorithm and redesigning the Ned Clinic towards a nurse-led service model. Site-specific implementation plans will be developed to deploy a localised nurse-led virtual clinic at each centre. Effectiveness will be evaluated using a historical control study comparing the survivorship outcomes of 300 PCa survivors enrolled in the Ned Clinic with 300 PCa survivors receiving traditional follow-up care.Ethics and disseminationAppropriate site-specific ethics approval will be secured prior to each research phase. Knowledge translation efforts will include diffusion, dissemination, and application approaches to ensure that knowledge is translated to both academic and lay audiences.

The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic

“…Motivated by the successes of dyadic virtual care programs, our team [ 56 ] has started to formalize caregiver inclusion in the service design and delivery of our virtual clinics for heart failure and cancer survivorship. Our Medly Clinic [ 57 ] supports remote heart failure monitoring [ 58 - 61 ], while our Ned Clinic [ 62 ] enables asynchronous prostate cancer survivorship care [ 63 , 64 ]. Both virtual clinics have historically excluded patients who were not comfortable using technology, did not have an email address, and had limited English proficiency; we previously assumed that these factors would challenge patients to use clinic services as intended and derive benefit.…”

Exploring virtual care clinical experience from non-physician healthcare providers (VCAPE)

“…Data supports that virtual care delivered with nursing involvement is successful. However, the experience of nurses with virtual care has not been highlighted ( Pham et al., 2021 ; Reddy et al., 2021 ). Survey data from an integrated medical health care system in West-Central Florida suggests that the providers were satisfied with video than telephone and felt comfortable and satisfied with virtual care ( Wright, Dewan, Hilty, & Dewan, 2020 ).…”

The Impact of Virtual Cancer Care on Chemotherapy Delivery and Clinical Outcomes in Colorectal Cancer Patients Receiving Systemic Therapy: A Pre- and Intra-Pandemic Analysis

“…It is also convenient, reduces travel time and lowers the cost associated with accessing care for patients [ 19 , 20 ]. On a system level, virtual care has the potential of providing safe, efficient and cost-effective follow-up and survivorship care to a rapidly growing Canadian cancer population [ 21 , 22 ]. Canadian data suggests that both patients and clinicians are generally satisfied with virtual care [ 23 ].…”