Remote patient-provider communication and quality of life: empirical test of a dialogic model of cancer care

Research design/methodology

TYPE: A before and after study.

VALIDITY: In this study, the subjects acted as their own controls. The lack of a contemporaneous control group has the potential to introduce bias to this study. Additionally, a number of study criteria need better definitions, for example, ‘newly diagnosed cancer’. The symptomatology or disease severity of individuals may change during the study, independent of the Cancer Care Dialogues intervention, and may have an impact on the outcomes.

ENVIRONMENT: Cancer clinic at a Veterans Affairs Medical Center (VAMC) in the USA

Research question

Is it feasible to use the Cancer Care Dialogues Model for daily telehealth interactions between home-based cancer patients on chemotherapy and their cancer care coordinators who provide supportive care?

Health-related quality of life (HRQL, which measures physical, mental and social well-being of patients) and cooperation rate for the study were measured at baseline, 3 months and 6 months after the introduction of the intervention.

Patient/Problem/Population definition

PATIENT: Thirty-four patients newly diagnosed with cancer and receiving chemotherapy

PROBLEM: Cancer patients on chemotherapy often suffer uncontrolled symptoms while at home. Lack of communication and feedback between the patients and their care providers may be a hindrance to effective care of such symptoms and may lead to poor HRQL.

POPULATION: Newly diagnosed cancer patients taking chemotherapy at a single VA medical center in the USA.

TYPE: Health services research

Intervention

The Cancer Care Dialogues Model was implemented by using a home messaging device connected through the home telephone network.

Comparison

The group’s mean HRQL and cooperation rate before the intervention was measured against itself after the intervention of daily telehealth consultation.

Outcome

There was significantimprovement in mean HRQL over the study period with a 6.5 point increase. MeanHRQL at baseline was 73.9 (SD 15.4) and 78.4 (SD 14.5) after six months and 84% mean cooperation rate was noted.

Application of results to patient care

This model seems useful for male Caucasian patients who were asymptomatic at baseline. Patients who had underlying depression and baseline pain did not respond well. Also, patients’ overall cooperation decreased during the study even though the HRQL seemingly improved.

Further areas for research

The study found that a higher proportion of non-completers reported pain at baseline (p<0.05). It was further noticed that patients who had symptomatic depression at baseline experienced a 20-point reduction in cooperation over the six-month period. It is possible that the patients who had good baseline quality of life would have continued to maintain this level without the use of the intervention.

Overall, reduction of cooperation during the study period despite an improvement of quality of life may imply that patients may be unaware of the improvement or that some aspect of the model was not well understood or liked by users. These findings warrant further analysis for the improvement of the Cancer Care Dialogues Model.

Further studies need to be conducted with proper use of controls for different groups of patients. For example, individuals with baseline pain with and without the use of the CCDM, and inclusion of women and men of various ethnic groups.