Improving outcomes in cancer patients on oral anti-cancer medications using a novel mobile phone-based intervention: study design of a randomized controlled trial
Agboola S, Flanagan C, Searl M, Elfiky A, Kvedar J, Jethwani K. Improving outcomes in cancer patients on oral anti-cancer medications using a novel mobile phone-based intervention: study design of a randomized controlled trial. JMIR Res Protoc. 2014 Dec 23;3(4):e79. doi: 10.2196/resprot.4041. PubMed PMID: 25537463.Read More...
The widespread and increasing use of oral anti-cancer medications has been ushered in by a rapidly increasing understanding of cancer pathophysiology. Furthermore, their popular ease of administration and potential cost savings has highlighted their central position in the health care system as a whole. These facts have heightened appreciation of the unique challenges associated with the use of oral anti-cancer medications; especially in the long-term use of these medications and the associated side effects that may impede optimal adherence to their use. Therefore, we developed ChemOtheRapy Assistant, CORA, a personalized mobile phone-based self-management application to help cancer patients on oral anti-cancer medications.
Our objective is to evaluate the effect of CORA on adherence to oral anti-cancer medications and other clinically relevant outcomes in the management of patients with renal and prostate cancer.
The study will be implemented as a 2-parallel group randomized controlled trial in 104 patients with renal or prostate cancer on oral anti-cancer medications over a 3-month study period. The intervention group will use CORA in addition to usual care for self-management while the control group will continue care as usual. Medication adherence will be measured objectively by a Medication Event Monitoring System device and is defined as the percentage of prescribed doses taken. We will also assess the effect of the intervention on cancer-related symptoms measured by the MD Anderson Symptom Inventory and unplanned hospital utilizations. Other outcomes that will be measured at study start, midpoint, and endpoint are health-related quality of life, cancer-related fatigue, and anxiety. Group differences in medication adherence will be examined by t tests or by non-parametric Mann-Whitney tests if the data are not normally distributed. Logistic regression will be used to identify potential predictors of adherence.
We expect to have results for this study before the end of 2016.
This novel mobile phone-enabled, multimodal self-management and educational intervention could lead to improvements in clinical outcomes and serve as a foundation for future mHealth research in improving outcomes for patients on oral anti-cancer medications.
“Real-World” Practical Evaluation Strategies: A Review of Telehealth Evaluation
Agboola S, Hale TM, Masters C, Kvedar J, Jethwani K. “Real-World” Practical Evaluation Strategies: A Review of Telehealth Evaluation. JMIR Res Protoc. 2014 Dec 17;3(4):e75. doi: 10.2196/resprot.3459. PubMed PMID: 25524892.Read More...
Background: Currently, the increasing interest in telehealth and significant technological breakthroughs of the past decade create favorable conditions for the widespread adoption of telehealth services. Therefore, expectations are high that telehealth can help alleviate prevailing challenges in health care delivery. However, in order to translate current research to policy and facilitate adoption by patients and health care providers, there is need for compelling evidence of the effectiveness of telehealth interventions. Such evidence is gathered from rigorously designed research studies, which may not always be practical in many real-world settings.
Objective: Our aim was to summarize current telehealth evaluation strategies and challenges and to outline practical approaches to conduct evaluation in real-world settings using one of our previously reported telehealth initiatives, the Diabetes Connect program, as a case study.
Methods: We reviewed commonly used current evaluation frameworks and strategies, as well as best practices based on successful evaluative efforts to date to address commonly encountered challenges in telehealth evaluation. These challenges in telehealth evaluation and commonly used frameworks are described relevant to the evaluation of Diabetes Connect, a 12-month Web-based blood glucose monitoring program.
Results: Designers of telehealth evaluation frameworks must give careful consideration to the elements of planning, implementation, and impact assessment of interventions. Evaluating performance at each of these phases is critical to the overall success of an intervention. Although impact assessment occurs at the end of a program, our review shows that it should begin at the point of problem definition. Critical to the success of an evaluative strategy is early planning that involves all stakeholders to identify the overall goals of the program and key measures of success at each phase of the program life cycle. This strategy should enable selection of an appropriate evaluation strategy and measures to aid in the ongoing development and implementation of telehealth and provide better evidence of program impact.
Conclusions: We recommend a pragmatic, multi-method, multi-phase approach to telehealth evaluation that is flexible and can be adapted to the characteristics and challenges unique to each telehealth program.
Pain management in cancer patients using a mobile app: study design of a randomized controlled trial
Agboola S, Kamdar M, Flanagan C, Searl M, Traeger L, Kvedar J, Jethwani K. Pain management in cancer patients using a mobile app: study design of a randomized controlled trial. JMIR Res Protoc. 2014 Dec 12;3(4):e76. doi: 10.2196/resprot.3957. PubMed PMID: 25500281.Read More...
Despite the availability of effective medications and clinical guidelines for pain management, pain control is suboptimal in a sizeable proportion of patients with cancer pain. The National Comprehensive Cancer Network guidelines recommend a comprehensive and multimodal approach for management of cancer pain. We developed a mobile phone application, ePAL, based on clinical guidelines to empower patients for cancer pain management by prompting regular pain assessments and coaching for self-management.
The objective of this study is to evaluate the effect of a multidimensional mobile phone-based pain management application, ePAL, on controlling cancer pain and improving quality of life in patients with cancer pain being treated at an academic palliative care clinic.
The study will be implemented as a 2-arm randomized controlled trial with 110 adult patients with CP who own a mobile phone over a follow-up period of two months. Participants will be randomized to either the intervention group receiving ePAL and usual care or to a control group receiving only usual care. The brief pain inventory will be used to assess our primary outcome which is pain intensity. We will also evaluate the effect of the intervention on secondary outcomes which include the effect of the intervention on hospital utilization for pain crisis, quality of life, adherence to analgesic medications, barriers to pain control, anxiety and patient engagement. Instruments that will be used in evaluating secondary outcomes include the Brief Pain Inventory, Morisky Medication Adherence Scale, Barriers Questionnaire-II, Functional Assessment of Cancer Therapy-General, Edmonton Symptom Assessment System, Generalized Anxiety Disorder 7-item scale, and the Functional Assessment of Chronic Illness Therapy-Fatigue. The intention-to-treat approach will be used to evaluate outcomes. Our primary outcome, pain intensity, measured longitudinally over eight weeks, will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations.
The study is still in progress. We hope to have results by the end of 2015.
The multidimensional approach to pain management implemented on a mobile phone application could lead to significant improvements in patient outcomes.
Privacy and Security Concerns in Telehealth
Hale TM, Kvedar JC. Privacy and security concerns in telehealth. Virtual Mentor. 2014;16:981-985. PubMed PMID: 25493367.Read More...
Innovative connected health technologies offer a promising solution to many of the challenges facing health care delivery in the United States. Connected health refers to a wide range of care delivery models that utilize communications technologies (sometimes referred to as telehealth and telemedicine) to help patients manage their conditions through improved self-care and to extend clinical care outside of traditional settings. Health care systems that combine patient-reported information and objective data from telehealth devices and sensors can be used to create patient-centered, personalized health interventions. Although these new technologies promise to improve the quality of care, reduce costs, and increase patient satisfaction, they raise a number of ethical issues.
Representation of Health Conditions on Facebook: Content Analysis and Evaluation of User Engagement
Hale TM, Pathipati AS, Zan S, Jethwani K. Representation of health conditions on facebook: content analysis and evaluation of user engagement. J Med Internet Res. 2014 Aug 4;16(8):e182. doi: 10.2196/jmir.3275. PubMed PMID: 25092386.Read More...
A sizable majority of adult Internet users report looking for health information online. Social networking sites (SNS) like Facebook represent a common place to seek information, but very little is known about the representation and use of health content on SNS.
Our goal in this study was to understand the role of SNS in health information seeking. More specifically, we aimed to describe how health conditions are represented on Facebook Pages and how users interact with these different conditions.
We used Google Insights to identify the 20 most searched for health conditions on Google and then searched each of the resulting terms on Facebook. We compiled a list of the first 50 Facebook "Pages" results for each health condition. After filtering results to identify pages relevant to our research, we categorized pages into one of seven categories based on the page's primary purpose. We then measured user engagement by evaluating the number of "Likes" for different conditions and types of pages.
The search returned 50 pages for 18 of the health conditions, but only 48 pages were found for "anemia" and 5 pages were found for "flu symptoms", yielding a total of 953 pages. A large number of pages (29.4%, 280/953) were irrelevant to the health condition searched. Of the 673 relevant pages, 151 were not in English or originated outside the United States, leaving 522 pages to be coded for content. The most common type of page was marketing/promotion (32.2%, 168/522) followed by information/awareness (20.7%, 108/522), Wikipedia-type pages (15.5%, 81/522), patient support (9.4%, 49/522), and general support (3.6%, 19/522). Health conditions varied greatly by the primary page type. All health conditions had some marketing/promotion pages and this made up 76% (29/38) of pages on acquired immunodeficiency syndrome (AIDS). The largest percentage of general support pages were cancer (19%, 6/32) and stomach (16%, 4/25). For patient support, stroke (67%, 4/6), lupus (33%, 10/30), breast cancer (19%, 6/31), arthritis (16%, 6/36), and diabetes (16%, 6/37) ranked the highest. Six health conditions were not represented by any type of support pages (ie, human papillomavirus, diarrhea, flu symptoms, pneumonia, spine, human immunodeficiency virus). Marketing/promotion pages accounted for 46.73% (10,371,169/22,191,633) of all Likes, followed by support pages (40.66%, 9,023,234/22,191,633). Cancer and breast cancer accounted for 86.90% (19,284,066/22,191,633) of all page Likes.
This research represents the first attempts to comprehensively describe publicly available health content and user engagement with health conditions on Facebook pages. Public health interventions using Facebook will need to be designed to ensure relevant information is easy to find and with an understanding that stigma associated with some health conditions may limit the users' engagement with Facebook pages. This line of research merits further investigation as Facebook and other SNS continue to evolve over the coming years.
Using Social Media for Research: Addressing Regulatory Challenges
Hale, Timothy M., Melissa Abraham, Shiyi Zan, and Kamal Jethwani. 2014. “Using Social Media for Research: Addressing Regulatory Challenges.” Pp. 95-107 in Applying Social Media Technologies in Heatlhcare Environments, edited by Christina Beach Thielst. Chicago, IL: HIMSS.Read More...
Applying Social Media Technologies in Healthcare Environments provides an indispensable overview of successful use of the latest innovations in the healthcare provider-patient relationship. As professionals realize that success in the business of healthcare requires incorporation of the tools of social media into all aspects of their worlds and recognize the value offered by the numerous media channels, this compendium of case studies from various voices in the field—caregivers, administrators, marketers, patients, lawyers, clinicians, and healthcare information specialists—will serve as a valuable resource for novices as well as experienced communicators. Written by experienced players in the healthcare social media space and edited with the eye of an administrator, chapters provide insight into the motivation, planning, execution, and evaluation of a range of innovative social media activities. Complete with checklists, tips, and screenshots that demonstrate proven application of various social channels in a range of situations, this will be a valuable tool to maximize opportunities in meeting the challenges of new healthcare demands.
Hale, Timothy M. 2014. “eHealth.” in The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, edited by William C. Cockerham, Robert Dingwall, and Stella R. Quah. John Wiley & Sons, Ltd.Read More...
Available online or as a five-volume print set, this is the first comprehensive, interdisciplinary, and international reference work on all aspects of the social scientific study of health and illness.
- Represents the most authoritative resource covering concepts, theories, and substantive topics relating to the study of health in our globalized, 21st-century world
- Brings together an experienced author team from across America, Asia, and Europe, who represent a variety of health-related disciplines
- Accessibly structured A to Z entries also benefit from brief bibliographies and cross-references for enhanced clarity
- Offers a definitive representation of each topic, combining different areas of the social scientific study of health in a way that reflects and promotes the interdisciplinary development of health research
The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management
Bashshur RL, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, Bashshur N, Brown EM, Coye MJ, Doarn CR, Ferguson S, Grigsby J, Krupinski EA, Kvedar JC, Linkous J, Merrell RC, Nesbitt T, Poropatich R, Rheuban KS, Sanders JH, Watson AR, Weinstein RS, Yellowlees P. Telemed J E Health. 2014 Jun 26. [Epub ahead of print] PubMed PMID: 24968105.Read More...
The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.
Surveying Indian Gay Men for Coping Skills and HIV Testing Patterns Using the Internet
Jethwani KS, Mishra SV, Jethwani PS, Sawant NS. Surveying Indian gay men for coping skills and HIV testing patterns using the internet. J Postgrad Med. 2014 Apr-Jun;60(2):130-4. doi: 10.4103/0022-3859.132315. PubMed PMID: 24823510.Read More...
Surveying vulnerable and incarcerated populations is often challenging. Newer methods to reach and collect sensitive information in a safe, secure, and valid manner can go a long way in addressing this unmet need. Homosexual men in India live with inadequate social support, marginalization, and lack legal recognition. These make them less reachable by public health agencies, and make them more likely to continue with high-risk behaviors, and contract human immunodeficiency virus (HIV).
To understand coping skills and HIV testing patterns of homosexual men versus heterosexual men.
MATERIALS AND METHODS:
An internet based study using a secure web platform and an anonymised questionnaire. The brief COPE Inventory was used to assess coping styles.
A total of 124 respondents were studied. Homosexual men used negative coping skills such as behavioral disengagement and tested for HIV significantly more often than heterosexual men. Heterosexual respondents used positive coping skills more often. The most commonly used coping skill by heterosexual men was instrumental coping and by homosexual men was acceptance.
Overall, homosexual men used negative coping mechanisms, like behavioral disengagement more often. The Indian family structure and social support is probably responsible for heterosexual men's over-reliance on instrumental coping, while resulting in disengagement in homosexuals.
The lack of legal and social recognition of homosexuality has negatively impacted lives of gay men in India. This is strongly linked to harmful psychological and public health implications for HIV prevention and mental health for homosexual men.
Web-Based Depression Screening and Psychiatric Consultation for College Students: A Feasibility and Acceptability Study
Williams A, Larocca R, Chang T, Trinh NH, Fava M, Kvedar J, Yeung A. Web-based depression screening and psychiatric consultation for college students: a feasibility and acceptability study. Int J Telemed Appl. 2014;2014:580786. doi: 10.1155/2014/580786. Epub 2014 Mar 30. PubMed PMID: 24799895.Read More...
Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9) online; those who screened positive (PHQ-9 ≥ 10) or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4%) students found the interview useful in helping them understand their depression. Fifteen (88.2%) students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality.
Internet Use and Depression Among Retired Adults: A Longitudinal Analysis
Cotten SR, Ford G, Ford S, Hale TM. Internet use and depression among retired older adults in the United States: a longitudinal analysis. J Gerontol B Psychol Sci Soc Sci. 2014 Sep;69(5):763-71. doi: 10.1093/geronb/gbu018. Epub 2014 Mar 26. PubMed PMID: 24671896.Read More...
The purpose of this study is to examine the association between Internet use among retired older adults in the United States and changes in a commonly used predictor of depression (the CES-D).
Analyzing data from four waves (2002-2008) of the Health and Retirement Survey, we assess whether an available and commonly used index of a depression state was affected by prior values of the index and Internet use. The sample includes 3,075 respondents observed over 4 waves of data, yielding a total of 12,300 observations. We analyzed the effect on depression of Internet use and past depression in a full sample and a matched sample. We also conducted informal tests for confounders. Finally, we tested a basic mediation model to determine whether Internet use affected depression through its relationship with loneliness and social isolation.
Across methods, we found a positive contribution of Internet use to mental well-being of retired older adults in the United States, where Internet use reduced the probability of a depression state by one third. We found no evidence of confounding. Some evidence of mediation was found.
Our dynamic probit model indicates that for retired older adults in the United States, Internet use was found to reduce the probability of a depressed state by about 33%. Number of people in the household partially mediates this relationship, with the reduction in depression largest for people living alone. This provides some evidence that the mechanism linking Internet use to depression is the remediation of social isolation and loneliness. Encouraging older adults to use the Internet may help decrease isolation and depression.
Telehealth Among US Hospitals: Several Factors, Including State Reimbursement and Licensure Policies, Influence Adoption
Adler-Milstein J, Kvedar J, Bates DW. Telehealth among US hospitals: several factors, including state reimbursement and licensure policies, influence adoption. Health Aff (Millwood). 2014 Feb;33(2):207-15. doi: 10.1377/hlthaff.2013.1054. PubMed PMID: 24493762.Read More...
Telehealth is widely believed to hold great potential to improve access to, and increase the value of, health care. Gaining a better understanding of why some hospitals adopt telehealth technologies while others do not is critically important. We examined factors associated with telehealth adoption among US hospitals. Data from the Information Technology Supplement to the American Hospital Association's 2012 annual survey of acute care hospitals show that 42 percent of US hospitals have telehealth capabilities. Hospitals more likely to have telehealth capabilities are teaching hospitals, those equipped with additional advanced medical technology, those that are members of a larger system, and those that are nonprofit institutions. Rates of hospital telehealth adoption by state vary substantially and are associated with differences in state policy. Policies that promote private payer reimbursement for telehealth are associated with greater likelihood of telehealth adoption, while policies that require out-of-state providers to have a special license to provide telehealth services reduce the likelihood of adoption. Our findings suggest steps that policy makers can take to achieve greater adoption of telehealth by hospitals.
Connected Health: A Review of Technologies and Strategies to Improve Patient Care with Telemedicine and Telehealth
Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Aff (Millwood). 2014 Feb;33(2):194-9. doi: 10.1377/hlthaff.2013.0992. PubMed PMID: 24493760.Read More...
With the advent of national health reform, millions more Americans are gaining access to a health care system that is struggling to provide high-quality care at reduced costs. The increasing adoption of electronic technologies is widely recognized as a key strategy for making health care more cost-effective. This article examines the concept of connected health as an overarching structure for telemedicine and telehealth, and it provides examples of its value to professionals as well as patients. Policy makers, academe, patient advocacy groups, and private-sector organizations need to create partnerships to rapidly test, evaluate, deploy, and pay for new care models that use telemedicine.