UP-12 Patient acceptance of a preliminary asynchronous care model for prostate cancer survivors: A pilot study
Thursday June 27, 2019 from
TBD
Presenter

Jason Hearn, Canada

Memorial University of Newfoundland

Abstract

Patient acceptance of a preliminary asynchronous care model for prostate cancer survivors: A pilot study

Jason Hearn1,2, Quynh Pham2,3, Joseph A Cafazzo2,3, Alejandro Berlin4,5, Ian R. Brown6,7, Antonio Finelli8, Robert J. Hamilton9, Andrew H. Feifer10,11.

1Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada; 2Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada; 3Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 4Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; 5Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; 6Division of Urology, Niagara Health, Niagara, ON, Canada; 7Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; 8Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada; 9Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada; 10Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada; 11Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada

Introduction: The potential for virtual care has never been greater. One attractive model is asynchronous care - a sequential process involving a) patient-completed tasks (e.g. laboratory tests, imaging, surveys), b) a review by a provider, and c) a treatment plan sent to the patient or a virtual visit to investigate ongoing issues. One area likely to benefit from such care models is prostate cancer (PCa) survivorship. Asynchronous care has been effective for PCa survivors internationally, but has yet to be adequately investigated in Canada. 

Methods: A user-centred design process was used to develop Ned. Ned comprises a web application where patients can see current tasks, access their prostate-specific antigen (PSA), and report quality of life using the expanded PCa index composite (EPIC-26) (Fig. 1). Clinicians can visualize PSA kinetics, be alerted of worrisome EPIC-26 results, and send treatment plans to patients (Fig. 2). To assess patient interactions with Ned, a pilot study was completed amongst PCa survivors in Mississauga, ON. Participants were provided with access to Ned and asked to complete the EPIC-26 each month.

Results: A total of 38 PCa survivors (aged 68 ± 10 years) were enrolled between October 2017 and June 2019. Mean enrolment duration was 21 months (range = 1-34). Mean compliance with the monthly EPIC-26 was 85% ± 20%. A total of 536 alerts (0.67 per patient-month on Ned) were triggered, most commonly in the domains of hormonal function (150), bowel function (148), and urinary incontinence (132). Number of alerts was positively-correlated with status post-surgery (R2 = 0.35, N = 3) and negatively-correlated with status post-radiation (R2 = -0.16, N = 18). 

Conclusions: An asynchronous care model was well-adopted by a group of Canadian PCa survivors and effective in exposing important quality-of-life issues. Ned may enable prompt intervention upon identified patient issues, as well as reduce unnecessary clinic visits for stable PCa survivors. Further work to validate and iterate the design of Ned is ongoing.


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