JMIR Publications

ABSTRACT

Background:

Cancer immunotherapy (CIT) has been shown to extend overall survival in patients with locally advanced/metastatic non-small cell lung cancer (NSCLC). However, many patients experience treatment-related symptoms, assessment of which relies on patients recalling adverse events between hospital visits. Digital patient monitoring (DPM) tools may improve clinical practice by allowing real-time symptom reporting.

Objective:

This proof-of-concept pilot study assessed user experience and impact of our DPM tool on quality of clinical care for healthcare professionals (HCPs) and CIT-treated patients with advanced/metastatic NSCLC.

Methods:

Four advisory boards were conducted in order to co-develop a drug- and indication-specific module (CIT+), based on a generic CIT DPM tool (Kaiku Health, Helsinki, Finland). Forty-five patients treated with second-line single-agent CIT (atezolizumab or otherwise) for advanced/metastatic NSCLC, and HCPs (exact number decided by clinic), were recruited from 10 clinics in Germany, Finland, and Switzerland, between February–May 2019. All clinics were provided with the Kaiku generic CIT DPM and our CIT+ module. Data on user experience, overall satisfaction, and impact of the tool on clinical practice were collected using anonymized surveys (answers rated 1 [low agreement]–5 [high agreement]) and HCP interviews; the surveys and interviews consisted of closed-ended/Likert Scale and open-ended questions, respectively. The first survey was conducted after 2 months of DPM use, and a second survey and HCP interviews at study end. Data from surveys were analyzed quantitatively; interviews were recorded, transcribed verbatim, and translated into English for coding.

Results:

Among interim survey respondents (n=51; 13 nurses, 11 physicians, and 27 patients), average rankings of the tool’s usability attributes ranged from 3.2–4.4 (nurses), 3.7–4.5 (physicians), and 3.7–4.2 (patients). At the end-of-study survey (n=48; 19 nurses, 8 physicians, and 21 patients), respondents agreed that the tool facilitated more efficient and focused discussions between patients and HCPs (nurses and patients: average rating=4.2/5; physicians: 4.4/5) and allowed HCPs to tailor discussions with patients (4.35/5). The standalone tool was well integrated into HCP daily clinical workflow (average rating 3.8/5), enabled workflow optimization between physicians and nurses (3.75/5), and saved time by decreasing the need for phone consultations (3.75/5) and patient visits (3.45/5). Workload was the most common challenge of tool use (n=12/19 interviewees; 63%). Among HCPs and patients, the most appreciated tool functions were the patient symptom alerts (n=26/27; 96%) and symptoms questionnaire (n=20/21; 95%), respectively.

Conclusions:

Our results demonstrate high user satisfaction and acceptance of DPM tools by HCPs and patients, and highlight the improvements to clinical care in patients with CIT-monotherapy treated advanced/metastatic NSCLC. However, further integration of the tool into the clinical information technology data flow is required. Future studies or registries using our DPM tool may provide insights into significant effects on patient quality of life, or health-economic benefits. Clinical Trial: N/A