JMIR Publications

ABSTRACT

Background:

Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease quality of life. Digital communication tools that allow patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient–provider communication, clinical outcomes, and health-related quality of life (HRQoL). Such tools have the potential to prepare patients as well as health care providers prior to visits and facilitate shared decision making for treatment and care. Despite the rapid development and number of digital communication tools that have shown positive research results, barriers to realizing the benefits offered through these interventions still exist.

Objective:

The overall aim of this study was to prepare the implementation of a digital patient–provider communication tool into daily workflow at two outpatient clinics. The objective was to identify potential facilitators and barriers to implementation using the Consolidated Framework for Implementation Research (CFIR) in order to: (1) tailor the use of the digital communication tool to the intended context, and (2) identify key aspects for an implementation plan.

Methods:

A combination of focus group interviews, a workshop, and project steering committee meetings was conducted with health care providers (n=14) and patient representatives (n=2) from two outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes and notes were analyzed and coded into the five CFIR domains using thematic analysis.

Results:

Examining potential facilitators and barriers to implementation, current practice was described as hectic, with no established system for digital communication. Health care providers described patients experiencing symptoms that impact HRQoL. A digital tool was perceived to have the potential to improve patient–provider communication and symptom management, although there were concerns for patient acceptance. Lack of integration of such a tool with existing digital systems was perceived as a barrier. Engagement from leaders, and dedicated personnel with a desire to improve patient–provider communication, was seen as potentially supporting the implementation. Some participants were concerned that a digital tool could increase their workload; others were enthusiastic by what they considered as potential benefits of such a tool for clinical practice. Identified barriers concerning lack of integration, increased workload and patient acceptance were addressed to tailor the digital communication tool. Suggestions for the implementation plan included: involving key stakeholders; external facilitation; information; training and coaching.

Conclusions:

The study offers insight into the involvement of end users in the tailoring and implementation planning of a digital communication tool to clinical practice. End-user identification of implementation facilitators and barriers can contribute to necessary tailoring of how digital communication tools are used, and also support systematic and targeted implementation planning. Clinical Trial: NCT04218721