JMIR Publications

ABSTRACT

Background:

Cancer is a disease that predominantly affects older adults and several organizations recommend the completion of a geriatric assessment (GA) to help with cancer treatment decision-making. Due to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, an online geriatric assessment may improve access to GA for older adults. In order to develop an online GA that will present test results to older adults, we systematically reviewed the literature to obtain the latest evidence for the design of our Comprehensive Health Assessment for My Plan (CHAMP) online GA tool.

Objective:

Our review questions were: 1) what is the impact of providing health test results to older adults in an online environment without a healthcare provider present on patient-centered outcomes including satisfaction, perceived harm, empowerment, quality of life, and health care utilization (hospitalization, physician visits, emergency room visits, costs, etc.?); and 2) what recommendations do older adults and developers have for designing future apps/websites for older adults?

Methods:

This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Studies were limited to publications examining an online tool that provided test results to older adults (65+) without the presence of a health care provider, published in English. A Health Sciences Librarian performed the search on November 29, 2019, using the following electronic databases: Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. The quality of studies included was assessed using the Mixed Methods Appraisal Tool Version 2018. Findings are summarized narratively and in tabular format.

Results:

A total of 26,898 titles and abstracts were screened by 2 independent reviewers, with 94 selected for full-text review, and 9 studies included in this review. There were only two randomized controlled trials of high quality that explored the effect of receiving health care results online via eHealth tools on older adults or provided evidence-based recommendations for designing the tools. Older adults were generally satisfied with receiving screening results via eHealth tools and several studies suggested that receiving health screening results electronically improved participants’ quality of life. However, user interfaces that were not designed with older adults in mind, as well as older adults’ lack of confidence in navigating eHealth tools, proved challenging to eHealth uptake and use. All nine studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults.

Conclusions:

eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without healthcare providers present on patient-centered outcomes in this population.