JMIR Publications

ABSTRACT

Background:

Oncological healthcare services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms (DCP) are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a DCP or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and healthcare provider reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a DCP in oncological care.

Objective:

The aim of this systematic review is to collect the best available evidence of the effect of a DCP on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and healthcare provider-reported experiences. Additionally, barriers and facilitators for implementation of DCPs were analyzed.

Methods:

PubMed (Medline), Embase, CINAHL and Cochrane Library were searched for the period of January 2000 and May 2020 for studies assessing the effect of a DCP on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of the studies.

Results:

Seventeen studies were included for final analysis, comprising eight clinical studies on the effectiveness of the DCP and 13 studies describing barriers and facilitators. Usage of a DCP appeared to enhance the availability of information and self-efficacy. There was no data on the effect of DCP on continuity of care. However, based on focus group interviews, DCPs could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences, such as satisfaction with the platform, were considerably positive. Most barriers for implementation were identified on the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found on the patient and innovation level, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned on the economic and political level.

Conclusions:

The use of DCPs is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators on the patient level illustrate that patients are positive towards a DCP. However, despite these favorable results, robust evidence concerning the effectiveness of DCPs, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of DCPs, and barriers and facilitators on the economic and political level.