JMIR Publications

ABSTRACT

Background:

Men with prostate cancer require long term monitoring and follow up for recurrence or progression in order to identify and address a range of direct and indirect consequences of the cancer and its treatment. Remote systems are becoming increasingly embedded within the NHS and hold considerable potential for saving time and resources. Holistic Needs Assessment (HNA) for men, during and after treatment, seeks to ensure a patient centred approach to immediate and long-term cancer care. Paper based, generic assessment tools however have had limited uptake within cancer services and there is little evidence of their impact on outcomes. In the light of the expansion of remote, internet-based methods of care delivery and to enhance the value of the generic tools, we have developed an online, Composite Holistic needs Assessment Tool specifically for prostate cancer (CHAT-P). The output of CHAT-P is shared between men and members of their health care teams to help ensure prostate specific and broader needs are identified and addressed at each stage of the pathway of care. In addition, CHAT-P aims to empower men to self -manage by providing links to relevant sources of advice and information.

Objective:

To describe the conceptual underpinning, the stages of development and initial evaluation of CHAT-P and to consider the strengths and limitations of our approach. We seek to inform and contribute to the development of other digital systems with potential for innovative methods of care delivery.

Methods:

Development of CHAT-P was guided by the principles of co-production. Men with prostate cancer and clinicians contributed to each stage of the process. Several stages of testing were conducted over a five-year period with both cancer service users and clinicians involved in prostate cancer care.

Results:

A rapid review of patient reported outcome measures identified a wide range of items for inclusion. These items were categorised into overarching domains and items allocated into each. Further items were added, improvements in the branching of items and refinement of response categories were made based on findings from the first round of user testing. A linked care plan was developed based on interviews and informal discussions with a variety of healthcare professionals. A fully functioning version of CHAT-P was tested with 16 patients, and modifications to design and content based on analysis of interview data were implemented. The final version of CHAT-P was tested in a primary care based feasibility study, and a final round of refinements made subsequently.

Conclusions:

CHAT-P offers an innovative means by which men can highlight their concerns to their healthcare teams prior to a physical or remote consultation. There is now a need for full evaluation of outcomes where CHAT-P is introduced into the clinical pathway. There is also scope to adapt the CHAT-P model to other cancers.