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Engagement with telehealth approaches by adult patients with advanced cancer: A systematic review of the international literature
ABSTRACT
Background:
Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests telehealth is acceptable to most patients, however the extent of and factors influencing patient engagement remain unclear.
Objective:
To characterise the extent and influencing factors of engagement with telehealth interventions in patients with advanced cancer.
Methods:
A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies) including MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science, up until the end of 2020. A narrative synthesis was conducted to outline the design, population, and context of studies. A conceptual framework comprising behavioural measures of engagement with telehealth approaches (frequency, amount, duration and depth of use) framed analysis. Frequency data were transformed to a percentage (actual engagement as a proportion of intended engagement), and interventions were characterised by intensity (high, medium and low intended engagement) and mode of delivery for standardised comparisons across studies.
Results:
Of the 19,676 identified papers, 40 papers, covering 39 different studies, were eligible for inclusion, dominated by US studies (n=20), with the majority being research studies (n=26). The most commonly reported measure of engagement was frequency (n=36) with substantial heterogeneity in the way in which it was measured. A standardised percentage of actual engagement was derived from 17 studies (n=1,255), ranging from 51% to 100%, with a weighted average of 75.4%. A directly proportional relationship was found between intervention intensity and actual engagement. Higher engagement occurred where a tablet computer or smartphone application was the mode of delivery.
Conclusions:
Frequency of engagement is commonly reported reflecting wide variation in actual versus intended engagement. Understanding engagement for people with advanced cancer can guide development of telehealth approaches at all stages, from their initial design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful, context- and condition-appropriate measures of telehealth engagement are needed to address the current heterogeneity in reporting whilst improving an understanding of optimal implementation of telehealth for oncology and palliative care.
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