Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 2, 2022
Date Accepted: Nov 13, 2022
Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: A Pragmatic Randomized Controlled Trial
ABSTRACT
Background:
Cancer poses a significant burden on the health of Canadians. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple healthcare providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists.
Objective:
The objective of this study was to examine whether a web- and text- based asynchronous system (eOncoNote) could facilitate communication between PCPs and cancer specialists (oncologists and oncology nurses) to improve patient-reported continuity of care among patients receiving treatment or post-treatment survivorship care.
Methods:
In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to the intervention arm (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or control arm (usual communication only), including 104 patients in the survivorship phase (breast and colorectal cancer) and 69 patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team/cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression (PHQ-9), and the Picker Patient Experience Questionnaire (PPE-15). Patients completed questionnaires at baseline and at two points post randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month post randomization, and at either 4 months (patients with prostate cancer) or 6 months post randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months post randomization and at 12 months post randomization.
Results:
The results did not show an intervention effect on the primary outcome of team/cross boundary continuity of care, nor for the secondary outcomes of depression and patient experience with their healthcare. However, there was an intervention effect on anxiety. In the treatment phase, there was a statistically significant difference in the change score from baseline to 1-month follow-up for GAD-7 (mean difference = -2.3, P=.03). In the survivorship phase, there was a statistically significant difference in the change score for GAD-7 between baseline and 6-month follow-up (mean difference = -1.7, P=.03), and between baseline and 12-month follow-up (mean difference = -2.4, P=.004).
Conclusions:
PCP and cancer specialist access to eOncoNote is not significantly associated with patient reported continuity of care. However, access to the eOncoNote intervention may help reduce patient anxiety. Clinical Trial: ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785
Citation
Per the author's request the PDF is not available.
Copyright
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