JMIR Publications

ABSTRACT

Background:

Person-centered care responsive to individual preferences, needs, and values is recognized as an important aspect of high-quality healthcare, and patient empowerment is increasingly viewed as a central core value of person-centered care. Web-based interventions aimed at empowerment report a beneficial effect on patient empowerment and physical activity but that there is limited information available on barriers, facilitators, and user experiences. A recent review on the effect of digital self-management support tools suggests a beneficial effect on quality of life in patients with cancer. Based on an overall philosophy of empowerment, Guided Self-Determination is a person-centered intervention that uses preparatory reflection sheets to help achieve focused communication between patients and nurses educated in the method. The intervention was adapted into a digital version called Digitally Assisted Guided Self-Determination (DA-GSD) hosted by the Danish National Health Portal on Sundhed.dk that can be delivered face to face, via video, or a combination of the two.

Objective:

To investigate the experiences of nurses, nurse managers, and patients of using DA-GSD in two oncology departments and one gynecology department over a five-year implementation period from 2018-2022.

Methods:

A qualitative study inspired by action research comprising the responses of 17 patients to an open-ended question on their experience of specific aspects of DA-GSD in an online questionnaire; 14 qualitative semi-structured interviews with nurses and patients who initially completed the online questionnaire; and transcripts of meetings held between the researchers and nurses during implementation of the intervention. The thematic analysis of all data was done using NVivo.

Results:

The analysis generated two main themes and seven subthemes that reflect conflicting perspectives and greater acceptability of the intervention among the nurses over time due to better familiarity with the increasingly mature technology. The first theme was the different experiences and perspectives of nurses and patients concerning barriers to using DA-GSD and comprised four subthemes: conflicting perspectives on the ability of patients to engage with DA-GSD and how to provide it; conflicting perspectives on DA-GSD as a threat to the nurse-patient relationship; functionality of DA-GSD and available technical equipment; and data security. The other theme was what influenced the increased acceptability of DA-GSD among the nurses over time and comprised three subthemes: reevaluation of the nurse-patient relationship; improved functionality of DA-GSD; and supervision, experience, patient feedback, and a global pandemic.

Conclusions:

The nurses experienced more barriers to DA-GSD than the patients did. Acceptance of the intervention increased over time among the nurses in keeping with the intervention’s improved functionality, additional guidance, and positive experiences, combined with patients finding it useful and beneficial. Our findings emphasize the importance of supporting and training nurses, if new technologies are to be implemented successfully. Clinical Trial: The study was registered with the Danish Data Protection Agency (file RH-2017-248, I-Suite 05720)