JMIR Publications

ABSTRACT

Background:

Telehomecare monitoring (TM) in patients with cancer is a complex and demanding intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management and practice transformation. Factors involved in these variations need to be better understood in order to improve implementation processes and assure the effectiveness of care.

Objective:

This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for people receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to: a) site characteristics (location, mission, resources, supports), b) team characteristics (clinicians, managers, coordination with primary care, community organizations), and c) characteristics of the PLC receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcomes (ePROs) and electronic patient-reported experience (ePRE) according to site, implementation process and PLC characteristics; (3) describe the acceptability and feasibility of TM from the perspective of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of province-wide implementation.

Methods:

This mixed methods evaluability study employs a Type II hybrid effectiveness-implementation design. Formative evaluation is integrated into an emerging practice in three participating sites representing a diversity of settings, providers and participants. Data for ePRO and ePRE are collected using validated questionnaires in oncology. Qualitative data are gathered from key informants using an interview guide based on dimensions of the RE-AIM/PRISM framework. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses of quantitative data will be undertaken alongside interpretive descriptive coding of qualitative data, followed by integration of quantitative and qualitative results. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice and transferable to other settings.

Results:

The study received approval from the institutional Research Ethics Board in August 2023. All questionnaires were pre-tested and the technological platform was co-developed with clinicians and cancer survivors. Preparatory work was done to configure the TM platform and activate coordinating mechanisms between patient partners, cancer team leaders, information technology experts and the research team. A steering committee was established with 3 working groups to support technological, clinical and evaluation aspects of the study. Recruitment of PLC for ePROs started in February 2024 and data collection will continue until March 2025. Provider interviews will begin in October 2024. Full analysis should be completed by September 2025.

Conclusions:

Given the current emphasis on modernizing care and services for people living with cancer, the study will produce new knowledge on the implementation of TM. It will clarify how, why, for whom and under what conditions this intervention can complement current care models while improving the equity and effectiveness of care and services.