JMIR Publications

ABSTRACT

Background:

The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association’s Life’s Simple 7 cardiovascular health (CVH) metrics to promote CVH assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors.

Objective:

We assessed provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD.

Methods:

Providers (physicians, nurse practitioners, physician assistants) completed a survey to assess acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology (UTAUT) survey (Performance Expectancy, Effort Expectancy, Attitude Toward using Technology, and Facilitating Conditions). Semi-structured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Post-treatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess acceptability of the AH-HA tool immediately after the designated study appointment.

Results:

Providers (n=15) reported high overall acceptability of the AH-HA training (mean=5.8, SD=1.0) and tool (mean=5.5, SD =1.4); provider acceptability was also supported by UTAUT scores (e.g., Effort Expectancy mean=5.6, SD=1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (e.g., It helps focus the conversation and give the patient a visual of continuum of progress). Providers were more favorable about using the AH-HA tool for post-treatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 years post-treatment (SD =3.7). Most survivors reported that they strongly agreed/agreed that they liked the AH-HA tool (94.3%, n=231). A larger proportion of survivors with high health literacy strongly agreed/agreed that it was helpful to see their heart health score (98.2%, n=161) compared to survivors with lower health literacy scores (89.5%, n=68; p=0.005).

Conclusions:

Quantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy. Clinical Trial: Assessing Effectiveness and Implementation of an EHR Tool to Assess Heart Health Among Survivors (AH-HA) NCT03935282 https://clinicaltrials.gov/study/NCT03935282?term=NCT03935282&rank=1