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Information and communication technologies (ICTs) in oncology can revolutionize the medical care of cancer patients. ICTs can promote patients’ empowerment and real-time disease monitoring. There is limited information about the impact of ICTs in cancer patients or their level of interest in using these tools for greater management of their condition.
This study aimed to understand the ICT usage profile in hematology-oncology patients to identify their needs and determine their level of interest in these technologies as a means of managing their disease.
A 28-item questionnaire was drawn up by a multidisciplinary team including pharmacists and oncologists. The questions were organized into 3 blocks, which were as follows: block A—sociodemographic characteristics; block B—use of ICTs when searching for health-related information; and block C—usage preferences for health apps. Hematology-oncology patients receiving treatment between May and July 2017 were included. A paper copy of the questionnaire was handed over to patients in either the day hospital or the pharmaceutical care consultancy in pharmacy services.
A total of 650 questionnaires were handed out, with a participation of 94.0% (611/650). Patient sociodemographic characteristics were as follows
The hematology-oncology patients showed a great deal of interest in searching for health-related information by means of ICTs, especially using smartphones and apps. The issues that drew the most interest in terms of apps were appointment management, advice on disease management, and communication with health professionals. Free access to these features and the recommendation by a health professional are important factors when it comes to their use. Therefore, the health care provider is a key element in the recommendation of ICTs, providing their knowledge and experience concerning their correct usage.
Population aging, improvements in public health care, and therapeutic advances have given rise to an epidemiological pattern that is mainly represented by chronic diseases. This new patient profile introduces additional requirements in terms of patient care (as it corresponds to more detailed health information) and greater opportunities for communication and even novel telecare services. In this regard, information and communication technologies (ICTs) are bringing about a revolution in the management of chronic patients, acting as a source of information on one hand, while providing real-time monitoring for health professionals and two-way communication between both parties on the other [
The introduction of mobile health has meant the classic features of ICTs (content, chats, and contacts) could be focused toward providing services for patients. The use of wireless and portable devices (smartphones, tablets, wearables, and smartwatches) facilitates the collection, processing, and transmission of health information of patient through mobile phone apps and remote monitoring devices. All these features can present several advantages such as developing the active role of patients in their own health care and affording health professionals’ real-time access to patient clinical information [
Oncology is one of the medical fields that could benefit the most from these new tools [
Currently, a wide range of health apps are available, particularly ones designed especially for oncology patients [
Therefore, our aim was to understand the usage profile of information and communication technologies in oncology patients to identify their needs and determine their degree of interest in these technologies as a means of managing their disease.
A 28-item questionnaire was designed by a multidisciplinary team, including pharmacists and oncologists, with experience of ICTs applied to the field of oncology. The questions were organized into the following 3 blocks: block A—sociodemographic characteristics of a patient (questions 1-9), block B—use of ICTs when searching for health-related information (questions 10-21), and block C—usage preferences for health apps (questions 22-28). The design of the questionnaire considered the model form created by ONTSI [
Hematology-oncology patients in antineoplastic therapy (chemotherapy, immunotherapy, oral targeted therapies, and hormone therapy) and/or support therapy were included. Patients younger than 18 years and those who would have had trouble understanding the questions because of language or cultural barriers were excluded. Participation was voluntary and anonymous. The inclusion period ran from May to July 2017. A paper copy of the questionnaire was handed over to every patient in the day hospital (administration or waiting rooms) or the pharmaceutical care consultancy in the outpatient pharmacy services area. Alternatively, patients could take the questionnaire home and return it filled out at their next appointment.
The questionnaire was approved by the clinical research ethics committee of the hospital, project code EHPHDO2017, and conducted in accordance with the ethical principles laid down by the Declaration of Helsinki. It did not include any information about the personal data of patients to ensure data confidentiality.
Data were analyzed using the software SPSS version 21.0 (IBM Corp) for Windows. The variables were analyzed using descriptive statistics. Normality was analyzed by means of the Kolmogorov-Smirnov test. Numeric variables were compared with Student
A total of 650 questionnaires were handed out, with a participation of 94% (we finally analyzed 611 questionnaires). Sociodemographic characteristics of patients are shown in
In response to the question concerning the reasons why patients looked for health information, 49.2% (301/611) replied they wanted to obtain information about disease prevention, healthy lifestyles, and health care, and 47.2% (289/611) were seeking information about the treatment their doctor had prescribed for them. We observed statistically significant differences depending on the level of education, age, sex, and tumor type. First, patients with secondary or university education and younger patients searched for more information on health (
As for the question regarding whether the information they found on the internet was easy to understand, 10.8% (66/611) of patients replied “always.” A higher proportion of young patients and those with secondary or university education responded “always” than those in other demographic groups (
Before going to their doctor’s appointment, 21.8% (133/611) of patients turned to the internet for information about their disease and/or treatment, an action that was more common in younger participants (
Sociodemographic characteristics of patients (N=611).
Demographic characteristics | Patients, n (%) | |
Male | 233 (38.1) | |
Female | 378 (61.9) | |
<55 | 256 (41.9) | |
56-65 | 179 (29.3) | |
>65 | 176 (28.8) | |
Yes | 61 (10.0) | |
No | 547 (89.5) | |
No response | 3 (0.5) | |
No | 576 (94.3) | |
Yes | 35 (5.7) | |
No education or incomplete primary education | 32 (5.2) | |
Primary education | 110 (18.0) | |
Secondary education | 220 (35.9) | |
University education | 249 (40.7) | |
No | 528 (86.4) | |
Needs help once a day | 29 (4.7) | |
Needs help several times a day | 39 (6.4) | |
Totally dependent | 14 (2.3) | |
No response | 1 (0.2) | |
Bladder | 9 (1.5) | |
Breast | 124 (20.3) | |
Cervical | 8 (1.3) | |
Colorectal | 113 (18.5) | |
Esophageal | 13 (2.1) | |
Head and neck | 16 (2.6) | |
Hematological | 179 (29.2) | |
Kidney | 16 (2.6) | |
Lung | 60 (9.8) | |
Ovarian | 31 (5.1) | |
Pancreatic | 28 (4.6) | |
Prostate | 12 (2.0) | |
Sarcoma | 16 (2.6) | |
Skin or melanoma | 8 (1.3) | |
Stomach | 11 (1.8) | |
Testicular | 6 (1.0) | |
Very good | 48 (7.9) | |
Good | 276 (45.2) | |
Average | 226 (37.0) | |
Poor | 50 (8.2) | |
Very poor | 8 (1.3) | |
No response | 3 (0.2) |
Frequency with which patients used different information and communication technologies to search for information on the internet.
Frequency of using new technologies to consult internet for oncohematological patients (N=611).
Use of information and communication technologies | Patients, n (%) | |
Mobile app | 413 (67.5) | |
Smartphone | 404 (66.0) | |
information and communication technologies | 179 (29.2) | |
I have not heard any of these terms before | 142 (23.2) | |
eHealth | 88 (14.4) | |
Mobile health or mHealth | 66 (10.8) | |
Wearable | 51 (8.3) | |
Mobile phone | 445 (72.7) | |
Desktop and/or laptop computer | 416 (68.0) | |
Tablet | 274 (44.8) | |
Television with internet (SmartTV) | 58 (9.5) | |
Smartwatch | 15 (2.5) | |
Others | 3 (0.5) | |
I do not look for information on the internet | 84 (13.7) | |
Yes | 532 (87.1) | |
No | 60 (9.8) | |
No response | 19 (3.1) | |
Health professionals | 462 (75.5) | |
Internet | 375 (61.3) | |
People close to me (friends, relatives, and workmates) | 160 (26.1) | |
Newspapers, magazines, and pamphlets | 151 (24.7) | |
Mobile apps | 62 (10.1) | |
Others | 23 (3.8) | |
436 (71.2) | ||
I do not search for medical information on the internet | 129 (21.1) | |
Medical societies | 124 (20.3) | |
Patient associations | 123 (20.1) | |
YouTube | 68 (11.1) | |
45 (7.4) | ||
Blogs | 43 (7.0) | |
Others | 21 (3.4) | |
Other social networks | 11 (1.8) | |
10 (1.6) | ||
Disease prevention, healthy lifestyles, and health care | 301 (49.2) | |
To find information about the treatment prescribed by my doctor | 289 (47.2) | |
To find symptoms and learn about potential diseases | 145 (23.7) | |
To find information about medical centers or health professionals | 139 (22.7) | |
To find information about alternative or complementary medicines (herbal products and acupuncture) | 107 (17.5) | |
To get in contact with other people with health problems such as mine | 71 (11.6) | |
Others | 69 (11.3) | |
Usually | 269 (44.0) | |
Sometimes | 148 (24.2) | |
No response | 77 (12.6) | |
Always | 66 (10.8) | |
Never | 51 (8.3) | |
Yes | 84 (13.7) | |
No | 129 (21.1) | |
Depends on the website | 336 (55.0) | |
No response | 62 (10.1) | |
No | 451 (73.8) | |
Yes | 133 (21.8) | |
No response | 27 (4.4) | |
Yes | 143 (23.4) | |
Only if I have still got doubts about something | 168 (27.5) | |
No | 270 (44.2) | |
No response | 30 (4.9) |
Usage preferences for health apps (N=611).
Usage preferences for health apps | n (%) | |
No | 93 (15.2) | |
Yes | 505 (82.7) | |
No response | 13 (2.1) | |
No | 478 (78.2) | |
Yes | 124 (20.3) | |
No response | 9 (1.5) | |
Normal phone use (calls, messages, and photos or videos) | 591 (96.6) | |
To access the internet | 347 (56.7) | |
Schedule planner and alarms | 305 (49.8) | |
To use apps | 262 (42.8) | |
Social networks | 233 (38.1) | |
Telephone | 470 (76.8) | |
270 (44.1) | ||
Mobile apps | 250 (40.8) | |
Videoconference | 116 (19.0) | |
Website | 51 (8.3) | |
Blogs | 20 (3.3) | |
Social networks | 18 (2.9) | |
Yes | 498 (81.5) | |
No | 82 (13.4) | |
No response | 31 (5.1) | |
No | 242 (39.6) | |
Probably | 199 (32.6) | |
Yes | 102 (16.7) | |
No response | 68 (11.1) |
Reasons why patients used a health app, and things they wish the app could help them with.
To our knowledge, this is the first survey aimed to identify the needs and interests of hematology-oncology patients in the ICT as a means of managing their disease. In this survey conducted in 611 patients, we observed that most of the patients (505/611, 82.7%) owned a smartphone. Furthermore, almost half of patients use their mobile, which was the most popular device among the different options, to perform internet searches every day.
We have seen that health is a cause for concern for 86.9% (531/611) of our patients. Traditionally, patients have tried to physically obtain medical information from ordinary health professionals (doctors, pharmacists, and nurses) [
In addition, in this study, we have noted that 21.8% (133/611) of patients look up facts about their disease before visiting the doctor, a figure that can rise to 50% after their appointment. These data are akin to those reported by ONTSI [
If we analyze interests of our patients, more than 40% (244/611) would like to be able to communicate with their health professional by means of an app or via email, a figure close to the 37.3% detailed in the ONTSI report published in April 2016 [
Despite the interest these new technologies generate, the cost is a key factor governing their use. Considering the average price of apps designed for cancer patients is €2.15 [
Finally, it is worth highlighting that although the world of apps is evolving considerably, they do not actually cover all our patients’ needs [
The survey is a type of quantitative research to obtain a large amount of information that objectively can be extrapolated. However, there are other qualitative techniques such as interviews or discussion groups that allow us to know in-depth the perceptions of patients. This type of technique can complete the surveys so that the analysis of the results is much more complete. The results of this survey are being taken into account in a larger project that we are carrying out. The aim of this project was to improve the integral circuit of oncohematological patient care. The semistructured interview methodology with groups of patients is being used. Another limitation of the survey was the number of questions, which could complicate its degree of fulfillment. The questionnaire was therefore handed out at the oncology day hospital so that patients could complete it while they received chemotherapy. Participants could also take the questionnaire home with them and return it completed at their next appointment that resulted in a very low percentage of dropouts. On the other hand, as the survey included new terms that were unfamiliar to some participants, they may not have understood some of the questions while completing the questionnaire. To overcome this limitation, the survey was mainly conducted in the oncology day hospital or outpatient clinic where collaborating researchers were available to help resolve any doubts patients may have had. The questionnaire also included a telephone number patients could call to clear up any doubts or questions that may arise while completing it at home. Finally, questions were completed by patients in Spain in the day hospital or the pharmaceutical care consultancy at pharmacy services. Thus, part of the results may not be representative of other cancer patients in different health systems. However, because we have described exhaustively the working methodology and the complete survey has been published, this work could be reproduced at any center.
The results of the survey show that hematology-oncology patients are very interested in finding health-related information via ICTs, especially using smartphones and apps. These apps, which are presented as tools that cover these needs, are used as both a source of information and as a new communication channel between patients and health professionals. Free access to apps is still an important factor when it comes to promoting their use and reaching a greater number of users. The app features that draw the most interest are appointment management, advice on disease management, and personalized communication with health professionals. However, many of the apps available have not been validated or updated and do not offer any alternatives to medical care. Therefore, the health professional plays an essential role in recommending and validating these tools to ensure they are of high quality standards.
information and communication technology
Spanish National Observatory of Telecommunications and Information Society
The authors would like to thank the team at Speak Talk Communicate SL for their help preparing the manuscript and Gesco Consultores for advice on the survey. This project was supported by iPharma (Pharmacy Innovation Center at the Hospital General Universitario Gregorio Marañón) through funding received from ERDF Project PI13/02056; aid co-financed by the European Regional Development Fund “ERDF, a way of making Europe.”
None declared.