Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial

Bojana Petrovic; Jim A Julian; Clare Liddy; Amir Afkham; Sharon F McGee; Scott C Morgan; Roanne Segal; Jonathan Sussman; Gregory R Pond; Mary Ann O'Brien; Jacqueline L Bender; Eva Grunfeld

doi:10.2196/40725

Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial

J Med Internet Res. 2023 Jan 18:25:e40725. doi: 10.2196/40725.

Authors

Bojana Petrovic^{1

2}, Jim A Julian³, Clare Liddy^{4

5}, Amir Afkham⁶, Sharon F McGee⁷, Scott C Morgan^{7

8}, Roanne Segal⁷, Jonathan Sussman³, Gregory R Pond³, Mary Ann O'Brien¹, Jacqueline L Bender^{2

9

10}, Eva Grunfeld^{1

2

10

11}

Affiliations

¹ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Department of Oncology, McMaster University, Hamilton, ON, Canada.
⁴ Bruyère Research Institute, Ottawa, ON, Canada.
⁵ Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Ontario Health East, Ottawa, ON, Canada.
⁷ The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.
⁸ Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada.
¹⁰ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹¹ Ontario Institute for Cancer Research, Toronto, ON, Canada.

PMID: 36652284
PMCID: PMC9892983
DOI: 10.2196/40725

Abstract

Background: Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists.

Objective: This study aimed 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 posttreatment survivorship care.

Methods: In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to either the intervention group (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or a control group (usual communication only), including 104 (60.1%) patients in the survivorship phase (breast and colorectal cancer) and 69 (39.9%) patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team and cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression, and Picker Patient Experience Questionnaire. Patients completed the questionnaires at baseline and at 2 points following randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month and at either 4 months (patients with prostate cancer) or 6 months following randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months and at 12 months following randomization.

Results: The results did not show an intervention effect on the primary outcome of team and cross-boundary continuity of care or on the secondary outcomes of depression and patient experience with their health care. 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 the 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 the 6-month follow-up (mean difference -1.7; P=.03) and between baseline and the 12-month follow-up (mean difference -2.4; P=.004).

Conclusions: PCPs' and cancer specialists' access to eOncoNote is not significantly associated with patient-reported continuity of care. However, PCPs' and cancer specialists' access to the eOncoNote intervention may be a factor in reducing patient anxiety.

Trial registration: ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785.

Keywords: cancer; coordination of care; electronic communication; primary care.

©Bojana Petrovic, Jim A Julian, Clare Liddy, Amir Afkham, Sharon F McGee, Scott C Morgan, Roanne Segal, Jonathan Sussman, Gregory R Pond, Mary Ann O'Brien, Jacqueline L Bender, Eva Grunfeld. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 18.01.2023.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / therapy
Communication
Continuity of Patient Care
Humans
Internet
Male
Prostatic Neoplasms*

Associated data

ClinicalTrials.gov/NCT03333785

Grants and funding

TT7-128272/CIHR/Canada