Abstract
Introduction
Digital health interventions (DHIs) provide patients with remote access to healthcare
information and services through devices and online portals. Older patients (≥65 years
old) with cancer may face difficulties using DHIs due to higher physical and psychological
burden, but little is known about their pattern of use. The aim of this systematic
review was to synthesise current findings related to user's perception of barriers
and enablers to uptake and adherence of DHIs in this population.
Materials and Methods
A search for English-language primary qualitative and mixed methods studies on uptake
and adherence of DHIs among older patients with cancer was conducted on seven databases
(CINAHL, Cochrane, Emcare, JBI, MEDLINE, Proquest, and SCOPUS), since inception until
September 2021. Relevant data was extracted, appraised using the MMAT tool, and synthesised
based on common themes.
Results
Five studies met the eligibility criteria. All five studies examined barriers and
enablers to uptake of DHIs but only two studies examined barriers and enablers to
adherence to these interventions. Two themes – usability and perceived usefulness
– emerged from all analyses. Usability was measured using system usability scale,
ease of use survey, and observation or participant feedback. High usability to uptake
was facilitated by minimalist and age-appropriate design. High usability to adherence
was facilitated by customisability of DHIs and availability to provide feedback on
DHI design. High perceived usefulness to uptake was facilitated by DHIs' ability to
provide health information and to connect the patient to their healthcare team. High
perceived usefulness to adherence was facilitated by DHIs ability to provide, reminders
and contingency plans, reinforce long-term treatment plans, and keep healthcare teams
updated on patients' progress. The review was limited by a small number of primary
studies and longitudinal studies.
Discussion
The enablers and barriers to uptake and adherence of DHIs among older patients with
cancer followed the same themes (usability and perceived usefulness) found in other
populations. The components of usability and perceived usefulness were similar to
other populations, rendering the need for more studies to identify factors unique
to this population.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Geriatric OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- What is Digital Health?.([Online]. Available:)
- Digital health.([Online]. Available:)https://www.ncbi.nlm.nih.gov/books/NBK470260/Date: January 2020
- The use of internet-based health and care services by elderly people in Europe and the importance of the country context: multilevel study.JMIR Aging. 2020; 3e15491
- In the digital age: a systematic literature review of the e-health literacy and influencing factors among Chinese older adults.J Public Health (Berl.). 2021; https://doi.org/10.1007/s10389-021-01604-z
- The use of e-health and m-health tools in health promotion and primary prevention among older adults: a systematic literature review.BMC Health Serv Res. 2016; https://doi.org/10.1186/s12913-016-1522-3
- Mobile health solutions for the aging population: a systematic narrative analysis.J Telemed Telecare. 2017; 23: 439-451
- Aging barriers influencing mobile health usability for older adults: a literature based framework (MOLD-US).Int J Med Inform. 2018; https://doi.org/10.1016/j.ijmedinf.2018.03.012
- Barriers and facilitators to the use of e-health by older adults: a scoping review.BMC Public Health. 2021; 21: 1556
- Trends and predictors of use of digital health technology in the United States.Am J Med. 2021; 134: 129-134
- Managing an older adult with cancer: considerations for radiation oncologists.BioMed Res Int. 2017; https://doi.org/10.1155/2017/1695101
- The experiences of older adults in the community dying from cancer and non-cancer causes: a national survey of bereaved relatives.Age Ageing. 2010; 1: 39
- Comparing the symptom experience of cancer patients and non-cancer patients.Support Care Cancer. 2017; 25: 1103-1109
- Digital interventions to support adolescents and young adults with cancer: systematic review.J Med Internet Res Cancer. 2019; 5e12071
- What are the current challenges of managing cancer pain and could digital technologies help?.BMJ Support Palliat Care. 2018; 8: 204-212
- Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: implications for eHealth.Psychooncology. 2017; 26: 1105-1112
- Development and usability testing of a web-based self-management intervention for oral cancer survivors and their family caregivers.Eur J Cancer Care (Engl). 2016; 25: 806-821
- The supportive care needs of cancer patients: a systematic review.J Cancer Educ. 2021; https://doi.org/10.1007/s13187-020-01941-9
- The pediatric cancer survivors' user experiences with DIgital Health Interventions.Cancer Nursing. 2020; https://doi.org/10.1097/NCC.0000000000000885
- Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives.Supportive Care in Cancer. 2020; https://doi.org/10.1007/s00520-020-05539-1
- eHealth and mHealth interventions in pediatric cancer: a systematic review of interventions across the cancer continuum.Psycho-Oncology. 2019; https://doi.org/10.1002/pon.5280
- Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study.J Clin Epidemiol. 2019; 111: 49-59
- Techniques to identify themes.Field Methods. 2003; 15: 85-109
- Triangulation analysis of tele-palliative care implementation in a rural community area in Japan.Telemed e-Health. 2006; 12: 655-662
- Older cancer patients’ user experiences with web-based health information tools: a think-aloud study.J Med Internet Res. 2016; 18e208
- Meeting the rehabilitation and support needs of patients with breast cancer during COVID-19: opening new frontiers in model of care.Rehab Oncol. 2020; 10: 159-168
- Developing an easy-to-use tablet computer application for assesing patient-reported outcomes in patients with cancer.Support Care Cancer. 2011; 19: 815-822
- Novel mHealth app to deliver geriatric assessment-driven interventions for older adults with cancer: pilot feasibility and usability study.JMIR Cancer. 2018; 4e10296
- SUS: A "quick and dirty" usability scale.in: Usability Evaluation in Industry. Taylor & Francis, London1996: 189-194
- Effects of a computerised system to support shared decision making in symptom management of cancer patients: preliminary results.J Am Med Inform Assoc. 2003; https://doi.org/10.1197/jamia.M1365
- Perceived usefulness, perceived ease of use, and user acceptance of information.MIS Q. 1989; 13: 319-340
- Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies.BMC Med Inform Decision Making. 2016; 16: 120
- The pediatric cancer survivors' user experiences with digital health interventions.Cancer Nursing. 2020; https://doi.org/10.1097/NCC.0000000000000885
- Older people’s perceived autonomy in residential care: an integrative review.Nurs Ethics. 2020; 28: 414-434
- Older people living alone at home with terminal cancer.Eur J Cancer Care. 2015; 25: 356-364
- Interviewee.in: Prolonged Isolocation may be Detrimental for Elderly Cancer Patients during the Pandemic. [Interview]. 2020 (15 May)
- eHealth literacy among older adults living with cancer and their caregivers: a scoping review.J Geriat Oncol. 2021; https://doi.org/10.1016/j.jgo.2021.11.008
- Unmet social support needs among older adults with cancer.Cancer. 2018; 125: 473-481
- Social isolation: impact on treatment and survival in patients with advanced cancer.J Clin Oncol. 2018; 36: 156
- Patients’ perception of the information security management in health centers: the role of organizational and human factors.BMC Med Inform Decision Making. 2018; https://doi.org/10.1186/s12911-018-0681-z
- The adoption and implementation of digital health care in the post–COVID-19 era.J Allergy Clin Immunol In Pract. 2020; 8: 2484-2486
Article info
Publication history
Published online: June 22, 2022
Accepted:
June 14,
2022
Received in revised form:
May 30,
2022
Received:
February 16,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
