Digital Therapy, Chemotherapy and Radiotherapy

Chemotherapy and radiotherapy

Discussion

The DNMLAB digital Platform provides a comprehensive set of clinical and clinical information for patients and their families. Among patients in both therapy settings, usability primarily refers to a better chance of personalizing treatment.

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Scores regarding awareness-raising and empowerment in the radiotherapy group (>4) were different from those in the chemotherapy group (<4). According to the narrative, this difference could be attributed to a pathway that guarantees continuity of care with the same healthcare professional for the duration of radiotherapy.

These Data are noteworthy, especially when considering that continuity of treatment with the same doctor is associated with improved patient outcomes. Responses from oncologists suggest that digital narrative medicine can improve relationships with patients, understand conditions as they are experienced, and can optimize time management during scheduled visits.

In addition, oncologists appreciate that this project is an opportunity for professional growth, mainly due to the opportunity to deepen their knowledge of disease-related aspects (that is, toxic side effects in everyday life in the patient's own words) and to improve the multidisciplinary approach.

Digital narrative medicine allows them to obtain information that the patient will not be able to communicate, which can improve therapeutic alliances and patient adherence to treatment. In this experience, the narrative is guided by clues prepared by specialized professionals to obtain information that is difficult to retrieve during typical chemotherapy or radiotherapy sessions.

The digital platform provides patients with a personal digital space in which personal opinions, wishes, fears, and requests can be expressed in a timely and uninterrupted manner, as well as the certainty that descriptions will be read and paid attention to.

Narratives are guided to ensure that the issues described will be relevant to healing. In this regard, it is important to note that clinical practice can be used to improve patient outcomes.

In addition, there are also a number of other features that can be found in the application, in the initial assessment, the strongest advantages of the use of digital diaries reported by health care professionals are the disclosure of relevant patient information that cannot be obtained, the optimization of clinical examinations, and the improvement of patient-doctor relations and doctor-to-doctor communication.

Despite this, although Cercato et al. narrative medicine has attracted interest over the past decades, standard methods in oncological clinical practice are still lacking.

Several narrative research studies of disease narratives and parallel charts (personal notebooks where clinicians can write down reflections and feelings) have provided insights for clinical practice and healthcare service organizations.

Time spent producing narratives is treatment time which does not necessarily create a burden on the organization and caregivers.

Conversely, facilitating treatment adherence and teamwork can substantially reduce time and costs. However, the introduction of a systematic narrative approach into clinical practice, training to improve narrative skills among clinicians, and a change in clinicians' perspectives on treatment are necessary.

In a further qualitative study aimed at exploring the impact of this approach on healthcare professionals ' perception of their own role, our results show that the diary is valued as a tool for application in narrative-based medicine, and the reading/writing format is considered to be of high quality and suitable for clinical practice.

The narrative approach involves personal experience and emotional resonance with healthcare professionals, leading them to redefine their values in terms of Health and illness.

Although this is a preliminary study aimed only at assessing the feasibility of these tools and specific methods, we believe that the results presented here will encourage further investigation to validate these instruments and propose an organizational path for healthcare institutions.

At our institute, we are conducting other research exploring different settings, covering more patients and healthcare professionals operating in different roles and disciplines, with the aim of validating the use of digital narrative pathways in oncological clinical care.

It is important to educate participants, and these new methods need to be adopted in clinical practice. In fact, participants consistently report that while feasible and useful in their private practice, the digital pathway is not entirely suitable for their current institutional organization.

The limitation of this study is that there are a small number of participants. The number of patients that can be entered, and prevent testing of the platform during the entire study period as well as the treatment and follow-up path.

Results

Forty-six patients were invited to take part in the study (26 received chemotherapy and 20 received radiotherapy); 31 patients (67%) agreed to participate, 15 (48%) from the Oncology Department and 16 (52%) from the Radiotherapy Department.

The median age was 58 years (range 31-79) in patients receiving chemotherapy, and 48 years (range 31-67) in patients receiving radiotherapy; the median age of the total was 52.5 years (range 31-79). Overall, 20 patients (65%) had breast cancer, nine had colorectal cancer (29%) and two (6%) had different solid tumors.

Only five participants were male (Table 3). Results from interviews investigating the lack of patient participation are reported in Table 2. The patient's usual use of electronic devices and the tendency to talk about themselves are the main drivers of participation among patients. The participating healthcare professionals consisted of two oncologists and six nurses, one from the Oncology Department and five from the Radiotherapy Department.

Patient evaluation of DNMLAB's final evaluation of the feasibility and usefulness of narrative drug Diaries was available for 14 patients receiving chemotherapy and for 16 patients receiving radiotherapy.

One patient in the chemotherapy group was unable to complete the final questionnaire due to the occurrence of a stroke event. All items related to eligibility received an average score of 4 by patients receiving chemotherapy as well as by those receiving radiotherapy.

Patients receiving chemotherapy primarily associated utility of the platform to improve the personalization of treatment. Items discussing the possibility to express one's point of view and perception of effectiveness in taking charge had an average score of 4 whereas items related to disease awareness and coping with the disease had a score of <4. 

Source

Cercato, M. C., Colella, E., Fabi, A., Bertazzi, I., Giardina, B. G., Di Ridolfi, P., ... & Cenci, C. (2022). Narrative medicine: feasibility of a digital narrative diary application in oncology. Journal of International Medical Research, 50(2), 03000605211045507.

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