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A systematic review identified the effects and use of eHealth, mHealth and telemedicine on cancer patients in minority populations.
Racial and ethnic minorities and lower-income populations have higher cancer burden compared with their counterparts. But with the plethora of technologies available for patients to improve their access to care and empower them to be active in their care, these populations have a chance improve their outcomes.
Researchers conducted a systematic review of the current evidence on the use of cancer-specific, patient-centered technologies among various underserved populations, because little is known about the use by these populations.
The authors reviewed 71 papers that used patient-centered technologies that primary targeted African Americans (31), rural populations (14) and Hispanics (12). Of the 71 papers, 41 used electronic health (eHealth) technologies, making it a leading source of cancer-related health information and improving outcomes like screening among nonadherent individuals and increasing knowledge about cancer and screening.
Mobile health (mHealth) studies revealed that participants reported favorable responses to getting health information sent via text messages. But the inability of participants to text was a challenge.
It was also found that more complex mobile technologies, like a tablet-based risk assessment tool, were favorable to use and accepted in underserved populations. However, like mHealth studies, these technologies presented more barriers, such as privacy worries and unfamiliarity with the technology.
Corresponding author Will L. Tarver, department of health policy & management at Indiana University’s Fairbanks School of Public Health, and David A. Haggstrom, M.D., division of general internal medicine and geriatrics at Indiana University’s School of Medicine, conducted a computer-based search in four academic databases: PubMed, Medline, PsycINFO and CINAHL.
Tarver and Haggstrom reviewed papers that features technologies including personal health records, eHealth technologies, mHealth apps and telemedicine.
Topics for the review included:
Tarver and Haggstrom identified 10 eHealth studies that primarily targeted African Americans, colorectal cancer or breast cancer.
Findings of the studies showed that eHealth interventions, from computer-assisted programs and web-based decisions aids to tailored, interactive soap operas, were positively impactful. Screening uptake and knowledge were two of the most common health outcomes assessed. Each study showed statistically significant results in the outcomes.
For example, in a randomized control trial comparing the efficacy of three inventions in promoting routine mammography screening among low-income African American women conducted by Champion et al., it was found that an interactive computer-assisted instruction program produced the greatest adherence to mammography (40%).
Another study found that the internet was the least relied on source of general health information and cancer health information among a low-income population.
Three mHealth studies were identified using an experimental design. Two studies showed statistically significant results in health outcome.
Lee et al. used a tailored interactive seven-day text message intervention to increase the knowledge and vaccination of human papillomavirus. Vaccination uptake increased by 30% among participants in the intervention and there was a significant increase in knowledge and intent to get vaccinated.
Additional research found that a web-based psychosocial intervention delivered on a tablet for a population with advanced prostate cancer — 40.5% of which were African Americans — achieved good retention, attendance rates, received favorable evaluations and decreased depressive symptoms, while improving relaxation self-efficacy.
Of two telemedicine studies identified using experimental design, both showed statistically significant results in health outcomes.
In one randomized control trial, it was found that telecare management improved depression and pain for cancer patients in both urban and rural areas.
And of eight telemedicine studies identified using an observational design, it was found that telemedicine was commonly used to provide psychosocial support.
Rural patients with lung, breast or colorectal cancer reported high levels of satisfaction with a videophone-based intervention providing dignity psychotherapy.
An interactive audio and video telemedicine program providing medical consultation for a sample of Alaskan native breast cancer patients received overall high satisfaction scores.
The systematic review is titled, “The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States,” and was published on April 23, 2019 in the Journal of Medical Internet Research.
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