Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Objectives Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs. Design Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline. Eligibility criteria Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal. Data extraction and synthesis Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators. Results Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients’ aptitude with the technology (n=9/33), and technical issues (n=12/33). Conclusions The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: As a result of advances in diagnostic testing in the field of Alzheimer’s Disease (AD), patients are diagnosed in earlier stages of the disease; for example in the stage of mild cognitive impairment (MCI). This poses novel challenges for the clinician during the diagnostic work-up with regard to diagnostic testing itself (which tests), but also how to engage patients in this decision and how to communicate test results. To this background, tools to support decision making and improve risk communication could be valuable for clinicians and patients. Objective: To describe the development of an online tool for clinicians in a memory clinic setting, that: 1) facilitates the interpretation of biomarker results in individual patients with MCI regarding their risk of progression to dementia, 2) supports clinicians in communicating biomarker test results and risks to MCI patients and their caregivers, and 3) supports clinicians in a process of shared decision-making regarding the diagnostic work-up of AD. Methods: A multi-phase, mixed-methods approach was used: phase 1) qualitative needs assessment among professionals, patients and caregivers, phase 2) iterative process of development and design of the tool (ADappt), and phase 3) quantitative and qualitative assessment of usability and acceptability of ADappt. Across these phases, co-creation was realized via a user-centered, qualitative approach with clinicians, patients and caregivers. Results: In phase 1, clinicians indicated the need for risk calculation tools and visual aids to communicate test results to patients. Patients and caregivers expressed their needs for more specific information on their risk for developing AD and related consequences. In phase 2, we developed the content and graphical design of ADappt encompassing three modules: a risk calculation tool, a risk communication tool including a summary sheet for patients and caregivers, and a conversation starter to support shared decision making regarding the diagnostic work-up. In phase 3, ADappt was considered to be clear and user friendly. Conclusions: This study presents ADappt, an online tool, developed in a multi-phase design characterized by co-creation, that supports clinicians in a memory clinic setting with individually tailored interpretation of biomarker test results, communication of test results and risks to patients and their caregivers, and shared decision making on diagnostic testing.