The review authors highlighted flaws in existing studies, saying they take a ‘systematic approach to the active ingredient of self-management’.
Digital interventions have the potential to improve a cancer patient’s ability to self-manage their condition, say experts.
A systematic review of 12 studies published in the JMIR found that eight of 12 randomised controlled trials demonstrated statistically significant improvements in outcomes including self-efficacy, survivorship care knowledge and attitude, quality of life, increased knowledge of treatment, and emotional and social functioning.
Self-management refers to a patient’s ability to “manage the symptoms, treatment, psychosocial consequences, and lifestyle inherent in living with a chronic condition”.
Lead author Dr Dwight Su Chun Lim from Flinders University described self-management as a “vague area” and said there was “very little literature to say what exactly it involves”.
He said that self-management skills were of special importance for patients suffering complex chronic diseases like cancer, where “in the long run, if they aren’t able to manage their conditions well, they end up coming back to hospital and it just results in higher rates of mortality”.
Out of the 12 studies, four were conducted in the US, four in the Netherlands, and there were single studies from Ireland, Finland, Sweden and China.
The most common digital technology studied was web-based education (8), with single studies examining a combined website and text messaging intervention, text messaging, educational videos and mobile phone apps.
The authors recommended that future digital technology interventions should focus on “decision making, goal setting and partnering with health care professionals to improve outcomes for patients with cancer”.
Dr Lim told Oncology Republic the digital space was growing “very quickly”.
He said digital interventions should be used to their full potential, “given that technology has been able to contribute to many areas of our life and we use it almost every day”.
“I think it’s a very good holder of information. And with databases becoming more readily available for people to record all our data. It can help us to give us an idea of what could be useful for patients with cancer to manage all the issues.”
He said that telehealth could be improved through a more thorough integration of core self-management skills.
“[The integration of these skills could] probe into how people think they’re managing their health, ask them to monitor their daily activities, and [ascertain] whether they feel confident enough to manage their own things.”
He added that digital interventions could provide information for patients on possible side effects and how to manage them.
However, the authors said “problem solving” was not a skill targeted in the studies reviewed, given the central role of self-management which is to address “problems as defined as patients”.
They posited that overlooking a patient’s self-efficacy and ability to solve problems was reflective of the “prevalent medical approach to chronic disease management, where the delivery of solutions and interventions rests within the health system rather than the patient”.
“Future research should explore the reasons for less focus on some of the SM skills from the perspective of the patients and the health professionals alike,” they wrote.
They argued that the review highlighted several weaknesses in the experimental design of studies targeting self-management strategies, which they said were “often not grounded in theory” and didn’t “take a systematic approach to the active ingredient of self-management, that is, the core skills that patients use”.
