Digital Therapeutics in the Oncology Outpatient Setting

Bob Gold
Chief Behavioral Technologist
GoMo Health

Oncology providers encounter a unique set of clinical, administrative, and patient-engagement challenges that require significant time, focus, and interaction. The care these professionals deliver is complex and long-term, and they are often required to manage large patient populations with a diverse range of healthcare needs. One remedy for addressing these challenges is an intuitive and personalized digital resource that empowers patients in their own care journey and streamlines the care plan for both patients and providers.

This digital resource is a true “concierge” type of service, delivering to patients with no expectations that they will be asked to perform an activity that takes them away from their daily life. Using proven behavioral engagement science, digital therapeutics empower patients using “lived environment” therapy (which embraces the concept of supporting individuals within the construct of their daily lives so as to become seamlessly integrated) to stimulate action, foster retention, and develop resiliency. As a result, these programs can improve clinical outcomes, lower the cost of care, enhance patient satisfaction, increase clinical joy in practice, and reduce physician and nurse fatigue.

Digital Therapeutic Solutions, Engagement, and Improved Outcomes

The goal of this article is to illustrate the practicality and efficacy of digital health programs in the outpatient oncology setting. These programs are designed to help patients become more actively engaged in their oncology care, which can increase adherence and help to reduce everyday burdens on the healthcare team. These results are achieved by applying evidence-based behavioral science and a telehealth system of remote care that makes it easier for patients and clinicians to achieve their desired goals.

For centuries, clinicians have evaluated patients (either in person or more recently, via telehealth), reached a treatment decision, and provided a plan of care. It is the hope and expectation that patient adherence to clinician instructions and care plans extend well beyond the customary 15- to 30-minute appointments and follow-up calls.

Over the past decade, telehealth and digital healthcare have been expanded and refined, but without sufficient input from patients or consideration of their psychosocial status or lifestyle factors. Many provider organizations have implemented patient portals, apps, and appointment reminder software that have not, for the most part, improved adherence or outcomes, while costs and adverse events continue to increase.

An important goal in achieving better outcomes is for patients to remain mindful of their clinician’s instructions as they go about their daily activities on their own schedules. This can be accomplished by creating a patient-partnered care plan that dynamically adjusts to the psychosocial and physical status of patients, making it much more likely that they will stay on course and activate the behaviors necessary to attain their health goals.

This integrated approach also offers several benefits to provider organizations, including reduced clinician fatigue, increased joy in practice and referrals, and scaled care delivery to populations served (with same full-time-equivalent). Furthermore, in today’s value-based payment structure, practices may experience increased reimbursements and opportunities to obtain shared savings dollars for hospitals and practices, and avoidance of potential penalties for unnecessary emergency department visits and hospital readmissions.

This article focuses on the following key concepts, which demonstrate how digital therapeutics can deliver measurable results through the integration of simple and easy functions for the clinical team as well as the patient:

  • Behavior Drives Health Outcomes
  • Point of Care Must Be Extended
  • Empowerment and Activation of Caregivers Is Essential
  • Mind-Body Resources Provide Necessary Support
  • Care Plans Should Become Part of Patients’ Daily Activities.

Modifying Behavior to Improve Health Outcomes

Shared decision-making is an important concept related to improved patient-centered care. When patients believe they have a direct influence on their care plan—that it considers their specific lifestyle factors, and they can accomplish the tasks within the plan—it is possible to achieve sustainable lifestyle behavior modification. Accomplishing this level of behavioral and cognitive modification, which leads to meaningful, improved quality metrics and health outcomes, requires proactively delivering individualized content and resources, at the right time and place, in a consistent manner.

The application of digital therapeutics within outpatient oncology includes tailoring digital messages to patients’ specific clinical and lifestyle issues, such as disease and medication management, emotional support, quality of life, circle of support, and other social determinants of health. These “in-the-moment” resources give patients the support they need, often without having to contact their care team. This frees up practice managers and administrative personnel so they can focus on other core issues.

This approach increases confidence in self-management, positively affects outlook, and reduces stress and the patient’s perceived burden of adherence to the care plan. Relying on patients to initiate access and navigate an app or portal, particularly if they are under medical distress, is an obstacle to achieving the level of psychological and cognitive “believability” or change in outlook that fosters sustained resilience in behavior modification, as attested to by Deborah Toppmeyer, MD, Chief Medical Officer at the Rutgers Cancer Institute of New Jersey.

“With this program, patients receive messages and helpful hints that let them know that somebody is looking out for them. And the messaging platform is effective at making people feel connected. This is important, as a cancer diagnosis can be very isolating,” she said.

Extending the Point of Care

“Point of care” generally refers to the physical point in time at which patients receive care from their providers. However, it can also refer to the intention of care, meaning that it should empower patients to take a more active role in the management of their disease. Interestingly, these 2 definitions intersect at the point of digital therapeutics. These programs extend care beyond traditional in-office or telehealth visits to give patients seamless continuity of treatment and the peace of mind that comes from consistent contact with their care team.

As Jacquelyn Lauria, RN, MSN, an oncology nurse practitioner at the Robert Wood Johnson University Hospital and the Rutgers Cancer Institute of New Jersey, explained, “Sometimes, patients are intimidated to reach out with an issue. They have this notion that they do not want to ‘bother’ the doctor or nurse if it is not an emergency. They are not necessarily disengaged, but they may feel like they are overstepping. (These therapeutics) give them a tool to make reaching out easier. Providing this tool sets the stage from the very beginning that we want them to talk with us.”

Extending the point of care through digital resources includes help with medication support and adherence, messaging on condition management and quality of life, and de-escalation assistance through bidirectional messaging.

Activating and Empowering Caregivers

Patients are not alone in engaging directly with oncology practice managers and staff. Caregivers are often active in their loved ones’ treatment, attending appointments and acting as advocates during interactions with providers. For this reason, it is important that digital therapeutics also include resources for this significant population, to empower them through the same level of supportive engagement.

Offering information on what to expect in the caregiver role, quality-of-life tips on caring for their loved one, and managing treatment-related side effects directly empowers caregivers to educate themselves, often without the need for contacting the care team directly. If these individuals are adequately informed from the start, they will be better able to act on their own when they have questions.

“Sometimes, a reminder that there is someone you can reach out to for help, support, and guidance can be a lifeline. For those who may not have a caregiver, a number or someone to call and reach out to can be extremely helpful,” said Paola Prudden, a caregiver to her husband in active treatment.

Providing Mind-Body Resources

Delivering digital therapeutics that include day-to-day psychosocial resources helps patients become more independent as they manage their disease. These programs offer ready-made support for a wide range of issues associated with cancer care, enabling patients to self-manage and cope with anxiety, stress, distress, fatigue, and sleep challenges.

“There were times when I had to act as a clinician and teach patients breathing and calming techniques over the phone. This patient is not having a crisis where they need to go to the emergency room, but our clinicians’ schedules are packed, and the patient does need help in the moment. Offering a resource on tai chi or breathing exercises like GoMo Health often can work wonders for those patients in that moment of crisis,” explained former practice manager William Golz, MHA.

Integrating Care Plans into Daily Behavior

Consistent and adaptable digital engagement can help patients make positive changes in their behavior and extend the telehealth therapeutic beyond the typical 15- to 30-minute in-office or telehealth visit. This is accomplished through flexible patient-partnered care plans that are adjustable to patients’ ever-changing activities of daily living driven by emotional, social, and physical factors. Lived environment therapy delivers the treatment plan right to the patient and activates the patients in their home through content that is provided in “snackable bites” for easy understanding. Patients and providers can build a deeper connection through daily support and treating each patient as an individual, focusing together on their specific needs to deliver the highest quality of care possible.

Efficacy of Oncology Digital Therapeutics

Through partnerships with several cancer treatment providers and support organizations, including National Cancer Institute comprehensive cancer centers and the Rutgers Cancer Institute of New Jersey, digital therapeutics deploy electronic versions of the National Comprehensive Cancer Network® (NCCN) Distress Thermometer and Problem List for Patients. Real-time data collection reflecting these best practices in action have yielded the following results and observations:

  • 1216 program opt-ins (1007 patients and 209 caregivers)
  • 85% program retention rate
  • Of issues expressed, 54% were psychological or outlook-related
    • 255 issues triaged and resolved via GoMo Health automated bot
    • 300 total escalations to clinical care team.

Top distress issues reported to treatment providers for in-the-moment intervention included sadness, depression, and anxiety-related fatigue.

Conclusion

Connecting daily with patients in their own environments, encouraging them to participate in the development and activation of their care plans, and communicating in real time is what makes digital therapeutics unique and successful for patients and providers alike. Managing a cancer diagnosis affects the body and mind, substantiated by psychological or outlook-related issues representing more than 50% of the top escalations to clinical care teams. Through the use of digital therapeutics, we can learn how to support patients by tracking their stress and anxiety levels to keep them as healthy as possible while they are going through treatment. Patients and providers can build a deeper connection through consistent support and communication, focusing together on specific needs to deliver the highest quality of care.

Click here to download an outcomes report from a GoMo Health digital therapeutic for oncology.

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