Patient-centric approach needed to minimize ’digital toxicity’ in cancer care
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Digital patient-facing technologies over the past decade have improved the coordination and delivery of oncology care, but they have the potential to overwhelm patients, according to a commentary published in JCO Clinical Cancer Informatics.
The authors used the term “digital toxicity” to describe the additional burden patients may feel throughout their care trajectory from increasing interactions with technology — ranging from the need to create multiple pass-word protected accounts to the expectation of completing electronic patient-reported outcomes assessments.
The authors identified three key factors that contribute to and increase the potential for digital toxicity: greater volume of digital technologies, lack of extensive user experience testing on these technologies, and lack of integration and connectedness between standalone digital technologies.
Efforts must be made to ensure the growing number of digital tools are accessible and realistic for all patient populations to ensure that the desire to improve communication and convenience does not inadvertently create or worsen health disparities.
“Every solution starts with awareness of the problem, and we can’t address or improve what we don’t measure,” co-author Caroline Chung, MD, MSc, vice president and chief data and analytics officer and director of data science development and implementation for the Institute for Data Science in Oncology at The University of Texas MD Anderson Cancer Center, told Healio. “We need to grow awareness that digital toxicity exists today and we must start measuring how common it is given the potential that it is only rising as we continue to introduce even more technologies at a faster pace. Engaging patients, health care providers and industry partners collectively is the best way for us to address this challenge.”
Healio spoke with Chung about the ways in which digital toxicity can create disparities, and how clinicians can decrease digital toxicity by considering each patient’s relationship to technology.
Healio: What is digital toxicity, and how prevalent is it?
Chung: We were motivated to put this term out there because there have been growing requirements for people to interact with various digital technologies as part of their medical care. This has been further accelerated through the pandemic. The many different digital technologies people interact with as part of their health care can result in convenience but, for others, it can result in anxiety, frustration and added burden.
Until now, we haven’t been systematically measuring the potential toxicity of all the digital points of interaction patients encounter while receiving health care. So we don’t have a good sense of how prevalent digital toxicity is, so now is the time for us to start measuring it so we can be more thoughtful about how we’re developing these tools.
Healio: How can digital toxicity affect the delivery of quality care?
Chung: Not all patients are equally proficient in using technology. Some patients might not be as tech-savvy and others may have different lifestyles, access to technology or levels of competency. This can lead to confusion or frustration, and might require others — for example, adult children of older patients — to take time out of their day to assist their parents with health-related technology. There are also different preferences around the use of technology in receiving medical care that should be considered.
Healio: How can a lack of integration between these technologies cause additional problems?
Chung: This can cause redundant notifications, duplicate requests for information, and the need to manage several password-protected accounts across a variety of digital platforms. This can not only result in frustration for patients, but also the care providers who need to interact with these same digital technologies, and it creates yet another source of fragmented information in the care.
Healio: How could the “patient-centric approach” you recommend alleviate digital toxicity?
Chung: This approach involves acknowledging that individuals will have different levels of comfort and competency, as well as preferences around these tools. We want to make sure we are implementing these technologies with enough adaptability to ensure we’re considering the various levels of comfort and competency as well as preferences across patients. If we’re going to introduce a new digital tool, we have to think about the people and the processes that will be involved, and make sure this technology is enabling patient care and not adding burden.
Healio: What can oncologists do to recognize and address digital toxicity among their patients?
Chung: The first step is communication. Ask your patients about their preferences or challenges around technology. It’s been very helpful for me to ask my own patients what their experience has been. They are more than willing to volunteer pieces that work and are convenient, and others that are very challenging. As we make note of this feedback, and we try to address it in a patient-centric way, we are working to reduce digital toxicity. For example, one patient may prefer phone calls, and they don’t know how to navigate digital systems. Others might prefer the digital notifications and might think, “Stop calling me.” Trying to personalize that and making sure we can consider their preferences is something that will really make a difference.
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For more information:
Caroline Chung, MD, MSc, can be reached at cchung3@mdanderson.org.
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