Download PDF
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(09): 845-854
DOI: 10.1055/a-2369-1489
GebFra Science
Original Article

From Gaps to Solutions: Semi-Structured Interviews to Identify Care Gaps in Breast Cancer Care and How to Solve Them with Digital Solutions

Von Lücken zu Lösungen: halbstrukturierte Interviews zur Ermittlung von Versorgungslücken in der Brustkrebsversorgung und wie diese mit digitalen Lösungen behoben werden können
Therese Pross 
1   Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
,
Maria Margarete Karsten 
1   Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
,
Jens-Uwe Blohmer 
1   Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background

Standardized treatment pathways should make it easier for medical staff and patients to achieve the best possible individual treatment outcome by making sure all relevant information are taken into consideration. The aim of this paper is to identify gaps in care along the treatment pathway through semi-structured patient interviews. Subsequently, it will be discussed if mobile health applications can close these identified gaps in care.

Material and Methods

Nine semi-structured interviews of patients with invasive lobular breast cancer were conducted in March 2023 in German at the breast cancer center at Charité Universitätsmedizin Berlin, which were subsequently transcribed word for word and processed using a thematic analysis approach.

Results

Eight recurring themes are identified in the patient interviews: 1. Limited capacity to absorb information, 2. Discrepancy between information needs and information provision, 3. Need for individual initiative, 4. Uncertainty, 5. not being seen and heard, 6. Patient’s desires and suggestions for improvement, 7. Use of mobile health apps, 8. Support through an app for patients.

Conclusions

The identified gaps in care of breast cancer patients can be largely addressed through the use of digital health solutions after the establishment of regulatory frameworks, thus improving care for patients with early breast cancer.

Trial Registration

The interviews were done within a registry for which ethical approval was obtained by the Ethics Committee of Charité Universitätsmedizin Berlin EA4/180/17.

Zusammenfassung

Hintergrund

Standardisierte Behandlungspfade sollten es dem medizinischen Personal und den Patienten erleichtern, das bestmögliche individuelle Behandlungsergebnis zu erzielen, indem sichergestellt wird, dass alle relevanten Informationen berücksichtigt werden. Ziel dieses Beitrags ist es, durch halbstrukturierte Patienteninterviews Versorgungslücken entlang des Versorgungspfads zu identifizieren. Anschließend wird erörtert, wie mobile Gesundheitsanwendungen diese identifizierten Versorgungslücken schließen können.

Material und Methoden

Im März 2023 wurden im Brustkrebszentrum der Charité Universitätsmedizin Berlin 9 halbstrukturierte Interviews mit Patientinnen mit invasivem lobulären Brustkrebs in deutscher Sprache geführt, die anschließend wortwörtlich transkribiert und mithilfe eines thematischen Analyseansatzes verarbeitet wurden.

Ergebnisse

In den Patienteninterviews wurden 8 wiederkehrende Themen identifiziert: 1. Begrenzte Fähigkeit, Informationen aufzunehmen, 2. Diskrepanz zwischen Informationsbedarf und Informationsangebot, 3. Notwendigkeit von Eigeninitiative, 4. Unsicherheit, 5. nicht gesehen und gehört zu werden, 6. Wünsche und Verbesserungsvorschläge der Patienten, 7. Nutzung von mobilen Gesundheits-Apps, 8. Unterstützung durch eine App für Patienten.

Zusammenfassung

Die identifizierten Versorgungslücken können nach der Schaffung von rechtlichen Rahmenbedingungen durch die Nutzung von mobilen Gesundheitsanwendungen zum großen Teil geschlossen werden und somit die Versorgung von Patientinnen mit frühem Brustkrebs verbessern.

Registrierung der Studie

Die Interviews wurden im Rahmen eines Registers durchgeführt, für das die Ethikkommission der Charité Universitätsmedizin Berlin EA4/180/17 ein positives Votum vergeben hat.

Keywords

breast cancer - treatment pathway - patient pathway - patient journey - care gap - mHealth - eHealth - digital health - oncology

Schlüsselwörter

Brustkrebs - Behandlungspfad - Patientenpfad - Patientenreise - Versorgungslücke - mHealth - eHealth - Digital Health - Onkologie


Publication History

Received: 15 April 2024

Accepted after revision: 17 July 2024

Article published online:
02 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Robert Koch-Institut. Brustkrebs (Mammakarzinom). Berlin: Robert Koch-Institut; 2022
    Search in Google Scholar
  • 2 Senkus E, Kyriakides S, Ohno S. et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl. 5) v8-v30
    CrossrefPubMedSearch in Google Scholar
  • 3 Gucalp A, Traina TA, Eisner JR. et al. Male breast cancer: a disease distinct from female breast cancer. Breast Cancer Res Treat 2019; 173: 37-48
    CrossrefPubMedSearch in Google Scholar
  • 4 Caswell-Jin JL, Sun LP, Munoz D. et al. Analysis of Breast Cancer Mortality in the US-1975 to 2019. JAMA 2024; 331: 233-241
    CrossrefPubMedSearch in Google Scholar
  • 5 Ciria-Suarez L, Jimenez-Fonseca P, Palacin-Lois M. et al. Breast cancer patient experiences through a journey map: A qualitative study. Plos One 2021; 16: 23
    CrossrefPubMedSearch in Google Scholar
  • 6 Wöckel A, Kreienberg R. Entwicklung der nationalen S3-Leitlinie „Diagnostik, Therapie und Nachsorge des Mammakarzinoms “. Senologie 2011; 8: 87-88
    PubMedSearch in Google Scholar
  • 7 De Bleser L, Depreitere R, De Waele K. et al. Defining pathways. J Nurs Manag 2006; 14: 553-563
    CrossrefPubMedSearch in Google Scholar
  • 8 Deery E, Johnston K, Butler T. “It’s Like Being Pushed into Sea on a Boat with No Oars”: Breast cancer survivorship and rehabilitation support in Ireland and the United Kingdom. J Hum Nutr Diet 2023; 36: 514-525
    CrossrefPubMedSearch in Google Scholar
  • 9 Smith SL, Singh-Carlson S, Downie L. et al. Survivors of breast cancer: patient perspectives on survivorship care planning. J Cancer Surviv 2011; 5: 337-344
    CrossrefPubMedSearch in Google Scholar
  • 10 Epstein RM, Street jr RL. The values and value of patient-centered care. Ann Fam Med 2011; 9: 100-103
    CrossrefPubMedSearch in Google Scholar
  • 11 Dettwiler R. Ist eine Patient Journey planbar?. OrganisationsEntwicklung 2021; 40: 106-108
    PubMedSearch in Google Scholar
  • 12 Davaris MT, Bunzli S, Dowsey MM. et al. Gamifying health literacy: how can digital technology optimize patient outcomes in surgery?. ANZ J Surg 2021; 91: 2008-2013
    CrossrefPubMedSearch in Google Scholar
  • 13 Rietjens JAC, Griffioen I, Sierra-Pérez J. et al. Improving shared decision-making about cancer treatment through design-based data-driven decision-support tools and redesigning care paths: an overview of the 4D PICTURE project. Palliat Care Soc Pract 2024; 18
    CrossrefPubMedSearch in Google Scholar
  • 14 van der Eijk M, Nijhuis FA, Faber MJ. et al. Moving from physician-centered care towards patient-centered care for Parkinson’s disease patients. Parkinsonism Relat Disord 2013; 19: 923-927
    CrossrefPubMedSearch in Google Scholar
  • 15 Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001.
    CrossrefSearch in Google Scholar
  • 16 Kupfer JM, Bond EU. Patient Satisfaction and Patient-Centered Care: Necessary but Not Equal. JAMA 2012; 308: 139-140
    CrossrefPubMedSearch in Google Scholar
  • 17 Picker Institute Europe PIE. The Picker Principles of Person Centred care. 2023 Accessed April 15, 2024 at: https://picker.org/who-we-are/the-picker-principles-of-person-centred-care/
    PubMedSearch in Google Scholar
  • 18 Bauman AE, Fardy HJ, Harris PG. Getting it right: why bother with patient-centred care?. Med J Aust 2003; 179: 253-256
    CrossrefPubMedSearch in Google Scholar
  • 19 Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med 2011; 24: 229-239
    CrossrefPubMedSearch in Google Scholar
  • 20 Richards T. Enlist the patients’ help. BMJ 2011; 343: d5827
    CrossrefPubMedSearch in Google Scholar
  • 21 Michie S, Miles J, Weinman J. Patient-centredness in chronic illness: what is it and does it matter?. Patient Educ Couns 2003; 51: 197-206
    CrossrefPubMedSearch in Google Scholar
  • 22 Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall. How the performance of the US Health care system compares internationally. New York: CommonWealth Fund; 2014
    Search in Google Scholar
  • 23 Adam R, McMichael D, Powell D. et al. Publicly available apps for cancer survivors: a scoping review. BMJ Open 2019; 9: e032510
    CrossrefPubMedSearch in Google Scholar
  • 24 Knöppler K, Stendera P. Transfer von Digital Health in den Versorgungsalltag. In: Haring R. Gesundheit digital: Perspektiven zur Digitalisierung im Gesundheitswesen. Berlin, Heidelberg: Springer; 2019: 83-97
    Search in Google Scholar
  • 25 Thiel R, Deimel L, Schmidtmann D, Piesche K, Hüsing T, Rennoch J, Stroetmann V, Stroetmann K. #SmartHealthSystems – Digitalisierungsstrategien im internationalen Vergleich. Gütersloh: BertelsmannStiftung; 2018
    Search in Google Scholar
  • 26 Stephani V, Busse R, Geissler A. Benchmarking der Krankenhaus-IT: Deutschland im internationalen Vergleich. In: Klauber J, Geraedts M, Friedrich J, Wasem J. Krankenhaus-Report 2019: Das digitale Krankenhaus. Berlin, Heidelberg: Springer; 2019: 17-32
    Search in Google Scholar
  • 27 Amelung V, Angelkorte M, Augurzky B, Brauer R, Freigang F, Fritzsche F, Geissler A, Göller A, Haering A, Haring M, Hollenbach J, Luckmann M, Materne K, O’Connor R, Peukert J, Püschner F, von Roehl L, Scheuer A, Snowdon A, Steuber C, Thun S, Vollrath I, Wiesmann A. DigitalRadar Zwischenbericht – Ergebnisse der ersten nationalen Reifegradmessung deutscher Krankenhäuser. 2022 Accessed April 15, 2024 at: https://www.digitalradar-krankenhaus.de/download/220914_Zwischenbericht_DigitalRadar_Krankenhaus.pdf
    PubMedSearch in Google Scholar
  • 28 Goldschmidt AJW, Marquardt K, Groneberg D. et al. Aufbruch oder verspielte Zukunft der Krankenhausdigitalisierung in Deutschland. Zbl Arbeitsmed 2023; 73: 170-181
    CrossrefPubMedSearch in Google Scholar
  • 29 Gerke S, Stern AD, Minssen T. Germany’s digital health reforms in the COVID-19 era: lessons and opportunities for other countries. NPJ Digit Med 2020; 3: 94
    CrossrefPubMedSearch in Google Scholar
  • 30 Verbraucherzentrale. Gesundheits-Apps: medizinische Anwendungen auf Rezept. 2020 Accessed April 15, 2024 at: https://www.verbraucherzentrale.de/wissen/gesundheit-pflege/aerzte-und-kliniken/gesundheitsapps-medizinische-anwendungen-auf-rezept-41241
    PubMedSearch in Google Scholar
  • 31 BfArM. Digitale Gesundheitsanwendungen (DiGa). 2022 Accessed April 15, 2024 at: https://www.bfarm.de/DE/Medizinprodukte/Aufgaben/DiGA-und-DiPA/DiGA/_node.html
    PubMedSearch in Google Scholar
  • 32 BfArM. DiGA-Leitfaden. 2023 Accessed April 15, 2024 at: https://www.bfarm.de/SharedDocs/Downloads/DE/Medizinprodukte/diga_leitfaden.pdf?__blob=publicationFile
    PubMedSearch in Google Scholar
  • 33 BfArM. DiGA-Verzeichnis. 2023 Accessed April 15, 2024 at: https://diga.bfarm.de/de/verzeichnis
    PubMedSearch in Google Scholar
  • 34 Costa F, Janela D, Molinos M. et al. Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study. BMC Musculoskelet Disord 2022; 23: 29
    CrossrefPubMedSearch in Google Scholar
  • 35 Coughlin SS, Besenyi GM, Bowen D. et al. Development of the Physical activity and Your Nutrition for Cancer (PYNC) smartphone app for preventing breast cancer in women. Mhealth 2017; 3: 5
    CrossrefPubMedSearch in Google Scholar
  • 36 Holtdirk F, Mehnert A, Weiss M. et al. Results of the Optimune trial: A randomized controlled trial evaluating a novel Internet intervention for breast cancer survivors. PLoS One 2021; 16: e0251276
    CrossrefPubMedSearch in Google Scholar
  • 37 Cinar D, Karadakovan A, Erdogan AP. Effect of mobile phone app-based training on the quality of life for women with breast cancer. Eur J Oncol Nurs 2021; 52: 9
    CrossrefPubMedSearch in Google Scholar
  • 38 Degenhardt T, Harbeck N, Fasching PA. et al. Documentation patterns and impact on observed side effects of the CANKADO ehealth application: An exploratory analysis of the PreCycle trial. Journal of Clinical Oncology 2020; 38: 2083-2083
    CrossrefPubMedSearch in Google Scholar
  • 39 Dahlhausen F, Zinner M, Bieske L. et al. There’s an app for that, but nobody’s using it: Insights on improving patient access and adherence to digital therapeutics in Germany. Digit Health 2022; 8
    CrossrefPubMedSearch in Google Scholar
  • 40 Bender JL, Katz J, Ferris LE. et al. What is the role of online support from the perspective of facilitators of face-to-face support groups? A multi-method study of the use of breast cancer online communities. Patient Educ Couns 2013; 93: 472-479
    CrossrefPubMedSearch in Google Scholar
  • 41 Jupp JCY, Sultani H, Cooper CA. et al. Evaluation of mobile phone applications to support medication adherence and symptom management in oncology patients. Pediatr Blood Cancer 2018; 65: e27278
    CrossrefPubMedSearch in Google Scholar
  • 42 Scholz S, Teetz L. Smart health via mHealth? Potentials of mobile health apps for improving prevention and adherence of breast cancer patients. Digit Health 2022; 8: 12
    CrossrefPubMedSearch in Google Scholar
  • 43 Knöppler K, Oschmann L, Neumann J, Neisecke T. Transfer von Digital-Health-Anwendungen in den Versorgungsalltag. Teil 1: Transfermodell, Varianten und Hürden. Gütersloh: Bertelsmann Stiftung; 2016
    Search in Google Scholar
  • 44 Kowatsch T, Otto L, Harperink S. et al. A design and evaluation framework for digital health interventions. IT-Information Technology 2019; 61: 253-263
    CrossrefPubMedSearch in Google Scholar
  • 45 World Health Organization. Classification of digital interventions, services and applications in health: A shared language to describe the uses of digital technology for health. 2. Geneva: World Health Organization; 2023
    Search in Google Scholar
  • 46 Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res 2016; 26: 1753-1760
    CrossrefPubMedSearch in Google Scholar
  • 47 Vasileiou K, Barnett J, Thorpe S. et al. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol 2018; 18: 148
    CrossrefPubMedSearch in Google Scholar
  • 48 Mayring P, Fenzl T. Qualitative Inhaltsanalyse. In: Baur N, Blasius J. Handbuch Methoden der empirischen Sozialforschung. Wiesbaden: Springer VS; 2019
    CrossrefSearch in Google Scholar
  • 49 Karbach U, Stamer M, Holmberg C. et al. [Qualitative research in health services research – discussion paper, Part 2: Qualitative research in health services research in Germany – an overview]. Gesundheitswesen 2012; 74: 516-525
    Thieme ConnectPubMedSearch in Google Scholar
  • 50 Fridriksdottir N, Ingadottir B, Skuladottir K. et al. Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study. JMIR Form Res 2023; 7: e50550
    CrossrefPubMedSearch in Google Scholar
  • 51 Tran C. The emerging role of mobile health in oncology. J Target Ther Cancer 2017; 6
    PubMed
  • 52 Brual J, Abdelmutti N, Agarwal A. et al. Developing an Education Pathway for Breast Cancer Patients Receiving Rapid Diagnostic Testing: Investigating Informational and Supportive Care Needs. J Cancer Educ 2022; 37: 568-577
    CrossrefPubMedSearch in Google Scholar
  • 53 Salmani H, Ahmadi M, Shahrokhi N. The Impact of Mobile Health on Cancer Screening: A Systematic Review. Cancer Inform 2020; 19: 1176935120954191
    CrossrefPubMedSearch in Google Scholar
  • 54 Ponder M, Venkatraman V, Charalambous L. et al. Mobile Health Application for Patients Undergoing Breast Cancer Surgery: Feasibility Study. JCO Oncol Pract 2021; 17: e1344-e1353
    CrossrefPubMedSearch in Google Scholar
  • 55 Geiger F, Novelli A, Berg D. et al. The Hospital-Wide Implementation of Shared Decision-Making–Initial Findings of the Kiel SHARE TO CARE Program. Dtsch Arztebl Int 2021; 118: 225-226
    CrossrefPubMedSearch in Google Scholar
  • 56 Mann DM, Lawrence K. Reimagining Connected Care in the Era of Digital Medicine. JMIR Mhealth Uhealth 2022; 10: e34483
    CrossrefPubMedSearch in Google Scholar
  • 57 Ciria-Suarez L, Jiménez-Fonseca P, Palacín-Lois M. et al. Breast cancer patient experiences through a journey map: A qualitative study. PLoS One 2021; 16: e0257680
    CrossrefPubMedSearch in Google Scholar
  • 58 Kim SH, Sung JH, Yoo SH. et al. Effects of digital self-management symptom interventions on symptom outcomes in adult cancer patients: A systematic review and meta-analysis. Eur J Oncol Nurs 2023; 66: 102404
    CrossrefPubMedSearch in Google Scholar
  • 59 Degenhardt T, Fasching PA, Lüftner D. et al. PRECYCLE: multicenter, randomized phase IV intergroup trial to evaluate the impact of eHealth-based patient-reported outcome (PRO) assessment on quality of life in patients with hormone receptor positive, HER2 negative locally advanced or metastatic breast cancer treated with palbociclib and an aromatase inhibitor or palbociclib and fulvestrant. Trials 2023; 24: 338
    CrossrefPubMedSearch in Google Scholar
  • 60 Harbeck N, Kates R, Schinköthe T. et al. Favorable impact of therapy management by an interactive eHealth system on severe adverse events in patients with hormone receptor-positive, HER2-negative locally advanced or metastatic breast cancer treated by palbociclib and endocrine therapy. Cancer Treat Rev 2023; 121: 102631
    CrossrefPubMedSearch in Google Scholar
  • 61 Lu DJ, Girgis M, David JM. et al. Evaluation of Mobile Health Applications to Track Patient-Reported Outcomes for Oncology Patients: A Systematic Review. Adv Radiat Oncol 2021; 6: 100576
    CrossrefPubMedSearch in Google Scholar
  • 62 Tawfik E, Ghallab E, Moustafa A. A nurse versus a chatbot – the effect of an empowerment program on chemotherapy-related side effects and the self-care behaviors of women living with breast Cancer: a randomized controlled trial. BMC Nurs 2023; 22: 102
    CrossrefPubMedSearch in Google Scholar
  • 63 Basch E, Deal AM, Kris MG. et al. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. J Clin Oncol 2016; 34: 557-565
    CrossrefPubMedSearch in Google Scholar
  • 64 Di Maio M, Basch E, Denis F. et al. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022; 33: 878-892
    CrossrefPubMedSearch in Google Scholar
  • 65 Basch E, Schrag D, Henson S. et al. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial. JAMA 2022; 327: 2413-2422
    CrossrefPubMedSearch in Google Scholar
  • 66 Lagendijk M, van Egdom LSE, van Veen FEE. et al. Patient-Reported Outcome Measures May Add Value in Breast Cancer Surgery. Ann Surg Oncol 2018; 25: 3563-3571
    CrossrefPubMedSearch in Google Scholar
  • 67 Martin E, Di Meglio A, Menvielle G. et al. Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study. Support Care Cancer 2022; 30: 8287-8299
    CrossrefPubMedSearch in Google Scholar
  • 68 Scholz S, Teetz L. Smart health via mHealth? Potentials of mobile health apps for improving prevention and adherence of breast cancer patients. Digit Health 2022; 8
    CrossrefPubMedSearch in Google Scholar
  • 69 Hamberger M, Ikonomi N, Schwab JD. et al. Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives. JMIR Mhealth Uhealth 2022; 10: e32696
    CrossrefPubMedSearch in Google Scholar