Evaluation of a web-based educational tool for patients with cancer to improve digital communication quality: A pre-post study of the SEND application.

Abstract

We developed a web-based application to help patients with cancer write high-quality secure messages to clinicians. Our objective was to test the effectiveness of the application, SEND, to determine if it positively impacted the clarity, directness, ability to express concerns and questions, specificity, and overall quality of messages. Patients with cancer 18 years and older were recruited through an online data collection and testing resource. They reflected on a time during their cancer treatment and wrote a simulated message to a clinician. After viewing SEND, they wrote another simulated message. Three oncology fellows blindly rated messages (pre- or post-intervention) based on five criteria: clarity, directness, expressiveness, specificity, and overall quality. Each criterion was rated on a five-point Likert scale ranging from 1 =poor to 5 =excellent. Data were analyzed using mixed-effects linear models to examine changes in outcomes over time while accounting for the non-independence of repeated measures within participants. Twenty-eight participants viewed SEND and wrote simulated messages. Most (53.6%) were female, and the mean age was 53 years. Raters evaluated a total of 56 messages (28 pre- and 28 post-). The word count of messages decreased from 47 to 43 words post-intervention. We found a significant improvement in the needs domain (β = 0.40, SE = 0.15, t = 2.64, p = .011), while all other domains increased post-intervention, but were not statistically significant. Our intervention was associated with improving the communication of patient needs (i.e. stating the main goal of the message). Improving the quality of secure messages written by patients has the potential to benefit both patients and clinicians. Patients can learn to craft succinct messages focusing on their main concerns, which may reduce clinicians' workload.