From Mark Levine, the Doc with Pink Tights
A Short Trip to England to Learn Something New

More than 20 years ago, I conducted research on how to improve communication between breast cancer patients and their oncologists. It was based on the concept that patients are provided with information about treatment options and the physician helps them make the decision. It was called “shared decision making.”

Fast forward to the current era of computers, internet, apps, and mobile phones, which is sometimes referred to as the era of “digital technology.” Society relies more and more on these modes of communication. I am interested in the potential for digital technology to improve communication between the patient and their health care team.

Consider the following example. Would it not be possible for a patient to contact their nurse or oncologist through an iPad or smart phone when they feel unwell? Perhaps a complication that is brewing could be nipped in the bud and a visit to the emergency room could be avoided.

I wrote this column on a plane on the way back from London England to Toronto. I arrived in England Sunday morning and it is now Tuesday. Hence it was a very quick visit and I am tired. However, I am very excited about what I learned and I want to share it with you.

It all started about four months ago, when I was reading about the potential for digital technology to enhance the connection between me and my patients. I became aware of a very exciting research project being conducted at the HHS General Hospital and I went down to the cardiac surgery ward to check it out.

I met with the lead investigator. Patients who undergo cardiac surgery have many issues that arise during the first four weeks after surgery. As a result, they frequently visit the emergency room (ER).
An intervention has been developed to reduce ER visits. It uses smart technology, where the patient wears a small gizmo at home that continuously records stuff like heart rate, heart rhythm, BP, weight, and temperature. The device transmits this information back to the cardiac unit in the hospital. If something is not right, then the team intervenes.

In addition, the patient is given a tablet when they go home. On the tablet, they can record their medications and how they are feeling. This information is sent back to the team in the cardiac unit. The tablet contains information on what symptoms the patient should be aware of. It has short videos of positive encouragement about the patient’s health. They can also message the team in the cardiac unit with questions

Key to this intervention is the theory of self-management. This means that the patient takes charge of managing their own health. I was very excited about what I saw and thought that it could be adapted for cancer care.

In Coventry, I met with a team of experts including a psychologist and nurses. They have developed a program called HOPE, which is a six-week program of self-management for cancer patients. It is based on goal setting, mindfulness, and peer support.

They told me that some of the patients on the program have had improvement in their symptoms of anxiety, depression and fatigue. HOPE is typically given in small groups with a facilitator using a manual. Recently, a digital version of the HOPE program, called iHOPE, has been created and can be accessed by patients through the internet.

I can envision that by combining self-management strategy and digital technology, new links can be created between the cancer patient and their team. This could ultimately have a significant benefit for the care of the patient and family. Stay-tuned.