Can chemotherapy at home benefit cancer patients?
Since 2015, some Danish cancer patients have had the opportunity to receive parts of their chemotherapy treatment in their own homes. What advantages and disadvantages does this have for the patients? This was the central question posed by Cecilie Jo Nielsen and Astrid Ellen Dalsjö in their MSc thesis from Digital Design and Communication at the IT University of Copenhagen (the programme changed its name to Digital Design and Interactive Technologies in November 2017).
What did you investigate?
We examined a telemedicine solution called “chemo at home” which allows cancer patients at Rigshospitalet and Roskilde Hospital to receive parts of their chemotherapy at home instead of being hospitalized. We evaluated the concept from a service design perspective in order to see how home treatment affects the patients.
It is often said that telemedicine empowers the patient, meaning that patients get a sense of control of their own treatment, but we hypothesized that this may not be the case for patients with a life-threatening disease like cancer.«
It is often said that telemedicine empowers the patient, meaning that patients get a sense of control of their own treatment, but we hypothesized that this may not be the case for patients with a life-threatening disease like cancer.
What advantages and disadvantages did the patients experience?
Through our collaboration with the two hospitals, we had the opportunity to interview and observe both patients and nurses. The majority of the patients we were in contact with found that home treatment helped them forget their disease and gave them a sense of freedom and normality. At home, they could be with their family and do everyday things like taking a walk.
However, at the same time, patients experienced a number of technical challenges that made the process less harmonious. For example, air could get into the chemo pump, in which case the patient had to go back to the hospital and get help from a nurse. We also found that patients feel insecure about being away from the hospital, and this affects their ability to take care of themselves.
Does that mean that chemo at home does not work?
No – chemo at home definitely has the potential to give patients a higher quality of treatment. Many patients actually prefer receiving treatment at home.
Many patients actually prefer receiving treatment at home. But in order to fully exploit the potential of telemedicine, patients must be able to take control of their own disease and know more about their illness.«
But in order to fully exploit the potential of telemedicine, patients have to take control of their own disease and know more about their illness. This is difficult with a group of patients that really just wants to forget about the disease and often wants a nurse's assessment of their situation. Therefore, when using the technology to replace interactions with nurses, it is vital to spend more resources on preparing patients well, so that they can create a comfortable environment for treatment at home.
How do you suggest improving the concept?
Based on our empirical data and a review of the literature on telemedicine, we developed a strategy for a more successful implementation of chemo at home. For example, nurses and patients should be educated to take on new roles – nurses should provide the patient with the necessary skills and knowledge. At the same time, it is important to create a comfortable environment for the patients at home. Patients should have more ways to interact with nurses from their home, for instance when experiencing technical problems. Patients should also feel prioritized when they need to get in touch with a nurse. We also suggest an app that answers questions about chemotherapy and online forums where patients can talk to other cancer patients.
In short, a more successful implementation would demand more time and resources put into investigating the needs of patients and adapting the treatment. In the end, this would both be more efficient for the hospitals and create more value for the patients.
Vibeke Arildsen, Press Officer, phone 2555 0447, email email@example.com