Tuesday 16th December 2014
Mac Voice, the magazine for Macmillan professionals: Winter 2014
Noëline Young describes the evidence that supports the change towards using eHNA rather than a paper format
In the management of cancer, good communication between people living with cancer and their healthcare teams, and the assessment of people's needs, treatment outcomes, psychosocial factors and quality of life, are crucial in decision making. 
The busy nature of outpatient clinics and short consultations may limit a detailed assessment of people's needs. This could constitute a barrier to delivering high-quality care and improving quality of life. Taenzer et al  identified that information technology (IT) was an easy and acceptable way to overcome this barrier and enables more precise assessment and data collection. The data from this study suggests a marked improvement in quality of life.
The advent of IT has offered an opportunity to have a more comprehensive assessment of how a person thinks and feels. Velikova et al  identified that using IT-based assessment tools enables the transfer of critically important information that helps to initiate and stimulate discussion. People felt that if the clinician had the results of the assessment, they were more likely to enquire about the issues raised and their quality of life, and satisfaction with the care they received increased.
Early work by Velikova et al  identified that IT was well-received as a method for assessment and preferred over paper, as it was quicker. Responses were legible and good software design meant it was less easy to skip questions and therefore data was more complete. Viewing fewer questions at a time on the screen was also considered an advantage over the paper where all the questions are visible on one page.
Many studies have piloted the use of computers for assessment and have found that it is a reliable method to assess quality of life and people's needs. Touch screen technology is mouse and keyboard-free, allowing input to the screen using finger or pen.  Cull et al  identified that IT was a practical and effective method of easing the administration burden, and that there was scope for using touch screens to enable more precise assessment and data collection. Wright et al  recognised manual methods were laborious and time-consuming, and that the use of self-reporting methods showed better detection rates. See also Ibottson. 
The validity of data gathered through touch screens was found to be stable when compared to paper formats. Gwaltney et al  identified that paper and IT formats gave directly comparable scores. This meta-analysis identifies the validity of using an IT solution. Gwaltney et al and Ashley et al  also identified that the answers to electronic questionnaires were equivalent to those on paper. Frennered et al  recognised the psychometric characteristics and score equivalents when using a touch screen for assessments were highly correlated, with no significant difference when compared to the paper format.
The major aim of introducing technology is to improve the HNA and care planning process, in order to improve treatment outcomes and satisfaction with services.
The completion of a touch screen questionnaire significantly increases the discussion of chronic symptoms by clinicians.
It also has a positive clinical improvement on a person's health and well-being. [1, 2]
Compared to paper, computerised assessments require less comparable time to complete, provide better data and result in a reliable format.  Bickmore et al  identified that people were generally receptive to technology and Velikova et al  recognised that the assessment enhanced communications and triggered appropriate referrals. Only half the people living with cancer in this study wanted a printed copy of the results; however, they felt that the process resulted in a significant improvement in the content of the consultation and improved doctor-patient relationships. There was a strong preference for the use of graphics.
Acceptance and user satisfaction
Despite concerns related to computer literacy and skills, touch screen instruments have been widely accepted by people living with cancer. [13, 14] Touch screens do not require typing or computer skills and with the minimum of training, there have been few problems reported related to use.  A high degree of user satisfaction with touch screen solutions has been found across all genders and age groups, irrespective of computer skills, literacy or ethnic background.  Wright et al  identified that 94% of people in their study had no problem using a touch screen device, however Velikova et al  identified that those who had severe disease were less inclined to complete an assessment using a touch screen. This paper also identified that staff had a crucial role in influencing compliance and therewas a need for commitment, training and skills for healthcare professionals.
Evidence of use
The use of computers has been widely adopted in the NHS as an alternative means to paper, and offers many benefits to improving efficiency and effectiveness in outcome assessments, including holistic needs.
The evidence to date suggests that computerisation of the HNA minimises missing data and duplication, while improving analysis, storage, retrieval and backup of information and data. It could aid in the scheduling and selection of appropriate assessment tools, ensuring that assessments are completed consistently across the population of people living with cancer.
Change Project Manager
Recovery Package, Macmillan Cancer Support
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2 Velikova G, Wright E P et al. Self reported quality of life of individual cancer patients: concordance of results with disease course and medical records. Journal of Clinical Oncology. 2001. 19(7): 2064–2073.
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