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Refining and Testing the Medical Appointment Planner

Margaret Clayton, PhD, APRN, University of Utah, Salt Lake City, Utah
Study abstract

Women with breast cancer frequently experience residual symptoms and late effects of treatment, fear of recurrence, and the challenge of maintaining a positive outlook while vigilantly monitoring for breast cancer recurrence. Breast cancer is also a disease of older women with 80% of breast cancer diagnosed over age 50 and the median age at diagnosis 61 years. As such, many women experience co morbid illnesses requiring interaction with multiple medical providers, in addition to cancer surveillance by medical oncologists. Medical office appointments are brief, and focused on the agenda of the provider, leaving little room for women to present their concerns and symptoms. When attending these visits women may have difficulty raising questions, presenting their concerns in an organized manner, and persisting if questions are dismissed, ignored, or only partially addressed. This contributes to uncertainty, worry, under treatment of symptoms, unnecessary prolongation of concerns, and over utilization of the health care system.

The purpose of this proposed trial is to test a web based approach to medical appointment planning using the Medical Appointment Planner (MAP). MAP is a tailored intervention focused on helping women identify and organize their concerns, then present their concerns and visit goals to providers effectively during medical office appointments so that survivor needs are met. Symptoms and concerns can be entered, prioritized, and organized by the appropriate medical provider. We also provide a way to track the severity and distress of symptoms and concerns women wish to discuss at these appointments, allowing healthcare providers to better understand the importance of these issues to women. Finally MAP includes coaching where women develop “prompting phrases” to initiate a discussion of their concerns with providers and “persisting phrases” to help ensure concerns are addressed during the visit. The newly programmed web based platform and remote data collection capability, with the assistance of the Army of Women, will allow wider evaluation of both the MAP medical visit planning approach and program usability.

Study review

The study investigated the impact of a structured online patient support program for women who have been diagnosed with breast cancer and are experiencing chronic pain. The research team’s accrual goal for the Army of Women was 75 women. Within 24 hours of the request to participate, 112 women signed up for the study, with a total of 222 women signing up over six weeks