Text message questionnaires support cancer patients

Cancer patients at Guy’s and St Thomas’ are more likely to highlight concerns and anxieties about their health when contacted by text message than other methods, a new paper has shown.

More than 600 patients completed an online evaluation of their concerns after getting a cancer diagnosis. They were twice as likely to say that they felt worried, fearful or anxious about their health, compared to those who did the survey in-person or on the phone with a member of clinical staff.

Nikki Cannon, transformation lead for cancer survivorship at Guy’s and St Thomas’, led the study Delivering personalised cancer care during COVID-19: Text eHNA. She presented the preliminary findings at the virtual annual meeting of the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology last month.

All patients who are diagnosed with cancer complete a questionnaire (known as a holistic needs assessment) with their nurse or healthcare professional as part of their personalised care at Guy’s Cancer. This allows them to raise any needs or concerns about their diagnosis, treatment, impact on their family, financial issues or other worries, so a personalised care plan can be created for them.

Prior to the COVID-19 pandemic, this was usually completed in-person at a clinic appointment. However, as many appointments went virtual to keep patients safe, staff looked for innovative ways to continue supporting patients.

An electronic holistic needs assessment was set up, with patients contacted by text message and asked to complete the short questionnaire online in their own time. Staff then called them to talk about their care plan in more detail.

Since April 2020, more than 650 holistic needs assessments were sent to patients by text message, with 80 percent completed by patients across 11 different tumour groups.

Analysis of the results so far has shown that as part of the new process patients have highlighted greater concerns when completing the questionnaires in their own time, from their own homes. Staff are working with patient groups to understand more about why this is the case.

‘Worry, fear or anxiety’ is the top concern raised by all patients. More than half (56 percent) of patients completing a text survey raised it (scoring it on average 6.5 out of 10). This compared to a quarter (26 percent) of patients who filled in the survey by other means, and with a lower average score of 5.4.

Other notable results include:

• Zero complaints were registered in nearly a third (31 percent) of all assessments not offered by text, compared to just 15 percent of those completed by text message.
• Emotional concerns make up an extra 6.7 percent of concerns raised when offered by text message compared to those flagged during a conventional needs assessment
• Emotional concerns highlighted by text survey were almost twice as likely to be scored between 7-10 compared to those raised during in-person assessments;

Nikki Cannon said: “Delivering personalised care is really important – we need to know what support patients most need after their cancer diagnosis. This is done by a holistic needs assessment.

“When we first introduced the assessment by text, we realised patients were flagging more concerns about their health than those who had in-person assessments. It could be those patients have more time at home to reflect on their answers, and they feel they can be more honest than if they are in a clinic. By continuing to focus on what our patients tell us we are better able to evolve our practice and work with partners to meet those needs.

“The text assessments have been a really useful additional tool for us to support patients, in addition to face-to-face, and it’s something we will continue to offer our patients.”

Clare Johnson was treated at Guy’s Cancer for breast cancer. The 56-year-old, from Beckenham in Kent, completed her questionnaire online.

She said: “Being able to complete the questionnaire in the comfort of my own home rather than a busy clinic, gave me the time I needed to really think about how I was feeling and be able to fill it in without worrying that I was taking too long.”