A study presented at the 2021 ASH Annual Meeting suggests domain-specific appraisal of electronic communication portals can improve health care delivery and intervention and maximize patient-centered care while decreasing therapy-related health care team burden.

Physician preference often guides therapy selection for patients with chronic lymphocytic leukemia (CLL) due to the many highly effective and well-tolerated targeted therapies options for CLL, making objective distinction between various therapeutic agents more difficult.

While secure electronic communication portals are federally mandated in health care, they pose a burden on every member of the health care team, particularly within hematology. There is little data suggesting that cancer patients are more likely than urology or family medicine patients to use electronic communication portals, however, health care utilization studies typically do not include this metric as a measure of therapy-related health care team burden. 

“Our study not only uniquely evaluates the quantitative impact of electronic communication portals use on therapy-related health care team burden, it also addresses qualitative domains that are used in electronic communication portals to provide a holistic and granular assessment of therapy-related health care team burden,” wrote Maishara Muquith, UT Southwestern Medical Center, Dallas, TX, and colleagues. 

A comprehensive cancer center provided the retrospective patient and electronic communication portal data for this study. A total of 412 patients with CLL and lymphoid malignancies were included in this study, 237 of which were treated with ibrutinib, 70 with acalabrutinib, and 105 with venetoclax. Some patients with AML who received venetoclax were also included in this study in order to understand disease and therapy specific issues. 

Published literature, the Naranjo adverse drug reaction probability scale and provider documentation were used to code each message. The final analysis included 95 patients who had at least one patient -initiated or clinician-initiated electronic communication portal message thread. Ibrutinib was used mostly as first or second-line therapy. Acalabrutinib and venetoclax were mostly used in later lines of therapy.

“We coded 3338 message threads, comprising 3272 patient-generated messages, and 2050 messages generated by 354 unique clinical staff,” wrote Ms Muquith, adding, “Our sampled population generated an average of 25.83 messages per patient and our healthcare clinical staff generated an average of 17.96 messages.”

The first six month of therapy garnered the highest amount of patient and health care team-generated messages, varying according to treatment. Patients receiving venetoclax had the highest frequency of interactions during the first 6 months of therapy, and were more likely to discuss supportive care and scheduling issues.

Treatment-related adverse events domains, treatment-unrelated adverse events domains, administrative domains, and supportive care domains were highest in patients with CLL who received venetoclax (P = .005), followed by those with AML (P = .07), suggesting a drug effect rather than the disease process.

This study addresses a poorly described measure of therapy-related health care team burden that has the potential to impact therapy selection, especially when there are multiple therapeutic options with similar outcomes available. 

“A non-reimbursed increase in [electronic communication portal] utilization poses significant [therapy-related health care team burden] which is not easily offset by increased staffing efforts and might result in under-utilization of potentially effective therapies, especially in resource limited settings,” wrote Ms Muquith and colleagues, adding “In addition, our domain-specific appraisal of [electronic communication portal] allows for identification for improvements in health care delivery and intervention with structured enhancements that can maximize patient-centered care while decreasing [therapy-related health care team burden].” 

Authors concluded, “[therapy-related health care team burden] should therefore include [electronic communication portal] use and be evaluated as part of a comprehensive assessment tool.”