Despite increasing use of digital health technology in cancer care, an effective framework for its implementation is lacking. This study examined the evidence relevant to the use of digital technology in cancer to inform the development of a strategic framework for implementation.
A meta-review of reviews and recommendations addressing digital technology in cancer from January 2013 to January 2018 was undertaken to identify barriers, enablers, opportunities, and priority needs in order to inform planned consultation with stakeholders.
The literature search identified 528 articles, narrowed through duplicate screening to 61 articles with an additional 18 identified from reference lists. Articles included 6 meta-analyses, 35 systematic reviews, 34 other reviews, two meta-reviews and two recommendation articles. Types of digital health reviewed were most commonly web-based apps (N=30), mobile apps (N=25), and social media/online networks (N = 8). Applications reviewed were used for psychosocial support/intervention, monitoring/self-management, and screening; intended users included patients and survivors, caregivers, health care professionals and the general public. Enablers of digital health implementation included accessibility, availability and low cost. Barriers included rapidly changing technology; gaps included lack of regulation, lack of quality standards, lack of evidence base, lack of content validity, lack of scientific and health professional involvement/endorsement, and a paucity of studies focusing on implementation. Priority needs included: the need for digital applications in cancer care to be more evidence-based and theory-based, tailored to specific oncological populations and cultural, socioeconomic and health literacy factors, and tested with methodological rigour and greater focus on implementation. Stakeholder consultation is currently proceeding to unify the findings of the literature review with the construction of a framework.
Current literature on digital health applications in cancer care offers little implementation guidance. A strategic framework needs to identify gaps in evidence and priorities for addressing them.