Assessing acceptability of home blood monitoring for cancer patients who are receiving systemic anti-cancer therapy from a patient, caregiver, and clinician perspective: a qualitative study

Background: Regular blood testing is an integral part of systemic anti-cancer therapy delivery. Blood tests are required before every administration of treatment to ensure a patient is well enough to receive it. Blood testing is burdensome for patients as they require either an extra visit within 48 hours of planned administration, or a significantly longer visit if done on the day of treatment. The additional time for appointments can have a significant impact upon the quality of life of someone who is living with cancer. In the UK the COVID-19 pandemic created an unprecedented disruption to the delivery of cancer care. Face to face hospital visits were reduced, resulting in a need to develop more innovative ways of working to minimise treatment interruptions. This led to a significant uptake of digital technologies, with new models of care rapidly deployed across the UK health service to meet these challenges.

Objective: To explore the acceptability of a point of care home blood monitoring device for people with cancer who are receiving systemic anti-cancer therapy, which is being developed in response to the increased need for remote care for patients with cancer.

Methods: Qualitative focus groups and semi-structured interviews were conducted with patients (n=23), caregivers (n=6), and healthcare professionals (n=18) over a 19-month timeframe, from May 2019 to December 2020. Data were analysed using framework analysis guided by the Unified Theory of Acceptance and Use of Technology model.

Results: Analysis identified four overarching themes: 1) performance expectancy; 2) effort expectancy; 3) social influence; 4) facilitating conditions.

Conclusion: This study found that patients with cancer, their caregivers, and healthcare professionals had positive perceptions of home blood monitoring. Whilst they are often considered synonymously, self-testing and self-management are not mutually exclusive, and this study illustrated some disparity in opinion regarding patient self-management. Home blood monitoring has the potential to provide patients with cancer with a convenient option for blood monitoring. It would minimise hospital attendances, decrease late treatment deferrals, and provide prompt recognition of cancer treatment toxicities, enhancing existing nurse-led protocols and clinical pathways. Home blood monitoring would create a long-term sustainable transformation for the delivery of cancer care, utilising digital health to act as a facilitator to address a pertinent issue regarding improving the efficiency of hospital resources and increasing the delivery of personalised patient care. Further research is needed regarding how and where home blood monitoring would sit within clinical pathways, in a way that is robust and equitable.