Exploring the use of a digital therapeutic intervention to support the pediatric cardiac care journey: Qualitative study on clinician perspectives

• Published in: PLOS digital health 2023-12, Vol.2 (12), p.e0000371-e0000371
• Main Authors: Wali, Sahr, Remtulla Tharani, Alliya, Balmer-Minnes, Diana, Cafazzo, Joseph A, Laks, Jessica, Jeewa, Aamir
• Format: Article
• Language: English
• Subjects: Adolescents; Blood pressure; Cardiology; Cardiovascular disease; Cardiovascular diseases; Caregivers; Cellular telephones; Clinical decision making; Collaboration; Congenital diseases; Data analysis; Data collection; Disease management; Families & family life; Health care networks; Heart; Hospitalization; Hospitals; Intervention; Interviews; Medicine and Health Sciences; Nutrition; Patients; Pediatrics; People and Places; Population; Qualitative research; Research ethics; Teenagers
• ISSN: 2767-3170; 2767-3170
• DOI: 10.1371/journal.pdig.0000371

Pediatric heart disease currently effects over one million infants, children, and adolescents in the United States alone. Unlike the adult population, pediatric patients face a more uncertain path with factors relating to their growth and maturation creating levels of complexity to their care management. With mobile phones increasingly being utilized amongst adolescents, digital therapeutics tools could provide a platform to help patients and families manage their condition. This study explored clinicians' views on the use of a digital therapeutic program to support pediatric heart disease management. Using the principles from user-centered design, semi-structured interviews were conducted with 4 cardiologists, 3 nurse practitioners and 1 cardiology fellow at the Hospital for Sick Children. All interview transcripts underwent inductive thematic analysis using Braun and Clarke's iterative six-phase approach. To further contextualize the analytic interpretation of the study findings, Eakin and Gladstone's value-adding approach was used. Five themes were identified: (i) multidisciplinary model of care; (ii) patient care needs change over time; (iii) treatment burden and difficulties in care management; (iv) transition to adulthood; and (v) filling care gaps with digital health. Clinicians valued the opportunity to monitor a patient's health status in real-time, as it allowed them to modify care regimens on a more preventive basis. However, with adolescent care often varying according to the patient's age and disease severity, a digital therapeutic program would only be valuable if it was customizable to the patients changing care journey. Digital therapeutic programs can ease the process of self-care for adolescents with heart disease throughout the growth and maturation of their care journey. However, to ensure the sustained use of a program, there is a need to work collaboratively with patients, caregivers, and clinicians to ensure their lived experiences guide the design and delivery of the overall program.