Guest Editor’s Note: Virtual platforms have grown increasingly popular for health- and wellness-promoting activities. But given patients’ unique backgrounds, capabilities, interests, and goals, promoting engagement represents a complex challenge both in the context of care delivery as well as research. In this installment of The ASCO Post ’s Integrative Oncology series, Tony K.W. Hung, MD, MBA, MSCR, summarizes the results of a study conducted to assess factors that influence engagement in virtual mind-body therapies by patients with cancer.
Overview
Patient engagement has increasingly been recognized as an integral component of cancer care.1-3 In recent years, a growing body of evidence demonstrates that oncology patients who actively engage in health-promoting activities, such as exercising regularly, experience improved symptom control, quality of life, and survival.4-7 However, numerous factors influence the extent to which a patient may engage in health-promoting activities—given individuals’ unique backgrounds, capabilities, interests, and goals.1,2 Thus, promoting patient engagement represents a complex challenge both in care delivery and in research.
“The convenience and accessibility offered by virtual mind-body therapies have contributed to their growing popularity.”— Tony K.W. Hung, MD, MBA, MSCR
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Since the COVID-19 pandemic, virtual platforms have become an acceptable—and sometimes preferable—medium to engage in health- and wellness-promoting activities, giving rise to a $1.5 trillion virtual wellness industry.8-10 Health- and wellness-oriented virtual platforms can offer various forms of modalities, ranging from physical-based (ie, fitness, tai chi) to more classical mind-body modalities (ie, yoga, meditation) and even creative-art interventions (ie, dance, music therapies).11-14 Herein, we will refer to these virtual health- and wellness-oriented interventions as virtual mind-body therapies.
“Engagement in virtual mind-body therapies varied by patients’ sociodemographic factors, underscoring the need to better integrate a gender-preferred, racially sensitive, and employment status–friendly experience.”— Tony K.W. Hung, MD, MBA, MSCR
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The convenience and accessibility offered by virtual mind-body therapies have contributed to their growing popularity. Since the COVID-19 pandemic, a major commercial virtual mind-body platform found a significant increase in the use of live-streamed (synchronous) classes from 7% to 85% and in prerecorded (asynchronous) videos from 17% to 73%.8 Early evaluations of virtual mind-body therapies also demonstrated qualitative benefits to help patients stay physically active, cope with stressors, and foster social relationships.15 Despite this trend, virtual mind-body therapies remain an understudied care delivery model. Particularly little is known about how to leverage this digital shift to promote patient engagement in virtual care.
Cross-Sectional Study Evaluates Patient Engagement in the Virtual Care Era
To explore the factors that influence oncology patient engagement in virtual mind-body therapies, integrative medicine researchers at Memorial Sloan Kettering Cancer Center (MSK) conducted a cross-sectional study among patients who participated in the MSK virtual mind-body therapy program in May 2021.
The program offered 7-day-a-week virtual mind-body group therapy classes through Zoom videoconferencing. Classes were led by licensed or trained instructors and included fitness, tai chi, yoga, meditation, dance, and music therapy. Patients could enroll in the program through a 1-month, 3-month, or 6-month paid subscription and voluntarily choose to participate in any of the available classes. Each class ranged from 30 to 45 minutes and occurred one to four times a week, totaling 20 classes per week.
Participants enrolled in the program were surveyed about their engagement, measured by self-reported weekly attendance. They were also surveyed about their interest in prerecorded video classes, which were not yet offered by the program at the time of the study. Using multivariate regression, researchers assessed associations of patient engagement with sociodemographic and clinical factors; they used a machine learning algorithm to partition engagement subgroups to determine preferential interest in prerecorded mind-body therapy videos. A description of the study and its findings were published in JCO Oncology Practice.16
Key Findings
Among 691 patients who participated in the program, 148 (21.4%) completed the survey. The majority were female (94.5%), White (83.1%), aged 65 or older (64.9%), and retired (64.2%). Patient engagement ranged from 1 to 13 classes per week and was significantly higher for patients who were female, non-White, and had retired from employment.
Our partition model identified three distinct engagement subgroups based on patients’ employment and racial ethnicity:
- Low engager: employed
- Intermediate engager: retired and White
- High engager: retired and non-White.
Particularly, low engagers had a preferential interest in videos relating to meditation (odds ratio [OR] = 2.85, P < .05), whereas both low and high engagers had a preferential interest in videos about tai chi (OR = 2.26, P < .05).
Concluding Thoughts
Understanding patient engagement and interest in virtual care is timely and essential for supporting oncology patients’ treatment and recovery. In this cross-sectional study, we found that engagement in virtual mind-body therapies varied by patients’ sociodemographic factors, underscoring the need to better integrate a gender-preferred, racially sensitive, and employment status–friendly experience. Furthermore, patient engagement subgroups showed distinct interest in prerecorded mind-body therapy videos, suggesting both synchronous and asynchronous virtual mind-body therapies are needed to meet the diverse needs of oncology patients.
Guest Editor
Jun J. Mao, MD, MSCE
Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
A few words of caution. Since this study was conducted at a single, cancer-specialized institution, the findings may not be generalizable to other settings and should be interpreted with the intent of hypothesis generation. The study is subject to other limitations, including survey recall bias and modest response rates. Given the multifactorial influences of patient engagement, results may have been affected by unaccounted confounding factors. Nevertheless, the study represents an important step toward better understanding oncology patient engagement in virtual mind-body therapies and reinforces the notion that virtual care is far from a one-size-fits-all model.
DISCLOSURE: Dr. Hung reported no conflicts of interest.
REFERENCES
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