Assessing health electronically for adolescent and young adult oncology patients (AHEAD Study).
Authors: Ketterl Tyler Garrett , Richardson Laura , McCarty Cari , Fanizzi Sarah , Field Mary , Fladeboe Kaitlyn , Patten Joanna Thome , VonHeeder-Phillips Gretchen , Wang Xing , Rosenberg Abby R. 
Published: June 2022

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Background: Screening and counseling for health risk behaviors (RB) are recommended but infrequently performed, particularly in individuals undergoing cancer therapy. Unmet needs among adolescents and young adults (AYAs) with cancer translate to poor physical and psychosocial outcomes. The authors aimed to 1) modify an existing RB electronic health assessment (eHA) and intervention tool and 2) determine the feasibility and acceptability of the RB eHA and intervention tool among AYAs with cancer and their oncology providers. Methods: The internally developed HRB eHA and intervention tool Check Yourself was adapted by a multidisciplinary healthcare professional panel for an AYA oncology population and informed by literature review and AYA stakeholder feedback. “Check Yourself Oncology” assesses risk and health domains including home, education, sexual health, safety, alcohol/drugs, mental health and medication adherence. Optional feedback is provided for sexual health, safety, alcohol/drugs and mental health domains. Eligible AYAs were 13 to 29 years old, diagnosed with cancer, receiving cancer directed therapy, follow-up scheduled with a Seattle Children’s Hospital oncology physician or nurse practitioner, and fluent in English. 72 hours prior to their next oncology clinic visit, participants were text messaged or emailed a personalized link to the Check Yourself Oncology tool to be completed prior to their next visit. Upon completion, a detailed report was sent to the primary clinical oncology team prior to the patient’s visit. Feasibility was defined as 1) ≥70% completion of the RB eHA and 2) a Feasibility of Intervention Measure (FIM) mean score >4. Acceptability was defined as an Acceptability of Intervention Measure (AIM) mean score >4 and qualitatively. The FIM and AIM were sent by REDCap survey following the clinical visit; verbal feedback from AYAs and clinicians was analyzed with qualitative content analysis. Results: Of 30 eligible, approached AYAs, 25 (83%) enrolled in the study and 23 (76%) completed the Check Yourself Oncology tool and follow-up assessments. The AYAs had a mean age of 17 years (SD = 2.9 years) and 50% identified as female. Four AYAs declined participation due to lack of interest, 1 due to declined parental consent, 1 passively declined after enrollment, and 1 declined further participation following the confidentiality terms. The mean FIM and AIM scores were 4.1 (SD=0.6) and 4.0 (SD =0.7) respectively. Seventeen AYAs (74%) felt that the feedback provided was relevant and useful. 74% of visits providers reported that they incorporated the results in the care of the patient and 87% reported the results positively impacted care. Conclusions: Risk behavior screening with motivational feedback though the modified eHA tool Check Yourself Oncology is feasible and acceptable in AYAs undergoing cancer directed therapy. Clinical trial information: NCT04484194.