title: Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis.
abstract: Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors-individuals living with and beyond cancer-to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are "complex," and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized.
  
  
  
  To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group.
  
  
  
  Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies.
  
  
  
  Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance-a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors' lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden.
  
  
  
  Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit.
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Anna
authors.identifier: 0000-0001-5254-1296
authors.initials: A
authors.lastname: Cox
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Grace
authors.identifier: 0000-0001-5941-5233
authors.initials: G
authors.lastname: Lucas
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Afrodita
authors.identifier: 0000-0002-5918-3417
authors.initials: A
authors.lastname: Marcu
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Marianne
authors.identifier: 0000-0003-0714-6339
authors.initials: M
authors.lastname: Piano
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Wendy
authors.identifier: 0000-0001-5529-7022
authors.initials: W
authors.lastname: Grosvenor
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Freda
authors.identifier: 0000-0002-6279-5537
authors.initials: F
authors.lastname: Mold
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Roma
authors.identifier: 0000-0003-4289-2433
authors.initials: R
authors.lastname: Maguire
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
authors.forename: Emma
authors.identifier: 0000-0001-5436-8036
authors.initials: E
authors.lastname: Ream
mesh_terms: D000328:Adult; D006801:Humans; D020407:Internet; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D057240:Patient Preference; D017060:Patient Satisfaction; D036301:Qualitative Research; D017741:Survivors / Q000523:psychology; D017216:Telemedicine
keywords: neoplasms; patient preference; patient satisfaction; survival; systematic review; telemedicine