User Requirements for Online Consultation in Cancer

Patient Portal Tan Khian Chuan, Nasriah Zakaria, Mohd Azam Osman

School of Computer Sciences, University Sains Malaysia

11800 USM, Malaysia

tankcc@hotmail.com

nasriah@cs.usm.my

azam@cs.usm.my

Abstract— This research studied the usefulness of online

consultation, users’ time-availability, cost of consultation,

criteria for choosing doctor, privacy and trust issues on

online consultation. We used questionnaires and

interviews to collect the user requirements for the online

consultation. Based on the result, we conclude that users

are willing to use online consultation in Cancer Patient

Portal.

Keywords— User Requirements, Online Consultation.

I. INTRODUCTION

Currently, cancer patients always need to go to hospitals for

consultation. Thus, they need to travel frequently from their

homes to hospitals and situations worsen when the distances

are long. According to [15], travel to cancer treatment is

described as inconvenient and a practical hardship for many

patients. According to [3], it may be perceived, or experienced

as, a barrier to seek appropriate treatment and care. According

to [2], the patients in rural areas needed to travel 2 to 3 times

farther to see medical specialists than those living in urban

area. Cancer patients who lived in rural area will suffer a lot

from travelling frequently especially to have repeating

consultation compare to those in urban area although those in

urban area affected by other factor like traffic jam that caused

the travel period became long.

As an example, by referring to [5], Malaysian patients in

Taiping need to travel 90 km in order to get medical treatment

in the General Hospital Butterworth. For a one way trip, it will

take 49 min for single journey using expressway. For 180 km

round trip journey, it will take 1 hour 38 min to go for

consultation in medical centers or hospital in urban area.

Another example for rural area is travelling from Jeli to Kota

Bharu which is approximately 87.8 km in distance by

referring to [4]. For a one way trip, it will take 58 min for

single journey using federal road. For 176 km round trip

journey, it will take 1 hour 57 min to go for consultation in

medical centers or hospital in urban area. As a result,

according to [10], some cancer patients were tired after having

travelled more than 30km round trip when arriving home with

some of them feeling very tired or exhausted.

II. LITERATURE REVIEW

Healthcare has been slow in catching up with the cutting

edge technology for patient treatment and monitoring.

However, according to [6], the industry has hardly made use

of Information and Communications Technologies (ICT) to

support these practices. This is changing rapidly as the

industry begins to realize the potential of ICT and increase

opportunities for vendors, system integrators, service

providers and resellers. In general, ICT can play following

roles in healthcare:

• Provide the right knowledge, at the right place at the

right time to support decisions.

• Support person to person, machine to machine and

person to machine communications.

• Support group communication.

• Support data transfer chain by transforming data into

information and then become knowledge [6].

As an example, medical tourism is emerging as potential

market for Malaysia. According to Nuwire Investors,

Malaysia is ranked as the world’s third preferred location for

medical tourism behind Panama and Brazil in 2007 [17].

According to Andy David, industry principle, Healthcare,

Industries & Solution Group at SAP Asia-Pacific Japan, ICT

can help to improve healthcare services and attract foreigners

to come for treatment. Currently, slow ICT adoption is the

main issues in healthcare industry [16].

Telemedicine is defined as any interaction between a

patient and a provider or other source of advice, information,

and treatment that is not face-to-face that can be delivered

over the telephone, the Internet or wireless technology.

According to [9], the range of telemedicine services varies

from online appointments to remote surgical process

procedures directed by a surgeon to a non-surgeon via

telecommunication technologies. Telemedicine involves

remote communication using a suitable infrastructure, of a

range of clinical elements and additional investigations.

2010 IEEE EMBS Conference on Biomedical Engineering & Sciences (IECBES 2010), Kuala Lumpur, Malaysia, 30th November - 2nd December 2010.

978-1-4244-7600-8/10/$26.00 ©2010 IEEE 389

According to [8], telemedicine aims for establishing

diagnosis, deciding on treatment, or performing follow-up,

without the need for patient to travel far. According to [12],

teleconsultation is defined as the consultation of one (or more)

distant healthcare professional(s) by a locally present

healthcare professional about a patient’s case, diagnosis and

treatment using telecommunication and information

technology to bridge the distance between the two (or more)

participants. Teleconsultation can be considered as one of the

most common applications of telemedicine and it is very

similar to a regular consultation. As an example,

teleconsultation has been used in oncology for communication

between oncologists and geographically distant clinicians.

According to [7], the teleconsultation sessions are conducted

on Oncologic Electronic Medical Record (OEMR) where

clinicians can navigate synchronously the pages of the

OEMR, share clinical data and images and discuss ongoing

care process in real time.

According to [13], cancer communication means any

exchange of information about cancer between a healthcare

consumer and an information source, including electronic,

print and interpersonal sources. According to [11], for cancer

communication, main issues faced by cancer patients and their

families are effective communication for medical care at the

time of diagnosis, complications or relapse, during

hospitalizations or other crisis, at disease progress and death.

Same problem faced by cancer patients and their families in

web communication. Cancer patients not able express

accurately their condition and thus may cause wrong

interpretation by medical doctors.

In the next section, we will talk about user requirements for

online consultation. This is to know the requirements of users

for online consultation in Cancer Patient Portal. Requirements

of users are very important in this stage of planning.

According to [1], requirements are everything that the set of

relevant stakeholders want from a system. Requirements are

regarded as the most important and crucial part of the systems

development process, and they are often the most

misunderstood development issue. According to [14],

researchers have noted that involvement is an important factor

that needs to be examined in the context of consumer

experience in online environments. If there are positive

responses from users, it means that users are willing to use

online consultation in Cancer Patient Portal.

III. METHODS

There are two methods being conducted in this research.

The first one is questionnaire survey while the second one is

interview.

A. Questionnaire

This survey is part of the pilot study of the research and the

sample size obtained is 50 people. This survey aims to

uncover the requirements for online consultation from public.

This survey is conducted in library of USM where

respondents need to fill in the questionnaire on the spot and

return immediately after they are done. Library is chosen

because there have tables and chairs that are convenient for

respondents to sit and write properly. The survey was done on

voluntary basis and no incentive was given to respondents.

Total returned questionnaires that valid are 50 which is 100%

return rate. The questionnaire contains 23 questions where

part A contains 10 questions and part B contains 13 questions.

Part A contained questions on basic online consultation like

age, consultation fee, frequency of consultation, consultation

hour, usefulness of online consultation and privacy. Criteria

for doctor’s part were given free for entry purposely to collect

respondents’ comments. Part B contained questions where

answers being categorized using Likert Scale from 1 to 5

where 1 represents Strongly Agree, 2 represents Agree, 3

represents No comment, 4 represents Disagree and 5

represents Strongly Disagree about usefulness, quality,

availability and privacy of online consultation.

B. Interview

There are total 4 interview sessions conducted with 7

participants. All participants are cancer survivors from 3 years

to 36 years. The participation was done on voluntary basis and

no incentive was given to respondents. Informant identities

were not recorded in the study data to ensure confidentiality

and privacy for patients.

Each interview sessions were conducted at different

locations selected by participants, which are Roti Bakar

Coffee Shop, Caring Society Complex, Mount Miriam Cancer

Hospital and participants’ house. The interviews conducted

were one to many participants (group interview) basis. The

Interview questions were prepared before the interview

session. Questions were created to elicit comments about

usefulness, quality, availability and privacy of online

consultation. Each interview was different but they all

followed the same basic structure, where participants were

being asked on the spot and answered immediately. Interviews

were digitally recorded, transcribed, and coded. Sample of

questions are listed as below.

1. Do you think online consultation is useful to you?

2. How much do you willing to pay for online

consultation?

3. What are your criteria to select medical doctors for

online consultation?

4. When do you like to have online consultation

session?

5. How frequent will you use online consultation?

6. Is there any difference between online consultation

and face to face consultation?

7. Will you take into consideration your privacy during

online consultation?

IV. DATA ANALYSIS AND RESULT

A. Questionnaire

Table 1 shows the result of questionnaire for part A from

the total of 50 respondents. Based on the result of

questionnaire, 62% of the respondents are aged less than 30

while 36% of them are aged between 30 and 50. Only 2% of

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them are aged more than 50. For consultation fee, 56% of the

respondents wish to have it less than RM40 while 20% of the

respondents wish to have it between RM40 and RM60. Only

4% of the respondents are willing to pay more than RM60.

For criteria for doctors, 70% of the respondents agreed that

experience of the doctor is most important compare to 20%

for name and 10% for other criteria. For frequency of online

consultation, 88% of the respondents felt that they will use it

less than 5 times and only 12% of them will use it between 5

and 10 times. For consultation hour, 70% of the respondents

choose to have online consultation at night while only 24% for

morning and 6% for afternoon. For usefulness, it consists of

questions as below. There are more than 83% of the

respondents think that online consultation is useful to them

compare to 17% think no.

• Have you heard of online consultation before?

• Do you think online consultation is useful to you?

• Do you think online consultation is convenient to

you?

For privacy, it consists of two questions as listed below.

There are 71% of the respondents answered they have no

concern on privacy and willing to help family members or

friends to have online consultation while only 29% answered

yes.

• Will you have concern on your privacy during online

consultation?

• Will you help your family members or friends to

have online consultation?

Table 1: Result of Questionnaire for Part A

Variable Category Frequency Percentage (%)

Age □ <30 31 62

□ 30-50 18 36

□ >50 1 2

Consultation fee □ <RM40 28 56

□ RM40-RM60 20 40

□ >RM60 2 4

Criteria for

doctors □ Experience 10 20

□ Name 35 70

□ other 5 10

Frequency □ <5 44 88

□ 5-10 6 12

□ >10 0 0

Consultation hour □ Morning 12 24

□ Afternoon 3 6

□ Night 35 70

Usefulness □ Yes 42 83.3333

□ No 8 16.6667

Privacy □ Yes 14 29

□ No 36 71

Table 2 shows the result of questionnaire for part B from

the total of 50 respondents. For usefulness, there are total of

77% of respondents agreed that online consultation is useful

to them. However, 13% of respondents feel no comment on

the usefulness of online consultation and another 10% do not

agree that online consultation is useful to them. For quality of

doctor in online consultation, 93% of respondents agreed that

they want to meet their preferred doctor and know the profile

while 7% of them do not have comment. For availability of

online consultation, 91% of respondents agreed that they

would like to choose the online consultation time and meet the

doctor whenever they like. Another 5% of them do not wish to

comment while 4% disagree with it. For efficiency of online

consultation, 55% of respondents disagree that online

consultation in virtual is as efficient as physical face to face

consultation. 36% of them no comment on it and only 9%

agreed that online consultation in virtual is as efficient as

physical face to face consultation and there are no difference

between them. For privacy, 50.5% of respondents agreed that

they are concerned with their privacy. There are 38.5% of

them no comment on this while another 11% of them

disagreed.

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Table 2: Result of Questionnaire for Part B

Category

Variable

Percentage

(%)

Usefulness (%)

-Online consultation reduces my cost of Strongly agree 10.6667

travelling.

Agree 66

-I am affordable to pay

for online No comment 13.3333

consultation fee.

Disagree 9.3333

-I like to try online

consultation. Strongly Disagree 0.6667

Quality (%)

-I would like to meet

my preferred Strongly agree 8

doctor during online

consultation. Agree 85

-I would like to know

the doctor's No comment 7

profile before online

consultation. Disagree 0

Strongly Disagree 0

Availability

(%)

-I would like to meet

my doctor Strongly agree 20

whenever I need to.

Agree 71

-I would like choose the

time of No comment 5

online consultation.

Disagree 3

Strongly Disagree 1

Efficiency

(%)

-There is no difference

between online Strongly agree 0

consultation and face to face consultation. Agree 9

-Online consultation is

as efficient as face to No comment 36

face consultation.

Disagree 40

Strongly Disagree 15

Privacy (%)

-I would like to see my

doctor's face clearly Strongly agree 3.5

during online consultation. Agree 47

-I will attend online

consultation session No comment 38.5

one to one with my

doctor. Disagree 11

-I will share my

condition honestly Strongly Disagree 0

to doctor during online

consultation.

-I do not need help from

other parties during

online consultation.

B. Interview

There is 1 category of theme related to online consultation.

This category has multiple codes that are part of the

consultation in Cancer Patient Portal. They are advantage,

availability, cost, criteria, disadvantage, privacy and trust.

Table 3 shows main category and codes of interview.

Table 3: Main category and Codes of Interview

Category Code Frequency (n)

Consultation Advantage 12

Availability 5

Cost 4

Criteria 7

Disadvantage 21

Privacy 11

Trust 2

For interview, the advantages of online consultation are as

below.

• Use for second opinion regarding a diagnosis of

doctor “So, this patient maybe wants a second opinion, he may need

use this online thing to ask.”(P6)

• Somebody to talk to “At online one, everybody can share, can ask questions. So at

least they have somebody to talk to.”(P3)

• Provide reliable source of information “They provide reliable information. Because sometimes we go

to a website, we don’t have reliable source.”(P4)

• Convenient “You can do it easily without any go purposely to the doctor.

So convenient.”(P6)

For availability, the feedback from participants on

consultation hour as below.

• Immediate consultation “and if online it say 8 o'clock, I don’t want to be 8 o'clock. So

that I am sick. I want immediate answer.”(P1)

• Office hour “The consultation is office hours one.”(P6)

For cost, the response from participants on consultation fee

as below.

• RM60 for the first time “The first time is RM60, the subsequence only RM45.”(P2)

• RM40 for consultation fee “Certain hospital they charge 40 dollars per consultation, the

specialist fee.”(P6)

• Don’t want to pay a fee “I don’t think that I will pay for that part of

consultation.”(P6)

For criteria, from participants, the criterion for choosing

doctor as below.

• Well known “I think information to find out, which one is more... what

you call… people… through people, through mouth. They will

said… this doctor is good... this doctor not so good … through

information from those who has visit the doctor.”(P6)

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• Qualification and experience “We did found out their qualification, their experience, how

long they had been working in hospital. Very often the

specialist, they work in several places. The number now we

have got one oncology specialist. He has just come back from

UK after training. But, before the training, he was quite

experience in his field, in KL and he has been working in this

hospital for short time and then he has working at

government hospital and all that… so such people you know.

After all the experiences and then the courses they’re attend,

make a person… one thing that feel that… experiences is very

important.”(P6)

• Types of sickness “Depending on what type of sickness you have.”(P6)

For disadvantage of online consultation, the answers of

respondents as below.

• Cannot rely on what patients said “Some doctors cannot explain to you online because they

can’t know. They cannot rely on what you said. Sometimes a

patient may say wrong thing, because he is not a

professional.”(P3)

• Physical face to face meeting is better “Face to face is better because you can touch, or hug”(P3)

“Face to face can talk. Body language gives patient more

encouragement to talk.”(P4)

“Face to face is more efficient than online one”(P5)

• Virtual meeting in online consultation not real “You cannot have real consultation. Any decision made. Just

a second advice.”(P3)

For privacy, the response of participants as below.

• No concern “You don't care. What privacy is there, you are fighting for

your life.”(P1)

For trust, the response of participants as below.

• Don’t trust “I don’t trust. I don’t trust that doctor.”(P3)

V. DISCUSSION

For questionnaire, since the majority of respondents are less

than 30 years old, majority of respondents agreed that online

consultation is useful. Most of them will choose the doctors

based on name and prefer to have online consultation at night.

For consultation fee, 56% willing to pay less than RM40

because everyone wishes for lower price. However, another

40% are willing to pay between RM40 and RM60 shows that

actual consultation fee still reasonable if the fee is between

this ranges. In part B, for usefulness, the percentage of

respondents who choose no comment is 13%. This is because

they might not understand what online consultation is and

never listen before. For quality, respondents basically request

to meet their preferred doctor and know their profile. No one

disagree on this. For availability, only small percentages of

respondents have no comment or disagree to choose their

online consultation hour. For efficiency, though majority

disagreed that online consultation in virtual meeting is same

with face to face consultation in physical meeting, there are

36% of people with no comment on this. This is because they

are not sure of what online consultation is and cannot compare

it. For privacy, there are 38.5% of respondents felt no

comment on it. This is caused by the respondents are less

concern on their privacy.

All participants interviewed are aged more than 50 years

old. From the interview, participants felt that online

consultation only can serve as reference or second opinion

purpose of doctors’ diagnosis. Thus, it can reduce travelling

for consultation for patients in rural area. According to [2],

patients in rural area needed to travel 2 to 3 times farther than

those living in urban area to see medical specialists.

According to [6], ICT can play the roles in healthcare to

provide the right knowledge, at the right place at the right time

to support decisions. Although ICT can help to improve

healthcare services, online consultation cannot replace the

physical face to face consultation as it is virtual, which has

limitation on physical contact and it is not real. According to

[11], main issue faced by cancer patients and their families for

cancer communication is effective communication. Since

cancer patients are not able to express accurately their

condition, doctors also cannot just rely on what patients said

as it might not provide accurate information and they cannot

diagnose based on their experience only without checking. It

may cause wrong interpretation by doctors. Participants also

commented that they cannot feel the sense of touch and show

their body language to the doctors in online consultation.

Participants think that when they are sick, they would prefer

to get immediate consultation rather than waiting for

availability of doctor. This is because it is too tiring for them

to wait for consultation when they are sick. They want to

know their condition and get advice from doctors to relieve

their worries and pains immediately. For criteria of doctors,

participants think that the names of the doctors are as

important as qualification and experience of doctors. They get

to know the doctors based on recommendation from doctors

and other users. For consultation fee, based on the interview,

the consultation fee of the online consultation in virtual should

be same or close to physical face to face consultation fee at

least so that users willing to pay and use this service. Based on

feedback, comfortable price for online consultation is between

RM40 and RM60. For privacy concern on participants’

identities and condition, they have no concern on it. However,

although participants have no concern on their privacy in

online consultation, they don’t trust the doctor that they meet

online due to the doctors are not known to them. As a result,

they are not willing to meet the doctors online. They only

want to meet their preferred doctors.

ACKNOWLEDGEMENT

Thanks to our reviewers for the comments and

suggestions. We would like to thank Lim S.H., Khor A.H.,

Seow H.P. for Cancer Portal Prototype development,

Nursakirah Abdul Rahman and Nurakmar Hamid for

Cancer Portal maintenance and documentation.

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REFERENCES

[1] Avison, D.E. & Fitzgerald, G. (2006) Information Systems

Development: Methodologies, Techniques, and Tools, 4th Rev.

edition. McGraw-Hill College, New York.

[2] Chan, L., Hart, L.G. & Goodman, D.C. (2006) Geographic Access

to Health Care for Rural Medicare Beneficiaries. The Journal of

Rural Health, Vol. 22, Issue 2, p. 140-146.

[3] Costain, S.K. & Hewison, J. (1999) Experiencing Cancer. Open

University Press, Buckingham. [4] Destination Distance in Kelantan (2007) [Online]. [Accessed 01st

May 2009]. Available from World Wide Web:

http://mdt.kelantan.gov.my/infojarakkel.html [5] Destination Distance in Malaysia (2007) [Online]. [Accessed 01st

May 2009]. Available from World Wide Web: http://mdt.kelantan.gov.my/infojarakmal.html

[6] Eastwood, G. (2005) ICT Opportunities in Healthcare. Business

Insights. [7] Forti, S., Galvagni, M., Galligioni, E. (2005) A Real Time

Teleconsultation System for Sharing an Oncologic Web-based

Electronic Medical Record. AMIA Annual Symposium Proceedings v.2005.

[8] Geoffroy, O., Acar, P., Caillet, D., Edmar, A., Crepin, D.,

Salvodelli, M., et al. (2008) Videoconference Pediatric and

Congenital Cardiology Consultations: A New Application in

Telemedicine. Archives of Cardiovascular Diseases 101, p. 89-93.

[9] Goldstein, D.E. (2000) E-healthcare: Harness the Power of

Internet E-commerce & E-care. Jones & Bartlett Publishers. P.

189-191.

[10] Junor, E.J., Macbeth, F.R. & Barrett, A. (1992) An Audit of Travel and Waiting Times for Outpatient Radiotherapy. Clinical

Oncology 4, p. 174-176.

[11] Moore, R.J. & Spiegel, D. (2003) Cancer, Culture and Communication. Springer. P. 118-123.

[12] Nerlich, M. & Schaechinger, U. (2003) Integration of Health

Telematics into Medical Practice. Volume 97 of Studies in Health Technology and Informatics, p. 3-6.

[13] Niederdeppe, J.D., Hornik, R.C., Kelly, B.J. (2007) Exploring the

Dimensions of Cancer-related Information Seeking and Scanning

Behavior. Health Communication. 2007, 22(2), p. 1-15.

[14] Novak, T.P., Hoffman, D.L. & Yung, Y.F. (2000) Measuring the

Flow Construct in Online Environments: A Structural Modeling

Approach. Marketing Science 19(1), p. 22-42.

[15] Payne, S., Jarrett, N. & Jeffs, D. (2008) The Impact of Travel on

Cancer Patient’s Experience of Treatment: A Literature Review. European Journal of Cancer Care, Vol. 9, Issue 4, p. 197-203.

[16] Tech & U * NST Online (2009) [Online]. [Accessed 10th August

2009]. Available from World Wide Web: http://technu.nst.com.my/Current_News/techNu/Monday/TechTal

k/20090412200235/Article/index_html

[17] Top 5 Medical Tourism Destinations (2008) [Online]. [Accessed 10th August 2009]. Available from World Wide Web:

http://www.nuwireinvestor.com/articles/top-5-medical-tourism-

destinations-51502.aspx

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