A Delphi study of digital health consensus for improving quality of life among Indonesians with breast cancer

Women with breast cancer in developing countries, such as Indonesia, frequently face high rates of disability and premature death. This is often attributed to delayed diagnosis and limited access to quality care. Consequently, digital health solutions offer promising opportunities to improve clinical outcomes and overall quality of life. However, less consensus exists regarding effective strategies for improving quality of life specifically among patients with breast cancer. This study aimed to identify essential digital health interventions that support holistic nursing care. Furthermore, it sought to assess expert consensus on the feasibility and potential impact of these interventions. To achieve these aims, a two-round Delphi method was employed. This method facilitated the gathering of expert consensus on digital health interventions designed for breast cancer support. The study actively involved 23 experts and 165 stakeholders. Their contributions helped to shape and finalize a comprehensive digital intervention model. This model encompassed psychological, physical, spiritual, and care support domains. Researchers then utilized content analysis to identify key themes emerging from the expert input. Following this, interquartile range (IQR) and median scores were applied to determine the level of consensus. The consensus process identified key domains for digital health interventions. Notably, these domains align with the principles of holistic nursing, including physical, psychological, spiritual, and social dimensions, alongside application usability requirements. Consensus was reached across all dimensions with the exception of the sexuality-related sub-domain. Moreover, experts achieved a general consensus on key intervention areas. However, lower-rated aspects revealed more varied opinions among the experts. Clinical nurses contribute to integrate their clinical insights and emphasizing patient-centered care. Future research should prioritize the development of culturally adaptive and user-friendly applications. Finally, conducting rigorous trials will be crucial to assess the actual impact of digital health interventions on patients' quality of life. Keywords: Breast cancer, Delphi study, digital health, quality of life, supportive care