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Skiba MB, Wells SJ, Brick R, Tanner L, Rock K, Marchese V, Khalil N, Raches D, Thomas K, Krause KJ, Swartz MC. A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability. Telemed J E Health 2024; 30:901-918. [PMID: 38010811 DOI: 10.1089/tmj.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.
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Affiliation(s)
- Meghan B Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Stephanie J Wells
- Division of Pediatric, Pediatrics-Research Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
| | - Lynn Tanner
- Physical Medicine and Rehabilitation, Children's Minnesota Hospital, Minneapolis, Minnesota, USA
| | - Kelly Rock
- Physical Therapy Department, University of Florida, Gainesville, Florida, USA
- Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victoria Marchese
- Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nashwa Khalil
- Rusk Rehabilitation, NYU Langone Health, New York, New York, USA
| | - Darcy Raches
- Psychology Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kristin Thomas
- Laboratory Howard Heads Sports Medicine, Vail Health, Edwards, Colorado, USA
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria C Swartz
- Division of Pediatric, Pediatrics-Research Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Stegenga K, Erickson JM, Linder L, Macpherson CF, Elswick RK, Ameringer S. Development and psychometric evaluation of the Symptom Self-Management Behaviors Tool for adolescents/young adults with cancer. Palliat Support Care 2024; 22:274-280. [PMID: 37387259 DOI: 10.1017/s1478951523000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Adolescents and Young Adults (AYAs) with cancer experience symptoms related to disease and treatment. To manage these symptoms, they need to develop self-management behaviors, yet no tool exists to assess these behaviors. The Symptom Self-Management Behaviors Tool (SSMBT) was developed to meet this need. METHODS The study consisted of 2 phases. Phase 1 evaluated content validity, and Phase 2 evaluated reliability and validity. The SSMBT initially contained 14 items with 2 dimensions: (1) behaviors used to Manage Symptoms and (2) behaviors used to communicate with providers regarding symptoms. Four oncology professionals and 5 AYAs with cancer assessed the content validity. Evaluation of reliability and validity involved 61 AYAs with cancer. Reliability was evaluated using Cronbach's alpha. Construct validity was assessed with factor analysis. Discriminant validity was assessed using associations with symptom severity and distress. RESULTS Content validity evaluation supported the importance of the items. Factor analysis supported a two-factor structure: Manage Symptoms (8 items) and Communicate with Healthcare Providers (4 items) subscales. Internal consistency reliability for the total SSMBT was acceptable with Cronbach's alpha = 0.74. Cronbach's alpha value for the Manage Symptoms subscale was α = 0.69 and for the Communicate with Healthcare Providers subscale was α = 0.78. The SSMBT total and the Manage Symptoms subscale scores were moderately correlated with symptom severity (r = 0.35, p = 0.014; r = 0.44, p = 0.002, respectively), partially supporting discriminant validity. SIGNIFICANCE OF RESULTS Systematic assessment of behaviors AYAs use is critical for clinical practice and evaluate interventions to improve self-management. The SSMBT demonstrates initial reliability and validity but requires further evaluation for clinical interpretation and future use.
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Affiliation(s)
- Kristin Stegenga
- Children's Mercy Hospital, Division of Hematology/Oncology and BMT, Kansas City, MO, USA
| | - Jeanne M Erickson
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lauri Linder
- University of Utah College of Nursing and Primary Children's Hospital, Center for Cancer and Blood Disorders, Salt Lake City, UT, USA
| | | | - R K Elswick
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne Ameringer
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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Grant MJ, Chiang AC. Telehealth and Outcomes in Patients With Cancer: Data and Innovation. Cancer J 2024; 30:16-21. [PMID: 38265921 DOI: 10.1097/ppo.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Despite that telehealth has been crucial to the delivery of oncology care during the COVID-19 pandemic, the impact of this care delivery mechanism on outcomes in cancer care has not been rigorously studied relative standard in-person care for patients with cancer. Patient-centered outcomes such as quality of life, patient satisfaction, and symptoms are important outcomes that have been the primary focus of many of the existing studies in this space, yet only a select few have evaluated overall survival and other objective efficacy endpoints. Studies have alluded to positive effects of telehealth on mitigating financial toxicity and enhancing cost-effective care delivery in oncology. Telehealth carries much potential for advancing care for patients with cancer, but future study should focus on additional efficacy endpoints, implementation, and ways to reduce disparities.
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Bentsen L, Hanghøj S, Hjerming M, Bergmann MB, Thycosen M, Borup A, Larsen C, Pappot H. Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study. JMIR Cancer 2023; 9:e49735. [PMID: 38048144 PMCID: PMC10734624 DOI: 10.2196/49735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/28/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. OBJECTIVE This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. METHODS Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. RESULTS Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: "Role functioning" (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33; P=.04) and "Pain" (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33; P=.04). The "Global health/Overall QoL" scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00; P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: "Physical functioning" (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00; P=.03), "Cognitive functioning" (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00; P=.02), and "Social functioning" (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00; P=.05), as well as in the "Global health/Overall QoL" scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73; P<.001). CONCLUSIONS In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10098.
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Affiliation(s)
- Line Bentsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Signe Hanghøj
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Anette Borup
- Department of Blood Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Larsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Pappot
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Simon JDHP, Schepers SA, van Gorp M, Michiels EMC, Fiocco M, Grootenhuis MA, Tissing WJE. Pain monitoring app leads to less pain in children with cancer at home: Results of a randomized controlled trial. Cancer 2023. [PMID: 37947136 DOI: 10.1002/cncr.35100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The authors developed a pain monitoring app offering educational information, and real-time health care professional feedback on clinically significant pain (>4 numeric rating scale [NRS]-11) for children with cancer to reduce pain at home. METHODS This monocenter, nonblinded randomized controlled trial enrolled Dutch children (0-18 years old) receiving cancer treatment (≥3 months after diagnosis, ≥2 months treatment remaining). Children were randomly assigned to use the app or receive usual care (two parallel groups). We assessed whether use of the app yielded less clinically significant pain (aim 1) and whether it affected pain severity, duration, interference, pain management strategies, and parental emotional well-being (aim 2). The app was also evaluated by families (aim 3). RESULTS A total of 94 children were randomized to use the app (15 drop-outs), and 90 were to receive care as usual (11 drop-outs). The app group (n = 79, mean age: 7.5 [5.1] years, 48% girls, 63% hemato-oncology diagnosis) reported significantly less clinically significant pain compared to usual care (n = 79, mean age: 7.5 [5.4] years, 52% girls, 65% hemato-oncology diagnosis) (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.198-0.734]) (aim 1), as well as significantly lower pain severity (β = -0.27; 95% CI, -0.407 to -0.142). No differences were found for duration, interference, or management strategies. Parents in the app group reported significantly less distress compared to usual care (β = -0.84; 95% CI, -1.61 to -0.03]) (aim 2). Families generally evaluated the app positively (aim 3). CONCLUSIONS Use of the app resulted in less clinically significant pain at home. The exact working mechanisms of the app should be further elucidated.
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Affiliation(s)
- Julia D H P Simon
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Erna M C Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Jibb LA, Sivaratnam S, Hashemi E, Chu CH, Nathan PC, Chartrand J, Alberts NM, Masama T, Pease HG, Torres LB, Cortes HG, Zworth M, Kuczynski S, Fortier MA. Parent and clinician perceptions and recommendations on a pediatric cancer pain management app: A qualitative co-design study. PLOS DIGITAL HEALTH 2023; 2:e0000169. [PMID: 38019890 PMCID: PMC10686487 DOI: 10.1371/journal.pdig.0000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/14/2023] [Indexed: 12/01/2023]
Abstract
Pain is one of the most prevalent and burdensome pediatric cancer symptoms for young children and their families. A significant proportion of pain episodes are experienced in environments where management options are limited, including at home. Digital innovations such as apps may have positive impacts on pain outcomes for young children in these environments. Our overall aim is to co-design such an app and the objective of this study was to explore the perceptions of children's parents about app utility, needed system features, and challenges. We recruited parents of young children with cancer and multidisciplinary pediatric oncology clinicians from two pediatric cancer care centers to participate in audio-recorded, semi-structured, co-design interviews. We conducted interviews structured around technology acceptance and family caregiving theories until data saturation was reached. Audio-recordings were then transcribed, coded, and analyzed using thematic analysis. Forty-two participants took part in the process. Participants endorsed the concept of an app as a useful, safe, and convenient way to engage caregivers in managing their young child's pain. Overall, the app was valued as a means to provide real-time, multimodal informational and procedural pain support to parents, while also reducing the emotional burden of pain care. Recommendations for intervention design included accessibility-focused features, comprehensive symptom tracking, and embedded scientific- and clinically-sound symptom assessments and management advice. Predicted challenges to app use included the workload burden it may place on parents and clinicians. The insights gathered will inform the design principles of our future childhood cancer pain digital research.
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Affiliation(s)
- Lindsay A. Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elham Hashemi
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Charlene H. Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul C. Nathan
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Tatenda Masama
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Hannah G. Pease
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
| | - Lessley B. Torres
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Haydee G. Cortes
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
| | - Mallory Zworth
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Toronto, Canada
| | - Michelle A. Fortier
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, United States of America
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, California, United States of America
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, United States of America
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Holmen H, Winger A, Steindal SA, Riiser K, Castor C, Kvarme LG, Mariussen KL, Lee A. Patient-reported outcome measures in children, adolescents, and young adults with palliative care needs-a scoping review. BMC Palliat Care 2023; 22:148. [PMID: 37798706 PMCID: PMC10557323 DOI: 10.1186/s12904-023-01271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Measuring outcomes facilitates evaluation of palliative services for children, adolescents, and young adults (CAYAs) with life-limiting and/or life-threatening (LL/LT) conditions. Implementation of patient-reported, proxy-reported, or patient-centered outcome measures (hereafter PROMs) is recommended to ensure palliative services. The purpose of this scoping review was to provide an overview of PROMs relevant for CAYAs living with LL/LT conditions eligible for pediatric palliative care (PPC). METHODS Arksey and O'Malley's 6-stage scoping review framework was used to guide the review. The identified citations had to report on PROMs in any context including CAYAs with LL/LT conditions up to 25 years of age. A systematic search of Medline, EMBASE, CINAHL, APA PsycInfo, Health and Psychosocial Instruments, and AMED took place in January 2021 and was updated in June 2022. Citations were screened independently by pairs of researchers. The scoping review protocol was registered, and peer-review published. RESULTS Of 3690 identified citations, 98 reports were included, of which the majority were from Western countries and about PROMs in CAYAs living with cancer or organ failure. A total of 80 PROMs were identified, assessing a range of phenomena, where quality of life and symptoms (especially pain) during the stage of ongoing care were the most frequent. There were only a few reports about outcome measures at time of diagnosis or in end-of-life care. CAYAs self-reported on the PROMs or collaborated with their parents in about half of the reports, while the remaining had proxies answering on behalf of the CAYAs. In the identified reports, PROMs were used to characterize a sample through cross-sectional or longitudinal research, and less often to assess effects of interventions. CONCLUSION The identified PROMs in the CAYA population eligible for PPC is characterized by studies in high-income countries during ongoing care, primarily in patients with cancer or organ failure. More research is needed in patients living with other LL/LT conditions, and during different stages of the disease course, especially at time of diagnosis, during transition to adulthood, and in end-of-life care. This scoping review of PROMs relevant for young patients eligible for PPC may inform future research about patient-/proxy-reported or patient-centered outcome measures in PPC. TRIAL REGISTRATION Review registration: ( https://osf.io/yfch2/ ) and published protocol (Holmen et al. Syst Rev. 10:237, 2021).
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway.
| | - Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
| | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Nydalen, Box 4950, 0424, Oslo, Norway
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Novrianda D, Herini ES, Haryanti F, Supriyadi E, Lazuardi L. Chemo assist for children mobile health application to manage chemotherapy-related symptoms in acute leukemia in Indonesia: a user-centered design approach. BMC Pediatr 2023; 23:274. [PMID: 37254039 DOI: 10.1186/s12887-023-04076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND A mobile health (mHealth) application can encourage parents and pediatric patients to be involved in caring for their child's health condition by providing the ability to identify and actively manage chemotherapy-related symptoms in their child. Several monitoring systems available today are diverse in features and system basis. This study aimed to develop and trial the Chemo Assist for Children (CAC) mHealth application for symptom management in children with acute lymphoblastic leukemia (ALL). METHODS In this study, the development of the CAC application went through multiple phases and methods. Study phases included: (1) development of the application's feature based on the need assessment, (2) creation of content of application based on literature review, (3) develop prototyping of CAC, (4) expert review and feedback on the application content, (5) usability testing by targeted end-user. RESULTS Based on need assessment, it was determined that parents with leukemia children were interested in symptom management of chemotherapy and preferred mobile applications. Therefore, a mHealth application was designed to include features to identify symptoms and provide recommendation strategies to manage the symptom. Usability evaluation by end-user revealed that mHealth is a valid, accessible, and appropriate application for users. CONCLUSIONS The CAC mHealth application developed can meet the needs of technology users to identify symptoms and manage chemotherapy-related symptoms in children with ALL. The CAC mHealth application can accommodate data not recorded at out-of-hospital care, increase the independence of symptom management, and improve communication between parents of children with ALL and health workers.
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Affiliation(s)
- Dwi Novrianda
- Department of Pediatrics and Maternity Nursing, Faculty of Nursing, Universitas Andalas, Padang, Indonesia
| | - Elisabeth Siti Herini
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Fitri Haryanti
- Department of Pediatric-Maternity Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Lutfan Lazuardi
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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He Y, Tang Z, Sun G, Cai C, Wang Y, Yang G, Bao Z. Effectiveness of a Mindfulness Meditation App Based on an Electroencephalography-Based Brain-Computer Interface in Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e44855. [PMID: 37133926 DOI: 10.2196/44855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) can generate considerable physical and psychological discomfort under conscious sedation. App-based mindfulness meditation combined with an electroencephalography (EEG)-based brain-computer interface (BCI) shows promise as effective and accessible adjuncts in medical practice. OBJECTIVE This study aimed to investigate the effectiveness of a BCI-based mindfulness meditation app in improving the experience of patients with AF during RFCA. METHODS This single-center pilot randomized controlled trial involved 84 eligible patients with AF scheduled for RFCA, who were randomized 1:1 to the intervention and control groups. Both groups received a standardized RFCA procedure and a conscious sedative regimen. Patients in the control group were administered conventional care, while those in the intervention group received BCI-based app-delivered mindfulness meditation from a research nurse. The primary outcomes were the changes in the numeric rating scale, State Anxiety Inventory, and Brief Fatigue Inventory scores. Secondary outcomes were the differences in hemodynamic parameters (heart rate, blood pressure, and peripheral oxygen saturation), adverse events, patient-reported pain, and the doses of sedative drugs used in ablation. RESULTS BCI-based app-delivered mindfulness meditation, compared to conventional care, resulted in a significantly lower mean numeric rating scale (mean 4.6, SD 1.7 [app-based mindfulness meditation] vs mean 5.7, SD 2.1 [conventional care]; P=.008), State Anxiety Inventory (mean 36.7, SD 5.5 vs mean 42.3, SD 7.2; P<.001), and Brief Fatigue Inventory (mean 3.4, SD 2.3 vs mean 4.7, SD 2.2; P=.01) scores. No significant differences were observed in hemodynamic parameters or the amounts of parecoxib and dexmedetomidine used in RFCA between the 2 groups. The intervention group exhibited a significant decrease in fentanyl use compared to the control group, with a mean dose of 3.96 (SD 1.37) mcg/kg versus 4.85 (SD 1.25) mcg/kg in the control group (P=.003).The incidence of adverse events was lower in the intervention group (5/40) than in the control group (10/40), though this difference was not significant (P=.15). CONCLUSIONS BCI-based app-delivered mindfulness meditation effectively relieved physical and psychological discomfort and may reduce the doses of sedative medication used in RFCA for patients with AF. TRIAL REGISTRATION ClinicalTrials.gov NCT05306015; https://clinicaltrials.gov/ct2/show/NCT05306015.
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Affiliation(s)
- Ying He
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijie Tang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Guozhen Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Cai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiPeng Bao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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A Scoping Review and a Taxonomy to Assess the Impact of Mobile Apps on Cancer Care Management. Cancers (Basel) 2023; 15:cancers15061775. [PMID: 36980661 PMCID: PMC10046563 DOI: 10.3390/cancers15061775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Mobile Health (mHealth) has a great potential to enhance the self-management of cancer patients and survivors. Our study aimed to perform a scoping review to evaluate the impact and trends of mobile application-based interventions on adherence and their effects on health outcomes among the cancer population. In addition, we aimed to develop a taxonomy of mobile-app-based interventions to assist app developers and healthcare researchers in creating future mHealth cancer care solutions. Relevant articles were screened from the online databases PubMed, EMBASE, and Scopus, spanning the time period from 1 January 2016 to 31 December 2022. Of the 4135 articles initially identified, 55 were finally selected for the review. In the selected studies, breast cancer was the focus of 20 studies (36%), while mixed cancers were the subject of 23 studies (42%). The studies revealed that the usage rate of mHealth was over 80% in 41 of the 55 studies, with factors such as guided supervision, personalized suggestions, theoretical intervention foundations, and wearable technology enhancing adherence and efficacy. However, cancer progression, technical challenges, and unfamiliarity with devices were common factors that led to dropouts. We also proposed a taxonomy based on diverse theoretical foundations of mHealth interventions, delivery methods, psycho-educational programs, and social platforms. We suggest that future research should investigate, improve, and verify this taxonomy classification to enhance the design and efficacy of mHealth interventions.
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11
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Simon JDHP, Hooijman IS, Van Gorp M, Schepers SA, Michiels EMC, Tissing WJE, Grootenhuis MA. Digital health tools for pain monitoring in pediatric oncology: a scoping review and qualitative assessment of barriers and facilitators of implementation. Support Care Cancer 2023; 31:175. [PMID: 36802278 PMCID: PMC9944681 DOI: 10.1007/s00520-023-07629-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE We aimed to systematically identify and characterize existing digital health tools for pain monitoring in children with cancer, and to assess common barriers and facilitators of implementation. METHODS A comprehensive literature search (PubMed, Cochrane, Embase, and PsycINFO) was carried out to identify published research on mobile apps and wearable devices focusing on acute and/or chronic pain in children (0-18 years) with cancer (all diagnoses) during active treatment. Tools had to at least include a monitoring feature for one or more pain characteristic(s) (e.g., presence, severity, perceived cause interference with daily life). Project leaders of identified tools were invited for an interview on barriers and facilitators. RESULTS Of 121 potential publications, 33 met inclusion criteria, describing 14 tools. Two methods of delivery were used: apps (n=13), and a wearable wristband (n=1). Most publications focused on feasibility and acceptability. Results of interviews with project leaders (100% response rate), reveal that most barriers to implementation were identified in the organizational context (47% of barriers), with financial resources and insufficient time available mentioned most often. Most factors that facilitated implementation related to end users (56% of facilitators), with end-user cooperation and end-user satisfaction mentioned most often. CONCLUSIONS Existing digital tools for pain in children with cancer were mostly apps directed at pain severity monitoring and little is still known about their effectiveness. Paying attention to common barriers and facilitators, especially taking into account realistic funding expectations and involving end users during early stages of new projects, might prevent evidence based interventions from ending up unused.
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Affiliation(s)
- J D H P Simon
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - I S Hooijman
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - M Van Gorp
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - S A Schepers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - E M C Michiels
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.,Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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12
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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13
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Wickline M, Wolpin S, Cho S, Tomashek H, Louca T, Frisk T, Templin J, Loechl A, Goff B, Berry D. Usability and acceptability of the electronic self-assessment and care (eSAC) program in advanced ovarian cancer: A mixed methods study. Gynecol Oncol 2022; 167:239-246. [PMID: 36150917 DOI: 10.1016/j.ygyno.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine usability and acceptability of the electronic self-assessment and care (eSAC) web-based, patient reported outcome (PRO) program for people with advanced ovarian cancer. METHODS Patient participants recruited from a single ambulatory site were prompted by email to answer symptom/quality of life items prior to each clinic visit. Patient participant acceptability was measured with the Acceptability E-Scale Score (AES). Usability was measured among a subset of patient participants using semi-structured interviews. Clinician participant acceptability and usability were measured via survey and semi-structured interviews. Quantitative data were analyzed with descriptive statistics. Qualitative data were analyzed using thematic content analysis. A mixed methods analysis was performed. RESULTS Of 163 eligible patients approached, 143 (87.7%) provided written consent. Patient participants (n = 71) who created an eSAC report prior to at least 3 clinic visits, rated eSAC as acceptable with a mean AES score of 26.19 ± 3.36 (out of 30). Interview data from patient participants (n = 33) revealed that eSAC was easy to use and important to the clinic visit conversation. Data from clinician surveys (n = 8) and focus groups (n = 3) revealed that the eSAC program was acceptable and useful for clinicians. Qualitative analysis suggested process improvements from patients and clinicians for effectiveness in the advanced ovarian cancer setting. Mixed methods analysis demonstrated no major discrepancies between quantitative and qualitative findings, with the qualitative data broadening understanding of quantitative ratings. CONCLUSION eSAC was useful and acceptable in this setting. This PRO is a promising strategy for enhancing patient-centered care for people with advanced ovarian cancer.
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Affiliation(s)
- Mihkai Wickline
- University of Washington School of Nursing, BOX 357260, University of Washington, Seattle, WA 98195, United States of America.
| | - Seth Wolpin
- University of Washington School of Nursing, BOX 357260, University of Washington, Seattle, WA 98195, United States of America
| | - Susie Cho
- University of Washington School of Nursing, BOX 357260, University of Washington, Seattle, WA 98195, United States of America
| | - Holly Tomashek
- University of Washington Medical Center - Montlake, Gynecologic Oncology, United States of America
| | - Tanya Louca
- North York General Hospital, Toronto, Canada
| | - Tori Frisk
- EvergreenHealth, United States of America
| | - Janna Templin
- Microsoft Health and Life Sciences, United States of America
| | - Alison Loechl
- University of Washington School of Nursing, BOX 357260, University of Washington, Seattle, WA 98195, United States of America
| | - Barbara Goff
- Department of Obstetrics and Gynecology, University of Washington, Seattle, United States of America
| | - Donna Berry
- University of Washington School of Nursing, BOX 357260, University of Washington, Seattle, WA 98195, United States of America
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Breakey VR, Gupta A, Johnston DL, Portwine C, Laverdiere C, May SL, Dick B, Hundert A, Nishat F, Killackey T, Nguyen C, Lalloo C, Stinson J. A Pilot Randomized Control Trial of Teens Taking Charge: A Web-based Self-management Program for Adolescents with Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:366-378. [PMID: 35759365 DOI: 10.1177/27527530211068778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: There is a lack of self-management tools for adolescents with cancer (AWC). This study evaluated the feasibility of Teens Taking Charge Cancer, a web-based self-management program. Methods: A pilot randomized control trial (RCT) was conducted across 4 pediatric oncology clinics. AWC (12-18 years) and their caregivers were randomized to either the intervention or control group. All were asked to complete 12 website modules over 12 weeks (at their own pace) and received monthly calls from health coaches. The intervention website was based on cognitive behavioral principals, designed as an interactive self-guided online program, while the control consisted of education and included links to 12 general cancer websites. Outcome assessments occurred at enrollment and 12 weeks post-intervention. The primary outcomes included rate of accrual and retention, adherence to the protocol, acceptability and satisfaction with intervention using questionnaire and semi-structured interviews, adverse events and engagement with the intervention. Results: Eighty-one teen-caregiver dyads were enrolled with a retention rate of 33%. In the intervention group 46% (n = 18) logged in at least once over the 12-week period. A mean of 2.4 of 12 modules (SD 3.0) were completed; and no one completed the program. Thirty-three percent of caregivers in the intervention logged into the website at least once and none completed the full program. Discussion: The results from this pilot study suggest that the current design of the Teens Taking Charge Cancer RCT lacks feasiblity. Future web-based interventions for this group should include additional features to promote uptake and engagement with the program.
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Affiliation(s)
| | - Abha Gupta
- 7315The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
| | | | - Carol Portwine
- 103398McMaster Children's Hospital, Hamilton, ON, Canada
| | - Caroline Laverdiere
- Department of Pediatrics, 5622University of Montreal, Centre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine), Montréal, QC, Canada
| | - Sylvie Le May
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada
| | - Bruce Dick
- Department of Anesthesiology & Pain Medicine, Division of Pain and Medicine, 7979University of Alberta, Edmonton, AB, Canada
| | - Amos Hundert
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Fareha Nishat
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Tieghan Killackey
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Cynthia Nguyen
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Chitra Lalloo
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Jennifer Stinson
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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15
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Pyke-Grimm KA, Franck LS, Halpern-Felsher B, Goldsby RE, Rehm RS. Day-to-Day Decision Making by Adolescents and Young Adults with Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:290-303. [PMID: 35538622 PMCID: PMC9807778 DOI: 10.1177/27527530211068718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.
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Affiliation(s)
- Kimberly A. Pyke-Grimm
- Stanford Children's Health, Department of Nursing Research and
Evidence-Based Practice, Palo Alto, CA, USA,Division of Hematology/Oncology, Department of Pediatrics, Stanford
University School of Medicine,Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA,Kimberly A. Pyke-Grimm, PhD, RN, CNS,
CPHON, Department of Nursing Research and Evidence-Based Practice, Stanford
Children's Health, 750 Welch Road, Palo Alto, CA 94304, USA.
| | - Linda S. Franck
- Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | | | - Roberta S. Rehm
- Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA,*Professor Emeritus
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16
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Müller J, Weinert L, Svensson L, Rivinius R, Kreusser MM, Heinze O. Mobile Access to Medical Records in Heart Transplantation Aftercare: Mixed-Methods Study Assessing Usability, Feasibility and Effects of a Mobile Application. Life (Basel) 2022; 12:1204. [PMID: 36013383 PMCID: PMC9410472 DOI: 10.3390/life12081204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patient access to medical records can improve quality of care. The phellow application (app) was developed to provide patients access to selected content of their medical record. It was tested at a heart transplantation (HTx) outpatient clinic. The aims of this study were (1) to assess usability of phellow, (2) to determine feasibility of implementation in routine care, and (3) to study the effects app use had on patients' self-management. METHODS Usability was measured quantitatively through the System Usability Scale (SUS). Furthermore, usability, feasibility, and effects on self-management were qualitatively assessed through interviews with users, non-users, and health care providers. RESULTS The SUS rating (n = 31) was 79.9, indicating good usability. Twenty-three interviews were conducted. Although appreciation and willingness-to-use were high, usability problems such as incompleteness of record, technical issues, and complex registration procedures were reported. Improved technical support infrastructure, clearly defined responsibilities, and app-specific trainings were suggested for further implementation. Patients described positive effects on their self-management. CONCLUSIONS To be feasible for implementation in routine care, usability problems should be addressed. Feedback on the effect of app use was encouraging. Accompanying research is crucial to monitor usability improvements and to further assess effects of app use on patients.
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Affiliation(s)
- Julia Müller
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Michael M. Kreusser
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Oliver Heinze
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Content features and its implementation in novel app-based psycho-oncological interventions for cancer survivors: a narrative review. Curr Opin Oncol 2022; 34:313-319. [PMID: 35837701 DOI: 10.1097/cco.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The interest in and availability of app-based psycho-oncological interventions for cancer survivors has grown rapidly. In this narrative review, we therefore aim to provide an overview of the psychological content features included in psycho-oncological apps and how the content is implemented in the apps. RECENT FINDINGS A total of 19 studies (six randomized controlled trials, six studies with prepost design, five study protocols and two app developments), all published in the last 18 months (July 2020 to December 2021), were analyzed in terms of the described app-based interventions and their psycho-oncological content. Apps for cancer survivors are conducted for a variety of different diagnoses and often target a specific patient population, for example patients with a specific therapy. The most frequent content features are psychoeducation, self-monitoring of symptoms, and some sort of exercise or relaxation program. Depending on the app's purpose, some offer specific content, such as decision aids, medication schedules or modules to improve coping strategies. Most apps combine informative and interactive elements. SUMMARY Psycho-oncological apps for cancer survivors target many relevant psychological problem areas and aim to improve patient empowerment. Available mHealth interventions can therefore be seen as a good complement for cancer care and also offer the possibility to improve patient involvement.
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18
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Darabos K, Li Y, O'Hagan B, Palermo T, King-Dowling S, Jubelirer T, Huang J, Barakat LP, Schwartz LA. Trajectories of Pain Severity and Interference Among Adolescent and Young Adults With Cancer: A Microlongitudinal Study. Clin J Pain 2022; 38:443-450. [PMID: 35686575 DOI: 10.1097/ajp.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cancer-related pain is a pervasive concern among adolescent and young adults (AYA) with cancer and is an emerging long-term health concern. Few studies have examined the complex contributions to pain among AYA. We aimed to fill a gap by (1) identifying subgroups of AYA with distinct patterns of pain severity and interference over time and (2) explore possible predictors of these patterns. METHODS Daily text messages over a 9-week period were used to model group-based trajectory analyses of pain severity and interference by identifying subgroups of AYA who experience common patterns of changes in pain. Demographic, medical, physical symptom burden, and psychological distress were examined as possible predictors of these patterns. RESULTS AYA were on average 16.93 years old and 2.5 years since diagnosis. Subgroups of AYA were identified for pain severity and interference over time: high variability (37.7%; 37.7%, respectively), consistent high pain (35.8%; 18.9%, respectively), and consistent low pain (26.4%; 43.4%, respectively). AYA with greater psychological distress were more likely to belong to the high consistent pain severity and interference groups. AYA with greater physical symptoms were more likely to belong to the high consistent pain interference group. No significant associations between demographic/medical characteristics and trajectory subgroups were found. CONCLUSIONS AYA with elevated physical and psychological symptoms were more likely to experience high consistent pain severity and pain interreference over time. Interventions aimed at reducing pain through focusing on teaching AYA how to alleviate physical symptoms and teaching coping skills to manage psychological distress may be beneficial.
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Affiliation(s)
- Katie Darabos
- Division of Oncology, The Children's Hospital of Philadelphia
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Bridget O'Hagan
- Division of Oncology, The Children's Hospital of Philadelphia
| | - Toyna Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | | | - Tracey Jubelirer
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jing Huang
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
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19
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van Deursen L, Versluis A, van der Vaart R, Standaar L, Struijs J, Chavannes N, Aardoom JJ. eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens. JMIR Cancer 2022; 8:e37093. [PMID: 35699991 PMCID: PMC9240931 DOI: 10.2196/37093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. Objective The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). Methods The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. Results A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. Conclusions eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual.
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Affiliation(s)
- Liza van Deursen
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Rosalie van der Vaart
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Lucille Standaar
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Department of Quality and Organization of Care, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Jeroen Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska J Aardoom
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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20
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The effect of using an interactive mobile application for the management of chemotherapy-induced nausea and vomiting in children: Randomized controlled study. Eur J Oncol Nurs 2022; 58:102121. [DOI: 10.1016/j.ejon.2022.102121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/25/2022]
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21
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Amonoo HL, Harnedy LE, Staton SC, Longley RM, Daskalakis E, El-Jawahri A, Huffman JC. Peer support in patients with hematologic malignancies: a systematic review. Bone Marrow Transplant 2022; 57:1240-1249. [PMID: 35597891 DOI: 10.1038/s41409-022-01709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Peer support has been utilized and associated with clinical outcomes (e.g., improved mood) in patients with solid malignancies. However, to date, there is minimal literature examining peer support among patients with hematologic malignancies and/or patients who have undergone hematopoietic stem cell transplantation (HSCT). METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we completed a systematic review using five databases to assess the relationship between peer support and clinical outcomes (e.g., distress, physical symptoms) among patients with hematologic malignancies or HSCT recipients. RESULTS The eight included studies examined peer support in a total of 574 patients. Four intervention studies highlighted the potential benefits of peer support, such as improved physical symptoms. Two studies, one interventional and one cross-sectional, highlighted the need for more empirically based peer support interventions in the HSCT population. CONCLUSION Among patients with hematologic malignancies and/or HSCT recipients, there is a dearth of literature examining the association between peer support and outcomes, although few studies have described a positive association between peer support and better health outcomes. More randomized controlled studies are needed to better understand the role of peer support and peer support interventions on outcomes in these vulnerable populations.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sophie C Staton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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22
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Meyer R, Wang K, Yearley A, Grob S, Zeitlin J, Bloomfeld J, You M, Lee D, Bonner M, Shah N, Page K. Usability and Acceptability of the QuestLeukemia Mobile Application: A Pilot Study for An Educational and Psychological Intervention for Children with Chronic Illnesses. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:137-142. [PMID: 35467435 DOI: 10.1177/27527530221068422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
It is widely accepted that educational interventions benefit children with chronic diseases (disease awareness and autonomy) or those undergoing medical procedures (decreased anxiety and improved satisfaction). Hematopoietic cell transplantation (HCT) is an intensive procedure to treat life-threatening diseases but is associated with multiple adverse medical experiences. QuestLeukemia (QuestED, Durham, NC) is a mobile app designed to educate pediatric patients preparing for HCT through age-appropriate videos and quizzes. Here we describe the results of the initial pilot study assessing acceptability and feasibility of QuestLeukemia app. Eligible participants were selected from a convenience sample (inpatient HCT unit and outpatient clinic). Participants spent 30-60 min using the app then completed a survey assessing the app for usability, accessibility, and user satisfaction. Participants identified the app as a useful tool for gaining disease-related knowledge and reported greater autonomy over their disease process. On average, patients indicated that the app was easy to use (M = 4.93), enjoyable (M = 4.79), and comprehensive (M = 4.71). Parents followed similar trends of satisfaction with the app. Pediatric HCT providers likewise reported that the app was easy to use (M = 4.22), enjoyable (M = 4.85), and educationally comprehensive (M = 4.77). The QuestLeukemia mobile application prototype provides an easy, enjoyable, and educational tool for pediatric patients undergoing HCT. This application was well received by patients, parents, and providers. These findings will be used to design future iterations of the game in clinical care.
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Affiliation(s)
| | - Kira Wang
- 3065Duke University, Durham, NC, USA
| | - Alexander Yearley
- 3065Duke University, Durham, NC, USA
- 1812Harvard Medical School, Durham, NC, USA
| | | | | | | | | | - Diane Lee
- 3065Duke University, Durham, NC, USA
| | - Melanie Bonner
- 213852Duke University Hospital, Durham, NC, USA
- 3065Duke University, Durham, NC, USA
| | - Nirmish Shah
- 213852Duke University Hospital, Durham, NC, USA
- 3065Duke University, Durham, NC, USA
| | - Kristin Page
- 213852Duke University Hospital, Durham, NC, USA
- 3065Duke University, Durham, NC, USA
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23
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Nurse-led telehealth interventions for symptom management in patients with cancer receiving systemic or radiation therapy: a systematic review and meta-analysis. Support Care Cancer 2022; 30:7119-7132. [PMID: 35420331 PMCID: PMC9008678 DOI: 10.1007/s00520-022-07052-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Purpose Patients receiving cancer treatments experience many treatment-related symptoms. Telehealth is increasingly being used to support symptom management. The overall aim was to determine the effectiveness of nurse-led telehealth symptom management interventions for patients with cancer receiving systemic or radiation therapy compared to usual care on health service use, quality of life, and symptom severity. Methods A systematic review was conducted following the Cochrane Handbook and PRISMA reporting guidelines. Five electronic databases were searched. Two independent reviewers screened articles and extracted data. Meta-analysis was performed if data were clinically and methodologically homogeneous. Subanalysis was conducted on reactive and scheduled telehealth interventions. Results Of 7749 citations screened, 10 studies were included (8 randomized control trials, 2 quasi-experimental). Five were reactive telehealth interventions with patient-initiated contact and five evaluated scheduled telehealth interventions initiated by nurses. Compared to usual care (typically patient-initiated calls), nurse-led telehealth interventions for symptom management showed no statistically significant difference in hospitalizations, emergency department visits, or unscheduled clinic visits. Two of three studies of reactive telehealth interventions showed improved quality of life. All telehealth interventions showed reduction in the severity of most symptoms. Pain severity was significantly reduced (standard mean difference − 0.54; 95% CI − 0.88, − 0.19). Significant heterogeneity prevented meta-analysis for most outcomes. Conclusion Few studies evaluated nurse-led telehealth interventions for cancer symptom management. Compared to usual care, patients exposed to telehealth interventions had reduced symptom severity and no difference in health services use. Future research should focus on better reporting intervention characteristics and consistently measuring outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07052-z.
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24
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Briggs LG, Labban M, Alkhatib K, Nguyen DD, Cole AP, Trinh QD. Digital technologies in cancer care: a review from the clinician's perspective. J Comp Eff Res 2022; 11:533-544. [PMID: 35416050 DOI: 10.2217/cer-2021-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Physicians are increasingly utilizing digital health technologies (DHT) such as smartphone applications, network-enabled wearable devices, web-based communication platforms, videoconferencing, chatbots, artificial intelligence and virtual reality to improve access to, and quality of, care. DHT aid in cancer screening, patient education, shared decision-making, promotion of positive health habits, symptom monitoring and intervention, patient-provider communication, provision of psychological support and delivery of effective survivorship care. This narrative review outlines how physicians may utilize digital health to improve or augment their delivery of cancer care. For the full potential of DHT to be realized, experts must develop appropriate solutions to issues surrounding the regulation, liability, quality, security, equity and reimbursement of DHT.
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Affiliation(s)
- Logan G Briggs
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Muhieddine Labban
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Khalid Alkhatib
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David-Dan Nguyen
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alexander P Cole
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Quoc-Dien Trinh
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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25
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Mobile applications for early breast cancer chemotherapy-related symptoms reporting and management: A scoping review. Cancer Treat Rev 2022; 105:102364. [DOI: 10.1016/j.ctrv.2022.102364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022]
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26
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Win H, Russell S, Wertheim BC, Maizes V, Crocker R, Brooks AJ, Mesa R, Huberty J, Geyer H, Eckert R, Larsen A, Gowin K. Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e33581. [PMID: 35357315 PMCID: PMC9015738 DOI: 10.2196/33581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted.
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Affiliation(s)
- Hninyee Win
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Samantha Russell
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Robert Crocker
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Ruben Mesa
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Jennifer Huberty
- Department of Hematology, University of Arizona, Tucson, AZ, United States
| | - Holly Geyer
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ryan Eckert
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ashley Larsen
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Krisstina Gowin
- Department of Hematology, University of Arizona, Tucson, AZ, United States
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27
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The predictive trifecta? Fatigue, pain, and anxiety severity forecast the suffering profile of children with cancer. Support Care Cancer 2022; 30:2081-2089. [PMID: 34661748 PMCID: PMC8919269 DOI: 10.1007/s00520-021-06622-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fatigue, pain, and anxiety, symptoms commonly experienced by children with cancer, may predict pediatric symptom suffering profile membership that is amenable to treatment. METHODS Three latent profiles (Low, Medium, and High symptom suffering) from 436 pediatric patients undergoing cancer care were assessed for association with three single-item symptoms and socio-demographic variables. RESULTS Pediatric-PRO-CTCAE fatigue, pain, and anxiety severity scores at baseline were highly and significantly associated with the Medium and High Suffering profiles comprised of PROMIS pediatric symptom and function measures. The likelihood of membership in the Medium Suffering group was 11.37 times higher for patients who experienced fatigue severity than those with did not, while experience of pain severity increased the likelihood of the child's membership in the Medium Suffering profile by 2.59 times and anxiety by 3.67 times. The severity of fatigue increased the likelihood of presence in the High Suffering group by 2.99 times while pain severity increased the likelihood of the child's membership in the High Suffering profile by 6.36 times and anxiety by 16.75 times. Controlling for experience of symptom severity, older patients were more likely to be in the Higher or Medium Suffering profile than in the Low Suffering profile; no other socio-demographic or clinical variables had a significant effect on the latent profile classification. CONCLUSION Clinician knowledge of the strong association between fatigue, pain, and anxiety severity and suffering profiles may help focus supportive care to improve the cancer experience for children most at risk from time of diagnosis through treatment.
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28
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Jibb LA, Ameringer S, Macpherson CF, Sivaratnam S. The Symptom Experience in Pediatric Cancer: Current Conceptualizations and Future Directions. Curr Oncol Rep 2022; 24:443-450. [PMID: 35150393 DOI: 10.1007/s11912-022-01222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We aimed to review the recent research on the childhood cancer symptom experience pertaining to socioeconomic factors, biology and genetics, growth and development, family psychosocial dynamics, and social and treating environments to begin to formulate recommendations for a personalized approach to symptom management. RECENT FINDINGS Cancer symptoms are common and distressing in children and negatively impact child and family quality of life. Many interacting factors influence children's cancer symptoms experiences, including the assessment and management of such symptoms. This paper highlights several gaps in the research related to the cancer symptom experience including routine symptom assessment, the impact of socioeconomic, biological, and genetic factors on symptoms, and the establishment of effective symptom management partnerships with families. Based on our findings, we provide recommendations related to that research which is ready to be implemented into clinical practice and areas for needed future efforts.
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Affiliation(s)
- Lindsay A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, M5T 1P8, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.
| | | | | | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Canada
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29
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Connelly M, Lee RR. Technology to Assess and Treat Pain in Pediatric Rheumatology. Rheum Dis Clin North Am 2022; 48:31-50. [PMID: 34798955 DOI: 10.1016/j.rdc.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Advancements in eHealth offer unique opportunities for assisting in and augmenting aspects of evidence-based pain evaluation and management with children and adolescents. In this article, we present an overview of some of the opportunities and challenges in pain eHealth for pediatric rheumatologists to consider while caring for children and adolescents seen in their practice.
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Affiliation(s)
- Mark Connelly
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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30
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Turnbull A, Sculley D, Santos D, Maarj M, Chapple L, Gironès X, Fellas A, Coda A. Emerging Tools to Capture Self-Reported Acute and Chronic Pain Outcome in Children and Adolescents: A Literature Review. Med Sci (Basel) 2022; 10:medsci10010006. [PMID: 35225940 PMCID: PMC8884018 DOI: 10.3390/medsci10010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
The advancement of digital health provides strategic and cost-effective opportunities for the progression of health care in children and adolescents. It is important for clinicians to be aware of the potential of emerging pain outcome measures and employ evidence-based tools capable of reliably tracking acute and chronic pain over time. The main emerging pain outcome measures for children and adolescents were examined. Overall, seven main texts and their corresponding digital health technologies were included in this study. The main findings indicated that the use of emerging digital health is able to reduce recall bias and can improve the real time paediatric data capture of acute and chronic symptoms. This literature review highlights new developments in pain management in children and adolescents and emphasizes the need for further research to be conducted on the use of emerging technologies in pain management. This may include larger scale, multicentre studies to further assess validity and reliability of these tools across various demographics. The privacy and security of mHealth data must also be carefully evaluated when choosing health applications that can be introduced into daily clinical settings.
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Affiliation(s)
- Alexandra Turnbull
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Dean Sculley
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia;
| | - Derek Santos
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Mohammed Maarj
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Lachlan Chapple
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Xavier Gironès
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain;
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah 2258, Australia; (A.T.); (D.S.); (M.M.); (L.C.); (A.F.)
- Priority Research Centre Health Behaviour, Hunter Medical Research Institute, Newcastle 2305, Australia
- Correspondence:
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31
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Hogan TP, Etingen B, McMahon N, Bixler FR, Am L, Wacks RE, Shimada SL, Reilly ED, Frisbee KL, Smith BM. Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation. JMIR Form Res 2022; 6:e33716. [PMID: 35049515 PMCID: PMC8814923 DOI: 10.2196/33716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/17/2021] [Accepted: 11/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1%). These veterans received our outreach program; 236 (236/393, 60.1%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2% (24/236) used Pain Coach, and 58% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3%). Conclusions Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study.
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Affiliation(s)
- Timothy P Hogan
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bella Etingen
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, United States
| | - Nicholas McMahon
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Felicia R Bixler
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, United States
| | - Linda Am
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Rachel E Wacks
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Stephanie L Shimada
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Erin D Reilly
- Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Social and Community Reintegration Research (SoCRR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Kathleen L Frisbee
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Office of Connected Care, Veterans Health Administration, Washington, DC, United States
| | - Bridget M Smith
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Hoffmann S, Schraut R, Kröll T, Scholz W, Belova T, Erhardt J, Gollmer D, Mauck C, Zacharioudakis G, Meyerheim M, Bonotis P, Kakalou C, Chatzimina M, Karamanidou C, Sander A, Didi J, Graf N, Natsiavas P. AquaScouts: ePROs Implemented as a Serious Game for Children With Cancer to Support Palliative Care. Front Digit Health 2021; 3:730948. [PMID: 34957461 PMCID: PMC8692290 DOI: 10.3389/fdgth.2021.730948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
MyPal is a European initiative focusing on the use of the electronic patient reported outcome (ePRO) measures to enhance patient engagement in palliative cancer care via digital self-reporting palliative care for patients with cancer. As a part of its approach, MyPal also focuses on pediatric patients, implementing a specific digital health platform including a serious game to facilitate the reporting of the symptoms and overall status regarding their quality of life (QoL). To this end, the reduction of psychological burden related to frequent reporting, a.k.a. as “reporting fatigue” has been identified as a priority. In this study, we present the MyPal-CHILD platform, emphasizing on the serious game named AquaScouts and its key design decisions, while also emphasizing on the respective challenges. More specifically, we provide insights on the participatory design approach applied during the design of the platform and the high-level goals defined based on end-user input. In addition, the validation process applied before the use of the platform under real-world conditions is also presented. Finally, we discuss a number of challenges and the prospects of deploying eHealth interventions to support palliative care.
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Affiliation(s)
- Stefan Hoffmann
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Robert Schraut
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Thomas Kröll
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Wiebke Scholz
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Tatiana Belova
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Johann Erhardt
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Daniel Gollmer
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Christian Mauck
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Giorgos Zacharioudakis
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Marcel Meyerheim
- Clinic for Pediatric Hematology-Oncology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Panos Bonotis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Christine Kakalou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Chatzimina
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Annette Sander
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Jana Didi
- Centre for Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Norbert Graf
- Clinic for Pediatric Hematology-Oncology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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Newton AS, March S, Gehring ND, Rowe AK, Radomski AD. Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review. J Med Internet Res 2021; 23:e25012. [PMID: 34860671 PMCID: PMC8686463 DOI: 10.2196/25012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/27/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. OBJECTIVE We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. METHODS We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. RESULTS Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. CONCLUSIONS Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sonja March
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Nicole D Gehring
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Arlen K Rowe
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Ashley D Radomski
- Knowledge Institute for Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.,CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON, Canada
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Scarfò L, Karamanidou C, Doubek M, Garani-Papadatos T, Didi J, Pontikoglou C, Ling J, Payne C, Papadaki HΑ, Rosenquist R, Stavroyianni N, Payne S, Ghia P, Natsiavas P, Maramis C, Stamatopoulos K. MyPal ADULT study protocol: a randomised clinical trial of the MyPal ePRO-based early palliative care system in adult patients with haematological malignancies. BMJ Open 2021; 11:e050256. [PMID: 34728446 PMCID: PMC8565565 DOI: 10.1136/bmjopen-2021-050256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The systematic collection of electronic patient-reported outcome (ePRO) in the routine care of patients with chronic haematological malignancies such as chronic lymphocytic leukaemia (CLL) and myelodysplasia syndromes (MDS) can constitute a very ambitious but worthwhile challenge. MyPal is a Horizon 2020 Research & Innovation Action aiming to meet this challenge and foster palliative care for patients with CLL or MDS by leveraging ePRO systems to adapt to the personal needs of patients and caregiver(s). METHODS AND ANALYSIS In this interventional randomised trial, 300 patients with CLL or MDS will be recruited across Europe. Patients will be randomly allocated to early palliative care using the MyPal system (n=150) versus standard care including general palliative care if needed (n=150). Patients in the experimental arm will be given access to the MyPal digital health platform which consists of purposely designed software available on smartphones and/or tablets. The platform entails different functionalities including physical and psychoemotional symptom reporting via regular questionnaire completion, spontaneous self-reporting, motivational messages, medication management and a personalised search engine for health information. Data on patients' activity (daily steps and sleep quality) will be automatically collected via wearable devices. ETHICS AND DISSEMINATION The integration of ePROs via mobile applications has raised ethical concerns regarding inclusion criteria, information provided to participants, free and voluntary consent, and respect for their autonomy. These have been carefully addressed by a multidisciplinary team. Data processing, dissemination and exploitation of the study findings will take place in full compliance with European Union data protection law. A participatory design was adopted in the development of the digital platform involving focus groups and discussions with patients to identify needs and preferences. The protocol was approved by the ethics committees of San Raffaele (8/2020), Thessaloniki 'George Papanikolaou' Hospital (849), Karolinska Institutet (20.10.2020), University General Hospital of Heraklion (07/15.4.2020) and University of Brno (01-120220/EK). TRIAL REGISTRATION NUMBER NCT04370457.
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Affiliation(s)
- Lydia Scarfò
- Internal Medicine, Vita Salute San Raffaele University, Milan, Italy
- Strategic Research Program on CLL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Michael Doubek
- Department of Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Jana Didi
- Department of Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Charalampos Pontikoglou
- Department of Hematology, University of Crete School of Medicine, Heraklion, Crete, Greece
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Julie Ling
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Cathy Payne
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Helen Α Papadaki
- Department of Hematology, University of Crete School of Medicine, Heraklion, Crete, Greece
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Sheila Payne
- International Observatory on End of Life Care, University of Lancaster, Lancaster, UK
| | - Paolo Ghia
- Strategic Research Program on CLL, IRCCS San Raffaele Hospital, Milan, Italy
- Medical Oncology, Vita Salute San Raffaele University, Milan, Italy
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
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Yu J, Wu J, Huang O, Chen X, Shen K. A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study. J Med Internet Res 2021; 23:e27576. [PMID: 34528890 PMCID: PMC8485191 DOI: 10.2196/27576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/24/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. OBJECTIVE This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. METHODS Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. RESULTS A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). CONCLUSIONS This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Karamanidou C, Natsiavas P, Koumakis L, Marias K, Schera F, Schäfer M, Payne S, Maramis C. Electronic Patient-Reported Outcome-Based Interventions for Palliative Cancer Care: A Systematic and Mapping Review. JCO Clin Cancer Inform 2021; 4:647-656. [PMID: 32697604 DOI: 10.1200/cci.20.00015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Capitalizing on the promise of patient-reported outcomes (PROs), electronic implementations of PROs (ePROs) are expected to play an important role in the development of novel digital health interventions targeting palliative cancer care. We performed a systematic and mapping review of the scientific literature on the current ePRO-based approaches used for palliative cancer care. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, the conducted review answered the research questions: "What are the current ePRO-based approaches for palliative cancer care; what is their contribution/value in the domain of palliative cancer care; and what are the potential gaps, challenges, and opportunities for further research?" After a screening step, the corpus of included articles indexed in PubMed or the Web of Science underwent full text review, which mapped the articles across 15 predefined axes. RESULTS The corpus of 24 mapped studies includes 9 study protocols, 7 technical tools/solutions, 7 pilot/feasibility/acceptability studies, and 1 evaluation study. The review of the corpus revealed (1) an archetype of ePRO-enabled interventions for palliative cancer care, which most commonly use ePROs as study end point assessment instruments rather than integral intervention components; (2) the fact that the literature has not fully embraced the modern definitions that expand the scope of palliative care; (3) the striking shortage of promising ubiquitous computing devices (eg, smart activity trackers); and (4) emerging evidence about the benefits of narrowing down the target cancer population, especially when combined with modern patient-centered intervention design methodologies. CONCLUSION Although research on exploiting ePROs for the development of digital palliative cancer care interventions is considerably active and demonstrates several successful cases, there is considerable room for improvement along the directions of the aforementioned findings.
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Affiliation(s)
- Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Lefteris Koumakis
- Institute of Computer Science, Foundation for Research & Technology Hellas, Heraklion, Greece
| | - Kostas Marias
- Institute of Computer Science, Foundation for Research & Technology Hellas, Heraklion, Greece
| | - Fatima Schera
- Fraunhofer Institute for Biomedical Engineering IBMT, St Ingbert, Germany
| | - Michael Schäfer
- Fraunhofer Institute for Biomedical Engineering IBMT, St Ingbert, Germany
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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How the nursing profession should adapt for a digital future. BRITISH MEDICAL JOURNAL 2021. [PMCID: PMC8201520 DOI: 10.1136/bmj.n1190] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Linder LA, Ameringer S, Stegenga K, Macpherson CF, Erickson J. A Person-Centered Approach to Symptom Assessment and Management for Children and Adolescents Receiving Cancer Treatment. Semin Oncol Nurs 2021; 37:151164. [PMID: 34134924 DOI: 10.1016/j.soncn.2021.151164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Discuss the clinical assessment and management of symptoms for children and adolescents receiving treatment for cancer with attention to a person-centered approach to care. DATA SOURCES Review of currently published literature and guidelines pertaining to symptom assessment and management for children and adolescents receiving treatment for cancer. CONCLUSION Symptoms such as pain, nausea, and fatigue are commonly reported by children and adolescents receiving cancer treatment and are associated with greater symptom burden. Symptom assessment should be tailored to the child or adolescent and include the child's or adolescent's preference for reporting symptoms and attention to the symptoms that are of greatest priority. Evidence-based guidelines for the management of symptoms, including pain and nausea, are available to guide symptom management interventions and should be tailored to provide person-centered care. IMPLICATIONS FOR NURSING PRACTICE Nurses can lead efforts through clinical practice and research initiatives to advance person-centered symptom care for children and adolescents with cancer on a global level. Priorities for future work to advance person-centered symptom assessment and management include (1) identification of best practices for symptom assessment, (2) attention to social determinants of health and their subsequent influence on symptom outcomes, (3) compilation of evidence for management of less commonly reported symptoms, and (4) implementation of published clinical guidelines for symptom management in practice settings.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City; Primary Children's Hospital, Salt Lake City, UT.
| | | | | | | | - Jeanne Erickson
- Milwaukee College of Nursing, University of Wisconsin, Milwaukee
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Kong Y, Posada-Quintero HF, Chon KH. Real-Time High-Level Acute Pain Detection Using a Smartphone and a Wrist-Worn Electrodermal Activity Sensor. SENSORS (BASEL, SWITZERLAND) 2021; 21:3956. [PMID: 34201268 PMCID: PMC8227650 DOI: 10.3390/s21123956] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023]
Abstract
The subjectiveness of pain can lead to inaccurate prescribing of pain medication, which can exacerbate drug addiction and overdose. Given that pain is often experienced in patients' homes, there is an urgent need for ambulatory devices that can quantify pain in real-time. We implemented three time- and frequency-domain electrodermal activity (EDA) indices in our smartphone application that collects EDA signals using a wrist-worn device. We then evaluated our computational algorithms using thermal grill data from ten subjects. The thermal grill delivered a level of pain that was calibrated for each subject to be 8 out of 10 on a visual analog scale (VAS). Furthermore, we simulated the real-time processing of the smartphone application using a dataset pre-collected from another group of fifteen subjects who underwent pain stimulation using electrical pulses, which elicited a VAS pain score level 7 out of 10. All EDA features showed significant difference between painless and pain segments, termed for the 5-s segments before and after each pain stimulus. Random forest showed the highest accuracy in detecting pain, 81.5%, with 78.9% sensitivity and 84.2% specificity with leave-one-subject-out cross-validation approach. Our results show the potential of a smartphone application to provide near real-time objective pain detection.
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Affiliation(s)
| | | | - Ki H. Chon
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06269, USA; (Y.K.); (H.F.P.-Q.)
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Tiozzo E, Biagioli V, Brancaccio M, Ricci R, Marchetti A, Dall'Oglio I, Gawronski O, Bonanni F, Piga S, Celesti L, Offidani C, Tozzi AE, Cirulli L, Raponi M. Using an App to monitor postoperative pain at home in pediatric patients. J Child Health Care 2021; 25:212-224. [PMID: 33571013 DOI: 10.1177/1367493520919313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the 'Bambino Gesù' Children's Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4-17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.
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Affiliation(s)
- Emanuela Tiozzo
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Biagioli
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matilde Brancaccio
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Marchetti
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabiana Bonanni
- Unit of Ambulatory Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Piga
- Unit of Edidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucia Celesti
- Hospitality and Family Services, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Health Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- Innovation and Clinical Pathways Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luisa Cirulli
- Unit of Ambulatory Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Parimbelli E, Wilk S, Cornet R, Sniatala P, Sniatala K, Glaser SLC, Fraterman I, Boekhout AH, Ottaviano M, Peleg M. A review of AI and Data Science support for cancer management. Artif Intell Med 2021; 117:102111. [PMID: 34127240 DOI: 10.1016/j.artmed.2021.102111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/23/2020] [Accepted: 05/11/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Thanks to improvement of care, cancer has become a chronic condition. But due to the toxicity of treatment, the importance of supporting the quality of life (QoL) of cancer patients increases. Monitoring and managing QoL relies on data collected by the patient in his/her home environment, its integration, and its analysis, which supports personalization of cancer management recommendations. We review the state-of-the-art of computerized systems that employ AI and Data Science methods to monitor the health status and provide support to cancer patients managed at home. OBJECTIVE Our main objective is to analyze the literature to identify open research challenges that a novel decision support system for cancer patients and clinicians will need to address, point to potential solutions, and provide a list of established best-practices to adopt. METHODS We designed a review study, in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, analyzing studies retrieved from PubMed related to monitoring cancer patients in their home environments via sensors and self-reporting: what data is collected, what are the techniques used to collect data, semantically integrate it, infer the patient's state from it and deliver coaching/behavior change interventions. RESULTS Starting from an initial corpus of 819 unique articles, a total of 180 papers were considered in the full-text analysis and 109 were finally included in the review. Our findings are organized and presented in four main sub-topics consisting of data collection, data integration, predictive modeling and patient coaching. CONCLUSION Development of modern decision support systems for cancer needs to utilize best practices like the use of validated electronic questionnaires for quality-of-life assessment, adoption of appropriate information modeling standards supplemented by terminologies/ontologies, adherence to FAIR data principles, external validation, stratification of patients in subgroups for better predictive modeling, and adoption of formal behavior change theories. Open research challenges include supporting emotional and social dimensions of well-being, including PROs in predictive modeling, and providing better customization of behavioral interventions for the specific population of cancer patients.
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Affiliation(s)
| | - S Wilk
- Poznan University of Technology, Poland
| | - R Cornet
- Amsterdam University Medical Centre, the Netherlands
| | | | | | - S L C Glaser
- Amsterdam University Medical Centre, the Netherlands
| | - I Fraterman
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A H Boekhout
- Netherlands Cancer Institute, Amsterdam, the Netherlands
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An Interactive Pain Application (MServ) Improves Postoperative Pain Management. Pain Res Manag 2021; 2021:8898170. [PMID: 33868524 PMCID: PMC8035036 DOI: 10.1155/2021/8898170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 11/21/2022]
Abstract
Background Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.
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Lang EV, Jackson W, Senn P, Aroni DKK, Finkelman MD, Corino TA, Conway G, Kulich RJ. Efficacy of a Self-Hypnotic Relaxation App on Pain and Anxiety in a Randomized Clinical Trial: Results and Considerations on the Design of Active and Control Apps. Int J Clin Exp Hypn 2021; 69:277-295. [PMID: 33724898 PMCID: PMC9976960 DOI: 10.1080/00207144.2021.1883988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite an explosion of mobile app offerings for management of pain and anxiety, the evidence for effectiveness is scarce. Placebo-controlled trials are the most desirable but designing inactive placebo apps can be challenging. For a prospective randomized clinical trial with 72 patients in a craniofacial pain center, we created an app with self-hypnotic relaxation (SHR) for use with iOS and Android systems. A placebo background audio (BA) app was built with the same look and functionality. Both iOS and Android SHR apps alone and in comparison to the BA group significantly reduced pain and anxiety during the waiting-room time. The Android BA app significantly reduced anxiety but not pain. The iOS BA app affected neither pain nor anxiety, functioning as an ideal placebo. Usage analysis revealed that different default approaches of the iOS and Android devices accounted for the difference in results.
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Affiliation(s)
| | - William Jackson
- Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Paul Senn
- Hypnalgesics, LLC, Brookline, Massachusetts, USA
| | - Donavon Khosrow K Aroni
- Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Matthew D Finkelman
- Department of Public Health and Community Service, TuftsUniversity School of Dental Medicine, Boston, Massachusetts, USA
| | | | | | - Ronald J Kulich
- Craniofacial Pain Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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The effect of digital health technologies on managing symptoms across pediatric cancer continuum: A systematic review. Int J Nurs Sci 2021; 8:22-29. [PMID: 33575441 PMCID: PMC7859551 DOI: 10.1016/j.ijnss.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/28/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Objective Pediatric cancer patients endure multiple symptoms during treatment and also in survivorship. Digital health technologies provide an innovative way to support their symptom management. This review aimed to examine the effect of digital health technologies on managing symptoms among across pediatric cancer continuum. Methods A systematic literature search of six English and three Chinese electronic databases was combined with hand searching, to identify eligible research studies from database establishment to November 30, 2019. Two reviewers carried out data selection, data extraction, and quality appraisal independently. A narrative approach was taken to summarize data. Results Four randomized control trials, two quasi-experiments, and five one group pre-posttest designed studies, were included in the review with a total of 425 participants. The methodological quality of the studies was generally fair. Seven symptoms (anxiety, depression, pain, anger, fatigue, fear, distress) and seven digital health technologies (visual reality, website, humanoid robot, app, wearable devices, short messages and videoconference) were reported in the included studies. Conclusions Current evidence supports the effect of digital health technologies is generally mixed and inconclusive. There is a trend of positive effects found in the interventions that feature digital health technologies' interactive function. This review highlights the need for further investigation with rigorous research designs and the consideration of influencing factors from the symptoms, participants, and context levels to inform a better digital health implementation.
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45
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Self-efficacy in symptom management for adolescents and young adults with cancer: a systematic review. Support Care Cancer 2021; 29:2851-2862. [PMID: 33403400 DOI: 10.1007/s00520-020-05960-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) have more frequent and intense adverse effects from cancer therapy than other age groups. Self-efficacy, the ability for persons to maintain health-related behavior change, may assist with symptom management but the role it plays in AYAs with cancer has not been thoroughly investigated. This review explores the role that self-efficacy has in symptom management for AYAs with cancer and provides guidance for clinicians to utilize self-efficacy as a means to reduce side effects of therapy. METHODS A systematic review of peer-reviewed literature was conducted to identify works discussing self-efficacy and symptom management for AYAs with cancer. Five databases were searched with key terms and articles that discussed relationships between self-efficacy and cancer therapy symptoms were retained for analysis. FINDINGS Twelve manuscripts representing 1180 individuals age 12 to 43 years were identified. Self-efficacy was found to be related to (1) health management behaviors, (2) psychosocial health, (3) sexual and reproductive health, and (4) physical symptoms. Self-efficacy had direct correlations with physical activity, nutritional intake, symptom regulation, mental health, sexual health, and fertility preservation. The included studies did not find significant relationships with medication adherence or pain management. DISCUSSION Self-efficacy is an attribute that impacts behavior change, health maintenance, and overall wellness and can be changed over time and through interventions to improve symptoms of cancer therapy. Self-efficacy should be evaluated as a construct in relevant studies aimed at improving side effects of cancer therapy to better understand outcomes from interventions. Symptoms, toxicities, and adverse effects of cancer therapy may be improved by increasing self-efficacy of patients.
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46
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Linder LA, Newman AR, Stegenga K, Chiu YS, Wawrzynski SE, Kramer H, Weir C, Narus S, Altizer R. Feasibility and acceptability of a game-based symptom-reporting app for children with cancer: perspectives of children and parents. Support Care Cancer 2021; 29:301-310. [PMID: 32358779 PMCID: PMC7606212 DOI: 10.1007/s00520-020-05495-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. PROCEDURE Nineteen school-age children (6-12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. RESULTS Children used the app a median of 4 days (range 1-12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. CONCLUSION Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
- Center for Cancer and Blood Disorders, Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Amy R Newman
- College of Nursing, Marquette University, Milwaukee, WI, USA
- Children's Hospital Wisconsin, Milwaukee, WI, USA
| | | | - Yin-Shun Chiu
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sarah E Wawrzynski
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Scott Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Roger Altizer
- Population Health Sciences, Entertainment Arts & Engineering, University of Utah, Salt Lake City, UT, USA
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Puthenpura V, Marks AM. Clinical Application of Digital Technologies in Adolescent and Young Adult Oncology Supportive Care. J Adolesc Young Adult Oncol 2020; 10:127-130. [PMID: 33296259 DOI: 10.1089/jayao.2020.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Asher M Marks
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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48
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Simon JDHP, Van Loon FRAA, Van Amstel J, Elmont GS, Zwaan CM, Fiocco M, Schepers SA, Tissing WJE, Michiels EMC. Pain at home during childhood cancer treatment: Severity, prevalence, analgesic use, and interference with daily life. Pediatr Blood Cancer 2020; 67:e28699. [PMID: 32926551 DOI: 10.1002/pbc.28699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pain is a common symptom in childhood cancer. Since children spend more time at home, families are increasingly responsible for pain management. This study aimed at assessing pain at home. PROCEDURE In this longitudinal observational study (April 2016-January 2017), pain severity and prevalence, analgesic use, and pain interference with daily life (Brief Pain Inventory Short Form) were assessed for 4 consecutive days around the time of multiple chemotherapy appointments. Descriptive statistics (frequencies and percentages) were used to report pain severity (with clinically significant pain defined as: score ≥ 4 on "worst pain" or "average pain in the last 24 h"), pain prevalence, and analgesic use. Mixed models were estimated to assess whether patient characteristics were associated with pain severity, and whether pain severity was associated with interference with daily life. RESULTS Seventy-three children (50.7% male) participated (1-18 years). A majority (N = 57, 78%) experienced clinically significant pain at least once, and 30% reported clinically significant pain at least half the time. In 33.6% of scores ≥ 4, no medication was used. We found an association between pain severity and interference with daily life: the higher the pain, the bigger the interference (estimated regression coefficient = 1.01 [95% CI 0.98-1.13]). CONCLUSIONS The majority of children experienced clinically significant pain at home, and families frequently indicated no medication use. A stronger focus on education and coaching of families seems essential, as well as routine screening for pain in the home setting.
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Affiliation(s)
- Julia D H P Simon
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Femke R A A Van Loon
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - Juul Van Amstel
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - Gina S Elmont
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna M C Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
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Lau N, Waldbaum S, Parigoris R, O'Daffer A, Walsh C, Colt SF, Yi-Frazier JP, Palermo TM, McCauley E, Rosenberg AR. eHealth and mHealth Psychosocial Interventions for Youths With Chronic Illnesses: Systematic Review. JMIR Pediatr Parent 2020; 3:e22329. [PMID: 33075743 PMCID: PMC7685926 DOI: 10.2196/22329] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND An estimated 12.8% of children and adolescents experience chronic health conditions that lead to poor quality of life, adjustment and coping issues, and concurrent mental health problems. Digital health deployment of psychosocial interventions to support youth with chronic illness has become increasingly popular with the advent of the technological advances in the digital age. OBJECTIVE Our objectives were to systematically review published efficacy studies of eHealth and mHealth (mobile health) psychosocial interventions for youths with chronic illnesses and review intervention theory and treatment components. METHODS PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched for studies published from 2008 to 2019 of eHealth and mHealth psychosocial interventions designed for children and adolescents with chronic illnesses in which efficacy outcomes were reported. We excluded studies of interventions for caregivers, healthy youth, disease and medication management, and telehealth interventions that function solely as a platform to connect patients to providers via phone, text, or videoconference. RESULTS We screened 2551 articles and 133 relevant full-text articles. Sixteen efficacy studies with psychosocial and health outcomes representing 12 unique interventions met the inclusion criteria. Of the included studies, 12 were randomized controlled trials and 4 were prospective cohort studies with no comparison group. Most interventions were based in cognitive behavioral theory and designed as eHealth interventions; only 2 were designed as mHealth interventions. All but 2 interventions provided access to support staff via text, phone, email, or discussion forums. The significant heterogeneity in intervention content, intervention structure, medical diagnoses, and outcomes precluded meta-analysis. For example, measurement time points ranged from immediately postcompletion of the mHealth program to 18 months later, and we identified 39 unique outcomes of interest. The majority of included studies (11/16, 69%) reported significant changes in measured health and/or psychosocial posttreatment outcomes, with small to large effect sizes. CONCLUSIONS Although the available literature on the efficacy of eHealth and mHealth psychosocial interventions for youth with chronic illnesses is limited, preliminary research suggests some evidence of positive treatment responses. Future studies should continue to evaluate whether digital health platforms may be a viable alternative model of delivery to traditional face-to-face approaches.
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Affiliation(s)
- Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Shayna Waldbaum
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Ryan Parigoris
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
| | - Alison O'Daffer
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Casey Walsh
- Department of Health Services, University of Washington, Seattle, WA, United States.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Susannah F Colt
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
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50
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Cheng L, Kang Q, Wang Y, Hinds PS. Determining the Effectiveness of Using Patient-Reported Outcomes in Pediatric Clinical Practices. J Pediatr Nurs 2020; 55:100-109. [PMID: 32745906 DOI: 10.1016/j.pedn.2020.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
PROBLEM Patient-reported outcomes (PROs) are increasingly recognized in pediatric clinical care as adding essential information relevant to actual care. However, the effectiveness of using PROs in pediatric clinical settings has not been fully explored with synthesized evidence. The aim of this study was to evaluate the effectiveness of using patient-reported outcomes in pediatric clinical practices. ELIGIBILITY CRITERIA We searched four English and three Chinese databases to identify studies that examine the effectiveness of using PROs in pediatric clinical practices published from the inception date of each database to January 2020. SAMPLE Ten articles met the inclusion criteria. RESULTS There was wide a variation in the ten studies' designs, samples, PROs administered (type, length, timing, mode), and type of outcomes evaluated. The effect sizes of using PROs on three categories of outcomes (patient, process of care and health service) were assessed. Of 70 measured outcomes, 32 were positive, 5 were negative, and 33 were mixed. CONCLUSIONS Overall, there is a weak but trending positive impact of using PROs in pediatric clinical practice. IMPLICATIONS More rigorous study designs with sources of bias controlled are needed to more directly assess the impact of using PROs in pediatric care. If findings continue to be positive, then an implementation model addressing the numerous influencing factors is recommended to integrate PROs into pediatric care.
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Affiliation(s)
- Lei Cheng
- School of Nursing, Fudan University, China.
| | - Qiongfang Kang
- Pediatric Surgical Oncology Unit, Children's Hospital of Fudan University, China
| | - Yanqing Wang
- Pediatric Hematology&Oncology Unit, Children's Hospital of Zhejiang University School of Medicine, China
| | - Pamela S Hinds
- Children's National Hospital; Professor, The George Washington University, DC, USA.
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