Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer
Introduction
At the heart of person-centered care delivery is the development of services in health care that enable patients to have the most efficient and effective care, which is also experienced as respectful and promoting patient involvement in the therapeutic relationships (Leplege et al., 2007). Patients with cancer cared for as outpatients, frequently experience multiple symptoms and problems that, when not diagnosed, influence the patients' quality of life (QoL) and recovery (Pachman et al., 2012). For immediate and continuous dialogue between patients and health care professionals, innovative e-health services using Information and Communication Technologies (ICT) are encouraged. Appropriate tools for communication are needed to enable patients to report events that health care providers may respond to effectively (Mazor et al., 2012). There is a broad market for technology and devices for the self-monitoring of symptoms and problems. Some of these solutions are evidence-based and others not, and few include interactive components for immediate clinical management. Hence, the objective of our research program is to develop and evaluate an interactive ICT-platform for reporting and managing symptoms in real time during treatment for cancer. The ICT-platform, for use in smartphones and tablets, was developed in cooperation with a Swedish company, Health Navigator (specialized in health care management consulting and new innovative care solutions) responsible for the technical development and support. The platform is generic and the idea for the future is to test it for several diagnoses and in larger trials. In this first study, patients with prostate cancer during radiotherapy were included.
Patient-reported outcomes (PROs) may be defined as any aspect of a patient's health status (including disease symptoms, functioning, and health-related quality of life) that is directly reported by the patient with no interpretation of the patient's responses by a caregiver or anyone else (U.S. Department of Health Human Services and Research, 2006). Routine clinical use of PROs in real time may facilitate the assessment of problems, provide information on the effects of treatment, facilitate patient–clinician communication, promote shared decision making, improve patient satisfaction, and monitor quality improvement (Snyder and Aaronson, 2009, Valderas et al., 2008). Traditionally, PROs have been collected using pen and paper, but now more frequently a broad range of ICT solutions have been employed, including mobile phones, web-based systems and applications for smartphones and touch screens (Rose and Bezjak, 2009). In the UK, patients using a mobile phone-based system reported improved communication with health care professionals and improved symptom management when their symptoms were being monitored (Maguire et al., 2008, McCann et al., 2009). Moreover, a mobile phone-based monitoring system for heart failure patients developed and tested in a Canadian setting provided some evidence for improved self-care and clinic management (Seto et al., 2012a). In a recent RCT a web-based interactive health communication application monitoring symptoms and providing self-management support and access to e-communication with expert cancer nurses and other patients was tested by patients with breast and prostate cancer during any treatment (Ruland et al., 2013). The results showed a slight favor in the intervention group overall but additional research is needed. Mobile phone systems and applications have just begun to offer great opportunities in health care settings however, data showing sufficient evidence of feasibility and efficacy of these solutions has so far not been concluded. The importance of integrating the patients into the process (Donaldson, 2008) and to ensure user friendly data for both patients and health care professionals has been emphasized (Rose and Bezjak, 2009, Snyder and Aaronson, 2009).
In Sweden, prostate cancer is the most common cancer among men, representing 36% of all cancer cases in male adults in 2011 (National Board of Health and Welfare, 2011). Through early detection and improved therapies many are cured, but a major number of men need continuous surveillance and treatment (e.g., surgery, brachytherapy, radiotherapy, hormonal therapy). All the treatments available for local and advanced prostate cancer have side effects with a significant impact on the patients' QoL (Katz, 2007). Howlett et al. (2010) highlight the importance of evaluating, during and after radiotherapy, influences of treatment on various aspects of health and QoL. Patients with prostate cancer are commonly cared for as outpatients, visiting hospitals only to receive treatment, and this arrangement places great demands on them and their significant others. The aim of this study was to test the feasibility and acceptability of an interactive ICT-platform for smartphone use which collect and manage patient reported symptoms during radiotherapy for prostate cancer.
Section snippets
Methods
The design of our research program is underpinned by the Medical Research Council's (MRC) complex intervention evaluation framework (Campbell et al., 2007). The framework uses a stepwise approach for; i) defining and understanding the problem and the context; ii) developing the intervention and; iii) developing and optimizing the evaluation. In the first step patients and health care professionals were interviewed and a literature review was conducted to define the problem and the context
Results
Symptoms reported in the smartphone application by patients at baseline report are shown in Table 3.
The participants reported for a mean period of 10 days (Fig. 2), and they estimated the time required for each report at about 5 min. All symptoms included in the assessment had been reported by the participants, and the most frequently reported symptoms were flushing (n = 52), urinary urgency (n = 50), and fatigue (n = 44). During the study period, a total of 59 alerts were sent: 55 yellow and 4
Discussion
In this study, we tested a newly developed ICT-platform unique in the sense of being interactive for reporting and managing symptoms and problems during radiotherapy for prostate cancer. Overall, the patients found the application acceptable and user-friendly, despite the fact that most participants had never used a smartphone before and being older adults. Confidence among older individuals in their ability to use mobile phone and tablet applications has been shown in previous studies (Fromme
Conflict of interest
Authors of this manuscript declare no conflict of interests.
Acknowledgments
We would like to thank all the participants in this study and the staff at the two centers who assisted us with support. We would also like to thank Health Navigator for the collaboration and technical support in this project.
References (32)
- et al.
Validity and reliability of the Swedish version of the Memorial Symptom Assessment Scale (MSAS): an instrument for the evaluation of symptom prevalence, characteristics, and distress
Journal of Pain Symptom Management
(2013) Symptom management in oncology care – where are we?
European Journal of Oncology Nursing
(2010)- et al.
The role and interpretation of pilot studies in clinical research
Journal of Psychiatric Research
(2011) - et al.
Nurse's perceptions and experiences of using of a mobile-phone-based Advanced Symptom Management System (ASyMS) to monitor and manage chemotherapy-related toxicity
European Journal of Oncology Nursing
(2008) - et al.
The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress
European Journal of Cancer
(1994) - et al.
Use of patient-reported outcomes in clinical practice
Lancet
(2009) - et al.
Normative models of health technology assessment and the social production of evidence about telehealth care
Health Policy
(2003) - et al.
Developing Focus Group Research. Politics, Theory and Practice
(1999) - et al.
Designing and evaluating complex interventions to improve health care
British Medical Journal
(2007) Taking PROs and patient-centered care seriously: incremental and disruptive ideas for incorporating PROs in oncology practice
Quality of Life Research
(2008)
The qualitative content analysis process
Journal of Advanced Nursing
Developing an easy-to-use tablet computer application for assessing patient-reported outcomes in patients with cancer
Supportive Care in Cancer
Changes in sexual function on mood and quality of life in patients undergoing radiation therapy for prostate cancer
Oncology Nursing Forum
Symptom self-management strategies in patients with non-metastatic prostate cancer
Journal of Clinical Nursing
Care for Asthma via Mobile Phone (CAMP)
Studies of Health Technology Information
Quality of life for men with prostate cancer
Cancer Nursing
Cited by (35)
Supporting health literacy using an interactive app for symptom management during radiotherapy for prostate cancer
2021, Patient Education and CounselingGeriatric phone follow-up in the management of older patients treated for cancer: Telog study results
2020, Journal of Geriatric OncologyCitation Excerpt :When older patients with cancer often come to hospital for oncological treatment, geriatric assessment should be integrated in the follow-up [29]. Otherwise, in case of oral therapy and after surgery, different at home follow-up methods can be considered: telemonitoring system with connected objects and teleassistance [30–32] sometimes completed with nurse phone intervention [33], or providing alternate nurse phone call and at home visits [34]. Use of interactive platform don't seem to be applicable to the whole aged population yet [35].
Mobile applications in oncology: A systematic review of health science databases
2020, International Journal of Medical InformaticsCitation Excerpt :The geographical locations of the studies were North America (n = 20) [5,8,26,27,29,32–34,36,37,40,42,43,46,47,51,57,67,68] Europe (n = 14) [9,11,14,23,25,30,31,39,48,55,63,69] Asia (n = 9) [28,36,44,45,49,54,61,64,65] the United Kingdom (n = 5) [24,41,58–60] Oceania (n = 4) [15,35,53,66] and Latin America (n = 2) [22,56] (Table 2). Of the 54 publications found through the search, n = 33 [5,8,22,23,27,28,33–35,39,43–47,49–51,14,54,56–59,62,63,65–67,15,68,69] did not identify the name of the app they had used to carry out their study; the remainder (n = 21) [9,11,25,26,29–32,36,37,38,40–42,48,52,53,55,60,24,61] identified the app used, but of these, n = 12 [11,25,29–31,37,41,42,52,53,60] did not exist or were not available in the App Store for the iOS system or the Android Market for the Android operating system. The remaining apps (n = 9) [9,24,26,36,38,40,48,55,61] are shown in Table 3.
The influence of mobile health applications on patient - healthcare provider relationships: A systematic, narrative review
2019, Patient Education and CounselingCitation Excerpt :Its findings point to specific app design and usage features which can facilitate RCC. Including users, whether patients or HCP, in the design phase of app development allows for personalization and meeting of special needs, and ultimately ensures that the personhood of future users is considered as the first tenet of RCC [23,39–41]. Particularly for vulnerable or disenfranchised healthcare users, mhealth apps seem to create a channel that allows their voice and story to be heard more clearly, while preserving their privacy and dignity [7].
Mobile health (mHealth) interventions in prostate cancer survivorship: a scoping review
2023, Journal of Cancer Survivorship