Self-Care Support for Patients with Gastrointestinal Cancer: iCancerHealthFunding Medocity, Inc. supported the first 3 months of the study through a contract to the Dana–Farber Cancer Institute.
11 June 2018
23 September 2018
21 November 2018 (online)
Background Patient-centered symptom assessment and management tools allow patients to perform self-assessments and engage in self-symptom management. Efficacious tools exist for reducing symptom distress; however, little is known about feature-specific use.
Objectives This article evaluates the feasibility of the iCancerHealth app as an adjunct to usual patient education regarding cancer symptoms and medication management.
Methods We conducted a single-arm, pilot study grounded in the health outcomes model. Our evaluation included (1) enrollment rates, (2) 2-month utilization rates, (3) patient acceptability, and (4) clinician satisfaction with the provider-side application. English-speaking, adult patients receiving care in the gastrointestinal oncology service of a comprehensive cancer center were invited to participate. Research coordinators enrolled consenting participants who had a personal, Internet-connected device; participants registered and used the platform to complete the baseline symptom assessment in clinic. Participants were reminded weekly to use the app and to perform a symptom report 4 to 6 weeks later.
Results A total of 64 patients were approached, of which 57 (89%; 95% exact confidence interval [CI], 79–96%) enrolled. About half were ≥ 60 years old and 40% were women. Fifty-three patients (93%; 95% exact CI, 85–99%) accessed at least one app feature, at least once, from home. The most frequently used (86%) feature was Health Tracker in which participants monitored and reported symptoms; followed by My Inbox (63%) and My Medications features (60%). The mean acceptability score was 24.8 (standard deviation = 4.2), indicating good acceptability. Clinicians reported that the app was most acceptable with regard to facilitating in-person interactions that occurred after app use.
Conclusion In a sample of adults with various stages of gastrointestinal malignancies, the iCancerHealth app was utilized at a high rate. Features that focused on symptoms and medication side effects plus communication with clinicians were used most frequently. This extends our understanding of preferences and specific feature use with patient-centered technologies.
Protection of Human and Animal Subjects
This study was approved as minimal risk by the Dana–Farber Cancer Institute Institutional Review Board in Boston, Massachusetts.
- 1 Berry DL, Hong F, Halpenny B. , et al. The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial. BMC Cancer 2014; 14 (01) 513
- 2 Berry DL, Hong F, Halpenny B. , et al. Electronic self-report assessment for cancer and self-care support: results of a multicenter randomized trial. J Clin Oncol 2014; 32 (03) 199-205
- 3 Reilly CM, Bruner DW, Mitchell SA. , et al. A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment. Support Care Cancer 2013; 21 (06) 1525-1550
- 4 Fann JR, Hong F, Halpenny B, Blonquist TM, Berry DL. Psychosocial outcomes of an electronic self-report assessment and self-care intervention for patients with cancer: a randomized controlled trial. Psychooncology 2017; 26 (11) 1866-1871
- 5 Halfdanarson TR, Jatoi A. Oral cancer chemotherapy: the critical interplay between patient education and patient safety. Curr Oncol Rep 2010; 12 (04) 247-252
- 6 Ruddy KJ, Partridge AH. Adherence with adjuvant hormonal therapy for breast cancer. Ann Oncol 2009; 20 (03) 401-402
- 7 Hartigan K. Patient education: the cornerstone of successful oral chemotherapy treatment. Clin J Oncol Nurs 2003; 7 (6, Suppl): 21-24
- 8 Spoelstra SL, Given BA, Given CW. , et al. Issues related to overadherence to oral chemotherapy or targeted agents. Clin J Oncol Nurs 2013; 17 (06) 604-609
- 9 Boucher J, Lucca J, Hooper K, Pedulla L, Berry D. A Structured nursing intervention to address oral chemotherapy adherence in patients with non-small cell lung cancer. Onc Nurs Forum 2015; 42 (04) 383-389
- 10 Cleeland CS, Zhao F, Chang VT. , et al. The symptom burden of cancer: evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study. Cancer 2013; 119 (24) 4333-4340
- 11 Hamilton J, Kruse H, Holcomb L, Freche R. Distress and psychosocial needs: demographic predictors of clinical distress after a diagnosis of cancer. Clin J Oncol Nurs 2018; 22 (04) 390-397
- 12 Palma DA, Senan S, Tsujino K. , et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys 2013; 85 (02) 444-450
- 13 Carlson LE, Waller A, Groff SL, Bultz BD. Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems--secondary outcomes of a randomized controlled trial. Psychooncology 2013; 22 (08) 1880-1888
- 14 American College of Surgeons. Cancer Program Standards 2012: Ensuring Patient-Centered Care. Chicago, IL: American College of Surgeons; 2012. Available at: http://www.facs.org/cancer/coc/programstandards2012.pdf . Accessed October 20, 2018
- 15 Mooney K, Berry DL, Whisenant M, Sjoberg D. Improving cancer care through the patient experience: how to use patient-reported outcomes in clinical practice. American Society of Clinical Oncology educational book. American Society of Clinical Oncology Meeting; 2017 ;37:695–704
- 16 Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer 2012; 20 (08) 1589-1599
- 17 Heyn L, Ruland CM, Finset A. Effects of an interactive tailored patient assessment tool on eliciting and responding to cancer patients' cues and concerns in clinical consultations with physicians and nurses. Patient Educ Couns 2012; 86 (02) 158-165
- 18 Boyes A, Newell S, Girgis A, McElduff P, Sanson-Fisher R. Does routine assessment and real-time feedback improve cancer patients' psychosocial well-being?. Eur J Cancer Care (Engl) 2006; 15 (02) 163-171
- 19 Velikova G, Booth L, Smith AB. , et al. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol 2004; 22 (04) 714-724
- 20 Salsman JM, Grunberg SM, Beaumont JL. , et al. Communicating about chemotherapy-induced nausea and vomiting: a comparison of patient and provider perspectives. J Natl Compr Canc Netw 2012; 10 (02) 149-157
- 21 Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008; (02) CD000011
- 22 Williams AF, Manias E, Walker R. Adherence to multiple, prescribed medications in diabetic kidney disease: a qualitative study of consumers' and health professionals' perspectives. Int J Nurs Stud 2008; 45 (12) 1742-1756
- 23 Sommers RM, Miller K, Berry DL. Feasibility pilot on medication adherence and knowledge in ambulatory patients with gastrointestinal cancer. Oncol Nurs Forum 2012; 39 (04) E373-E379
- 24 Berry DL, Cunningham T, Eisenberg S, Wickline M, Hammer M, Berg C. Improving patient knowledge of discharge medications in an oncology setting. Clin J Oncol Nurs 2014; 18 (01) 35-37
- 25 Nielsen J. Usability 101: Introduction to Usability; 2012 . Available at: https://www.nngroup.com/articles/usability-101-introduction-to-usability/ . Accessed October 20, 2018
- 26 Wolpin S, Stewart M. A deliberate and rigorous approach to development of patient-centered technologies. Semin Oncol Nurs 2011; 27 (03) 183-191
- 27 Ruland CM, Andersen T, Jeneson A. , et al. Effects of an internet support system to assist cancer patients in reducing symptom distress: a randomized controlled trial. Cancer Nurs 2013; 36 (01) 6-17
- 28 Berry DL, Blonquist TM, Patel RA, Halpenny B, McReynolds J. Exposure to a patient-centered, Web-based intervention for managing cancer symptom and quality of life issues: impact on symptom distress. J Med Internet Res 2015; 17 (06) e136
- 29 Mitchell PH, Ferketich S, Jennings BM. ; American Academy of Nursing Expert Panel on Quality Health Care. Quality health outcomes model. Image J Nurs Sch 1998; 30 (01) 43-46
- 30 Tariman JD, Berry DL, Halpenny B, Wolpin S, Schepp K. Validation and testing of the Acceptability E-scale for web-based patient-reported outcomes in cancer care. Appl Nurs Res 2011; 24 (01) 53-58
- 31 Berry DL, Blumenstein BA, Halpenny B. , et al. Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. J Clin Oncol 2011; 29 (08) 1029-1035
- 32 Berry DL, Halpenny B, Hong F. , et al. The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: a multi-center randomized trial. Urol Oncol 2013; 31 (07) 1012-1021
- 33 Groat D, Soni H, Grando MA, Thompson B, Kaufman D, Cook CB. Design and testing of a smartphone application for real-time self-tracking diabetes self-management behaviors. Appl Clin Inform 2018; 9 (02) 440-449
- 34 Ruland CM, Maffei RM, Børøsund E, Krahn A, Andersen T, Grimsbø GH. Evaluation of different features of an eHealth application for personalized illness management support: cancer patients' use and appraisal of usefulness. Int J Med Inform 2013; 82 (07) 593-603
- 35 Rudin RS, Fanta CH, Predmore Z. , et al. Core components for a clinically integrated mHealth app for asthma symptom monitoring. Appl Clin Inform 2017; 8 (04) 1031-1043