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Lalani Y, Godinho A, Ellison K, Joshi K, Curtin Wach A, Rana P, Wegier P. Laying the foundation for iCANmeditate: A mixed methods study protocol for understanding patient and oncologist perspectives on meditation. PLoS One 2024; 19:e0290988. [PMID: 39172996 PMCID: PMC11341032 DOI: 10.1371/journal.pone.0290988] [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: 08/18/2023] [Accepted: 08/07/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND People with cancer experience heightened levels of stress and anxiety, including psychological or physical. In recent years, digitally delivered complimentary therapies, such as meditation, have gained attention in cancer research and advocacy communities for improving quality of life. However, most digital meditation resources are commercially available and are not tailored to the unique needs of cancer patients (addressing fears of recurrence). As such, this study lays the foundation to co-design a publicly available digital meditation program called iCANmeditate that contains cancer-specific meditation content. AIMS To understand: (1) cancer patients' perceptions and practices of meditation, as well as their needs in addressing the stress that accompanies their cancer diagnosis and (2) current knowledge of meditation and prescribing trends amongst oncologists in Canada. METHODS AND ANALYSIS A mixed-methods design comprised of online patient and oncologist surveys and interviews with patients will be used. Survey data analysis will use multivariate logistic regressions to examine predictors of: (1) interest in using a meditation app among patients and (2) prescribing meditation among oncologists. Patient interviews will gather insights about the contexts of daily living where meditation would be most beneficial for people with cancer; this data will be analyzed thematically. DISCUSSION The results of this study will inform iterative co-design workshops with cancer patients to build the digital meditation program iCANmeditate; interview results will be used to develop vignettes or "personas" that will supply the initial stimulus material for the iterative co-design workshops. Once the program has been finalized in partnership with cancer patient participants, a usability and pilot study will follow to test the functionality and efficacy of the tool. Results from the oncologist survey will form the basis of knowledge mobilization efforts to facilitate clinical buy-in and awareness of the benefits of meditation to cancer patients.
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Affiliation(s)
- Yasmin Lalani
- Humber River Health Research Institute, Humber River Health, Toronto, Ontario, Canada
| | - Alexandra Godinho
- Humber River Health Research Institute, Humber River Health, Toronto, Ontario, Canada
| | - Kirsten Ellison
- Humber River Health Research Institute, Humber River Health, Toronto, Ontario, Canada
| | - Krutika Joshi
- Humber River Health Research Institute, Humber River Health, Toronto, Ontario, Canada
| | - Aisling Curtin Wach
- Humber River Health Research Institute, Humber River Health, Toronto, Ontario, Canada
| | - Punam Rana
- Humber River Health, Toronto, Ontario, Canada
| | - Pete Wegier
- Humber River Health Research Institute, Humber River Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
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Kwok G, Senger A, Sharma A, Mandato I, Devine KA. Understanding the multilevel factors influencing the implementation of digital health interventions for supportive care in Adolescents and Young Adult (AYA) cancer survivorship: determinants of adopting mindfulness-based mobile applications. Implement Sci Commun 2024; 5:76. [PMID: 39020422 PMCID: PMC11253365 DOI: 10.1186/s43058-024-00612-w] [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: 01/15/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Adolescents and Young Adult (AYA) cancer survivors are at risk for psychological distress due to their unique developmental and medical needs. Healthcare providers can leverage the convenience and appeal of technology to provide supportive care for this vulnerable population. Using evidence-based mindfulness-based mobile interventions as a case example, the goal of this study was to identify key patient-, provider-, and organization-level barriers and facilitators to supportive care and implementing digital health interventions in AYA survivorship care. METHODS Twenty semi-structured interviews were conducted with stakeholders including AYA survivors (n = 10; between 18-29 years old) and clinical providers and administrators (n = 10). Interviews were transcribed and deductively mapped using the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) complementary frameworks. RESULTS Results indicated that factors like cost and patients' needs and resources were prevalent among both survivors and providers. There were key differences between providers and AYA survivors. Providers' adoption and promotion of digital health interventions were influenced most strongly by contextual factors, including available resources (Inner Setting), culture (Outer Setting), and networks and communications (Outer Setting). On the other hand, survivors emphasized individual and intervention-related factors; they reported that social influence and knowledge influenced their adoption and use of digital health interventions, including meditation apps. CONCLUSIONS These results identified barriers and facilitators to the adoption of supportive care digital health interventions from multiple stakeholders. Results can be used to guide the development of implementation strategies to improve the uptake of digital health interventions in survivorship care, ultimately improving the psychosocial well-being of AYA cancer survivors.
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Affiliation(s)
- Gary Kwok
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation, at Hackensack Meridian Health, Nutley, NJ, 07110, USA.
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA.
| | - Angela Senger
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Archana Sharma
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Ivelisse Mandato
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
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Kwok G, Sharma A, Mandato I, Devine KA. Feasibility and Acceptability of a Meditation Mobile App Intervention for Adolescent and Young Adult Survivors of Childhood Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:584. [PMID: 38791797 PMCID: PMC11121627 DOI: 10.3390/ijerph21050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Adolescent and young adult (AYA) survivors of childhood cancer are increasingly recognized as a vulnerable group with unique emotional, social, and practical needs due to the intersection of cancer survivorship and normal developmental processes. Mindfulness meditation has shown early efficacy in improving psychological distress among cancer patients. However, the overall scientific study of app-based mindfulness-based interventions is still in its early stages. The goal of this study was to evaluate the feasibility and acceptability of a commercially available mindfulness mobile app intervention "Ten Percent Happier" among AYA survivors of childhood cancer. METHODS We conducted a single-arm pilot intervention with 25 AYA survivors of childhood cancer ages 18-29 years. RESULTS A total of 108 potentially eligible individuals were initially identified for screening. Of the 45 individuals reached (contact rate = 41.67%), 20 declined to participate; 25 were enrolled in the study and completed the baseline survey (enrollment rate = 55.56%). Twenty-one participants completed the study (retention rate = 84%). Changes in several outcomes were promising, with medium to large effect sizes: Mindfulness (d = 0.74), Negative Emotion (d = 0.48), Perceived Stress (d = 0.52), and Mental Health (d = 0.45). Furthermore, results suggested that participants with consistent app usage showed greater improvement in reported outcomes than those who stopped their usage (e.g., Mindfulness: d = 0.74, Perceived Stress: d = 0.83, Mental Health: d = 0.51; Meaning and Purpose: d = 0.84; and Sleep Disturbance: d = 0.81). Qualitative feedback indicated high satisfaction, but participants suggested adding group or individual peer support to improve their experience with the app. CONCLUSIONS AYA survivors can be difficult to reach, but a mindfulness app was feasible and acceptable to this group. In particular, the robust retention rate and high satisfaction ratings indicate that the meditation mobile app was well received. Preliminary results suggest positive changes in health-related quality of life outcomes, warranting a larger efficacy trial.
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Affiliation(s)
- Gary Kwok
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Archana Sharma
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Ivelisse Mandato
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Katie A. Devine
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
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Kabir H, Hasan MK, Akter N, Marma USC, Alam T, Tutul AH, Biswas L, Ara R, Mitra DK. Factors associated with the intention of telehealth service utilization among Bangladeshi people: a cross-sectional study. F1000Res 2024; 11:996. [PMID: 38495779 PMCID: PMC10940848 DOI: 10.12688/f1000research.124410.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Background Telehealth is comprised of telecommunications and electronic information systems to support and maintain long-distance healthcare services. Although it has not been thoroughly explored, the intention of using the service among the general public is critical to its success. We investigated the factors associated with the intention to utilize telehealth services among the general population of Bangladesh. Methods This cross-sectional study was conducted between May 22, 2021 and June 15, 2021 in Bangladesh, where the total number of participants was 1038. The Pearson chi-square test and Kruskal-Wallis H tests were used to examine the unadjusted relationship between the explanatory variables and the intention to use telehealth services. A multinomial logistic regression model was fitted to determine the adjusted association. Shapiro-Wilk tests were used to check the normality of continuous data. Data were processed and analyzed by software STATA-16. Results The probability of utilizing the service increased significantly with increasing knowledge, perceived benefit, and predisposition levels among respondents. However, when perceived concern increased, the likelihood of utilizing the service dropped significantly. Age, marital status, educational status, profession, residence, and perceived health status were significantly associated with the participants' intention to utilize the telehealth service. Conclusions The influencing aspects of telehealth service utilization should be recognized by the respective authorities. Possible activities to enhance usability among people are also recommended.
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Affiliation(s)
- Humayun Kabir
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Md. Kamrul Hasan
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- Department of Biochemistry and Molecular Biology, Tejgoan College, Dhaka, 1215, Bangladesh
| | - Nahida Akter
- Penn State Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, PA 16802, USA
| | - U Swai Ching Marma
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
- International Organization for Migration, Cox's Bazar, Bangladesh
| | - Tohidul Alam
- International Organization for Migration, Cox's Bazar, Bangladesh
| | | | - Lila Biswas
- CRP Nursing College, Savar, 1343, Bangladesh
| | - Rawshan Ara
- Prime College of Nursing, Dhaka, 1229, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
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Guracho YD, Thomas SJ, Win KT. Smartphone application use patterns for mental health disorders: A systematic literature review and meta-analysis. Int J Med Inform 2023; 179:105217. [PMID: 37748330 DOI: 10.1016/j.ijmedinf.2023.105217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Mobile mental health applications play a significant role in mental health care to fill gaps in care for mental disorders. Despite the growth in mobile phone apps for mental health conditions, patients' mental health smartphone application use, perceived usefulness, and future interest in using apps for mental disorders have not been systematically examined. METHODS The authors designed and conducted this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Articles reporting mobile/smartphone applications used for mental disorders describing ownership, application use, perceived helpfulness, future interest to use, use patterns, and attitudes were included. PubMed/MEDLINE, EMBASE, PsychINFO, Scopus, and Google Scholar were searched. Published articles from 2014 up to October 2022 were included. The methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. The heterogeneity test, publication bias, funnel plots and Egger's test were applied. The outcome was calculated by metaprop command using a random-effects model. RESULTS Ten studies met the eligibility criteria. The pooled prevalence of smartphone ownership, application use for current mental health disorders, perceived usefulness, and future interest in using the app for their mental health problem was 88.63%, 23.29%, 72.80%, and 78.97%, respectively. Heterogeneity and publication bias were detected. CONCLUSIONS The results of this study indicate that despite a considerable number of smartphone users, perceived usefulness, and future interest in using smartphone mental health applications among patients with mental disorders, only about one-fifth use an application for mental health disorders. The results show that there is a large potential to increase the use of apps for patients to support self-care in the growing era of digital mental health. Further research with consumers and mental health professionals is recommended to address barriers and improve mhealth app utilization. REGISTRATION Prospero international prospective register of systematic reviews with ID: CRD42022359416.
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Affiliation(s)
- Yonas Deressa Guracho
- University of Wollongong, Faculty of Engineering and Information Sciences, Wollongong, Australia; Bahir Dar University, College of Medical and Health Sciences, Bahir Dar, Ethiopia.
| | - Susan J Thomas
- University of Wollongong, Faculty of Science Medicine and Health, Wollongong, Australia
| | - Khin Than Win
- University of Wollongong, Faculty of Engineering and Information Sciences, Wollongong, Australia
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Liu P, Li X, Zhang XM. Healthcare professionals' and patients' assessments of listed mobile health apps in China: a qualitative study. Front Public Health 2023; 11:1220160. [PMID: 37780445 PMCID: PMC10538635 DOI: 10.3389/fpubh.2023.1220160] [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: 05/10/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background In recent years, mobile health (mHealth) has gradually developed in China, and intelligent medicine has become an important research topic. However, there are still significant problems in mHealth applications (apps). Although healthcare professionals and patients are the main users, few studies have focused on their perceptions of the quality of mHealth apps. Objective This study aimed to (1) understand the respective perceptions of healthcare professionals and patients regarding mHealth apps, (2) assess what barriers exist that influence the user experience, and (3) explore how to improve the quality of mHealth apps and the development of the mHealth market in China. The study aims to promote the standardization of mHealth apps and provide effective information for the improvement and development of mHealth apps in the future. Methods Semistructured interviews with 9 patients and 14 healthcare professionals were conducted from January 2022 to April 2022 in the Affiliated Hospital of Xuzhou Medical University. The participants used mHealth apps for more than 3 months, including the "Good Mood" and "Peace and Safe Doctors" apps and apps developed by the hospital that were popular in China. Interview transcripts were analysed using thematic analysis. Results The following five themes were extracted: different concerns, hidden medical dangers, distance and insecurity, barriers for older people, and having positive perceptions of mHealth apps. Healthcare professionals prioritized simplicity in regard to mHealth apps, whereas patients rated effectiveness as the most crucial factor. The study also revealed several problems with mHealth apps, including insufficient information about physician qualifications, inaccurate medical content, nonstandard treatment processes, and unclear accountability, which led to a sense of distance and insecurity among participants. Older individuals faced additional obstacles when using mHealth apps. Despite these issues, the participants remained optimistic about the future of mHealth app development. Conclusion The utilization, advantages, and obstacles of mHealth applications for healthcare professionals and patients were explored through semistructured interviews. Despite the promising prospects for mHealth apps in China, numerous issues still need to be addressed. Enhancing the safety monitoring system and developing user-friendly mHealth apps for older adult patients are essential steps to bridge the gap between healthcare providers and patients.
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Affiliation(s)
- PeiYu Liu
- Department of Anesthesia and Operation Room, Nanjing Drum Tower Hospital, Nanjing, China
| | - XueYun Li
- Department of Anesthesia and Operation Room, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xiao Man Zhang
- Department of Nursing, Xuzhou Medical University, Xuzhou, China
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Ester M, Wagoner CW, Dreger J, Chen G, McDonough MH, McNeely ML, Culos-Reed SN. Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial. JMIR Cancer 2023; 9:e47187. [PMID: 37676714 PMCID: PMC10514772 DOI: 10.2196/47187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. OBJECTIVE This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. METHODS This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome-self-reported moderate-to-vigorous PA (MVPA) minutes-and secondary outcomes-objective MVPA minutes and steps and app usability ratings-were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. RESULTS Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). CONCLUSIONS The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. TRIAL REGISTRATION ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cct.2021.106474.
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Affiliation(s)
- Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Chad W Wagoner
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Julianna Dreger
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Data and Analytics, Alberta Health Services, Calgary, AB, Canada
| | | | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
- Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, AB, Canada
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Madi D, Abi Abdallah Doumit M, Hallal M, Moubarak MM. Outlooks on using a mobile health intervention for supportive pain management for children and adolescents with cancer: a qualitative study. BMC Nurs 2023; 22:301. [PMID: 37667338 PMCID: PMC10476416 DOI: 10.1186/s12912-023-01461-z] [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: 04/25/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Considerable improvements in the prognosis of pediatric cancer patients have been achieved over recent decades due to advances in treatment. Nevertheless, as the most common and distressing health issue for pediatrics with cancer, cancer-related pain is still a significant hurdle that impedes patients' journey to recovery, compromises their quality of life, and delays the positive outcome and effectiveness of their treatments. PURPOSE Taking into consideration that acceptability studies are imperative for the design, evaluation, and implementation of healthcare interventions, this study aims to explore pediatric oncology patients' readiness to use a mobile health application that emphasizes social assistance and peer support in addition to conventional pain management methods. DESIGN AND METHODS This study followed the Qualitative description approach. Twelve participants were chosen based on purposive sampling and maximum variation sampling. Interviews were analyzed using the conventional content analysis. RESULTS Analysis of the interviews revealed four major categories: (A) The need for connectedness; (B) An innovative way to connect yet fearful; (C) A 3D approach; (D) Fears of the unfamiliar. CONCLUSIONS This study is the first in Lebanon and the region to undertake an initiative towards introducing technology for pain assessment and management of children with cancer through a dedicated digital platform. The study results attested to the acceptability and potential utilization of this platform by children with cancer. PRACTICE IMPLICATIONS Nurses need to be trained to play an essential role in teaching children with cancer about the significance of social support and assisting them to establish their social support network. Children with cancer are encouraged to voice out their need for help. Our proposed application can create an enabling environment to harness the power of social support and provide children with cancer the opportunity to connect on a deeper level in a supportive and pity-free space.
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Affiliation(s)
- Dina Madi
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | | | - Mohammad Hallal
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maya M Moubarak
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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Bricker JB, Westmaas JL, Ostroff JS, Mull KE, Sullivan BM, Santiago-Torres M. Efficacy of smartphone applications to help cancer patients quit smoking: Protocol of the Quit2Heal randomized controlled trial. Contemp Clin Trials 2023; 129:107180. [PMID: 37040817 PMCID: PMC10283347 DOI: 10.1016/j.cct.2023.107180] [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] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/13/2023]
Abstract
Cigarette smoking is highly prevalent among cancer patients in the United States (US), with up to half of cancer patients smoking at the time of their initial cancer diagnosis. However, evidence-based cessation programs are rarely implemented in oncology care, and smoking is not consistently treated in cancer treatment settings. Consequently, there is an urgent need for accessible and efficacious cessation treatments that are uniquely tailored to the needs of cancer patients. Here we describe the design and implementation of a randomized controlled trial (RCT) testing the efficacy of a smartphone app (Quit2Heal) versus a US Clinical Practice Guidelines-based app (QuitGuide) for smoking cessation among a planned sample of 422 cancer patients. Quit2Heal is designed to address cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting. Quit2Heal is based on the principles of Acceptance and Commitment Therapy, a behavioral therapy that teaches skills for accepting cravings to smoke without smoking, values-driven motivation to quit, and preventing relapse. The primary aim of the RCT is to determine whether Quit2Heal has significantly higher self-reported 30-day point prevalence abstinence at 12 months relative to QuitGuide. The trial will also determine whether Quit2Heal's effect on cessation is (1) mediated by improvements in cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting; and (2) moderated by baseline factors (e.g., cancer type, stage, time since diagnosis). If successful, Quit2Heal will offer a more efficacious, broadly scalable smoking cessation treatment that could be implemented alongside existing oncology care, thereby improving cancer outcomes.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | | | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering, New York City, NY, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
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Báez Gutiérrez N, Rodríguez Ramallo H, Fernández González M, Abdel-Kader Martín L. Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content. JMIR Mhealth Uhealth 2022; 10:e35851. [PMID: 36125860 PMCID: PMC9533204 DOI: 10.2196/35851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/21/2022] [Accepted: 09/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hematological malignancies (HMs) are a heterogeneous group of cancers representing a significant cause of morbidity and mortality. The chronification of HMs and the increasing use of smartphones may lead patients to seek their current unmet needs through mobile health apps. OBJECTIVE The goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs. METHODS A systematic search of apps that were aimed at patients diagnosed with HMs, accessed from a Spain IP address, and were available on the iOS (App Store) and Android (Google Play) platforms was conducted in November 2021. The search terms used were "hematology," "blood cancer," "leukemia," "lymphoma," and "myeloma" apps in English, Spanish, or both languages. The identified apps were downloaded and analyzed independently by 2 reviewers. Information about general app characteristics was collected. The Mobile Application Rating Scale (MARS) was used to assess quality. The resulting parameter of the analyses, the mean score of the apps, was compared by Student t test. RESULTS Overall, 18 apps were identified; 7 were available on Android, 5 were available on iOS, and 6 were available on both platforms. All included apps were free; 3 were published in 2021, and among the apps published before 2021, only 6 were updated in 2021. Most (16/18, 89%) of the apps were aimed at patients with leukemia or lymphoma (16). The primary purposes of the apps were to provide general information about the condition (16/18, 89%) and monitor symptoms and clinical parameters (11/18, 61%). Health care professionals contributed to the development of 50% (9/18) of apps; 6 were owned and supported by scientific societies, and 3 were developed with the participation of health care professionals. The mean MARS score for the overall quality of the apps was 3.1 (SD 1.0). The engagement and aesthetics subscales were the lowest rated subscales, with only 44% (8/18) and 67% (12/18), respectively, of the apps obtaining acceptable scores. None of the included apps proved clinical efficacy through clinical trials in patients with HMs. Statistically significant differences were found in the MARS scores between operating systems (+1.0, P=.003) in favor of iOS apps. The participation of health care professionals in the development of the apps did not have a statistically significant impact on the MARS scores. CONCLUSIONS This systematic search and evaluation identified few acceptable quality mobile apps for patients with HMs. Current and future apps for patients with HMs should provide evidence-based valuable information, improve user engagement, incorporate functions according to patient preferences, and generate evidence regarding the efficacy of app use by patients with HMs.
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11
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Jacob C, Sezgin E, Sanchez-Vazquez A, Ivory C. Sociotechnical Factors Affecting Patients' Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis. JMIR Mhealth Uhealth 2022; 10:e36284. [PMID: 35318189 PMCID: PMC9121221 DOI: 10.2196/36284] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022] Open
Abstract
Background Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. Objective The aim of this review was to systematically investigate the literature to understand the factors affecting patients’ adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). Methods A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. Results The technical factors affecting patients’ adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team’s role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients’ insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions This review builds on the growing body of research that investigates patients’ adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools’ fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption.
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Affiliation(s)
- Christine Jacob
- University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
| | - Emre Sezgin
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,NORC at the University of Chicago, Chicago, IL, United States
| | - Antonio Sanchez-Vazquez
- Innovative Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovative Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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12
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Ester M, McNeely ML, McDonough MH, Culos-Reed SN. A survey of technology literacy and use in cancer survivors from the Alberta Cancer Exercise program. Digit Health 2021; 7:20552076211033426. [PMID: 34422280 PMCID: PMC8370891 DOI: 10.1177/20552076211033426] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background Supervised physical activity interventions can improve cancer survivor quality of life. However, they are resource intensive and may not support physical activity maintenance. Therefore, most cancer survivors remain inactive. Electronic health is a promising tool to support physical activity maintenance, yet technology-based physical activity interventions in oncology have shown mixed effectiveness. We surveyed cancer participants in the Alberta Cancer Exercise program to better understand their experience with technology. Methods Alberta Cancer Exercise participants were invited to complete a survey on technology literacy, usage, and perceived usefulness. Summary statistics were calculated for all variables. Multiple regression examined demographic prediction of technology usage and literacy. Results The response rate was 52.6% (n = 627/1191), with 93.3% survey completion (n = 585/627). Respondents were 60.6 ± 11.0 years old, 96.2% Caucasian, and of high socioeconomic status (83.3% with post-secondary education, 65.5% with income >$60,000). While electronic health literacy was low (mean 1.73 ± 0.73/4), computer (87.6%) and smartphone (87.5%) use was widespread, with 94.6% of smartphone users reporting daily use. One in two respondents used mobile applications or wearable trackers for physical activity, which were perceived as useful by >80% of users. Age and income were significant predictors of technology use and literacy. Conclusions Technology is part of the lives of cancer survivors who engaged in a physical activity program, with mobile devices perceived as useful to support physical activity. However, the present findings highlight a need to increase electronic health literacy via education and tailoring of digital tools. These survey findings are being used to build our patient-centered, technology-supported physical activity interventions.
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Affiliation(s)
- Manuel Ester
- Faculty of Kinesiology, University of Calgary, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, University of Alberta, Canada.,Department of Oncology, University of Alberta, Canada.,Rehabilitation Medicine, Cross Cancer Institute, Canada
| | | | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Canada.,Department of Oncology, Cummings School of Medicine, University of Calgary, Canada.,Department of Psychosocial Resources, Tom Baker Cancer Centre, Canada
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13
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Wang J, Fu Y, Lou V, Tan SY, Chui E. A systematic review of factors influencing attitudes towards and intention to use the long-distance caregiving technologies for older adults. Int J Med Inform 2021; 153:104536. [PMID: 34325206 DOI: 10.1016/j.ijmedinf.2021.104536] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Long-distance caregiving (LDC) technologies play a significant role in enabling distant care and facilitating living-alone older adults to keep socially connected. However, there is scarce research exploring the older adults' attitudes towards and intention to use such technologies. This paper is based on a systematic review of existing literature to explore the multifarious factors influencing independent community-living older adults' attitudes towards and intention to use LDC technologies. METHODS Articles published in English between 2006 and 2020 were reviewed by searching electronic databases of PubMed, ProQuest, EBSCOhost. The inclusion criteria were limited to quantitative, qualitative, or mixed-methods studies that involved: 1) distant caregiving; 2) older adults aged 60 years or above, who were living alone or with only their spouse in the community (even though the samples might also involve other non-older adults); 3) technologies including ICT-based devices, systems, or programs enabling data transmission were used; 4), intention to use or behavioral usage in regard to the technologies were reported or discussed. RESULTS In total, 41 out of 8674 articles were included. Both determinants and moderators of affecting the use of the ICT-based LDC technologies were identified with theoretical guidance. To summarize, there are personal factors involved, such as personality, concerns regarding security and privacy, health conditions, requisite knowledge, financial conditions, and influence from significant others, encompassing formal and informal caregivers; and factors related to the devices, in terms of their user-friendliness and functionality. CONCLUSION This review highlights the importance of striking a good balance between functionality and privacy concerns, besides considering the direct and indirect cost to users. LDC technology education should be promoted at the societal level to facilitate older adults' better understanding of the device utilities by enhancing their technological literacy. Implications for various stakeholders to cope with the challenges of an aging population are also discussed.
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Affiliation(s)
- J Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | - Y Fu
- School of Social Development and Public Policy, Beijing Normal University, North Main Building 2003, 19 Xinjiekou Wai St., Beijing 100875, China.
| | - V Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | - S Y Tan
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore 259772, Singapore.
| | - E Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong.
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14
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Douma JAJ, Zweegman S, Alberts M, Kruyswijk S, van de Donk NCWJ, van Linde M, Buffart LM, Verheul HMW. Smartphone measurements of physical activity and fitness are associated with early trial discontinuation of patients in (hemato)oncology phase I/II clinical trials. Support Care Cancer 2021; 29:3783-3792. [PMID: 33236210 PMCID: PMC8163675 DOI: 10.1007/s00520-020-05902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/16/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patients, who discontinue early, do not benefit from phase I/II clinical trials (early-phase clinical trials (EPCT)). In this study, associations between objective smartphone measurements of physical activity and fitness and early trial discontinuation in patients with cancer participating in EPCT were investigated. METHODS Before start of treatment, physical activity (steps/day) and physical fitness (meters walked in 6 min) were measured with a smartphone, and patient-reported physical function (PRO-PF) was assessed (EORTC QLQ-C30-PF). Early trial discontinuation was defined as discontinuation ≤ 28 days. Univariable logistic regression analyses were performed to study associations of physical activity, fitness, and function with early trial discontinuation. Optimal cutoff values of physical activity and fitness were assessed with ROCs, based on positive predictive values (PPV). RESULTS Median (interquartile range (IQR)) step count was 4263 (2548-6897) steps/day, mean ± standard deviation 6-min walking distance was 477 ± 120 m and median (IQR) PRO-PF score was 83 (67-95) points. Fourteen patients (12%) discontinued the trial early. Smartphone measurements of physical activity in units of 100 steps per day (odds ratio (OR) = 0.96, 95% CI = 0.94-0.99, p = 0.01), physical fitness (OR = 0.99, 95% CI = 0.98-0.99, p < 0.01), and PRO-PF (OR = 0.97, 95% CI = 0.94-1.00, p = 0.03) were associated with early trial discontinuation. Optimal cutoff values were < 900 steps for physical activity and < 285 m for physical fitness. PPV for early trial discontinuation was 100% in patients who walked both < 1500 steps per day and < 300 m in 6 min. CONCLUSIONS Objective smartphone measurements of physical activity and fitness are associated with early trial discontinuation. However, cutoff values should be externally validated in a larger cohort before implementation in clinical practice.
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Affiliation(s)
- Joeri A J Douma
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mieke Alberts
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Sandy Kruyswijk
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Niels C W J van de Donk
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Myra van Linde
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Physiology, Radboudumc, Geert Grooteplein 10, Nijmegen, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Medical Oncology, Radboudumc, Geert Grooteplein 10, Nijmegen, The Netherlands.
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15
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Van Asbroeck S, van Boxtel MPJ, Steyaert J, Köhler S, Heger I, de Vugt M, Verhey F, Deckers K. Increasing knowledge on dementia risk reduction in the general population: Results of a public awareness campaign. Prev Med 2021; 147:106522. [PMID: 33744328 DOI: 10.1016/j.ypmed.2021.106522] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Strategies to reduce dementia risk are needed to minimize the burden of this growing public health concern. Most individuals are not aware that dementia risk reduction is possible, let alone how this could be achieved. Health education, such as public awareness campaigns on the topic of dementia risk reduction, can meet this need. A public health campaign (including social media and offering an online individual risk assessment tool) was carried out over a 7-month period in Flanders, Belgium. Impact was assessed in two independent online surveys, before (n = 1003) and after the campaign (n = 1008), in representative samples of adults aged 40-75 years. Questions regarding personal needs, wishes and barriers were also included. After the campaign, more individuals (10.3%) were aware that dementia risk reduction is possible than before the campaign, and more individuals correctly identified 10 out of 12 surveyed modifiable dementia risk and protective factors. However, no differences were observed in low-educated individuals. Further, specific differences in potential needs, wishes and barriers for future campaigns or interventions were observed between demographic strata. The majority of the respondents (89%) indicated that they would welcome more information on improving their brain-health. More than half (54%) also believed that they lacked the necessary knowledge to make brain-healthy behavior changes. In conclusion, effective public awareness campaigns on the topic of dementia risk reduction are feasible and timely, given the state of the evidence. Special efforts need to be made to develop effective campaigns, tailored towards low-educated individuals.
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Affiliation(s)
- Stephanie Van Asbroeck
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Martin P J van Boxtel
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Jan Steyaert
- Department of Sociology, University of Antwerp, Antwerp, Belgium; The Flanders Centre of Expertise on Dementia, Lokkaardstraat 8, 2018 Antwerp, Belgium.
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Irene Heger
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Marjolein de Vugt
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Frans Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
| | - Kay Deckers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Dr. Tanslaan 12, 6229, ET, Maastricht, the Netherlands.
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Skiba MB, McElfresh JJ, Howe CL, Crane TE, Kopp LM, Jacobs ET, Thomson CA. Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2020; 9:315-327. [DOI: 10.1089/jayao.2019.0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Meghan B. Skiba
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer J. McElfresh
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Carol L. Howe
- University of Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Tracy E. Crane
- Department of Biobehavioral Sciences, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Lisa M. Kopp
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Abstract
Technological advancements in the capabilities of modern smartphones offer tremendous potential to generate big data from small devices that could influence oncologists' decision-making. Here we describe the value of patient-generated health data (PGHD) that can be captured using mobile devices. We comment on the current use of smartphones in oncology clinical research and describe how smartphones will bring big data into the oncology clinic by enabling continuous patient monitoring, information sharing, and personalized clinical decision making in cancer care. Lastly, we describe practical considerations about how we can access and store PGHD in the future, describing how to harness the clinical value of PGHD and comment on the emerging applications for digital biomarkers captured by smartphones.
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18
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Huberty J, Puzia M, Eckert R, Larkey L. Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study. JMIR Cancer 2020; 6:e16926. [PMID: 32039812 PMCID: PMC7055788 DOI: 10.2196/16926] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 01/05/2023] Open
Abstract
Background There is a need for tools to decrease cancer patients’ and survivors’ long-term symptom burden. Complementary strategies, such as meditation, can accompany pharmacologic therapy to improve symptoms. Although support programs with targeted content have wider reach, higher adherence, and greater impact, there are no consumer-based meditation apps designed specifically for cancer. Objective This study aimed to gather information to advise the development of a cancer-specific meditation app in a small convenience sample of cancer patients and survivors who currently use the Calm app. Methods Adult cancer patients and survivors who are Calm users (N=82) were recruited through the Daily Calm Facebook page. Participants completed a Web-based survey related to Calm app use and satisfaction, interest in and ideas for a cancer-specific Calm app, and demographic characteristics. Open-ended responses were inductively coded. Results Participants were aged between 18 and 72 years (mean 48.60 years, SD 15.20), mostly female (77/82, 94%), white (65/79, 82%), and non-Hispanic (70/75, 93%), and reported using Calm at least 5 times per week (49/82, 60%). Although rates of satisfaction with current Calm components were high (between 65/82, 79% and 51/81, 63%), only 49% (40/82) of participants used guided meditations that they felt specifically helped with their cancer-related symptoms and survivorship, and 40% (33/82) would prefer more cancer-related content, with guided meditations for cancer-specific anxieties (eg, fear of recurrence; n=15) and coping with strong emotions (n=12) being the most common suggestions. A majority of participants (51/82, 62%) reported that they would be interested in becoming a member of a Calm cancer community (eg, in-app discussion boards: 41/46, 89%; and social media communities: 35/42, 83%). Almost half of the participants (37/82, 45%) reported that they would benefit from features that tracked symptoms in concurrence with app usage, but respondents were divided on whether this information should be shared with health care providers through the app (49/82, 60% would share). Conclusions Responses suggest ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects.
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Affiliation(s)
- Jennifer Huberty
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Megan Puzia
- Behavioral Research and Analytics, LLC, Salt Lake City, UT, United States
| | - Ryan Eckert
- 3Mays Cancer Center, University of Texas Health MD Anderson, San Antonio, TX, United States
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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19
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Houghton LC, Howland RE, McDonald JA. Mobilizing Breast Cancer Prevention Research Through Smartphone Apps: A Systematic Review of the Literature. Front Public Health 2019; 7:298. [PMID: 31781525 PMCID: PMC6851054 DOI: 10.3389/fpubh.2019.00298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Breast cancer rates have been increasing worldwide, particularly among young women, suggesting important interactions between genes and health behaviors. At the same time, mobile technology, including smartphones applications (apps), has emerged as a new tool for delivering healthcare and health-related services. As of 2018, there were nearly 600 publicly available breast cancer apps designed to provide disease and treatment information, to manage disease, and to raise overall awareness. However, the extent to which apps are incorporated into breast cancer prevention research is unknown. Therefore, the objective of this review was to determine how mobile applications are being used for breast cancer prevention among women across the cancer control continuum. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed and Web of Science Core Collection databases using the keywords breast cancer, smartphone, mobile application, and phone app. Full-length journal articles available in English that addressed the research question were included. We categorized articles by prevention type (primary, secondary, and tertiary) and phase of research (protocol, development, feasibility, pilot, measurement, and effectiveness), and identified common themes and gaps. Results: Our search yielded 82 studies (69 unique) that used apps in breast cancer prevention research across 20 countries. Approximately half of the named apps were publicly available. The majority (73%) of studies targeted tertiary prevention; 15% targeted secondary and 13% targeted primary prevention. Apps were used across all phases of research with the predominant phase being feasibility in tertiary prevention (34%), effectiveness in secondary prevention (63%), and development (30%) and effectiveness (30%) in primary prevention. Common uses included assessing outcomes relevant to clinical care coordination, quality of life, increasing self-efficacy and screening behaviors, and tracking and managing health behaviors. Conclusions: We identified the following gaps: few effectiveness studies in tertiary prevention, minimal use of apps for breast cancer etiology or early detection, and few interventions in those at average risk of breast cancer. These findings suggest that while mobile apps can inform breast cancer prevention across the continuum, more work is needed to incorporate apps into primary prevention.
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Affiliation(s)
- Lauren C. Houghton
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
| | - Renata E. Howland
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Jasmine A. McDonald
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, United States
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Huberty J, Eckert R, Larkey L, Joeman L, Mesa R. Experiences of Using a Consumer-Based Mobile Meditation App to Improve Fatigue in Myeloproliferative Patients: Qualitative Study. JMIR Cancer 2019; 5:e14292. [PMID: 31333197 PMCID: PMC6681641 DOI: 10.2196/14292] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/10/2019] [Accepted: 07/09/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Myeloproliferative neoplasm (MPN) patients suffer from long-term symptoms and reduced quality of life. Mindfulness meditation is a complementary therapy shown to be beneficial for alleviating a range of cancer-related symptoms; however, in-person meditation interventions are difficult for cancer patients to attend. Meditation via a mobile phone app represents a novel approach in MPN patients for delivering meditation. OBJECTIVE The study aimed to report MPN patients' (ie, naïve or nearly naïve meditators) perceptions of meditation and explore their experiences in the context of using a mobile phone for meditation after participation in an 8-week consumer-based meditation app feasibility study. METHODS MPN patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 that received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min per day of mobile phone-based meditation, irrespective of the app and order in which they received the apps. At the conclusion of the study, participants were asked whether they would like to participate in a 20-min phone interview comprising 9 to 10 questions to discuss their perceptions and experiences while using the mobile phone meditation apps. The interviews were transcribed verbatim and imported into NVivo 12 (QSR International) for coding and analysis, using a combination of deductive and inductive methods to organize the data, generate categories, and develop themes and subthemes. RESULTS A total of 48 MPN patients completed postintervention interviews, of which 29% (14/48) of the patients only used the 10% Happier app, 21% (10/48) of the patients only used the Calm app, and 46% (22/48) of the patients used both apps during the 8-week intervention. Themes identified in the analysis of interview data related to (1) perceptions of meditation before, during, and after the study, (2) perceptions of the Calm app, (3) perceptions of the 10% Happier app, (4) perceived impacts of using the meditation apps, (5) overall experiences of participating in the study, (6) recommendations surrounding meditation for other MPN patients, and (7) plans to continue meditation. CONCLUSIONS The qualitative findings of this study suggest that MPN patients who are naïve or nearly naïve meditators perceived mobile phone meditation as enjoyable, preferred the Calm app over the 10% Happier app, perceived the Calm app as more appealing (eg, narrator's voice and different meditations or background sounds offered), and perceived beneficial effects of meditation on mental health, sleep, fatigue, and pain. Future research is needed to better understand the efficacy of mobile phone meditation on MPN patient outcomes and meditation app design features that enhance uptake among its users.
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Affiliation(s)
- Jennifer Huberty
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Ryan Eckert
- Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, TX, United States
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Lynda Joeman
- Lynda Joeman Research Consultancy, Tonbridge, Kent, United Kingdom
| | - Ruben Mesa
- Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, TX, United States
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Nápoles AM, Santoyo-Olsson J, Chacón L, Stewart AL, Dixit N, Ortiz C. Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors. JMIR Cancer 2019; 5:e13543. [PMID: 31290395 PMCID: PMC6647762 DOI: 10.2196/13543] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. OBJECTIVE This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. METHODS The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. RESULTS All women (n=23) were foreign-born with limited English proficiency; 13 (57%) had an elementary school education or less, 16 (70%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83%) completed all 5 coaching calls. The majority (n=17; 81%) rated the overall quality of the app as "very good" or "excellent" (all rated it as at least "good"). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=-.26; P=.02; Cohen d=0.4) and health distress levels (B=-.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). CONCLUSIONS We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors.
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Affiliation(s)
- Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Liliana Chacón
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Anita L Stewart
- Center for Aging in Diverse Communities, Institute for Health and Aging, University of California San Francisco, San Francisco, CA, United States
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco/Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, CA, United States
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Huberty J, Eckert R, Larkey L, Kurka J, Rodríguez De Jesús SA, Yoo W, Mesa R. Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials. JMIR Form Res 2019; 3:e12662. [PMID: 31033443 PMCID: PMC6658299 DOI: 10.2196/12662] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/11/2019] [Accepted: 03/24/2019] [Indexed: 12/20/2022] Open
Abstract
Background Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=−0.43), depression (P=.02; d=−0.38), sleep disturbance (P=.01; d=−0.40), total symptom burden (P=.13; d=−0.27), and fatigue (P=.06; d=−0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=−0.22), depression (P=.09; d=−0.29), sleep disturbance (P=.002; d=−0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=−0.27), and fatigue (P=.13; d=−0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM)
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Affiliation(s)
- Jennifer Huberty
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Ryan Eckert
- Mays Cancer Center, University of Texas Health MD Anderson, San Antonio, TX, United States
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Jonathan Kurka
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | | | - Wonsuk Yoo
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Ruben Mesa
- Mays Cancer Center, University of Texas Health MD Anderson, San Antonio, TX, United States
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23
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Raghunathan NJ, Korenstein D, Li QS, Tonorezos ES, Mao JJ. Determinants of mobile technology use and smartphone application interest in cancer patients. Cancer Med 2018; 7:5812-5819. [PMID: 30280495 PMCID: PMC6246952 DOI: 10.1002/cam4.1660] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/04/2018] [Accepted: 06/14/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Supportive care is a critical component of the treatment of cancer patients that is underutilized; patient lack of information about these services is an important barrier. Mobile technologies may be useful tools for delivering information, but cancer patient use of and interest in using them to learn about supportive care services have not been described. This study evaluates factors associated with cancer patient use of mobile technologies and interest in smartphone applications for information delivery about supportive care. METHODS We conducted a cross-sectional survey among cancer patients from one urban academic hospital and 11 community hospitals. Patients self-reported use of mobile technologies and interest in smartphone applications. Multivariate logistic analysis was used to identify determinants of mobile technology use and smartphone interest. RESULTS Among 631 participants, 466 (74%) reported regular use of mobile devices and 242 (39%) expressed an interest in supportive care information via smartphone applications. Patients under 45 were more likely to use a mobile device (Adjusted Odds Ratio [AOR] 6.8, 2.8-16.9 95% CI, P < 0.001) and were interested in smartphone applications for delivery of information (AOR 3.2, 1.8-5.9 95% CI, P < 0.001). Non-white patients had similar use of mobile technology compared to whites but reported greater interest in smartphone application-based information (AOR 3.4, 2.1-5.5 95% CI, P < 0.001). CONCLUSION Many patients expressed interest in smartphone application-based information about supportive care services, especially those who are younger and non-white. Future studies should investigate the characteristics of patients and smartphones applications that will optimize information delivery through a mobile technology platform.
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Affiliation(s)
| | - Deborah Korenstein
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Qing S. Li
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Emily S. Tonorezos
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
- Department of MedicineWeill Cornell Medical CollegeNew YorkNew York
| | - Jun J. Mao
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
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