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Pross T, Karsten MM, Blohmer JU. From Gaps to Solutions: Semi-Structured Interviews to Identify Care Gaps in Breast Cancer Care and How to Solve Them with Digital Solutions. Geburtshilfe Frauenheilkd 2024; 84:845-854. [PMID: 39229629 PMCID: PMC11368466 DOI: 10.1055/a-2369-1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/17/2024] [Indexed: 09/05/2024] Open
Abstract
Background Standardized treatment pathways should make it easier for medical staff and patients to achieve the best possible individual treatment outcome by making sure all relevant information are taken into consideration. The aim of this paper is to identify gaps in care along the treatment pathway through semi-structured patient interviews. Subsequently, it will be discussed if mobile health applications can close these identified gaps in care. Material and Methods Nine semi-structured interviews of patients with invasive lobular breast cancer were conducted in March 2023 in German at the breast cancer center at Charité Universitätsmedizin Berlin, which were subsequently transcribed word for word and processed using a thematic analysis approach. Results Eight recurring themes are identified in the patient interviews: 1. Limited capacity to absorb information, 2. Discrepancy between information needs and information provision, 3. Need for individual initiative, 4. Uncertainty, 5. not being seen and heard, 6. Patient's desires and suggestions for improvement, 7. Use of mobile health apps, 8. Support through an app for patients. Conclusions The identified gaps in care of breast cancer patients can be largely addressed through the use of digital health solutions after the establishment of regulatory frameworks, thus improving care for patients with early breast cancer. Trial Registration The interviews were done within a registry for which ethical approval was obtained by the Ethics Committee of Charité Universitätsmedizin Berlin EA4/180/17.
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Affiliation(s)
- Therese Pross
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Dang TH, Wickramasinghe N, Jayaraman PP, Burbury K, Alexander M, Whitechurch A, Quinn S, Rowan G, Brooks SL, Schofield P. Safety and adherence to medications and self-care advice in oncology (SAMSON): pilot randomised controlled trial protocol. BMJ Open 2024; 14:e079122. [PMID: 39043598 PMCID: PMC11268069 DOI: 10.1136/bmjopen-2023-079122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION With the increasing use of oral anti-cancer medicines (OAMs), research demonstrating the magnitude of the medication non-adherence problem and its consequences on treatments' efficacy and toxicity is drawing more attention. Mobile phone interventions may be a practical solution to support patients taking OAMs at home, yet evidence to inform the efficacy of these interventions is lacking. The safety and adherence to medications and self-care advice in oncology (SAMSON) pilot randomised control trial (RCT) aims to evaluate the acceptability, feasibility and potential efficacy of a novel digital solution to improve medication adherence (MA) among people with cancer. METHODS AND ANALYSIS This is a two-arm, 12-week, pilot RCT aiming to enrol 50 adults with haematological, lung or melanoma cancers at an Australian metropolitan specialised oncology hospital, who are taking oral anti-cancer medicines. Participants will be randomised (1:1 allocation ratio) to either the intervention group (SAMSON solution) or the control group (usual care). The primary outcomes are the acceptability and feasibility of SAMSON. The secondary outcomes are MA, toxicity self-management, anxiety and depressive symptoms, health-related quality of life, and parameters relating to optimal intervention strategy. Quantitative data will be analysed on a modified intention-to-treat basis. SUMMARY While multicomponent interventions are increasingly introduced, SAMSON incorporates novel approaches to the solution. SAMSON provides a comprehensive, patient-centred, digital MA intervention solution with seamless integration of a mobile platform with clinical consultations that are evidence-based, theory-based, co-designed and rigorously tested. The pilot trial will determine whether this type of intervention is feasible and acceptable in oncology and will provide a foundation for a future full-scale RCT. ETHICS AND DISSEMINATION Primary ethics approvals were received from Peter MacCallum Cancer Centre and Swinburne University of Technology Human Research Ethics Committees (HREC/95332/PMCC and 20237273-15836). Results will be disseminated via peer-reviewed publications and presentations at international and national conferences. TRIAL REGISTRATION NUMBER The protocol has been prospectively registered on the Australian New Zealand Clinical Trials Registry with trial registration number (ACTRN12623000472673).
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Affiliation(s)
- Thu Ha Dang
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Behavioural Sciences Unit, Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Digital Health Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Nilmini Wickramasinghe
- Optus Digital Health, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
- Department Health and Bio Statistics, School of Health Sciences and Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
| | - Prem Prakash Jayaraman
- Factory of the Future and Digital Innovation Lab, Department of Computer Science and Software Engineering, School Software and Electrical Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Kate Burbury
- Digital and Healthcare Innovation, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Tasmanian Health Services, Department of Health, Hobart, Tasmania, Australia
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ashley Whitechurch
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Steve Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Gail Rowan
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sally L Brooks
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, and Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Dang TH, Wickramasinghe N, Forkan ARM, Jayaraman PP, Burbury K, O'Callaghan C, Whitechurch A, Schofield P. Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach. JMIR Cancer 2024; 10:e46979. [PMID: 38569178 PMCID: PMC11024750 DOI: 10.2196/46979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 01/27/2024] [Accepted: 02/14/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. OBJECTIVE The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. METHODS Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. RESULTS The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78%). The app was engaging (18/27, 67%), informative, increased user interactions, and well organized (19/27, 70%). Most of the participants (21/27, 78%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. CONCLUSIONS This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions.
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Affiliation(s)
- Thu Ha Dang
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Digital Cancer Care Innovation, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Nilmini Wickramasinghe
- Department of Health and Bio Statistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Epworth Healthcare, Melbourne, Australia
- Optus Chair Digital Health, La Trobe University, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Abdur Rahim Mohammad Forkan
- Digital Innovation Lab, Department of Computer Science and Software Engineering, School Software and Electrical Engineering, Swinburne University of Technology, Hawthorn, Australia
| | - Prem Prakash Jayaraman
- Factory of the Future and Digital Innovation Lab, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Kate Burbury
- Digital and Healthcare Innovation, Peter McCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Clare O'Callaghan
- Caritas Christi and Psychosocial Cancer Care, St Vincent's Hospital, Melbourne, Australia
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Ashley Whitechurch
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Digital Cancer Care Innovation, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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Di Bello F, di Mauro E, Fusco GM, Falcone A, Pezone G, Ruvolo CC, Califano G, Fraia A, Passaro F, Pepillo F, Ranieri A, Alvino P, Mastrangelo F, Turco C, Cirillo L, Franzese CA, La Rocca R, Creta M, Longo N, Napolitano L. A mobile health application for prostate cancer antigen dosage: is it time to say goodbye to classic screening methods? Eur J Cancer Prev 2024; 33:87-94. [PMID: 38051582 DOI: 10.1097/cej.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To evaluate the quality of apps for prostate cancer antigen (PSA) dosage, available for downloading on the iOS and Android platforms, discussing the potential role of mobile health applications (MHAs) in update the screening protocol. METHODS An observational cross-sectional descriptive study of all smartphone apps for PSA dosage was performed through the most used platforms (iOS and Android). On 10 February 2023, a total of 457 apps were found according to the search criteria. Mobile Application Rating Scale (MARS) was adopted to assess apps' quality. Then, MARS items were analyzed through descriptive statistics and bivariate correlations between study variables with Pearson's coefficient. RESULTS Of all samples, 24 MHAs were included in the final analysis: 12% (n = 3) from the iTunes App Store and 88% (n = 21) from the Google Play Store. According to the MARS quality assessment, the mean values 2.61, 2.94, 3.11, 2.97, 2.94, and 2.63 were measured for the engagement, functionality, aesthetics, information, overall mean score, and subjective quality, respectively. CONCLUSION The MHAs for PSA were under the acceptability threshold and future improvements are required. Moreover, MHAs appropriately developed could play an active role in PSA screening campaign and adherence of follow-up regimens. Finally, the virtual instrument could both reduce the social divide of access to care for patients in rural areas and improve PCA detection, speeding up the active treatment.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Ernesto di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Giovanni Maria Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Alfonso Falcone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Francesco Passaro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Francesco Pepillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Alessandro Ranieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Pierluigi Alvino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Francesco Mastrangelo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Carmine Turco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | | | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II'
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Alvarez SJA, Pencheva B, Westfall E, Mwalija C, Parsell M, Greenleaf M, Porter CC, Lam WA, Mannino RG, Mitchell SG. A novel mobile health application to support cancer surveillance needs of patients and families with cancer predisposition syndromes. Pediatr Blood Cancer 2023; 70:e30537. [PMID: 37415085 PMCID: PMC11075126 DOI: 10.1002/pbc.30537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/24/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND At least 5%-10% of malignancies occur secondary to an underlying cancer predisposition syndrome (CPS). For these families, cancer surveillance is recommended with the goal of identifying malignancy earlier, in a presumably more curable form. Surveillance protocols, including imaging studies, bloodwork, and procedures, can be complex and differ based on age, gender, and syndrome, which adversely affect adherence. Mobile health (mHealth) applications (apps) have been utilized in oncology and could help to facilitate adherence to cancer surveillance protocols. METHODS Applying a user-centered mobile app design approach, patients with a CPS and/or primary caregivers were interviewed to identify current methods for care management and barriers to compliance with recommended surveillance protocols. Broad themes from these interviews informed the design of the mobile app, HomeTown, which was subsequently evaluated by usability experts. The design was then converted into software code in phases, evaluated by patients and caregivers in an iterative fashion. User population growth and app usage data were assessed. RESULTS Common themes identified included general distress surrounding surveillance protocol scheduling and results, difficulty remembering medical history, assembling a care team, and seeking resources for self-education. These themes were translated into specific functional app features, including push reminders, syndrome-specific surveillance recommendations, ability to annotate visits and results, storage of medical histories, and links to reliable educational resources. CONCLUSIONS Families with CPS demonstrate a desire for mHealth tools to facilitate adherence to cancer surveillance protocols, reduce related distress, relay medical information, and provide educational resources. HomeTown may be a useful tool for engaging this patient population.
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Affiliation(s)
- Santiago J Arconada Alvarez
- Emory University School of Medicine, Atlanta, Georgia, USA
- AppHatchery, Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, USA
| | - Bojana Pencheva
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Eleanor Westfall
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Comfort Mwalija
- Global Health Informatics Institute, Lilongwe Malawi
- AppHatchery, Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, USA
| | - Maren Parsell
- Emory University School of Medicine, Atlanta, Georgia, USA
- AppHatchery, Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, USA
| | - Morgan Greenleaf
- Emory University School of Medicine, Atlanta, Georgia, USA
- AppHatchery, Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, USA
| | - Christopher C Porter
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wilbur A Lam
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- AppHatchery, Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, USA
| | - Robert G Mannino
- Emory University School of Medicine, Atlanta, Georgia, USA
- AppHatchery, Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, USA
| | - Sarah G Mitchell
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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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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Ralph JE, Sezgin E, Stanek CJ, Landier W, Pai ALH, Gerhardt CA, Skeens MA. Improving medication adherence monitoring and clinical outcomes through mHealth: A randomized controlled trial protocol in pediatric stem cell transplant. PLoS One 2023; 18:e0289987. [PMID: 37590237 PMCID: PMC10434937 DOI: 10.1371/journal.pone.0289987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
Medication non-adherence rates in children range between 50% and 80% in the United States. Due to multifaceted outpatient routines, children receiving hematopoietic stem cell transplant (HCT) are at especially high risk of non-adherence, which can be life-threatening. Although digital health interventions have been effective in improving non-adherence in many pediatric conditions, limited research has examined their benefits among families of children receiving HCT. To address this gap, we created the BMT4me© mobile health app, an innovative intervention serving as a "virtual assistant" to send medication-taking reminders for caregivers and to track, in real-time, the child's medication taking, barriers to missed doses, symptoms or side effects, and other notes regarding their child's treatment. In this randomized controlled trial, caregivers will be randomized to either the control (standard of care) group or the intervention (BMT4me© app) group at initial discharge post-HCT. Both groups will receive an electronic adherence monitoring device (i.e., medication event monitoring system "MEMS" cap, Medy Remote Patient Management "MedyRPM" medication adherence box) to store their child's immunosuppressant medication. Caregivers who agree to participate will be asked to complete enrollment, weekly, and monthly parent-proxy measures of their child's medication adherence until the child reaches Day 100 or complete taper from immunosuppression. Caregivers will also participate in a 15 to 30-minute exit interview at the conclusion of the study. Descriptive statistics and correlations will be used to assess phone activity and use behavior over time. Independent samples t-tests will examine the efficacy of the intervention to improve adherence monitoring and reduce readmission rates. The primary expected outcome of this study is that the BMT4me© app will improve the real-time monitoring and medication adherence in children receiving hematopoietic stem cell transplant following discharge, thus improving clinical outcomes.
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Affiliation(s)
- Jessica E. Ralph
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Emre Sezgin
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Charis J. Stanek
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Wendy Landier
- University of Alabama Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Ahna L. H. Pai
- Cincinnati Children’s Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Micah A. Skeens
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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Niemann A, Hüer T, Neumann A, Wasem J, Schnell-Inderst P, Neusser S. Evaluation criteria for health apps supporting medication adherence in early-stage technology development - a scoping review. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2023; 21:Doc03. [PMID: 37260918 PMCID: PMC10227643 DOI: 10.3205/000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 06/02/2023]
Abstract
Introduction Health apps offer an approach to improve the patients' management of their medication. Although the Digital Healthcare Act (DVG) has created a claim in the statutory health insurance (SHI), the large number of health apps available and their varying quality make it difficult for service providers and especially for medical laypersons to select an adequate high-quality medication app. Manufacturers need guidance for the development of high-quality apps right from the start. Various general evaluation concepts for health apps have been available to date. However, the requirements that should be met by healthcare depend largely on the field of application and the type of apps. This article aims to provide an overview of the international evidence on specific criteria for the evaluation of medication apps. Methods Within the framework of a scoping review, a systematic search was conducted in PubMed and EMBASE on January 29, 2020. The search was limited to publications from 2007 onwards as well as to English and German articles. Additionally, a semi-systematic research of reference lists of the previously included articles as well as a structured search of websites of relevant stakeholders were conducted. Inclusion criteria were the following: the publication deals with health apps that can be used on smartphones and focus on supporting medication intake; the publication does not refer to evaluation criteria for a single app exclusively. The included publications were examined in a qualitative content analysis searching for evaluation criteria and categorizing them according to the framework criteria of the DVG and the Digital Health Applications Ordinance (DiGAV). Results 2,542 articles were identified in the systematic search (999 in PubMed, 1,543 in EMBASE, 560 duplicates). A total of 16 studies met the inclusion criteria. The semi-systematic research and the structured search identified one further study. A catalog of criteria was developed based on the included 17 studies. This catalog covers the general topics "patient orientation" (data protection and security, consumer protection, user friendliness) and "quality/core functions of medication apps" (reminder, self-monitoring, (drug) information, motivation to change behavior, drug/patient safety, robustness) as well as "interoperability/cooperation". Due to its specific importance for medication apps, the subcategory "motivation for behavioral change" stands out beneath the general topic "quality/core functions of medication apps". This category aims to evaluate the design of individual functions with regard to their potential to actually change the behavior of app users. Discussion The criteria for the evaluation of health apps mentioned in the DiGAV intersected with the criteria identified in the literature research. However, the area of positive health care effects was hardly covered by the included studies. In the development of the criteria catalog, it was not possible to weight the identified criteria. Therefore, the catalog should be understood as a supporting checklist for service providers, manufacturers, and/or users. Conclusions A large variety of possible evaluation criteria for medication apps could be shown. Future research should focus on the possibilities of weighting these diverse evaluation criteria, using not only clinical studies but also methods to identify preferences.
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Affiliation(s)
- Anja Niemann
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Theresa Hüer
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
| | - Silke Neusser
- Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany
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Yang S, Bui CN, Park K. Mobile Health Apps for Breast Cancer: Content Analysis and Quality Assessment. JMIR Mhealth Uhealth 2023; 11:e43522. [PMID: 36821352 PMCID: PMC9999256 DOI: 10.2196/43522] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/11/2022] [Accepted: 02/10/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required. OBJECTIVE The purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians. METHODS Based on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords "breast cancer" in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively. RESULTS The initial search identified 1148 apps, 69 (6%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001). CONCLUSIONS The quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes.
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Affiliation(s)
- Seongwoo Yang
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Cam Nhung Bui
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Republic of Korea
| | - Kyounghoon Park
- HERINGS, The Institute of Advanced Clinical & Biomedical Research, Seoul, Republic of Korea
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10
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Cirillo L, Manfredi C, Barone B, Morgera V, Cacace G, Mastrangelo F, Di Bello F, Abate M, Arcaniolo D, Spirito L, Crocetto F, La Rocca R, Creta M, Calace FP, Fusco GM, Napolitano L. Mobile health applications in kidney stone disease management: A reliable support for patients? Arch Ital Urol Androl 2023; 95:11076. [PMID: 36924375 DOI: 10.4081/aiua.2023.11076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Mobile health applications (MHAs) represent an interesting issue to assist and improve the quality of life of patients affected by Kidney Stone Disease (KSD). Despite this, their scientific quality and adherence to guidelines are not yet addressed. MATERIAL AND METHODS On 2 November 2022, we conducted an observational cross-sectional descriptive study of all MHAs on KSD. A search in the Apple App Store and Google Play Store was performed. We reviewed all mobile apps from Apple App Store and Google Play Store for KSD and evaluated their usage in screening, prevention, management, and adherence to EAU guidelines. RESULTS In total 13 MHA were included in the final analysis. All MHAs, 4 (30.8%) from the Apple App Store and 9 (69.2%) from the Google Play Store are geared towards the patient. Engagement ranged from 1.73 to 4.06; Functionality ranged from 3.17 to 4.75; Aesthetics ranged from 1.9 to 4.12; Information ranged from 2.25 to 4.27, and Subjective quality ranged from 1.58 to 3.23. MHAs reported low and medium adherence to EAU guidelines. CONCLUSIONS MHAs provide a very useful assistance in several medical fields, including KSD. Despite MHAs development is constantly increasing, the scientific validation, content, and quality are not yet solved. Future research is necessary to improve the quality of the apps and promote new user designed, and high-quality apps.
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Affiliation(s)
- Luigi Cirillo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Biagio Barone
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Vincenzo Morgera
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Gianluigi Cacace
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Francesco Mastrangelo
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Francesco Di Bello
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Marco Abate
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Felice Crocetto
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Roberto La Rocca
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Massimiliano Creta
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Francesco Paolo Calace
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Giovanni Maria Fusco
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
| | - Luigi Napolitano
- Unit of Urology, Department of Neurosciences, Reproductive Sciences, and Odontostomatology University of Naples "Federico II", Naples.
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11
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McGrady ME, Schwartz LE, Noser AE, Klages KL, Sweenie R, Breen G, Ramsey RR. Systematic Evaluation of the Behavior Change Techniques and Quality of Commercially Available Cancer Self-Management Apps. JCO Oncol Pract 2023; 19:e228-e237. [PMID: 36446046 PMCID: PMC9970297 DOI: 10.1200/op.22.00491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Apps have the potential to aid in cancer self-management, but there is limited guidance available for selecting among currently available options. The purpose of this study is to evaluate the behavior change techniques (BCTs) and quality of publicly available cancer self-management apps. METHODS Cancer self-management apps were identified from the Apple and Google Play stores in April 2022. Trained study team members coded the BCTs included in each app and rated its quality using the Mobile App Rating Scale (MARS). BCTs supported by previous literature were coded as cancer management BCTs. RESULTS The 39 apps meeting inclusion criteria included an average of 5.85 BCTs (standard deviation [SD], 3.49; range, 0-15) and 3.54 cancer management BCTs (SD, 1.90; range, 0-8). The most commonly included BCTs were educational or informational strategies: provide information about behavior-health link, provide instruction, and provide information on consequences. The overall app quality ranged from 1.69 to 4.20 (M, 3.29; SD, 0.67). CONCLUSION No cancer self-management apps were of excellent quality, and less than half included multiple cancer management BCTs beyond education. Clinical implications are discussed, and opportunities to improve the content and quality of apps to address the critical self-management needs of patients diagnosed with cancer are highlighted.
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Affiliation(s)
- Meghan E. McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Laura E. Schwartz
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy E. Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kimberly L. Klages
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachel Sweenie
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gabriella Breen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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12
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Vercell A, Gasteiger N, Yorke J, Dowding D. Patient-facing cancer mobile apps that enable patient reported outcome data to be collected: A systematic review of content, functionality, quality, and ability to integrate with electronic health records. Int J Med Inform 2023; 170:104931. [PMID: 36462398 DOI: 10.1016/j.ijmedinf.2022.104931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/30/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Enabling cancer patients to self-manage symptoms through mobile applications can result in more informed, autonomous patients who are partners in their care, consequently reducing the burden on health services. Electronic patient reported outcomes completed before a clinical review can increase the frequency and quality of holistic assessments, while integration into electronic health records can maximise clinical utility. The ability of apps to integrate with electronic health records is key to providing a real-time interface between patient reports and healthcare response. This review identifies patient-facing cancer apps which can record patient reported outcomes, and explores their purpose, functionality, quality, and ability to integrate with electronic health records. METHODS A systematic app review and content synthesis was conducted on patient-facing cancer apps available in the United Kingdom. Where applicable, the review aligned with the Preferred Reporting Items for Systematic Reviews and meta-Analysis. Two validated scales assessed functionality and quality: The IMS Institute for Healthcare Informatics functionality score and the Mobile App Rating Scale. Flesch-Kincaid metrics explored readability. RESULTS Apple App and Google Play stores identified 405 apps, of which 12 met the eligibility criteria. All were free to download, 1 (8%) had in-app purchases/subscriptions. Nine (75%) were affiliated with a professional health body/charity. Six (50%) analysed inputted data and provided medical advice based on answers. The average Flesch Reading Ease score was 42.7 out of 100. The apps had an average of 7.3 functions each and a mean MARS score of 4/5. None integrated with electronic health records. CONCLUSION While many cancer apps exist, few enable patient reported outcomes to be recorded and shared with clinicians in real-time. Further research is warranted to explore the feasibility of integrating with electronic health records, as this function can improve patient experience and outcomes, and increase efficiency of hospital resources through more proactive care.
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Affiliation(s)
- Amy Vercell
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom; Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
| | - Norina Gasteiger
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom; Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom; Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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13
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Vilasi A, Panuccio VA, Morante S, Villa A, Versace MC, Mezzatesta S, Mercuri S, Inguanta R, Aiello G, Cutrupi D, Puglisi R, Capria S, Li Vigni M, Tripepi G, Torino C. Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36766. [PMID: 38935948 PMCID: PMC11135230 DOI: 10.2196/36766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. OBJECTIVE With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. METHODS The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. RESULTS The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. CONCLUSIONS Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.
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Affiliation(s)
- Antonio Vilasi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | | | | | - Sabrina Mezzatesta
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | - Giuseppe Aiello
- Department of Engineering, University of Palermo, Palermo, Italy
| | - Demetrio Cutrupi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Salvatore Capria
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Giovanni Tripepi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
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14
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Napolitano L, Cirillo L, Fusco GM, Abate M, Falcone A, Morgera V, Cacace G, De Luca L, Reccia P, Mirone C, Crocetto F, Celentano G, Morra S, Barone B, Imbimbo C, Longo N, Mirone V, La Rocca R. Premature ejaculation in the era of mobile health application: A current analysis and evaluation of adherence to EAU guidelines. Arch Ital Urol Androl 2022; 94:328-333. [DOI: 10.4081/aiua.2022.3.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction: Several mobile health applications (MHAs) have been developed to assist and improve the quality of life of patients affected by premature ejaculation, but the scientific quality and adherence to guidelines are not yet addressed. Materials and methods: On 25 May 2022, we conducted a search in the Apple App Store and Google Play Store. We reviewed all mobile apps from Apple App Store and Google Play Store for premature ejaculation and evaluated their usage in screening, prevention, management, and adherence to EAU guidelines. Results: In total 9 MHA were reviewed. All MHAs are geared towards the patient and provide information about diagnoses and treatment of PE. The mean score were 2.87, 3.69, 2.77, 2.55, 2.86 for Engagement, Functionality, Aesthetics, Information, and Subjective quality respectively. MHAs reported low and medium adherence to EAU guidelines. Conclusions: MHAs provide different services in many medical fields, including male sexual dysfunction. Their development is constantly increasing, but the problems of scientific validation, content, and quality are not yet solved. Much future research is necessary to improve the quality of the apps and promote new user designed, and high-quality apps.
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15
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Pyke-Grimm KA, Franck LS, Halpern-Felsher B, Goldsby RE, Rehm RS. Day-to-Day Decision Making by Adolescents and Young Adults with Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:290-303. [PMID: 35538622 PMCID: PMC9807778 DOI: 10.1177/27527530211068718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.
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Affiliation(s)
- Kimberly A. Pyke-Grimm
- Stanford Children's Health, Department of Nursing Research and
Evidence-Based Practice, Palo Alto, CA, USA,Division of Hematology/Oncology, Department of Pediatrics, Stanford
University School of Medicine,Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA,Kimberly A. Pyke-Grimm, PhD, RN, CNS,
CPHON, Department of Nursing Research and Evidence-Based Practice, Stanford
Children's Health, 750 Welch Road, Palo Alto, CA 94304, USA.
| | - Linda S. Franck
- Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | | | - Roberta S. Rehm
- Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA,*Professor Emeritus
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16
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Sunjaya AP, Sengupta A, Martin A, Di Tanna GL, Jenkins C. Efficacy of self-management mobile applications for patients with breathlessness: Systematic review and quality assessment of publicly available applications. Respir Med 2022; 201:106947. [DOI: 10.1016/j.rmed.2022.106947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
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17
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Jones C, Venable JR. Theory-Based Problem Formulation and Ideation in mHealth. J ORGAN END USER COM 2022. [DOI: 10.4018/joeuc.289434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reports on an investigation into how to improve problem formulation and ideation in Design Science Research (DSR) within the mHealth domain. A Systematic Literature Review of problem formulation in published mHealth DSR papers found that problem formulation is often only weakly performed, with shortcomings in stakeholder analysis, patient-centricity, clinical input, use of kernel theory, and problem analysis. The study proposes using Coloured Cognitive Mapping for DSR (CCM4DSR) as a tool to improve problem formulation in mHealth DSR. A case study using CCM4DSR found that using CCM4DSR provided a more comprehensive problem formulation and analysis, highlighting aspects that, until CCM4DSR was used, weren’t apparent to the research team and which served as a better basis for mHealth feature ideation.
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18
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Thomas TH, Go K, Go K, McKinley NJ, Dougherty KR, You KL, Lee YJ. Empowerment through technology: A systematic evaluation of the content and quality of mobile applications to empower individuals with cancer. Int J Med Inform 2022; 163:104782. [PMID: 35525126 PMCID: PMC9130924 DOI: 10.1016/j.ijmedinf.2022.104782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/13/2022] [Accepted: 04/24/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Greater emphasis on patient empowerment has led to a plethora of mobile health applications aimed at empowering patients with cancer. However, the rigor and evidence of these apps are rarely acknowledged. This systematic review of patient empowerment apps describes the characteristics, quality, heuristics, and evidence supporting these apps. MATERIALS AND METHODS We identified commercially available apps through the Apple and Google Play stores using patient- and research-derived conceptualizations of patient empowerment. Three authors used the Mobile App Rating Scale, heuristics, readability, user ratings, and evidence to evaluate the apps' foci, features, and quality. App characteristics were summarized with descriptive analyses. RESULTS Twelve apps met the eligibility criteria and were analyzed. Apps' content focused on enhancing communication skills (n = 10, 83.3%), social support (n = 8, 66.7%), information about cancer and treatment (n = 8, 66.7%), and peer-to-peer support (n = 5, 41.7%). The mean objective (3.9 ± 0.5 out of 5) and subjective (3.7 ± 1.0 out of 5) quality scores were moderate to high. Most heuristics were not violated, and the mean reading level was 10th grade, which is above the recommended 8th grade level. Four apps had been evaluated in published research articles. DISCUSSION The contents of patient empowerment apps varied greatly, and the readability was exclusionary to the average reader. Apps. CONCLUSION Patient empowerment apps should be more rigorously designed and tested to ensure the apps are usable and beneficial to diverse groups of cancer survivors.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA; Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
| | - Kailey Go
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA.
| | - Kelsey Go
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA.
| | - Natalie Jane McKinley
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA.
| | - Kayla R Dougherty
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA.
| | - Kai-Lin You
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA.
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261, USA.
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Linder LA, Newman A, Bernier Carney KM, Wawrzynski S, Stegenga K, Chiu YS, Jung SH, Iacob E, Lewis M, Linder C, Fox K, Altizer R. Symptoms and daily experiences reported by children with cancer using a game-based app. J Pediatr Nurs 2022; 65:33-43. [PMID: 35490550 PMCID: PMC10405915 DOI: 10.1016/j.pedn.2022.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/18/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mobile health (mHealth) resources, including apps, are emerging as resources to support children in tracking symptoms and other health-related data. The purpose of this study was to describe symptoms and daily experiences reported by elementary school-age children receiving treatment for cancer using the newly developed Color Me Healthy app. DESIGN AND METHODS Participants in this descriptive study were children 6-12 years of age, who were receiving cancer treatment at a free-standing children's hospital in the Intermountain West of the United States. Children were requested to use the app for at least five days between clinical visits. Children's app-reported data were extracted from individual user accounts for analysis. Quantitative data were summarized descriptively. Qualitative data were summarized using qualitative content analysis. RESULTS Nineteen children (6-12 years; median 8 years; 7 females) completed 107 days of app use. All children reported symptoms at least once, and 14 reported at least one day with a symptom of moderate or greater severity. Daily experiences reported through the app reflected children's engagement in usual childhood experiences while also describing life with cancer, including symptoms. CONCLUSIONS Elementary school-age children are capable of self-reporting symptoms using a symptom reporting app, providing preliminary evidence for the potential benefits and clinical relevance of mHealth resources to support health outcomes within this population. PRACTICE IMPLICATIONS Clinicians should anticipate and support ongoing symptom management needs between clinical visits. Children's self-reported data can promote a person-centered approach to symptom assessment and management.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Amy Newman
- College of Nursing, Marquette University, 530 N 16(th) St., Milwaukee, WI 53233, USA
| | - Katherine M Bernier Carney
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; University of Connecticut School of Nursing, 231 Glenbrook Rd., Unit 4026, Storrs, CT 06269-4026, USA
| | - Sarah Wawrzynski
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kristin Stegenga
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Yin-Shun Chiu
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Se-Hee Jung
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Melina Lewis
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Huntsman Cancer Hospital, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Caitlin Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Kaitlyn Fox
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd, SN-ADM, Portland, OR 97239-2941, USA
| | - Roger Altizer
- Population Health Science, Entertainment Arts and Engineering, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
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20
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Evaluation of mobile health applications for cervical cancer in the digital marketplace. Obstet Gynecol Sci 2022; 65:244-255. [PMID: 35381627 PMCID: PMC9119733 DOI: 10.5468/ogs.22037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/28/2022] [Indexed: 11/08/2022] Open
Abstract
Objective To assess the quality of mobile health (mHealth) applications (apps) for cervical cancer using the mobile app rating scale (MARS), APPLICATIONS scoring system, and app rating using specific statements. Methods We searched for cervical cancer apps on two major mobile operating systems (Google Play Store and Apple iTunes Store) in March 2021. Eligible apps were downloaded and assessed for quality by two independent reviewers using multimodal assessment tools. Results The overall quality of the MARS score was 2.61±0.795. The highest scoring app was “The American Society for Colposcopy and Cervical Pathology (ASCCP) Management Guidelines” (3.98). Overall, apps scored highest in the functionality domain, followed by information, engagement, and aesthetics domains. The mean±standard deviation of the APPLICATIONS scoring system was 8.50±1.712. The highest-rated apps were “ASCCP Management Guidelines,” “The British Society for Colposcopy and Cervical Pathology (BSCCP),” and “Cervical Cancer Guide.” Apps scored the highest in the paid subscription and price domains. By contrast, apps scored poorly in the text search, literature, and subjective presentation domains. Concerning app content, many apps infrequently provided misconceptions regarding cervical cancer. The apps’ rating using specific statements was 7.81±4.562. Conclusion Overall, the apps analyzed using the MARS and APPLICATIONS scoring systems demonstrated above-average quality. However, there is a need to improve the essential information conveyed by these applications. Moreover, the assessment tools have influenced different app quality rating results, confirming the lack of standardized quality assessment tools for mHealth apps.
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Dang TH, Forkan ARM, Wickramasinghe N, Jayaraman PP, Alexander M, Burbury K, Schofield P. Investigation of Intervention Solutions to Enhance Adherence to Oral Anticancer Medicines in Adults: Overview of Reviews. JMIR Cancer 2022; 8:e34833. [PMID: 35475978 PMCID: PMC9096640 DOI: 10.2196/34833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/26/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to anticancer medicines is critical for the success of cancer treatments; however, nonadherence remains challenging, and there is limited evidence of interventions to improve adherence to medicines in patients with cancer. OBJECTIVE This overview of reviews aimed to identify and summarize available reviews of interventions to improve adherence to oral anticancer medicines in adult cancer survivors. METHODS A comprehensive search of 7 electronic databases was conducted by 2 reviewers who independently conducted the study selection, quality assessment using the A Measurement Tool to Assess Systematic Reviews 2, and data extraction. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was adapted to report the results. RESULTS A total of 29 reviews were included in the narrative synthesis. The overall quality of the systematic reviews was low. The 4 main strategies to promote adherence were focused on education, reminders, behavior and monitoring, and multicomponent approaches. Digital technology-based interventions were reported in most reviews (27/29, 93%). A few interventions applied theories (10/29, 34%), design frameworks (2/29, 7%), or engaged stakeholders (1/29, 3%) in the development processes. The effectiveness of interventions was inconsistent between and within reviews. However, interventions using multiple strategies to promote adherence were more likely to be effective than single-strategy interventions (12/29, 41% reviews). Unidirectional communication (7/29, 24% reviews) and technology alone (11/29, 38% reviews) were not sufficient to demonstrate improvement in adherence outcomes. Nurses and pharmacists played a critical role in promoting patient adherence to oral cancer therapies, especially with the support of digital technologies (7/29, 24% reviews). CONCLUSIONS Multicomponent interventions are potentially effective in promoting patient adherence to oral anticancer medicines. The seamless integration of digital solutions with direct clinical contacts is likely to be effective in promoting adherence. Future research for developing comprehensive digital adherence interventions should be evidence-based, theory-based, and rigorously evaluated.
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Affiliation(s)
- Thu Ha Dang
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Behavioural Sciences Unit, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Abdur Rahim Mohammad Forkan
- Digital Innovation Lab, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Department Health and Bio Statistics, School of Health Sciences and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
- Epworth Healthcare, Melbourne, Australia
| | - Prem Prakash Jayaraman
- Digital Innovation Lab, School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Australia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Kate Burbury
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Digital and Healthcare Innovation, Peter McCallum Cancer Centre, Melbourne, Australia
| | - Penelope Schofield
- Behavioural Sciences Unit, Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
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22
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Narrillos-Moraza Á, Gómez-Martínez-Sagrera P, Amor-García MÁ, Escudero-Vilaplana V, Collado-Borrell R, Villanueva-Bueno C, Gómez-Centurión I, Herranz-Alonso A, Sanjurjo-Sáez M. Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale. JMIR Mhealth Uhealth 2022; 10:e32826. [PMID: 35171109 PMCID: PMC8892317 DOI: 10.2196/32826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions. Objective The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS). Methods We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen κ coefficient. Results We identified 2100 apps in the initial search, and 4.19% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61% (54/88) were available on Android, 30% (26/88) were available on iOS, and 9% (8/88) were available on both platforms. Moreover, 7% (6/88) required payment, and 49% (43/88) were updated in the last year. Only 26% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68%), followed by preventive (23/88, 26%) and diagnostic (5/88, 6%). Most of the apps were intended for patients with anemia (23/88, 26%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78). Conclusions There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality.
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Affiliation(s)
| | | | | | | | | | | | | | - Ana Herranz-Alonso
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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23
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Scholz S, Teetz L. Smart health via mHealth? Potentials of mobile health apps for improving prevention and adherence of breast cancer patients. Digit Health 2022; 8:20552076221074127. [PMID: 35096411 PMCID: PMC8796094 DOI: 10.1177/20552076221074127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/27/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Today there are several health and medical apps (mHealth) in app stores. Germany is the world's first country that introduced apps paid by the regular health insurance service. Even though breast cancer is the most common cancer in women, mHealth for breast cancer has been largely unexplored. Methods A total of 33 apps from two major mobile application marketplaces (Google Play Store/Android; App Store/iOS) have been selected for analysis. Results The app analysis shows that there are currently only 10 mHealth apps in German, which are specifically dedicated to breast cancer patients. The features of these apps fall into two categories: improvement of health literacy and indirect intervention. These apps can be used for all phases of the patient journey starting with the diagnosis. Conclusions mHealth apps have the potential to support the adherence of breast cancer patients. In order to exploit this future potential, the app quality, as well as the information about the available apps, must be urgently improved. Currently, it is very difficult both for laypersons and for doctors/other therapists to identify high-quality apps. Guidance from independent or governmental institutions would be helpful to further the digitalization in health care.
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Affiliation(s)
- Stefanie Scholz
- SRH Fuerth University of Applied Sciences, Fuerth, Bayern, Germany
| | - Laura Teetz
- Sanacorp Pharmahandel GmbH (former: Bamberg University), Bamberg, Bayern, Germany
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24
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Woulfe F, Fadahunsi KP, Smith S, Chirambo GB, Larsson E, Henn P, Mawkin M, O' Donoghue J. Identification and Evaluation of Methodologies to Assess the Quality of Mobile Health Apps in High-, Low-, and Middle-Income Countries: Rapid Review. JMIR Mhealth Uhealth 2021; 9:e28384. [PMID: 34636737 PMCID: PMC8548973 DOI: 10.2196/28384] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, there has been rapid growth in the availability and use of mobile health (mHealth) apps around the world. A consensus regarding an accepted standard to assess the quality of such apps has yet to be reached. A factor that exacerbates the challenge of mHealth app quality assessment is variations in the interpretation of quality and its subdimensions. Consequently, it has become increasingly difficult for health care professionals worldwide to distinguish apps of high quality from those of lower quality. This exposes both patients and health care professionals to unnecessary risks. Despite progress, limited understanding of the contributions of researchers in low- and middle-income countries (LMICs) exists on this topic. Furthermore, the applicability of quality assessment methodologies in LMIC settings remains relatively unexplored. OBJECTIVE This rapid review aims to identify current methodologies in the literature to assess the quality of mHealth apps, understand what aspects of quality these methodologies address, determine what input has been made by authors from LMICs, and examine the applicability of such methodologies in LMICs. METHODS This review was registered with PROSPERO (International Prospective Register of Systematic Reviews). A search of PubMed, EMBASE, Web of Science, and Scopus was performed for papers related to mHealth app quality assessment methodologies, which were published in English between 2005 and 2020. By taking a rapid review approach, a thematic and descriptive analysis of the papers was performed. RESULTS Electronic database searches identified 841 papers. After the screening process, 52 papers remained for inclusion. Of the 52 papers, 5 (10%) proposed novel methodologies that could be used to evaluate mHealth apps of diverse medical areas of interest, 8 (15%) proposed methodologies that could be used to assess apps concerned with a specific medical focus, and 39 (75%) used methodologies developed by other published authors to evaluate the quality of various groups of mHealth apps. The authors in 6% (3/52) of papers were solely affiliated to institutes in LMICs. A further 15% (8/52) of papers had at least one coauthor affiliated to an institute in an LMIC. CONCLUSIONS Quality assessment of mHealth apps is complex in nature and at times subjective. Despite growing research on this topic, to date, an all-encompassing appropriate means for evaluating the quality of mHealth apps does not exist. There has been engagement with authors affiliated to institutes across LMICs; however, limited consideration of current generic methodologies for application in LMIC settings has been identified. TRIAL REGISTRATION PROSPERO CRD42020205149; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205149.
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Affiliation(s)
- Fionn Woulfe
- School of Medicine, University College Cork, Cork, Ireland
| | - Kayode Philip Fadahunsi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Simon Smith
- School of Medicine, University College Cork, Cork, Ireland
| | | | - Emma Larsson
- Ashford and St Peter's Hospitals NHS Trust, Chertsey, United Kingdom
| | - Patrick Henn
- Assert Centre, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Mala Mawkin
- School of Medicine, Imperial College London, London, United Kingdom
| | - John O' Donoghue
- Malawi eHealth Research Centre, University College Cork, College Road, Cork, Ireland
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25
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Sedhom R, McShea MJ, Cohen AB, Webster JA, Mathews SC. Mobile app validation: a digital health scorecard approach. NPJ Digit Med 2021; 4:111. [PMID: 34267296 PMCID: PMC8282811 DOI: 10.1038/s41746-021-00476-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
While digital health solutions continue to grow in number and in complexity, the ability for stakeholders in healthcare to easily discern quality lags far behind. This challenge is in part due to the lack of a transparent and standardized approach to validation. Evaluation of mobile health applications (apps) is further burdened by low barriers to development and direct-to-user marketing, leading to a crowded and confusing landscape. In this context, we investigated the pragmatic application of a previously described framework for digital health validation, the Digital Health Scorecard, in a cohort of 22 popular mobile health oncology apps. The apps evaluated using this framework performed poorly, scoring 49.4% across all evaluation criteria as a group. Performance across component domains varied considerably with cost scoring highest at 100%, usability at 56.7%, technical at 37.3%, and clinical at 15.9%. satisfaction of prospectively determined end-user requirements derived from patient, family, and clinician consensus scored 37.2%. While cost outperformed consistently and usability was adequate, the results also suggested that apps suffered from significant technical limitations, were of limited clinical value, and generally did not do what end users wanted. These large gaps further support the need for transparent and standardized evaluation to help all stakeholders in healthcare improve the quality of mobile health.
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Affiliation(s)
- Ramy Sedhom
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY, USA
| | - Michael J McShea
- Next Generation Care Delivery, National Health Mission Area, The Johns Hopkins University Applied Physics Lab (APL), Laurel, MD, USA
| | - Adam B Cohen
- Health Technologies, National Health Mission Area, The Johns Hopkins University Applied Physics Lab (APL), Laurel, MD, USA
- Johns Hopkins Medicine, Department of Neurology, Baltimore, MD, USA
| | - Jonathan A Webster
- Johns Hopkins Medicine, Department of Oncology, Division of Hematology, Baltimore, MD, USA
| | - Simon C Mathews
- Johns Hopkins Medicine, Department of Internal Medicine, Division of Gastroenterology, Baltimore, MD, USA.
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Meyerheim M, Karamanidou C, Payne S, Garani-Papadatos T, Sander A, Downing J, Stamatopoulos K, Ling J, Payne C, Scarfò L, Lokaj P, Maramis C, Graf N. MyPal-Child study protocol: an observational prospective clinical feasibility study of the MyPal ePRO-based early palliative care digital system in paediatric oncology patients. BMJ Open 2021; 11:e045226. [PMID: 33849855 PMCID: PMC8051393 DOI: 10.1136/bmjopen-2020-045226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electronic patient-reported outcomes (ePROs) have tremendous potential to optimise palliative and supportive care for children with cancer, their families and healthcare providers. Particularly, these children and their families are subjected to multiple strains caused by the disease and its treatment. The MyPal digital health platform is designed to address these complex demands by offering pursuant ePRO-based functionalities via two mobile applications, one developed for children and the other for their parents. METHODS AND ANALYSIS In this observational prospective feasibility study, 100 paediatric oncology patients aged between 6 and 17 years and at least one of their parents/legal guardians will be recruited at three clinical sites in two European countries (Germany and Czech Republic). They will use the mobile applications which are part of the novel digital health platform. During a 6-month study period, participants will complete various ePROs via the applications addressing quality of life, satisfaction with care and impact of the disease on the family at monthly intervals. Additionally, priority-based symptom reporting is integrated into a serious game for children. Outcomes that will be assessed concern the feasibility and the evaluation of the newly designed digital health platform to contribute to the evidence base of clinical ePRO use in paediatric oncology and palliative care process. ETHICS AND DISSEMINATION The MyPal-Child study obtained ethical approval from the Ethics Committee responsible for the University of Saarland, that is, the Ärztekammer des Saarlandes, the Ethics Committee of the Medical School Hannover and the Ethics Committee of the University of Brno. Study results will be disseminated through scientific publications, presentations at international conferences, congresses and a final report to the European Commission. General publicly accessible information can be found on the project website (www.mypal-project.eu) and social media. TRIAL REGISTRATION NUMBERS U1111-1251-0043, DRKS00021458, NCT04381221.
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Affiliation(s)
- Marcel Meyerheim
- Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - Sheila Payne
- International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, Lancashire, UK
| | - Tina Garani-Papadatos
- Department of Public Health Policy, University of West Attica, Athens, Attica, Greece
| | - Annette Sander
- Clinic for Paediatric Oncology and Haematology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, Avon, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - J Ling
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Cathy Payne
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Lydia Scarfò
- Department of Onco-Haematology, Division of Experimental Oncology, Università Vita Salute San Raffaele, Milano, Italy
| | - Petr Lokaj
- Department of Pediatric Oncology, University Hospital Brno, Brno, Jihomoravský, Czech Republic
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - Norbert Graf
- Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
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Bernier Carney KM, Jung SH, Iacob E, Lewis M, Linder LA. Communication of pain by school-age children with cancer using a game-based symptom assessment app: A secondary analysis. Eur J Oncol Nurs 2021; 52:101949. [PMID: 33813185 DOI: 10.1016/j.ejon.2021.101949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/18/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the self-reported pain experiences of school-age children with cancer participating in a feasibility trial of a game-based symptom assessment app. METHOD Nineteen children (median: 8 years, range 6-12 years old) receiving cancer treatment were recruited to complete five days of symptom tracking between clinical visits using a symptom assessment app. Children could report pain as a general symptom with the ability to further localize pain on an avatar. Children could also describe symptoms in response to the app's free-text questions or the app's diary. Descriptive statistics characterized reports of pain frequency, severity, bother, and location. Free-text responses were examined for pain-related statements and analyzed using content analysis. RESULTS All 19 children documented pain on at least one day of app reporting between clinical visits. Pain was most frequently recorded as of mild severity and mild bother. Participants localized pain most frequently to the head, followed by the stomach, chest, extremities, and mouth. Eleven children documented 32 qualitative statements which included rich descriptions of pain-related topics (i.e., "my port hurts a little") and location (i.e., "my vision aching"). CONCLUSIONS These results demonstrate that school-age children with cancer are willing to describe their ambulatory pain experiences on a game-based mobile app through quantitative reports and by using narrative descriptions. Additionally, these findings can potentially guide clinicians in using multiple approaches to elicit a clinically meaningful evaluation of pain in this population.
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Affiliation(s)
| | - Se-Hee Jung
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Eli Iacob
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Melina Lewis
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Lauri A Linder
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA; Primary Children's Hospital, Center for Cancer and Blood Disorders, Salt Lake City, UT, USA.
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28
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Heneghan MB, Hussain T, Barrera L, Cai SW, Haugen M, Morgan E, Rossoff J, Weinstein J, Hijiya N, Cella D, Badawy SM. Access to Technology and Preferences for an mHealth Intervention to Promote Medication Adherence in Pediatric Acute Lymphoblastic Leukemia: Approach Leveraging Behavior Change Techniques. J Med Internet Res 2021; 23:e24893. [PMID: 33599621 PMCID: PMC7932843 DOI: 10.2196/24893] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/04/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background Suboptimal adherence to 6-mercaptopurine (6-MP) is prevalent in pediatric acute lymphoblastic leukemia (ALL) and associated with increased risk of relapse. Rapid uptake of personal technology makes mobile health (mHealth) an attractive platform to promote adherence. Objective Study objectives were to examine access to mobile technology and preferences for an mHealth intervention to improve medication adherence in pediatric ALL. Methods A cross-sectional survey was administered in oncology clinic to parents of children with ALL as well as adolescents and young adults (AYAs) with ALL receiving maintenance chemotherapy. Results A total of 49 parents (median age [IQR] 39 [33-42] years; female 76% [37/49]) and 15 patients (median age [IQR] 17 [16-19]; male 80% [12/15]) participated. All parents and AYAs owned electronic tablets, smartphones, or both. Parents’ most endorsed mHealth app features included a list of medications (71%, 35/49), information about 6-MP (71%, 35/49), refill reminders (71%, 35/49), and reminders to take 6-MP (71%, 35/49). AYAs' most endorsed features included refill reminders (73%, 11/15), reminders to take 6-MP (73%, 11/15), and tracking 6-MP (73%, 11/15). Conclusions Parents and AYAs reported ubiquitous access to mobile technology and strong interest in multiple adherence-specific mHealth app features. Parents and AYAs provided valuable insight into preferred features for a multifunctional behavioral intervention (mHealth app) to promote medication adherence in pediatric ALL.
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Affiliation(s)
- Mallorie B Heneghan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Tasmeen Hussain
- Division of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Leonardo Barrera
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Stephanie W Cai
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Maureen Haugen
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Elaine Morgan
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jenna Rossoff
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joanna Weinstein
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nobuko Hijiya
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Linder LA, Newman AR, Stegenga K, Chiu YS, Wawrzynski SE, Kramer H, Weir C, Narus S, Altizer R. Feasibility and acceptability of a game-based symptom-reporting app for children with cancer: perspectives of children and parents. Support Care Cancer 2021; 29:301-310. [PMID: 32358779 PMCID: PMC7606212 DOI: 10.1007/s00520-020-05495-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. PROCEDURE Nineteen school-age children (6-12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. RESULTS Children used the app a median of 4 days (range 1-12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. CONCLUSION Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
- Center for Cancer and Blood Disorders, Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Amy R Newman
- College of Nursing, Marquette University, Milwaukee, WI, USA
- Children's Hospital Wisconsin, Milwaukee, WI, USA
| | | | - Yin-Shun Chiu
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sarah E Wawrzynski
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Scott Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Roger Altizer
- Population Health Sciences, Entertainment Arts & Engineering, University of Utah, Salt Lake City, UT, USA
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The Use and Effect of the Health Storylines mHealth App on Female Childhood Cancer Survivors' Self-efficacy, Health-Related Quality of Life and Perceived Illness. Cancer Nurs 2020; 45:61-69. [PMID: 33337669 DOI: 10.1097/ncc.0000000000000917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND mHealth apps have been not been well tested among childhood cancer survivors (CCSs) to track physical and psychosocial functioning for improved self-management of post-treatment needs. OBJECTIVES This pilot study had 3 aims: (1) assess the usage of the Health Storylines mHealth app; (2) examine its effect in improving self-efficacy in managing survivorship healthcare needs, health-related quality of life, and perceived illness; and (3) determine if app usage moderated the effects on the above patient-reported outcome measures among female CCSs. METHODS Study participants accessed the Health Storylines mHealth app on their own personal device. This single-group, pilot study included 3 measurement points: baseline and 3 and 6 months after initiation of using the app. RESULTS Use of the mHealth app ranged from 0 times to 902 times. Every study participant who used the app (n = 26) also used the mental health app component of the Health Storylines app. Generalized estimating equations were fit to examine the effect of the mHealth app use on self-efficacy, perceived illness, and health-related quality of life, between baseline, 3-month follow-up, and 6-month follow-up. No statistically significant changes were evident, on average, from baseline to 3- or 6-month follow-up on any outcome. Subsequent testing of effect moderation showed differential trends for high versus low users. CONCLUSIONS Studies are needed among this clinical population to determine who will benefit and who will perceive the app as a useful aspect of their survivorship care. IMPLICATIONS FOR PRACTICE Sharing mental health functioning tracked on mhealth apps with healthcare providers may inform needed interventions for young adult female CCSs.
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Grainger R, Devan H, Sangelaji B, Hay-Smith J. Issues in reporting of systematic review methods in health app-focused reviews: A scoping review. Health Informatics J 2020; 26:2930-2945. [PMID: 32914696 DOI: 10.1177/1460458220952917] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
No guidelines exist for the conduct and reporting of manuscripts with systematic searches of app stores for, and then appraisal of, mobile health apps ('health app-focused reviews'). We undertook a scoping review including a systematic literature search for health app-focused reviews describing systematic app store searches and app appraisal, for apps designed for patients or clinicians. We created a data extraction template which adapted data elements from the PRISMA guidelines for systematic literature reviews to data elements operationalised for health app-focused reviews. We extracted the data from included health app-focused reviews to describe: (1) which elements of the adapted 'usual' methods of systematic review are used; (2) methods of app appraisal; and (3) reporting of clinical efficacy and recommendations for app use. From 2798 records, the 26 included health app-focused reviews showed incomplete or unclear reporting of review protocol registration; use of reporting guidelines; processes of screening apps; data extraction; and appraisal tools. Reporting of clinical efficacy of apps or recommendations for app use were infrequent. The reporting of methods in health app-focused reviews is variable and could be improved by developing a consensus reporting standard for health app-focused reviews.
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Affiliation(s)
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherpay, University of Otago, Wellington, New Zealand
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Amor-García MÁ, Collado-Borrell R, Escudero-Vilaplana V, Melgarejo-Ortuño A, Herranz-Alonso A, Arranz Arija JÁ, Sanjurjo-Sáez M. Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth 2020; 8:e17609. [PMID: 32706737 PMCID: PMC7413276 DOI: 10.2196/17609] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/06/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer. OBJECTIVE The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps. METHODS We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5. RESULTS In total, 46 apps were analyzed. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% of cases (14/46) and cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: "Bladder cancer manager," "Kidney cancer manager," "My prostate cancer manager," "Target Ovarian Cancer Symptoms Diary," and "My Cancer Coach." We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62). CONCLUSIONS MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality.
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Affiliation(s)
- Miguel Ángel Amor-García
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Collado-Borrell
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Alejandra Melgarejo-Ortuño
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José Ángel Arranz Arija
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Rodrigues AT, Sousa CT, Pereira J, Figueiredo IV, Lima TDM. Mobile Applications (Apps) to Support the Hepatitis C Treatment: A Systematic Search in App Stores. Ther Innov Regul Sci 2020; 55:152-162. [PMID: 32700147 DOI: 10.1007/s43441-020-00201-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
The purpose of this review was to identify apps to support the HCV treatment and perform a quality assessment. A comprehensive search was conducted until February 2020 in Apple App Store (iOs) and Google Play Store (Android) using search term such "hepatitis", "hepatology", and "HCV". Two independent authors identified the apps and performed data extraction and quality assessment using Mobile App Rating Scale (MARS). Spearman's correlation analysis was used to analyze the relationships between user's star ratings found in the app stores and quality app defined by the MARS instrument. A total of 316 potential apps were identified, of which 12 apps fully met the eligibility criteria. Most apps were available in both App Stores and developed by commercial developers for healthcare provider. Almost all of apps were updated within the last two year and received 3.7 or above star ratings from users. Overall, only one app was considered with a good quality. The average scores for objective and subjective MARS quality of these apps were 3.54 (SD = 0.65) and 3.27 (SD = 0.76), respectively. Moreover, a majority of apps received objective scores between 3.29 and 4.37/5. However, MARS items such "interactivity", "visual appeal", "quality information", and "credibility" obtained minimum acceptable scores. MARS scores were not significantly correlation the user's star ratings. This systematic search found gaps in apps to support the HCV treatment; 12 apps were identified in this study and only one app achieved a good quality. There is a need that users use these apps cautiously as well as involve expert healthcare professionals in the development of new HCV apps.
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Affiliation(s)
| | | | - João Pereira
- Coimbra Institute for Biomedical Imaging and Translational Research, University Coimbra, Coimbra, Portugal
| | | | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro, Integrated Health Science Centre, Rua R. UAJ s/n, Zona Rural, Seropédica, RJ, 23897-090, Brazil.
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André N, Orbach D, Pasquier E. Metronomic Maintenance for High-Risk Pediatric Malignancies: One Size Will Not Fit All. Trends Cancer 2020; 6:819-828. [PMID: 32601045 DOI: 10.1016/j.trecan.2020.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
Maintenance therapy sometimes relies on the use of metronomic chemotherapy (MC); that is, the continuous administration of low-dose chemotherapy. Maintenance therapy has been successfully used for decades in pediatric patients with acute lymphoblastic leukemia (ALL) and recent results have demonstrated improved outcomes in patients with pediatric high-risk rhabdomyosarcoma (RMS) on maintenance therapy. Here, we review the use of metronomic maintenance therapy in pediatric cancer and discuss its mechanisms of action on the tumor microenvironment and cancer cells. We also discuss its potential use as a chemotherapy alone or in combination with targeted therapies, immunotherapies, or agents for drug repurposing.
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Affiliation(s)
- Nicolas André
- Pediatric Hematology and Oncology Department, Hôpital pour Enfant de La Timone, AP-HM, Marseille, France; Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix-Marseille University, Marseille, France; Metronomics Global Health Initiative, Marseille, France.
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Eddy Pasquier
- Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix-Marseille University, Marseille, France; Metronomics Global Health Initiative, Marseille, France
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State of the art in clinical decision support applications in pediatric perioperative medicine. Curr Opin Anaesthesiol 2020; 33:388-394. [DOI: 10.1097/aco.0000000000000850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Charbonneau DH, Hightower S, Katz A, Zhang K, Abrams J, Senft N, Beebe-Dimmer JL, Heath E, Eaton T, Thompson HS. Smartphone apps for cancer: A content analysis of the digital health marketplace. Digit Health 2020; 6:2055207620905413. [PMID: 32110428 PMCID: PMC7016299 DOI: 10.1177/2055207620905413] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022] Open
Abstract
Objective The purpose of this study was to examine the state of smartphone applications for cancer intended for the general public with a focus on interactive features, content sources, and application developer affiliations. The level of health provider involvement in screening or appraising application content was also assessed. Methods A total of 123 apps were identified for analysis from two major mobile application marketplaces (Apple iTunes = 40; Google Play = 83). Application characteristics were collected, analyzed, and reported. These included the mobile platform, cost, application developer affiliation, date of last update, purpose of application, content sources, and interactive features. Results In the study sample, 50% of the applications focused on general information for cancer (62/123). Next, this was followed by applications for breast cancer (15%, 19/123) and skin cancer (7%, 8/123). Only 10% of application descriptions (12/123) identified sources for application content. Interactive features included the ability to monitor symptoms, side effects, treatments, and chronic pain (20%, 25/123). Only 3% of the applications (4/123) stated content had been evaluated by health providers. Conclusions This study contributes an updated analysis of applications for cancer available in the digital health marketplace. The findings have implications for information quality and supportive resources for cancer care. More transparent information about content sources, organizational affiliations, and level of health provider oversight in screening application content is warranted. Recommendations for improving the quality of cancer applications are also offered.
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Affiliation(s)
| | | | - Anne Katz
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, USA
| | - Ke Zhang
- College of Education, Wayne State University, USA
| | - Judith Abrams
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, USA
| | - Nicole Senft
- Department of Medicine, Vanderbilt University Medical Center, USA
| | | | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, USA
| | - Tara Eaton
- Center for Outcomes Research and Evaluation, Atrium Health, USA
| | - Hayley S Thompson
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, USA
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Azad-Khaneghah P, Neubauer N, Miguel Cruz A, Liu L. Mobile health app usability and quality rating scales: a systematic review. Disabil Rehabil Assist Technol 2020; 16:712-721. [PMID: 31910687 DOI: 10.1080/17483107.2019.1701103] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the rating scales used to evaluate usability and quality of mobile health applications, and to compare their purpose, content, and intended target users (i.e., patients, caregivers, or researchers). MATERIAL AND METHODS We conducted a systematic review of the literature in accordance with the PRISMA statement on Medline, CINAHL, PsycINFO, IEEE Explore databases, as well as a review of the grey literature to identify rating scales used to evaluate usability and quality of mobile health applications (m-health apps), between January 1, 2000 and July 31, 2018. Two researchers screened the titles and abstracts of articles that met inclusion criteria, and retrieved usability and quality rating scales from the articles. RESULTS We identified 24 usability scales and 25 quality rating scales in 87 peer-reviewed articles. We identified only one quality rating scale designed for non-expert users (i.e., patients or caregivers). None of the studies used a theoretical framework for app evaluation to support the scales. The validity of existing quality rating scales is yet to be investigated. CONCLUSION Existing usability and quality rating scales are targeted at professionals, not end users who are patients or caregivers. Rating scales that are usable by all end-users would make mobile health apps accessible and meaningful to consumers.Implications for rehabilitationThe number of mobile health applications on app stores that can be used for rehabilitation is increasing.Most healthcare providers lack the training to identify m-health apps with high quality to be used in rehabilitation.This study has reviewed the current rating scales that can help clinicians and care providers rate the quality of m-health apps and identify the ones that are most appropriate for their practice.
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Affiliation(s)
| | - Noelannah Neubauer
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Antonio Miguel Cruz
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lili Liu
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Hanghøj S, Boisen KA, Hjerming M, Elsbernd A, Pappot H. Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study. JMIR Cancer 2020; 6:e15008. [PMID: 31895046 PMCID: PMC6966550 DOI: 10.2196/15008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/22/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022] Open
Abstract
Background Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kræftværket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience. Objective The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kræftværket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app. Methods A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kræftværket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization—female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app. Conclusions Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kræftværket app with the input of more AYAs.
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Affiliation(s)
- Signe Hanghøj
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, The Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, The Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Hematology, Department of Paediatrics and Adolescent Medicine, The Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Abbey Elsbernd
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Helle Pappot
- Department of Oncology, The Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Medeiros KS, Queiroz JF, Monteiro MN, Costa WA, Cobucci RN, Stransky B, Gonçalves AK. Impact of mobile applications on adherence to cancer treatment: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e027246. [PMID: 31699713 PMCID: PMC6858102 DOI: 10.1136/bmjopen-2018-027246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The number of patients taking oral chemotherapy is increasing around the world. It is essential to maximise the adherence to oral chemotherapy to improve the overall survival and life expectancy of the patients. In this systematic review and meta-analysis, we aim to evaluate the effectiveness of mobile applications in improving the adherence to oral chemotherapy and adjuvant hormonal therapy in cancer survivors. METHODS AND ANALYSIS MEDLINE, Embase, LILACS, clinicaltrials.gov, Scopus and the Cochrane Central Register of Controlled Trials will be searched for randomised or quasi-experimental studies published between January 2009 and July 2019. This systematic review and meta-analysis will include studies investigating the use of mobile applications by cancer survivors to aid adherence to oral chemotherapy and adjuvant hormonal therapy. Patient education, reminder tools, calendars, pillboxes and electronic reminders will not be evaluated. The primary outcome will be the improvement in adherence to anticancer drugs. The secondary outcomes will be an improvement in the overall survival and life expectancy, improved quality of life and control of cancer-related symptoms. Three independent reviewers will select the studies and extract data from the original publications. The risk-of-bias will be assessed using the Cochrane risk-of-bias tool. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will compute the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION This study will be a review of the published data, and thus, ethical approval is not required. Findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018102172.
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Affiliation(s)
- Kleyton Santos Medeiros
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Janice França Queiroz
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Beatriz Stransky
- Universidade Federal do Rio Grande do Norte, Centro de Tecnologia, Natal, Brazil
| | - Ana Katherine Gonçalves
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Chen L, Payne JB, Dance KV, Imbody CB, Ho CD, Ayers AA, Flowers CR. Priorities for Rural Lymphoma Survivors: A Qualitative Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:47-52.e3. [PMID: 31708453 DOI: 10.1016/j.clml.2019.09.599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/23/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We gathered rural patient perspectives on lymphoma care and unmet needs throughout the treatment course to better understand their attitudes toward treatment and their barriers to participating in clinical research studies. PATIENTS AND METHODS We conducted 12 individual semi-structured telephone interviews in the spring of 2018 with lymphoma survivors from rural counties in Georgia. Patients were identified by a residential address in counties classified as rural according to the Rural-Urban Commuting Areas codes. Participants were recruited from regional patient education conferences and from current research participants at a university research hospital in Georgia. The interviews were recorded and transcribed verbatim. Thematic analysis and MAXQDA, version 18.0.8, were used to facilitate a constant comparative coding process during theme development. RESULTS The greatest barrier to care was the travel distance. The participants described difficulty navigating between local clinics and larger cancer centers. The lack of communication between the local and specialized clinics complicated the process, and participants had difficulty contacting or seeking advice from the team at the larger cancer centers. Seeking treatment from specialized clinics farther away introduced additional barriers. Most participants agreed that the use of technology was important for improved communication. Participants described lymphoma etiology, subtype-specific studies, alternative therapies, and quality of life as key research priorities. CONCLUSION These findings suggest that targeted research and interventions are necessary to address the specific needs of rural patients with and survivors of lymphoma. To address the disparity in health outcomes within rural populations, healthcare professionals and investigators can use these data to engage rural patients in treatment decision-making and research planning.
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Affiliation(s)
- Lillian Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jackelyn B Payne
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Kaylin V Dance
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Conner B Imbody
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy D Ho
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Amy A Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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Medeiros KS, Silva BO, Queiroz JF, Cobucci RN, Stransky B, Gonçalves AK. Assessment of mobile phone applications for care management in gynecology and obstetrics. Int J Gynaecol Obstet 2019; 146:263-264. [PMID: 31099034 DOI: 10.1002/ijgo.12863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/04/2019] [Accepted: 05/15/2019] [Indexed: 11/06/2022]
Abstract
We identified mobile applications (apps) found on digital platforms (iTunes Store and Google Play) that addressed topics about gynecology and obstetrics.
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Affiliation(s)
- Kleyton S Medeiros
- Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.,Department of Nursing, Centro Universitário do Rio Grande do Norte, Natal, RN, Brazil
| | - Brenda O Silva
- Department of Nursing, Centro Universitário do Rio Grande do Norte, Natal, RN, Brazil
| | - Janice F Queiroz
- Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Ricardo Ney Cobucci
- Department of Obstetrics and Gynecology, Universidade Potiguar, Natal, RN, Brazil
| | - Beatriz Stransky
- Department of Biomedical Engineering, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Ana K Gonçalves
- Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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