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Yan C, Cao R, Hu X, Hu Y, Liu H. A longitudinal study of a mHealth app and regional policies on the uptake of postpartum depression referral after positive screening in Shenzhen. BMC Pregnancy Childbirth 2024; 24:536. [PMID: 39143520 PMCID: PMC11325571 DOI: 10.1186/s12884-024-06733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) has received widespread attention. Shenzhen has been running a large-scale program for PPD since 2013. The program requires mothers to self-assess when applying information technology to PPD screening beginning in 2021. The purpose of this study was to conduct a longitudinal analysis of the impact of mHealth apps on the health-seeking behaviors of PPD patients. METHODS Longitudinal data from districts in the Shenzhen Maternal and Child Health Management Information System (MCHMIS) for ten years was used in this study. Referral success rate (RSR, successful referrals to designated hospitals as a percentage of needed referrals) was used to assess health-seeking behavior. Trend χ2 tests were used to assess the overall trend of change after the implementation of mHealth in ten districts in Shenzhen. Interrupted Time Series Analysis (ITSA) was employed to assess the role of the mHealth app in changing patient health-seeking behaviors. RESULTS For the results of the trend χ2 tests, the ten districts of Shenzhen showed an upward trend. For the ITSA results, different results were shown between districts. Nanshan district, Longhua district, and Longgang district all demonstrated an upward trend in the first-year application of the mHealth app. Nanshan district and Longgang district both exhibited an upward trend in terms of sustained effects. CONCLUSIONS There is a difference in the performance of the mHealth app across the ten districts. The results show that the three districts with better health resource allocation, Nanshan, Longgang, and Longhua districts, demonstrated more significant mHealth app improvements. The mHealth app's functions, management systems, and health resource allocation may be potential factors in the results. This suggests that when leveraging mHealth applications, the first step is to focus on macro-level area resource allocation measures. Secondly, there should be effective process design and strict regulatory measures. Finally, there should also be appropriate means of publicity.
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Affiliation(s)
- Chaoyang Yan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, 215006, China
| | - Ruoyun Cao
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, 215006, China
| | - Xinxin Hu
- Women's Health Care Department, ShenZhen Pingshan Maternal and Child Health Hospital, Pingshan District, Shenzhen, 518122, China
| | - Yancen Hu
- Department of Women's Health Section, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong Province, 518000, China
| | - Huimin Liu
- Department of Women's Health Section, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong Province, 518000, China.
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Denti M, Pecorari A, Accogli MA, Costi S, Mainini C, Pellegrini M, Boni C, Barbara B, Braglia L, Fugazzaro S. Facing the COVID-19 pandemic: An Italian feasibility study of a mixed in-person/telerehabilitation intervention for cancer patients. Cancer Med 2024; 13:e70022. [PMID: 39095954 PMCID: PMC11296954 DOI: 10.1002/cam4.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic impacted healthcare organizations, necessitating a rapid transition from in-person to virtual care. Our study explored the feasibility of a mixed in-person/telerehabilitation intervention for cancer patients and its effects on cancer-related fatigue (CRF), quality of life (QoL), physical function, patient satisfaction, and perceived usefulness. METHODS TRACE 2020 is an observational prospective study that enrolled adult cancer patients, between January 2021 and March 2023, who were eligible for a rehabilitation program to be provided also in telerehabilitation. Patients were assessed at baseline and after the rehabilitation program. Adherence to sessions, reasons for non-adherence and adverse events were collected. RESULTS Of the 23 patients enrolled, 87% received a mixed intervention, with an average of 60% in-person sessions and 40% telerehabilitation sessions. Adherence was very high (91%). Evaluation scales showed an improvement in CRF, QoL, and lower limb strength and a relevant increase in patients' level of physical activity (PA). Most patients reported good satisfaction; the few criticisms mainly concerned difficulties in connectivity, lack of physical contact and difficulties in understanding how to perform exercises during telerehabilitation sessions. The physiotherapist underlined the usefulness of the innovative approach and suggested ways to facilitate future implementation. CONCLUSION A mixed intervention including telerehabilitation is feasible and accepted by cancer patients. It may have a positive effect on their CRF, QoL, and level of PA and render patient care more flexible. The findings suggest what characteristics the target population for telerehabilitation should have, in order to integrate telerehabilitation in standard care for cancer patients.
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Affiliation(s)
- Monica Denti
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Alessia Pecorari
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Monia A. Accogli
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Stefania Costi
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
- Unit of Dentistry and Oral‐Maxillo‐Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO)University of Modena and Reggio EmiliaModenaItaly
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Martina Pellegrini
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Chiara Boni
- Department of Surgery, Medicine, Dentistry and Morphological SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Bressi Barbara
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Luca Braglia
- Clinical Trials Center, Azienda USL‐IRCSS di Reggio EmiliaReggio EmiliaItaly
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
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Lazarou I, Krooupa AM, Nikolopoulos S, Apostolidis L, Sarris N, Papadopoulos S, Kompatsiaris I. Cancer Patients' Perspectives and Requirements of Digital Health Technologies: A Scoping Literature Review. Cancers (Basel) 2024; 16:2293. [PMID: 39001356 PMCID: PMC11240750 DOI: 10.3390/cancers16132293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Digital health technologies have the potential to alleviate the increasing cancer burden. Incorporating patients' perspectives on digital health tools has been identified as a critical determinant for their successful uptake in cancer care. The main objective of this scoping review was to provide an overview of the existing evidence on cancer patients' perspectives and requirements for patient-facing digital health technologies. Three databases (CINAHL, MEDLINE, Science Direct) were searched and 128 studies were identified as eligible for inclusion. Web-based software/platforms, mobile or smartphone devices/applications, and remote sensing/wearable technologies employed for the delivery of interventions and patient monitoring were the most frequently employed technologies in cancer care. The abilities of digital tools to enable care management, user-friendliness, and facilitate patient-clinician interactions were the technological requirements predominantly considered as important by cancer patients. The findings from this review provide evidence that could inform future research on technology-associated parameters influencing cancer patients' decisions regarding the uptake and adoption of patient-facing digital health technologies.
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Affiliation(s)
- Ioulietta Lazarou
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Anna-Maria Krooupa
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Lazaros Apostolidis
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Nikos Sarris
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Symeon Papadopoulos
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
| | - Ioannis Kompatsiaris
- Information Technologies Institute (ITI), Centre for Research and Technology Hellas (CERTH), 6th km Charilaou-Thermi Road, P.O. Box 6036, 57001 Thessaloniki, Greece
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Indah N, Nilawati Usman A, Sanusi Baso Y, Syarif S, Ahmad M, Agus Mumang A. Early detection of self-breast examination using smartphone breast application. Breast Dis 2024; 43:135-144. [PMID: 38820009 PMCID: PMC11191427 DOI: 10.3233/bd-249004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Breast self-examination (BSE) is a screening method that can help empower, raise awareness, and detect breast abnormalities in women. The use of smartphone applications for breast cancer early detection is able to overcome some of these barriers. This study aimed to conduct a systematic review to assess the effectiveness of the effect of using smartphone application-based technology on breast cancer. METHODS Google Scholar, PubMed, Proquest, and ScienceDirect were searched for "breast self-examination" and "smartphone application" literature. This literature's study designs were quasi-experimental, prospective cohort, qualitative, and systematic review. The study contained five unique research projects with 828 varied participants. RESULTS The use of smartphones was seen to have advantages in terms of increased knowledge, perceived vulnerability, barriers to breast self-examination (BSE), self-efficacy, health motivation, and BSE practices. CONCLUSIONS The utilization of smartphone apps related to BSE is shown through the availability, accessibility, and focus of information and is in line with the Health Belief Model (HBM).
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Affiliation(s)
- Nur Indah
- Department of Midwifery, Graduate School, Hasanuddin University, Makassar, Indonesia
| | - Andi Nilawati Usman
- Department of Midwifery, Graduate School, Hasanuddin University, Makassar, Indonesia
| | - Yusring Sanusi Baso
- Learning Media Center, Learning Resources and E-Learning, Hasanuddin University, Makassar, Indonesia
| | - Syafruddin Syarif
- Department of Engineering, Hasanuddin University, Makassar, Indonesia
| | - Mardiana Ahmad
- Department of Midwifery, Graduate School, Hasanuddin University, Makassar, Indonesia
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Changrani K, Chima S, Sharma A, Han GG, Sharma A, McNamara M, Jefford M, Emery J, Druce P. A systematic review of smartphone applications for cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01435-9. [PMID: 37700151 DOI: 10.1007/s11764-023-01435-9] [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: 11/30/2022] [Accepted: 07/21/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Mobile phone applications are positioned to support, educate, and empower cancer survivors during post-treatment care. We undertook a review to assess the utility of such smartphone applications; determine whether their use correlates with improved quality of life and other self-reported outcomes; and understand the feasibility of integrating mobile apps into routine follow-up care. METHODS MEDLINE, EMBASE, Emcare, and PsycINFO databases were searched for studies evaluating apps that addressed at least one of the five Cancer Survivorship Care Quality Framework (CSCQF) domains published up until December 2021. Studies were narratively synthesized. Implementation barriers and facilitators were mapped against the Technology Acceptance Model. RESULTS Twenty-three primary studies were included in this review. Only three randomized controlled trials (RCTs) were identified. Studies generally found mobile apps to be feasible, acceptable, and well-placed to support survivorship care. Health promotion was the most predominant CSCQF domain with apps primarily aiming to support exercise and dietary changes. The domains of monitoring for cancer recurrence (n=5) and management of co-morbidities (n=1) were underrepresented. Barriers to app use included greater time since active treatment, lack of familiarity with technology, and content not tailored to the user. CONCLUSIONS Mobile apps are both feasible and acceptable in supporting the transition between active treatment and follow-up care. However, understanding the utility of such apps is limited by the low number of RCTs. IMPLICATIONS FOR CANCER SURVIVORS Mobile apps have the potential to be useful support tools for patients post-treatment. However, given the number of apps developed, targeted, and available to cancer survivors, practical guidance to help cancer survivors choose appropriate apps is needed.
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Affiliation(s)
| | - Sophie Chima
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Arun Sharma
- The Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Gil-Gyu Han
- The Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Anushka Sharma
- The Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Mairead McNamara
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Paige Druce
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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von Kalckreuth N, Feufel MA. Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany. JMIR Hum Factors 2023; 10:e45503. [PMID: 37585259 PMCID: PMC10468710 DOI: 10.2196/45503] [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: 01/04/2023] [Revised: 05/13/2023] [Accepted: 06/21/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances. OBJECTIVE This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies. METHODS A survey study was conducted to empirically validate our model, using a case vignette as cover story. Data were collected from 250 German participants and analyzed using a covariance-based structural equation model. RESULTS The model explains R2=79.3% of the variance in intention to use. The 3 main factors (social norms, attitude to privacy, and perceived control over personal data) influenced the intention to use mHealth apps, albeit partially indirectly. The intention to use mHealth apps is driven by the perceived benefits of the technology, trust in the provider, and social norms. Privacy concerns have no bearing on the intention to use. The attitude to privacy has a large inhibiting effect on perceived benefits, as well as on trust in the provider. Perceived control over personal data clearly dispels privacy concerns and supports the relationship of trust between the user and the provider. CONCLUSIONS Based on the privacy calculus, our domain-specific model explains the intention to use mHealth apps better than previous, more general models. The findings allow health care providers to improve their products and to increase usage by targeting specific user groups.
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Affiliation(s)
- Niklas von Kalckreuth
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Berlin, Germany
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Liu Y, Zhang X, Liu L, Lai KH. Does voice matter? Investigating patient satisfaction on mobile health consultation. Inf Process Manag 2023. [DOI: 10.1016/j.ipm.2023.103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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8
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Irurita-Morales P, Soto-Ruiz N, San Martín-Rodríguez L, Escalada-Hernández P, García-Vivar C. Use of Telehealth Among Cancer Survivors: A Scoping Review. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leticia San Martín-Rodríguez
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Breast Cancer Survivorship: the Role of Rehabilitation According to the International Classification of Functioning Disability and Health-a Scoping Review. Curr Oncol Rep 2022; 24:1163-1175. [PMID: 35403973 PMCID: PMC9467947 DOI: 10.1007/s11912-022-01262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
Purpose of Review The population of breast cancer (BC) survivors is growing due to earlier diagnosis and effective combined treatments. A scoping review was performed to explore the role of rehabilitation in BC survivorship and the major issues in BC survivors with International Classification of Functioning Disability and Health (ICF) perspective. Recent Findings The authors searched PubMed from January 1, 2018, up until November 9, 2021. The 65 selected publications were analyzed with the Comprehensive ICF BC Core Set (CCS) perspective and assigned to the categories of the CCS components along with the 3 areas of health (physical, mental, and social health). The multidimensional aspects of BC survivor disability are evident, whereas the topics of the articles concern several categories of the ICF BC CCS and all 3 areas of health. However, the current ICF BC CCS does not include certain categories related to emerging issues of BC survivorship recurring in the papers. Summary Rehabilitation is crucial in BC survivorship management to give personalized answers to women beyond BC, and the ICF BC CCS remains an essential tool in rehabilitation assessment for BC survivors although it needs updating.
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Respiratory Physiotherapy Intervention Strategies in the Sequelae of Breast Cancer Treatment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073800. [PMID: 35409486 PMCID: PMC8997605 DOI: 10.3390/ijerph19073800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 02/05/2023]
Abstract
Breast cancer treatments can trigger respiratory sequelae. Respiratory physiotherapy helps to eliminate or mitigate the sequelae by optimizing respiratory function. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of respiratory physiotherapy in the sequelae of breast cancer. The Cochrane Library, Physiotherapy Evidence Database, PubMed, Web of Science, Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Literature Complete, and Scopus were searched. Study quality was determined using the PEDro scale, STROBE Statement, and Single-Case Experimental Design Scale. Ten studies, six clinical trials, one case study, and three observational studies were selected. The mean methodological quality of the clinical trials was 5.6, that of the case study was 7, and that of the observational studies was 56%. Respiratory physiotherapy has been observed to improve respiratory capacity, lung function, respiratory muscle strength, effort tolerance, dyspnea, fatigue, thoracic mobility, upper limb volume, sleep quality and quality of life, as well as sensitivity to adverse physiological reactions, nausea, vomiting, and anxiety. However, it is not effective for vasomotor symptoms. More clinical trials are needed. These studies should homogenize the techniques used, as well as improve their methodological quality.
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Wang T, Stanforth PR, Fleming RYD, Wolf JS, Stanforth D, Tanaka H. A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study. JMIR Perioper Med 2021; 4:e32575. [PMID: 34967752 PMCID: PMC8759016 DOI: 10.2196/32575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. Objective This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. Methods The app was developed using “Appy Pie,” a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non–team-member users. Results We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. Conclusions This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future.
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Affiliation(s)
- Tianyu Wang
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Philip R Stanforth
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - R Y Declan Fleming
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - J Stuart Wolf
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Dixie Stanforth
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
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12
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Cross Sectional E-Health Evaluation Study for Telemedicine and M-Health Approaches in Monitoring COVID-19 Patients with Chronic Obstructive Pulmonary Disease (COPD). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168513. [PMID: 34444261 PMCID: PMC8392397 DOI: 10.3390/ijerph18168513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
Monitoring COVID-19 patients with COPD has become one of the major tasks in preventing transmission and delivering emergency healthcare services after vaccination in case of any issues. Most COVID-19-affected patients are suggested to self-quarantine at home or in institutionalized quarantine centers. In such cases, it is essential to provide remote healthcare services. For remote healthcare monitoring, two approaches are being considered in this study, which include mHealth and Telehealth. A mixed-methods approach is adopted, where survey questionnaires are used for collecting information from 108 patients and semi-structured interviews are used with seven physicians regarding mHealth and Telehealth approaches. Survey results indicated that mHealth is rated to be slightly more effective than Telehealth, and interview results indicated that Telehealth is identified to be slightly more effective than mHealth in relation to parameters including usefulness, ease of use and learnability, interface and interaction quality, reliability, and satisfaction. However, both physicians and patients opined that both mHealth and Telehealth have a promising future with increasing adoption. Based on the findings, it can be concluded that both mHealth and Telehealth are considered to be effective in delivering remote care for COPD patients infected with COVID-19 at home. Implications of the study findings are discussed.
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13
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Koontz BF, Levine E, McSherry F, Niedzwiecki D, Sutton L, Dale T, Streicher M, Rushing C, Owen L, Kraus WE, Bennett G, Pollak KI. Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program (ICanSTEP). Support Care Cancer 2021; 29:7339-7349. [PMID: 34050402 DOI: 10.1007/s00520-021-06281-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cancer survivors are often sedentary. Self-monitoring may promote physical activity through self-activation. We conducted a pilot trial to evaluate whether wearable activity tracker with personalized text message feedback would increase physical activity. METHODS We enrolled 30 patients with solid tumor cancers into a non-randomized prospective intervention trial (NCT02627079): 15 had completed treatment in the past year and 15 under active treatment. Each participant received an activity tracker and daily text messages personalized to their activity level. We assessed patient-reported outcomes and 6-min walk (6 MW) at baseline and 3 months. RESULTS Twenty-six participants completed the study. There was substantial variation in baseline activity. Overall, 39% of participants increased their steps taken by at least 20%, and 23% increased their 6 MW distance by 20% or more. More participants who had completed treatment strongly agreed (73%) that the intervention increased their exercise levels than those receiving active treatment (47%). At 3 months, there was a significant improvement in median Beck Depression Inventory-II and Godin Leisure Index composite scores. At 6 months, 72% still wore their activity tracker at least 4 days per week. CONCLUSION We found that the intervention was well-accepted with a high completion rate at 3 months and continued self-use at 6 months. In this pilot study of combined activity tracker and motivational messaging, we found a signal for increased physical activity over a 3-month period. Future research is needed to study this technique for its impact on activity and other physical and psychological measures of well-being. IMPLICATION FOR CANCER SURVIVORS Activity tracker with personalized motivational messaging may be useful in promoting physical activity in cancer survivors.
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Affiliation(s)
- Bridget F Koontz
- Department of Radiation Oncology,, Duke Cancer Institute, DUMC Box 3085, NC, 27710, Durham, USA.
| | - Erica Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, NY, New York, USA.,Duke Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Frances McSherry
- Duke Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics, Durham, NC, 27710, USA
| | - Donna Niedzwiecki
- Duke Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics, Durham, NC, 27710, USA
| | - Linda Sutton
- Department of Medicine, Duke School of Medicine, Durham, NC, 27710, USA.,Duke Cancer Network, Durham, NC, 27710, USA
| | - Tykeytra Dale
- Department of Radiation Oncology,, Duke Cancer Institute, DUMC Box 3085, NC, 27710, Durham, USA
| | - Martin Streicher
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, 27710, USA
| | - Christel Rushing
- Duke Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics, Durham, NC, 27710, USA
| | - Lynda Owen
- Duke Cancer Network, Durham, NC, 27710, USA
| | - William E Kraus
- Department of Medicine, Duke School of Medicine, Durham, NC, 27710, USA.,Department of Population Health Sciences, Duke School of Medicine, Durham, NC, 27710, USA
| | - Gary Bennett
- Duke Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.,Cancer Control and Population Sciences Program, Duke Cancer Institute, Durham, NC, 27710, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, 27710, USA.,Cancer Control and Population Sciences Program, Duke Cancer Institute, Durham, NC, 27710, USA
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14
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O'Neill L, Guinan E, Brennan L, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2021; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Louise Brennan
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Suzanne L. Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M. Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V. Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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15
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Lim JY, Kim JK, Kim Y, Ahn SY, Yu J, Hwang JH. A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study. JMIR Form Res 2021; 5:e23304. [PMID: 33847589 PMCID: PMC8080147 DOI: 10.2196/23304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/04/2020] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum.
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Affiliation(s)
- Ji Young Lim
- Department of Physical Therapy, General Graduate School of Medical Sciences, Konyang University, Daejeon, Republic of Korea
| | | | - Yoon Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Republic of Korea
| | - So-Yeon Ahn
- Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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16
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The effects of mobile apps on stress, anxiety, and depression: overview of systematic reviews. Int J Technol Assess Health Care 2020; 37:e4. [PMID: 33314997 DOI: 10.1017/s0266462320002093] [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: 12/13/2022]
Abstract
OBJECTIVES Despite a large number of mobile apps in the field of mental health, it is difficult to find a useful and reliable one, mainly due to the fact that the effectiveness of many apps has not been assessed scientifically. The present study aimed to assess the effects of mental health apps on managing the symptoms of stress, anxiety, and depression. METHODS A comprehensive literature search was conducted in PubMed, Scopus, EMBASE, Cochrane, and Web of Science databases for the papers published from 2000 to 2019. Studies were included if they reviewed articles or mobile apps for their effectiveness in stress, anxiety, and depression. The reviews that had considered mobile apps or web-based mobile applications as an intervention or part of intervention were included, as well. RESULTS A total of 4,999 peer-reviewed articles were identified, out of which nine systematic reviews met the inclusion criteria. Seven systematic reviews measured depression outcomes, three measured stress, and five systematic reviews measured anxiety symptoms. The applications that used behavior change strategies, such as Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Behavioral Activation, reported significant effects on depression, anxiety, and stress. CONCLUSION It seems that mental health apps can be promising media for reducing depressive symptoms. This field is an emerging area of mobile health, and further research should be done in future in order to reach conclusive evidence.
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17
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O'Neill L, Guinan E, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2020; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Suzanne L Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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18
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Monteiro-Guerra F, Signorelli GR, Rivera-Romero O, Dorronzoro-Zubiete E, Caulfield B. Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App-Based Physical Activity Coaching Interventions: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e18867. [PMID: 32955446 PMCID: PMC7536602 DOI: 10.2196/18867] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity.
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Affiliation(s)
- Francisco Monteiro-Guerra
- Salumedia Tecnologías, Seville, Spain.,The Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Gabriel Ruiz Signorelli
- The Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Oncoavanze, Seville, Spain
| | | | | | - Brian Caulfield
- The Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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19
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Leonardsen ACL, Hardeland C, Helgesen AK, Grøndahl VA. Patient experiences with technology enabled care across healthcare settings- a systematic review. BMC Health Serv Res 2020; 20:779. [PMID: 32838784 PMCID: PMC7446109 DOI: 10.1186/s12913-020-05633-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Healthcare services are facing extensive challenges due to the increased proportion of elderly persons and persons with chronic disease. Technology enabled care (TEC) is a collective term for telecare, telehealth, telemedicine, mobile (m)-, digital- and electronic (e) health services. TEC is increasingly seen as a solution to many of the challenges facing the health sector. Patient perspectives may provide a useful evaluation tool for new healthcare technologies that have limited clinical data to support their effectiveness. More studies need to be done to better understand the acceptance of technology in healthcare. This review aim to summarize empirical studies exploring patient experiences with TEC. Findings in this study can be used to better understand what is needed to develop, implement and improve such services. METHODS Systematic searches were conducted in the Pubmed, Psycinfo, Cinahl, Embase, Cochrane systematic reviews and Cochrane clinical trials databases. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, subjected to quality appraisals using the Critical Appraisal Skills Program (CASP), and synthesized via integrative analysis. RESULTS After removal of duplicates, languages other than English, and non-scientific records, 4087 titles and abstracts were screened. After assessment against inclusion and exclusion criteria, 69 records were screened in full-text, and underwent quality appraisal. 21 records were included in the integrative analysis. Patients' experiences with TEC related to 1) technological features, namely functionality and appearance, and 2) evolving independence, namely empowerment, autonomy and security. Technological challenges lead to frustrations and negative experiences, while a stigmatizing appearance lead to patients not using the solution. Through the use of TECs, patients felt more empowered, learning about their condition, increasing awareness to their symptoms and treatment, and feeling more safe and self-efficient. Patient participation was seen as a central aspect of the development of the TECT, as well as when using it. CONCLUSION This review deepens the understanding of patients' experiences with technology enabled care solutions. Patients' experiences not only relate to the practical/technical element of the device or solution, but to how this impact on their everyday life. Patient participation in development and planned use of such solutions should be considered an integral part in healthcare quality initiatives.
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Affiliation(s)
| | - Camilla Hardeland
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
| | - Ann Karin Helgesen
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
| | - Vigdis A. Grøndahl
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
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20
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Brennan L, Kessie T, Caulfield B. Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e19721. [PMID: 32687476 PMCID: PMC7424492 DOI: 10.2196/19721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective The aims of this study were to explore patients’ rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of “Rehabilitation” and “Technology” and performed a thematic analysis on the interview data. Results Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer–specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance.
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Affiliation(s)
- Louise Brennan
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Threase Kessie
- Maynooth University Innovation Lab, Maynooth University, Kildare, Ireland
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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21
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Monteiro-Guerra F, Signorelli GR, Tadas S, Dorronzoro Zubiete E, Rivera Romero O, Fernandez-Luque L, Caulfield B. A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing. JMIR Mhealth Uhealth 2020; 8:e17552. [PMID: 32673271 PMCID: PMC7391671 DOI: 10.2196/17552] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. Objective This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. Methods The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. Results The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. Conclusions Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.
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Affiliation(s)
- Francisco Monteiro-Guerra
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Gabriel Ruiz Signorelli
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Salumedia Tecnologias, Seville, Spain
| | - Shreya Tadas
- Insight Centre for Data Analytics, School of Computer Science, University College Dublin, Dublin, Ireland
| | | | | | | | - Brian Caulfield
- Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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22
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Abstract
Technological advancements in the capabilities of modern smartphones offer tremendous potential to generate big data from small devices that could influence oncologists' decision-making. Here we describe the value of patient-generated health data (PGHD) that can be captured using mobile devices. We comment on the current use of smartphones in oncology clinical research and describe how smartphones will bring big data into the oncology clinic by enabling continuous patient monitoring, information sharing, and personalized clinical decision making in cancer care. Lastly, we describe practical considerations about how we can access and store PGHD in the future, describing how to harness the clinical value of PGHD and comment on the emerging applications for digital biomarkers captured by smartphones.
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23
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Hou IC, Lin HY, Shen SH, Chang KJ, Tai HC, Tsai AJ, Dykes PC. Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17084. [PMID: 32130181 PMCID: PMC7081131 DOI: 10.2196/17084] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/25/2019] [Accepted: 01/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. OBJECTIVE The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. METHODS After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires-the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)-were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. RESULTS A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. CONCLUSIONS This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248.
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Affiliation(s)
- I-Ching Hou
- School of Nursing, National Yang-Ming University, Taipei City, Taiwan
| | - Hsin-Yi Lin
- School of Nursing, National Yang-Ming University, Taipei City, Taiwan
- Department of Nursing, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Shan-Hsiang Shen
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | | | - Hao-Chih Tai
- Department of Surgery, National Taiwan University, Taipei, Taiwan
| | - Ay-Jen Tsai
- Taiwan Breast Cancer Foundation, Taipei, Taiwan
| | - Patricia C Dykes
- Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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24
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Bertucci F, Le Corroller-Soriano AG, Monneur A, Fluzin S, Viens P, Maraninchi D, Goncalves A. [E-health and "Cancer outside the hospital walls", Big Data and artificial intelligence]. Bull Cancer 2019; 107:102-112. [PMID: 31543271 DOI: 10.1016/j.bulcan.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 07/04/2019] [Indexed: 12/25/2022]
Abstract
To heal otherwise in oncology has become an imperative of Public Health and an economic imperative in France. Patients can therefore receive live most of their care outside of hospital with more ambulatory care. This ambulatory shift will benefit from the digital revolution and the development of digital health or e-health. Cancer research will also benefit with Big Data and artificial intelligence, which gather and analyze a huge amount of data. In this synthesis, we describe the different e-health tools and their potential impacts in oncology, at the levels of education and information of patients and caregivers, prevention, screening and diagnosis, treatment, follow-up, and research. A few randomized studies have already demonstrated clinical benefits. Large Big Data projects such as ConSoRe and Health Data Hub have been launched in France. We also discuss the issues and limitations of "cancer outside the hospital walls and e-health" from the point of view of patients, health care professionals, health facilities and government. This new organization will have to provide remote support "outside the walls" with care and follow-up of quality, continuous and prolonged in total safety and equity. Ongoing and future randomized clinical trials will need to definitively demonstrate areas of interest, advantages and drawbacks not only for patients, but also for caregivers, health facilities and governments.
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Affiliation(s)
- François Bertucci
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France.
| | - Anne-Gaëlle Le Corroller-Soriano
- Aix-Marseille université, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, Inserm UMR912, 13009 Marseille, France
| | - Audrey Monneur
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France
| | - Sylvain Fluzin
- Institut Paoli-Calmettes, direction du système d'information et de l'organisation, 13009 Marseille, France
| | - Patrice Viens
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Dominique Maraninchi
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
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25
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Lozano-Lozano M, Cantarero-Villanueva I, Martin-Martin L, Galiano-Castillo N, Sanchez MJ, Fernández-Lao C, Postigo-Martin P, Arroyo-Morales M. A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e14136. [PMID: 31237570 PMCID: PMC6614997 DOI: 10.2196/14136] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors’ lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results BENECA was considered feasible by the breast cancer survivors in terms of use (76%, 58/76), adoption (69%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 0.39-14.37, P=.04), and reduced body weight (MD −1.42, 95% CI −1.97 to −0.87, P<.001). Conclusions BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring.
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Affiliation(s)
- Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Biohealth Research Institute in Granada, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Biohealth Research Institute in Granada, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
| | - Lydia Martin-Martin
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Biohealth Research Institute in Granada, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Biohealth Research Institute in Granada, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
| | - Maria-José Sanchez
- Biohealth Research Institute in Granada, Granada, Spain.,Andalusian School of Public Health, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Carolina Fernández-Lao
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Biohealth Research Institute in Granada, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
| | - Paula Postigo-Martin
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
| | - Manuel Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute, Granada, Spain.,Biohealth Research Institute in Granada, Granada, Spain.,Cuidate-Support Unit for Oncology Patients, Granada, Spain
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26
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Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on "Cancer outside the Hospital Walls". Cancers (Basel) 2019; 11:cancers11020219. [PMID: 30769858 PMCID: PMC6406853 DOI: 10.3390/cancers11020219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/06/2019] [Accepted: 02/10/2019] [Indexed: 01/21/2023] Open
Abstract
In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less "invasive", with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of "cancer outside the hospital walls" from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.
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