Feasibility of a Mobile Health Application To Monitor Recovery and Patient-reported Outcomes after Robot-assisted Radical Prostatectomy

Desires and attitudes of outpatients and physicians regarding the use of teleurology during the pandemic: a prospective survey study

OBJECTIVE

It is not known to date how many patients admitted to urology outpatient clinics are willing to use telemedicine. We aimed to investigate knowledge levels and attitudes concerning the utilization of teleurology by patients applying to urology outpatient clinics.

METHODS

This prospective multicentre survey study included 334 patients aged 18-65 years who applied to an urology outpatient clinics. The patients were asked questions about their attitudes and expectations regarding teleurology. Diseases were divided into seven subgroups due to the broad spectrum of diagnoses. Physicians' and patients' opinions on whether it was possible to manage the current medical condition via teleurology were recorded.

RESULTS

69.5% of patients stated that they had sufficient technical skills to use teleurology by themselves for medical examination. 55.4% of patients and 78.4% of physicians responded that the existing complaints were suitable for teleurology. Both patients and physicians deemed genital system diseases and urinary tract infections suitable for teleurology (p<0.001, p<0.001 for physicians, and p<0.001, p<0.001 for patients), whereas urine transport, storage and emptying disorders (p=0.003) and benign prostatic hyperplasia (p=0.029) were deemed to be suitable for teleurology only by the physicians.

CONCLUSION

Our study shows that (i) the majority of our patient population has a telecommunications infrastructure suitable for teleurology, (ii) teleurology has aroused interest among patients, particularly during the pandemic period, and (iii) physicians and patients have high expectations that the problem can be solved with teleurology in suitable patients.

Attitudes and barriers toward video visits in surgical care: Insights from a nationwide survey among surgeons

BACKGROUND

Surgeons rapidly adopted video visits during the COVID-19 pandemic. However, video visit use among surgeons has significantly declined, pointing to the need to better understand current attitudes and barriers to their use in surgical care.

METHODS

From August 2022 to March 2023, a nationwide survey was conducted among practicing surgeons in 6 specialties. The survey included multiple-choice and free-response questions based on an implementation determinants framework, covering demographics, provider, patient, and organizational factors.

RESULTS

A total of 170 surgeons responded (24% response rate). Overall, 67% of surgeons said their practice lacked motivation for video visit implementation. Additionally, 69% disagreed with using video visits as the sole means for preoperative surgical consultation, even with relevant medical history, labs, and imaging. Nearly 43% cited the need for a physical examination, whereas 58% of surgeons said video visits carried a greater malpractice risk than in-person visits. Other barriers included technological limitations, billing, and care quality concerns. Nevertheless, 41% agreed that video visits could improve outcomes for some patients, and 60% expressed openness to using video visits exclusively for postoperative consultations in uncomplicated surgeries.

CONCLUSION

Surgeons recognize the potential benefits of video visits for certain patients. However, perceived barriers include the need for a physical examination, technological limitations, care quality concerns, and malpractice risks.

Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature

PURPOSE OF REVIEW

There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges.

RECENT FINDINGS

There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality.

SUMMARY

Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.

Challenges and opportunities in prostate cancer surgery in South America: Insights into robot-assisted radical prostatectomies-A perspective

Background and Aims

Prostate cancer imposes a significant health burden, particularly in South America with its high incidence and mortality rates. This article explores the emergence of robot-assisted radical prostatectomy (RARP) as a potential solution in the region.

Methods

This study relies on a comprehensive review of relevant literature. The analysis highlights the advantages of RARP, identifies impediments to its implementation, and proposes strategies to overcome these barriers.

Results

RARP demonstrates notable benefits, including improved functional outcomes, reduced complications, and minimized incisions. However, the integration of RARP in South America is hindered by challenges such as regional disparities, financial limitations, and data gaps. Limited healthcare infrastructure and a scarcity of skilled professionals further compound the issues.

Conclusion

Despite its potential, RARP faces obstacles to widespread adoption in South America. Strategic solutions encompassing technology investment, healthcare infrastructure enhancement, and workforce training are imperative. Overcoming these challenges can establish RARP as a crucial tool in managing prostate cancer in the region, ultimately enhancing patient care and treatment outcomes.

Personalised electronic health programme for recovery after major abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial

BACKGROUND

Despite the adoption of minimally invasive techniques, recovery after abdominal surgery takes a long time. Electronic health (eHealth) modalities can provide guidance to patients, facilitating early return to normal activities. We aimed to assess the impact of a personalised eHealth programme on patients' return to normal activities after major abdominal surgery.

METHODS

This single-blind, randomised, placebo-controlled trial was done at 11 teaching hospitals in the Netherlands. Eligible participants were aged 18-75 years who underwent a laparoscopic or open colectomy or hysterectomy. An independent researcher randomly allocated participants (in a 1:1 ratio) to either the intervention or control group by use of computer-based randomisation lists, with stratification by sex, type of surgery, and hospital. Participants in the intervention group had access to a perioperative, personalised eHealth programme consisting of both standard face-to-face care and eHealth, that comprised interactive tools offering goal attainment and a personalised outcome measurement, which managed recovery expectations and provided postoperative guidance tailored to each patient. Patients were provided with an activity tracker and had access to a website and mobile app with an electronic consultation (eConsult) functionality. The control group received standard care and access to a placebo website containing recovery advice provided by the hospital. The primary outcome was the number of days between surgery and personalised return to normal activities, assessed with Kaplan-Meier curves. Intention-to-treat and per-protocol analyses were done with a Cox regression model. This trial is registered with the Netherlands National Trial Register (NTR5686).

FINDINGS

Between Feb 11, 2016, and Aug 9, 2017, 355 participants were randomly assigned to the intervention (n=178) or control (n=177) groups. 342 participants were included in the intention-to-treat analysis. The median time until return to normal activities was 52 days (IQR 33-111) in the intervention group, and 65 days (39-152) in the control group (adjusted hazard ratio 1·30 [95% CI 1·03-1·64]; p=0·027). The frequency of postoperative complications did not differ between groups.

INTERPRETATION

This eHealth programme, delivering personalised care based on goal attainment scaling, enabled patients to return to their normal activities 13 days earlier than those who received standard care.

FUNDING

ZonMw.

Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care

BACKGROUND

Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries.

MATERIAL AND METHODS

This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians.

RESULTS

The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system.

CONCLUSION

Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.

Mobile health (mHealth) interventions in prostate cancer survivorship: a scoping review

PURPOSE

This scoping review explores the application of mHealth technology in prostate cancer (CaP) management along the survivorship continuum.

METHODS

The scoping review was conducted using the five-step framework developed by Arksey and O'Malley. Using predefined criteria, we screened citations from Embase, EBSCOHost, Cochrane Library, PubMed, ProQuest, SCOPUS, and Web of Science for primary studies published before December 2021. We selected studies that explored the application of mHealth technology in CaP management and survivorship. Evidence from 14 eligible studies was summarized using narrative synthesis.

RESULTS

Fourteen studies published between 2015 and 2021 were included. Ten mHealth apps were identified with only one still in use. Most apps were explored for their supportive care roles during radiotherapy (n = 9) and androgen deprivation therapy (ADT) (n = 1) treatment, mainly to assess outcomes (n = 1) and manage patient-reported symptoms (n = 5). One study deployed mHealth to facilitate recovery after surgery. Very few studies (n = 3) applied mHealth for lifestyle management (i.e., physical activity). Barriers to app usage included connectivity issues, end-user familiarity with the app, login hurdles, and time constraints. Facilitators of app usage included apps being downloaded for participants, devices provided for participants, and the ability to connect with providers through the platform.

CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS

The improving survival rates from CaP suggest that men are now living longer with unfavorable treatment side effects such as reduced sexual functioning, pain, and fatigue. Hence, mHealth represents new hope in men's illness trajectory. However, current application in patients' care pathways remains poor, particularly in the active phase of CaP management. Efforts must be accelerated to explore individual and healthcare-level drivers of mHealth use. The feasibility and descriptive nature of current studies point to a lack of attention to actual implementation and scale-up issues in research considering mHealth application in CaP, hence accounting partly for the gap in research/practice.

Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis

An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.

Telemedicine in Urology: Where Have We Been and Where Are We Heading?

Context

Humanity is facing significant challenges, and in 2019, a new coronavirus caused an unprecedented global disease outbreak. The coronavirus disease 2019 (COVID-19) pandemic vastly impacted health care delivery, generating devastating economic, social, and public health disruption. Although previously underutilized, it was not until recently that telemedicine emerged and amassed tremendous popularity.

Objective

To examine and assess telemedicine's past, present, and future roles in urology.

Evidence acquisition

We queried relevant literature investigating the role of telemedicine in urology using the electronic PubMed database and mainly focused on English-language studies of any design.

Evidence synthesis

Growing attention has been paid to the widespread adoption of novel telehealth technologies for managing various diseases. Meanwhile, solid evidence supports the meaningful use of telemedicine for most urological diagnoses. Existing literature delineates telemedicine as a viable, safe, and convenient alternative to in-person clinical visits.

Conclusions

The present article overviews the evolution of telemedicine in urology, and discusses its application in outpatient and physician's office settings. In addition, it highlights the technical, legal, ethical, and financial aspects of telemedicine while providing valuable insights and practical considerations for the future of telehealth in urology.

Patient summary

Urologists must adopt telemedicine carefully in daily practice, always adhering to predefined regulatory frameworks.

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study

INTRODUCTION

The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care.

METHODS

We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person.

RESULTS

Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits.

CONCLUSIONS

Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).

The Mobile Patient Information Assistant (PIA) App during the Inpatient Surgical Hospital Stay: Evaluation of Usability and Patient Approval

Mobile eHealth apps are becoming increasingly important tools in healthcare management, capable of providing education and support at any time. There is little knowledge about surgical patients' appreciation and use of these apps. The objective of this study was to develop and evaluate a user-friendly medical app (PIA; Patient Information Assistant) for providing individual patient information before and after inpatient urological surgery. Twenty-two patients aged 35 to 75 years were provided with timely information, push notifications, and personalized agendas (e.g., date of presentation, time of surgery, time of doctor's consultation, imaging appointment) via the PIA app. Of the 22 patients, 19 evaluated the PIA app in terms of usage and usability, benefits, and potential for improvement. Of the study participants, 95% did not need any assistance to use the app, 74% confirmed that the PIA app made them feel better informed and more satisfied with their hospital stay, and 89% stated that they would like to re-use the PIA app and support the general use of medical apps in healthcare. Thus, we created an innovative digital health information tool, allowing targeted support for doctor-nurse-patient communication and offering great potential for patient support before and after surgery. Our study revealed that use of an app during the surgical hospital stay is readily accepted and benefits patients by acting as an additional informative tool.

Integrative review of remote patient monitoring in gynecologic and urologic surgical oncology

Patients with cancer facing complex and invasive urologic and gynecologic cancer surgery often experience symptoms and rapid declines in functional capacity postoperatively. Remote patient monitoring that leverages patient-generated health data is a potential approach to assess and promote postoperative recovery. This integrative review aims to provide an overview of the current literature and research on remote patient monitoring in gynecologic and urologic surgical oncology.

Feasibility of a smartphone application for inguinal hernia care: a prospective pilot study

The Inguinal Hernia Application (IHAPP) is designed to overcome current limitations of regular follow-up after inguinal hernia surgery. It has two goals: Minimizing unnecessary healthcare consumption by supplying patient information and facilitating registration of patient-reported outcome measures (PROMs) by offering simple questionnaires. In this study we evaluated the usability and validity of the app. Patients (≥18 years) scheduled for elective hernia repair were assessed for eligibility. Feasibility of the app was evaluated by measuring patient satisfaction about utilization. Validity (internal consistency and convergent validity) was tested by comparing answers in the app to the scores of the standardized EuraHS-Quality of Life instrument. Furthermore, test-retest reliability was analyzed correlating scores obtained at 6 weeks to outcomes after 44 days (6 weeks and 2 days). During a 3-month period, a total of 100 patients were included. Median age was 56 years and 98% were male. Most respondents (68%) valued the application as a supplementary tool to their treatment. The pre-operative information was reported as useful by 77% and the app was regarded user-friendly by 71%. Patient adherence was mediocre, 47% completed all questionnaires during follow-up. Reliability of the app was considered excellent (α > 0.90) and convergent validity was significant (p = 0.01). The same applies to test-retest reliability (p = 0.01). Our results demonstrate the IHAPP is a useful tool for reliable data registration and serves as patient information platform. However, further improvements are necessary to increase patient compliance in recording PROMs.

Development and acceptability of a mobile health application integrated with the electronic heath record for treatment of chronic insomnia disorder

STUDY OBJECTIVES

To describe the development and feasibility of a cognitive behavioral therapy for insomnia (CBT-I) program delivered via personal digital devices and fully integrated with the electronic health record (EHR).

METHODS

A multidisciplinary team of clinicians and members of our Center for Digital Health collaborated to develop a Chronic Insomnia Interactive Care Plan (ChI-ICP), an application that provides personalized and just in time education and promotes self-management using CBT-I concepts, and is activated from and fully integrated into the EHR. Following development, we evaluated patient engagement and workflows, assessed changes to provider workload, and examined outcomes on measures of insomnia during a pilot deployment of the application.

RESULTS

A total of 222 patients were enrolled and 179 engaged with the plan during the 3-month pilot program. Enrolled patients generated an average of 3.9 ± 2.3 In Basket messages, most being automated notifications related to noncompletion of assigned tasks, while only a few were related to patients requesting additional training or help with insomnia. Sleep efficiency improved from baseline until the completion of the program from 74.5% ± 16.7% to 87.6% ± 10.8% (P = .001), and the Insomnia Severity Index improved from 14.9 ± 5.22 to 11.6 ± 4.80 (P = .006).

CONCLUSIONS

In this pilot implementation of an integrated ChI-ICP, patient engagement was favorable, workflows and workload were not significantly burdensome for the care teams, and initial evaluation of efficacy was favorable. This provides evidence for an application that is a scalable method to assist patients with chronic insomnia and future work should assess its efficacy in controlled trials.

CITATION

Morgenthaler TI, Kolla BP, Anderson SE, et al. Development and acceptability of a mobile health application integrated with the electronic heath record for treatment of chronic insomnia disorder. J Clin Sleep Med. 2022;18(12):2785-2792.

The Impact of Perioperative Remote Patient Monitoring on Clinical Staff Workflows: Scoping Review

BACKGROUND

Remote patient monitoring (RPM) interventions are being increasingly implemented in health care environments, given their benefits for different stakeholders. However, the effects of these interventions on the workflow of clinical staff are not always considered in RPM research and practice.

OBJECTIVE

This review explored how contemporary RPM interventions affect clinical staff and their workflows in perioperative settings.

METHODS

We conducted a scoping review of recent articles reporting the impact of RPM interventions implemented in perioperative settings on clinical staff and their workflow. The databases accessed were Embase and PubMed. A qualitative analysis was performed to identify the main problems and advantages that RPM brings to staff, in addition to the approaches taken to evaluate the impact of those interventions. Different themes were identified in terms of the challenges of RPM for clinical staff as well as in terms of benefits, risk-reduction strategies, and methods for measuring the impact of these interventions on the workflow of clinical staff.

RESULTS

A total of 1063 papers were found during the initial search, of which 21 (1.98%) met the inclusion criteria. Of the 21 included papers, 15 (71%) focused on evaluating new RPM systems, 4 (19%) focused on existing systems, and 2 (10%) were reviews.

CONCLUSIONS

The reviewed literature shows that the impact on staff work experience is a crucial factor to consider when developing and implementing RPM interventions in perioperative settings. However, we noticed both underdevelopment and lack of standardization in the methods for assessing the impact of these interventions on clinical staff and their workflow. On the basis of the reviewed literature, we recommend the development of more robust methods for evaluating the impact of RPM interventions on staff experience in perioperative care; the adoption of a stronger focus on transition management when introducing these interventions in clinical practice; and the inclusion of longer periods of assessment, including the evaluation of long-term goals.

Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review

Background

Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions.

Objective

To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions.

Methods

This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1.

Results

In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions.

Conclusions

This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-045596

Mobile health technology for remote home monitoring after surgery: a meta-analysis

BACKGROUND

Mobile health (mHealth) technology has been proposed as a method of improving post-discharge surveillance. Little is known about how mHealth has been used to track patients after surgery and whether its use is associated with differences in postoperative recovery.

METHODS

Three databases (PubMed, MEDLINE and the Cochrane Central Registry of Controlled Trials) were searched to identify studies published between January 1999 and February 2021. Mobile health was defined as any smartphone or tablet computer capable of electronically capturing health-related patient information and transmitting these data to the clinical team. Comparable outcomes were pooled via meta-analysis with additional studies compiled via narrative review. The quality of each study was assessed based on Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Forty-five articles met inclusion criteria. While the majority of devices were designed to capture general health information, others were specifically adapted to the expected outcomes or potential complications of the index procedure. Exposure to mHealth was associated with fewer emergency department visits (odds ratio 0.42, 95 per cent c.i. 0.23 to 0.79) and readmissions (odds ratio 0.47, 95 per cent c.i. 0.29 to 0.77) as well as accelerated improvements in quality of life after surgery. There were limited data on other postoperative outcomes.

CONCLUSION

Remote home monitoring via mHealth is feasible, adaptable, and may even promote more effective postoperative care. Given the rapid expansion of mHealth, physicians and policymakers need to understand these technologies better so that they can be integrated into high-quality clinical care.

Development and Usability Testing of a Mobile Application to Monitor Patient-Reported Outcomes after Stress Urinary Incontinence Surgery

OBJECTIVE

To develop and perform a usability testing of a mobile application (app) with representative users of surgeons and female patients undergoing stress urinary incontinence (SUI) surgery.

METHODS

A mobile app was developed with the Medical Device Epidemiology Network (MDEpiNet) High-Performance Integrated Virtual Environment (HIVE) to streamline the collection of patient-reported outcomes following SUI surgery using validated questionnaires. It was designed as a collaborative effort with the Women's Health Initiative (WHI), including patient and surgeon involvement. The app evaluation questions addressed the user's rating on the clarity and length of the questions and the comfort level in using the interface for patients to report post-operative outcomes and surgeons to review them.

RESULTS

A total of twenty patients and 5 surgeons tested the mobile app and reported their experience and level of satisfaction. The average patient experience score was 9 out of ten, with ten being the best. Eleven patients (55%) were interested in replacing in-person follow-up visits with the app. The surgeons reported an average user experience score of 8.6 out of ten. Four surgeons (80%) were interested in replacing in-person visits with the app. The combined experience score between all users was 8.9 out of ten. Fifteen out of twenty-five users (60%) showed interest in replacing in-person visits with the app.

CONCLUSION

The mobile app for SUI captured important patient-reported outcomes with a high satisfaction reporting from patients and surgeons.

A novel mHealth App (RyPros) for prostate cancer management: an accessibility and acceptability study

BACKGROUND

Over the past decade, there has been a significant increase in research on the use of mobile health (mHealth) apps as disease management tools. However, very few apps are currently available for prostate cancer (PCa) patient management, and the available apps do not combine the needs of physicians with the requirements of patients. This study aimed to describe the development of a mHealth application for PCa survivors called RyPros, which includes dynamic visualization, intelligent reminders, and instant messaging to support decision-making regarding treatment and follow-up and test the initial accessibility and acceptability application.

METHODS

The application was developed through a three-step procedure: logical structure design, application programming, and testing. Dynamic visualization, intelligent reminders, and instant messaging were the core functions of RyPros. Twenty-eight participants who had PCa were enrolled in four weeks of follow-up using the RyPros App. We initially evaluated participants' acceptance of RyPros based on their use of the app (login data, questionnaire completion) and a satisfaction survey.

RESULTS

We successfully designed and tested the application. A total of 32 participants were enrolled, of whom 28 completed the 4-week follow-up, yielding a participation rate of 87.5%. Each participant logged on an average of 2.82 times and achieved an average of 0.89 questionnaires per week over the four weeks. Most participants (64%) liked the app, and most participants (71%) were satisfied, giving the RyPros app a rating of 4 or 5. More than half of the participants (61%) intended to use the RyPros app regularly, and the majority of participants agreed that the three core functionalities of RyPros were helpful (20/28, 71% for instant messaging; 16/28, 57% for visualization; and 18/28, 64% for reminders and assessments).

CONCLUSIONS

The mHealth application we developed for PCa survivor management provided dynamic visualization, reminders, assessments, and instant messaging to support decision-making based on multidisciplinary collaboration. PCa survivors showed high acceptance of the RyPros app.

Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review

BACKGROUND

Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients' acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations.

OBJECTIVE

The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers.

METHODS

PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients' use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized.

RESULTS

Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients' response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS.

CONCLUSIONS

Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients' long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes.

Intensified and Standardized Digital Communication with Cystectomy Patients as a Potentially Simple and Effective Modality for Early Detection of Postoperative Complications: Results from a Pilot Study

BACKGROUND

Postoperative readmission rates following radical cystectomy remain significant. Early identification of emerging complications could potentially allow for immediate institution of therapy.

OBJECTIVE

To intensify postoperative patient-physician communication via a cellphone-based health care application (CHA) and to evaluate its potential for early detection of complications.

DESIGN SETTING AND PARTICIPANTS

This was a pilot study involving 18 radical cystectomy patients. During the first 30 d, patients received a push cellphone notification twice a week requesting data input into the CHA. This was reduced to once a week from day 31 to day 90. De-identified recorded data were reviewed by the surgeon involved. If deemed necessary, patients were contacted by the surgeon via telephone to obtain more detailed clinical information.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Descriptive statistics were used.

RESULTS AND LIMITATIONS

Of the 18 patients enrolled, all completed the 90-d reporting period. On two occasions, interventions were necessary on the basis of data recorded on the CHA. One neobladder patient was given antibiotic therapy for pyelonephritis. Another patient reported weight loss and nausea with clinical suspicion of metabolic acidosis, and his sodium bicarbonate and fluid intake were increased. Limitations include the small number of cases from a single low-volume center.

CONCLUSIONS

CHA-based monitoring of clinical parameters within the crucial 90-d postoperative period following radical cystectomy provides meaningful information. In this pilot study, two potential readmissions were possibly avoided on the basis of recorded basic vital signs and early intervention.

PATIENT SUMMARY

Besides regular clinic follow-up visits after radical cystectomy, additional aids such as a cellphone-based health care application can provide treating physicians with relevant clinical information and may help to identify imminent deviations from normal postoperative recovery at an early stage.

The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future

CONTEXT

The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward.

OBJECTIVE

To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic.

EVIDENCE ACQUISITION

A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families.

EVIDENCE SYNTHESIS

Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement.

CONCLUSIONS

The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care.

PATIENT SUMMARY

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

Usability of Mobile Health Apps for Postoperative Care: Systematic Review

BACKGROUND

Mobile health (mHealth) apps are increasingly used postoperatively to monitor, educate, and rehabilitate. The usability of mHealth apps is critical to their implementation.

OBJECTIVE

This systematic review evaluates the (1) methodology of usability analyses, (2) domains of usability being assessed, and (3) results of usability analyses.

METHODS

The A Measurement Tool to Assess Systematic Reviews checklist was consulted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was adhered to. Screening was undertaken by 2 independent reviewers. All included studies were assessed for risk of bias. Domains of usability were compared with the gold-standard mHealth App Usability Questionnaire (MAUQ).

RESULTS

A total of 33 of 720 identified studies were included for data extraction. Of the 5 included randomized controlled trials (RCTs), usability was never the primary end point. Methodology of usability analyses included interview (10/33), self-created questionnaire (18/33), and validated questionnaire (9/33). Of the 3 domains of usability proposed in the MAUQ, satisfaction was assessed in 28 of the 33 studies, system information arrangement was assessed in 11 of the 33 studies, and usefulness was assessed in 18 of the 33 studies. Usability of mHealth apps was above industry average, with median System Usability Scale scores ranging from 76 to 95 out of 100.

CONCLUSIONS

Current analyses of mHealth app usability are substandard. RCTs are rare, and validated questionnaires are infrequently consulted. Of the 3 domains of usability, only satisfaction is regularly assessed. There is significant bias throughout the literature, particularly with regards to conflicts of interest. Future studies should adhere to the MAUQ to assess usability and improve the utility of mHealth apps.

Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic?

Context

Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse.

Objective

To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth.

Evidence acquisition

After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed.

Evidence synthesis

We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good.

Conclusions

Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary.

Patient summary

The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.