A Nurse-Led mHealth Self-Management Program (mChemotherapy) for Breast Cancer Patients Undergoing Chemotherapy: Study Protocol of a Randomized Controlled Pilot Study

Oral self-management of palbociclib using mobile technology: Findings from a nurse-led randomized controlled trial

Objective

Test the feasibility and effectiveness of a text message reminder intervention for the self-management of oral anticancer medication in patients with metastatic breast cancer.

Methods

Forty-three females initiating treatment with palbociclib participated in a two-armed prospective randomized clinical trial. Participants were randomized into the control (n = 21) and intervention groups (n = 22) from January 2020 to January 2023. Survey responses were collected at three-time points; (1) at consent, (2) end of treatment cycles, and (3) at a follow-up clinic visit. Surveys included a demographic questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, post-study assessment, and the R-15 Participant Satisfaction Questionnaire. Nurse providers completed the Adaptation of Stamps Nurse Workload questionnaire.

Results

The COVID-19 pandemic and regulatory decisions supporting other CDK4/6 medications negatively influence recruitment; thus, a small sample for each arm only detected large differences between the two arms regarding effectiveness. Feasibility analysis was not conducted due to insufficient data, but the participants frequently used their smartphones for text messaging. Although the survey data were limited, participants provided anecdotal information supporting the use of text messaging as a positive method to remind them to take their medication, have their labs drawn, and attend MD visits. Participants would have liked text messages at the exact time they took their medications as a simple reminder.

Conclusions

Given the importance of cancer treatments and the difficulties patients experience during these treatments, text messages using smartphones can actively improve patients' engagement and their ability to manage their treatment regimens.

Trial registration

ClinicalTrials.gov; ID: NCT04216576.

Perceptions of utilizing a symptom self-management app for breast cancer patients receiving outpatient chemotherapy

PURPOSE

Breast cancer (BC) patients who are undergoing outpatient chemotherapy encounter difficulties in symptom self-management at home. We have developed a mobile app with the support of self-regulation activities and nurse-led social service to empower self-management of BC patients during outpatient chemotherapy. The study aimed to explore the perceptions of breast cancer patients and nurses in utilizing an app with the functions of proactive nursing support and empowerment.

METHODS

This is a qualitative study including group interviews with nurses and patients with breast cancer receiving outpatient chemotherapy. A total of eleven patients and five nurses were enrolled from August 2022 to October 2022. Thematic analysis was adopted to analyze the interview transcripts. Main themes and related sub-themes were drawn from the transcripts.

RESULTS

Barriers (the lack of a contractual spirit) and facilitators (social support and native high-adherence) to app usage were identified. Following the six-week program, patients underwent various transformations such as improved health awareness and a tendency to pay more attention to psychological symptoms. This program also led to various changes in the nurses, including a transformation from taking the reactive emergency calls to a proactive approach of incorporating a self-regulation process and social support.

CONCLUSIONS

The findings from the group interviews stressed the importance of integrating technology and nursing social support in facilitating patient symptom self-management.

Feasibility of a mobile health app-based self-management program for Chinese patients with breast cancer receiving chemotherapy: A randomized controlled pilot study

Objective

There are currently an increasing number of mobile health (mHealth) programs offered to patients with breast cancer undergoing chemotherapy, but their rate of adherence to app usage has remained low. This study aimed to examine the feasibility of an mHealth app-based program such as the adherence rate of app usage and determine the preliminary effects on self-efficacy, quality of life, symptom burden and healthcare utilization in these patients.

Methods

We conducted a randomized controlled pilot trial. Ninety-six participants were randomly allocated into either an intervention group or a control group (routine care plus a placebo app). The intervention group engaged in a 6-week self-regulation activity and received nurse-led social support via the app. The intention-to-treat principle was adopted. The generalized estimating equation was utilized to analyze the between-group, within-group and interaction effectiveness of this program.

Results

Totally 96 participants were enrolled from 16 May to 23 August 2022. The average rate of adherence to app usage increased from 4.8% at week 3 to 51.2% at week 6. There was a statistically significant reduction in the physiological efficacy scores of the intervention (p < .001) and control groups (p < .001) at week 6, compared with the baseline. At week 6, the intervention group reported a significantly lower symptom burden (p = .042) and significantly better physical well-being than the control group (p = .024).

Conclusions

It is feasible to perform an mHealth app-based self-management program for patients with breast cancer receiving chemotherapy. Nurses can utilize this program to facilitate patient self-management of symptoms during chemotherapy.

Registration

Clinicaltrials.gov, https://clinicaltrials.gov, (NCT05192525).

The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial

BACKGROUND

Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time.

OBJECTIVE

We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app.

METHODS

This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect.

RESULTS

A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ²₁=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=-1.98, 95% CI -3.78 to -0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=-1.38, 95% CI -1.98 to -0.78, P<.001), with a marginal increase at T3.

CONCLUSIONS

The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1159/000509129.