Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study (Preprint)

Abstract

BACKGROUND Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate and an approach to research this empirically includes to examine engagement by assessing usage and exploring user experiences. Actual usage in correspondence to the intended use – adherence - is an essential factor of engagement. OBJECTIVE This study aims to describe engagement with the Interaktor app among patients with breast and prostate cancer during their treatment. METHODS All patients from the intervention groups of two separate randomized controlled trials were included. Patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. RESULTS The median adherence to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a higher total number of free text messages sent (P = .04). Among the patients treated for prostate cancer, higher age (P = .01) and higher education level (P = .04), predicted an increase in total views on self-care advice, whilst higher comorbidity (P = .004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P = .02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom-alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as more comprehensive and detailed information as the patient progressed through treatment. CONCLUSIONS Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differs in between patient groups, but higher age and a higher educational level predicts higher usage of specific app-functions for both patient groups. Patients’ experience of relevance and interactivity influence their engagement positively. CLINICALTRIAL RCT Breast cancer NCT02479607 RCT Prostate cancer NCT02477137

Electronic Medical Record–Based Electronic Messaging Among Patients with Breast Cancer: A Systematic Review

“…One study looked at the efficacy of using electronic messaging for symptom management. This was a mixed-methods study of engagement in an application for symptom self-management during treatment in patients with breast cancer by Crafoord et al 33 This study was conducted in Sweden using an app-based intervention for symptom management. Utilizing the app, breast cancer patients were able to report symptoms, view self-care advice, and send free messages to members of their care team.…”

“…First, there may be some variation in what is considered patient-provider based messaging. Some studies looked directly at EMR messages 22 29 30 31 32 33 while others used national surveys 27 28 to assess patient use of electronic messages with care teams. The latter method introduces potential bias as patients may have different ideas on what is considered an electronic message.…”

“…Other studies used apps developed in-house by the researchers themselves. 33 Because electronic messaging is not standard across the studies included in this analysis, comparison between studies may not be reliable.…”

Efficacy of Mobile Phone Technology for Managing Side Effects Associated with Chemotherapy among Cancer Patients: A Systematic Review and Meta-Analysis

“…Use of mobile technology for self-care monitoring and reporting of the symptoms along with alert system that focus on severity of symptoms can enhance the living quality of cancer patients by reducing symptom burden of the chemotherapy. 15…”