Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development

Abstract

BackgroundOral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management.ObjectiveThe objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer.MethodsWe used a 5-step development model to create a comprehensive mobile app with theoretically informed content. The research and technical development team worked together to develop and iteratively test the app. In addition to the research team, key stakeholders including patients and family members, oncology clinicians, health care representatives, and practice administrators contributed to the content refinement of the intervention. Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the randomized controlled trial.ResultsWe incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing. App components included medication reminders, self-reporting of medication adherence and symptoms, an education library including nutritional information, Fitbit integration, social networking resources, and individually tailored symptom management feedback. We are conducting a randomized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy, quality of life, and burden of symptoms and side effects. At every stage in this trial, we are engaging stakeholders to solicit feedback on our progress and next steps.ConclusionsTo our knowledge, we are the first to describe the development of an app designed for people taking oral chemotherapy. The app addresses many concerns with oral chemotherapy, such as medication adherence and symptom management. Soliciting feedback from stakeholders with broad perspectives and expertise ensured that the app was acceptable and potentially beneficial for patients, caregivers, and clinicians. In our development process, we instantiated 7 of the 8 best practices proposed in a recent review of mobile health app development. Our process demonstrated the importance of effective communication between research groups and technical teams, as well as meticulous planning of technical specifications before development begins. Future efforts should consider incorporating other proven strategies in software, such as gamification, to bolster the impact of mobile health apps. Fo...

Evaluation of mobile phone applications to support medication adherence and symptom management in oncology patients

“…The following apps, described in the literature, were not available in either app store: Chemotherapy Assistant (CORA), Pain Squad+, Onco‐TreC, Eating After Transplant (EAT! ), Mobile Oncology Symptom Tracker (mOST), and CareZone Cancer .…”

“…Also, gamification was lacking in the majority of apps in our review and is an untapped capability of smartphone technology. Fishbein et al . reported that gamification could help bolster app impact and evidence exists to support the use of games to improve health outcomes in patients with asthma and diabetes .…”

“…Fishbein et al . reported that gamification could help bolster app impact and evidence exists to support the use of games to improve health outcomes in patients with asthma and diabetes . Calfazzo et al .…”

“…Also, gamification was lacking in the majority of apps in our review and is an untapped capability of smartphone technology. Fishbein et al 22 reported that gamification could help bolster app impact 22 and evidence exists to support the use of games to improve health outcomes in patients with asthma and diabetes. 16,30 Calfazzo et al 31 concluded that incorporating incentives demonstrated an improvement in adolescent blood glucose monitoring frequency and could be used to reinforce patient actions and decision-making.…”

Patient Experiences With Oral Chemotherapy: Adherence, Symptoms, and Quality of Life

“…28 Within our current Patient-Centered Outcomes Research Institute-funded study (IHS-1306-03616), we developed and are testing the efficacy of a mobile app that incorporates symptom tracking, oral therapy reminders and treatment planning, resources for symptom management and activity tracking, and symptom data transfer to the oncology team. 30 Despite being on oral therapy, patients reported a high cancer-related symptom burden that is not being addressed in the current care delivery model. Patients in this sample reported fatigue, drowsiness, and disturbed sleep as the most burdensome and severe symptoms.…”