Pilot implementation to assess the feasibility and care team impact of an app-based interactive care plan to remotely monitor breast cancer survivors

Abstract

Purpose To assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors. Methods A single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients’ engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system’s functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled. Results Twenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation. Conclusion Implementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption. Implications for Cancer Survivors An ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied.

Advancing the care of individuals with cancer through innovation & technology: Proceedings from the cardiology oncology innovation summit 2020 and 2021

“…The Education speed panel discussed the use of innovative technology in medical and patient education, with salient suggestions as follows: Identify an inclusive group of stakeholders for cardio-oncology education, including medical and graduate students, residents, fellows, hematologists/oncologists, cardiologists, primary care physicians, advanced practice providers, pharmacists, and other cardiovascular team members across subspecialties in heart failure, heart rhythm, interventional cardiology, cardio-oncology, and so on, as well as our patients; Develop innovative case-based cardio-oncology education not only at the fellow level, but also at the resident, medical student, and staff level; Use virtual platforms to expand the reach of conferences that have traditionally been restricted to in-person learning, with future integration of simulations and rich media; Determine the best technology platforms to deliver education (e.g., Twitter journal clubs, educational apps, recorded CME events, real-time streaming events); Use patient portals before and after clinic or hospital visits to ascertain patient reported outcomes and then deliver tailored patient education, resources, and health care team access; Create and utilize of mobile apps to collect patient reported information and deliver patients ongoing education in frequent but smaller quantities [ 42 ]; Advance connected care with Long Term Evolution (LTE)-enabled (i.e., 4G wireless broadband) remote monitoring to increase equitable access, optimize outpatient management, and reduce hospitalizations [ 43 , 44 ]; Facilitate self-advocacy to encourage healthy lifestyle behaviors (e.g., message reminders to exercise and personalized videos for self-care before, during, and after cancer treatment), with potential to improve outcomes; Emulate innovative behavioral modeling video enactment customized for patients to improve self-efficacy for future behavior change; Promote existing patient-directed digital educational formats such as CardioSmart ; Translate oncology practice guidelines in easy to understand and readily accessible interactive formats via mobile apps accessed by both health care professionals and patients. …”

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

“…The primary study outcome was patient satisfaction and perceived usefulness of the proactive pathway, as assessed in the Patient Pathway Experience Survey. Following recommendations for sample size estimations for pilot studies [23][24][25] and mirroring similar pilot implementation studies, [26][27][28][29][30][31][32] a minimum of 50 answers to the overall survey were prespecified as needed to provide an initial assessment of patient experience/satisfaction. Pathway progression criteria were defined as at least 70% of the patients receiving the entire pathway reporting to be very satisfied or completely satisfied.…”

Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review

“…Some of the studies (2/55, 4%) were excluded because they did not have a lifestyle or behavior modification element despite using an app [47,48]. We also excluded studies where the feasibility of an app or the app functionality or engagement was being tested rather than the effectiveness of its contents on QOL and well-being [49,50]. Furthermore, all secondary analyses were excluded, as were pilot or feasibility studies if subsequent randomized controlled trial (RCT) studies had been published.…”