Outcomes of a randomised controlled trial assessing a smartphone application to reduce unmet needs among people diagnosed with CancEr (ACE)

Deakin Health Economics, Quality and Patient Safety

Using smartphone technology to deliver practical solutions for people affected by cancer at previously unimaginable scale.

Challenge

With improved detection and treatment, cancer survival rates are improving. Despite these advancements, people diagnosed with cancer experience distress and unmet needs during their treatment and beyond. Current support strategies are not meeting patient needs and there is an opportunity to develop supports that are easy to access and address patient concerns.

Solution

Providing cancer patients and survivors with quality information and adequate support as they adjust to life during and after their treatment can be of great benefit. Co-designing a smartphone app with people affected by cancer, that can deliver practical solutions, such as information, appointment monitoring, and improved access to cancer support services has the potential reduce distress and meet the specific needs of this population.

Impact

The smartphone app was acceptable and well received by the participants. It showed some reduction in distress for those utilising the app, however no reductions were seen in unmet needs. The study calls for strategies to overcome the practicalities of implementing technology-based research in hospital settings, and to identify mechanisms that will promote ongoing engagement with smartphone apps, such as involving support persons of those receiving care for cancer.

Partners

Faculty of Health, School of Nursing and Midwifery, Biostatistics Unit, Deakin University

Duke University School of Medicine

Epworth Health Care

Andrew Love Cancer Centre, Barwon Health

The University of Melbourne, Medicine, Dentistry and Health Sciences

Faculty of Health, University of Technology Sydney

Faculty of Medicine, Nursing and Health Sciences, Monash University

Eastern Health, Department of Oncology

Simble Solutions

Optus

Smartphone technology represents an opportunity to deliver practical solutions at a scale that was previously unimaginable. It offers new possibilities for health promotion and treatment management that can reach patients regardless of where they live, including appointment monitoring, [1,2] improved access to cancer information and support services [3] and lead to improved participation in health care over time.[4,5]

This study, led by the Institute’s Professor Trish Livingston, aimed to determine whether a smartphone app reduced the unmet needs among people newly diagnosed with cancer.

Unmet needs refer to the gap between a person’s experience of services and the actual services required or desired. [6] Despite consistent evidence and widespread acknowledgment of the psychological impact of a cancer diagnosis, unmet needs that may contribute to an individual’s distress are poorly recognised and undertreated. [7] A systematic review found that up to 93% of newly diagnosed patients reported unmet needs across a range of domains comprising psychological, informational, and physical. [8] An earlier review [9] identified that the most common unmet needs were those associated with activities of daily living, economic needs, physical needs, supportive care needs, and sexuality. This situation has not changed in nearly a decade. [10]

With the rapid development of information science and technology, digital health has become an important tool for health care. As a result, many people seek health-related information on the Internet. [11, 12] However, concerns over the quality of information [12] and level of e-health literacy [13] highlight the need to provide people affected by cancer with quality and flexible access to information from reputable sources.

There has been increasing interest in mobile phones as a platform for interventions for people with cancer. [14] A recent systematic review highlighted mobile interventions for people with cancer only met treatment or symptom-related information needs and did not meet patients’ full range of cancer-related information needs, from information on psychological support to how to manage finances during cancer, and the long-term effects of treatment. [14] The smartphone app intervention attempted to fill this gap by providing information, support services, clinical trials information, and allied health resources to people newly diagnosed with cancer.

The researchers conducted a single blind, multisite randomised controlled trial to determine the impact of an app-based, four-month intervention that was co-designed with cancer patients. Patients in the intervention group received access to the newly designed app, and those included in the control group received usual care.

The app included cancer information, with links to reputable sources such as cancer support services, clinical trials and allied health services. It also included health service navigation and appointment scheduling features, a notebook for writing down questions prior to appointments and emergency contact numbers. To measure impacts on distress, the app included a distress thermometer, which participants completed at baseline and then monthly until the conclusion of the intervention.  Participants also completed surveys to measure unmet needs, cancer distress, health education impact, health literacy and satisfaction with the app. App usage data was downloaded to track frequency and patterns of use over time.

Despite consumer involvement in the design of this smartphone technology, the app did not reduce unmet needs. This may have been due to the study being underpowered. The results did indicate an encouraging reduction in distress.

The practical difficulties in undertaking smartphone technology research are highlighted by this study. The practicality of apps may not match the reality in that people may use such apps initially but tend not to continue to use them consistently for longer periods. Providing additional information such as survivorship features or sharing the app with carers may facilitate ongoing use. Undertaking technology-based research in hospital settings can be problematic with Internet black spots, firewalls and technology incompatibility, posing substantial impediments to the conduct of studies. [15]

To contribute to a meaningful understanding and improved implementation of smartphone technology to support people affected by cancer, practical considerations, such as recruitment issues and access to, and confidence with, apps, need to be considered.

 

1: Aggarwal ADavies JSullivan R“Nudge” and the epidemic of missed appointmentsJ Health Organ Manag2016;30(4):558564.

2: Kheirkhah PFeng QTravis LMTavakoli-Tabasi SSharafkhaneh APrevalence, predictors and economic consequences of no-showsBMC Health Serv Res2016;14(16):13.

3: Mirkovic JKaufman DRRuland CMSupporting cancer patients in illness management: usability evaluation of a mobile appJMIR Mhealth Uhealth2014;2(3):e33.

4: Wang JWang YWei C, et al. Smartphone interventions for long-term health management of chronic diseases: an integrative reviewTelemed J E Health2014;20(6):570583.

5: Bender JLYue RYTo MJDeacken LJadad ARA lot of action, but not in the right direction: systematic review and content analysis of smartphone applications for the prevention, detection, and management of cancerJ Med Internet Res2013;15(12):e287.

6: Carr WWolfe SUnmet needs as sociomedical indicatorsInr J Health Ser1976;6:417429.

7: de Vries MStiefel FPsycho-oncological interventions and psychotherapy in the oncology settingRecent Results Cancer Res2014;197:121135.

8: Puts MTEPapoutsis ASpringall ETourangeau AEA systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatmentSupport Care Cancer2012;20(7):13771394.

9: Harrison JDYoung JMPrice MAButow PNSolomon MJWhat are the unmet supportive care needs of people with cancer? A systematic reviewSupport Care Cancer2009;17(8):11171128.

10: Okediji PTSalako OFatiregun OOPattern and predictors of unmet supportive care needs in cancer patientsCureus2017;17(8):11171128.

11: Holmes MMWhy people living with and beyond cancer use the internetIntegr Cancer Ther2019;18:1534735419829830.

12: Jo HSPark KJung SMA scoping review of consumer needs for cancer informationPatient Educ Couns2019;102(7):12371250.

13: Kim HGoldsmith JVSengupta S, et al. Mobile health application and e-health literacy: opportunities and concerns for cancer patients and caregiversJ Cancer Educ2019;34(1):38.

14: Richards RKinnersley PBrain KMcCutchan GStaffurth JWood FUse of mobile devices to help cancer patients meet their information needs in non-inpatient settings. Systematic reviewJMIR Mhealth Uhealth2018;6(12):e10026.

15: Russell LPascoe MCSeymour JF, et al. The trials and tribulations of conducting an m-health pilot randomized controlled trial to improve oral cancer therapy adherence: recommendations for future multisite, non-drug clinical trialsBMC Res Notes2019;12(1):226.