Background: Despite the growing popularity of mobile app interventions, specific engagement components of mobile apps have not been well studied. Methods: The objectives of this scoping review are to determine which components of mobile health intervention apps encouraged or hindered engagement, and examine how studies measured engagement. Results: A PubMed search on March 5, 2020 yielded 239 articles that featured the terms engagement, mobile app/ mobile health, and adult. After applying exclusion criteria, only 54 studies were included in the final analysis. Discussion: Common app components associated with increased engagement included: personalized content/feedback, data visualization, reminders/push notifications, educational information/material, logging/self-monitoring functions, and goal-setting features. On the other hand, social media integration, social forums, poor app navigation, and technical difficulties appeared to contribute to lower engagement rates or decreased usage. Notably, the review revealed a great variability in how engagement with mobile health apps is measured due to lack of established processes. Conclusion: There is a critical need for controlled studies to provide guidelines and standards to help facilitate engagement and its measurement in research and clinical trial work using mobile health intervention apps.
Informal caregivers are a critical source of support for cancer patients. However, their perspectives are not routinely collected, despite health impacts related to the burden of caregiving. We created the TOGETHERCare smartphone application (app) to collect observer-reported outcomes regarding the cancer patient’s health and caregiver’s perceptions of their own mental and physical health, and to provide tips and resources for self-care and patient care. We enrolled 54 caregivers between October 2020 and March 2021 from Kaiser Permanente Northern California (KPNC), an integrated healthcare system. Fifty caregivers used the app for approximately 28 days. Usability and acceptability were assessed using questions from the Mobile App Rating Scale (MARS), the System Usability Scale (SUS), the Net Promoter Score (NPS), and semi-structured interviews. The caregivers’ mean age was 54.4 years, 38% were female and 36% were non-White. The SUS total mean score was 83.4 (SD = 14.2), for a percentile rank of 90–95 (“excellent”). Median MARS responses to the functionality questions were also high. The NPS score of 30 at the end of the study indicated that most caregivers would recommend the app. Themes from semi-structured interviews were consistent across the study period and indicated that the app was easy to use and helpful. Caregivers indicated a need for feedback from the app, suggested some changes to the wording of questions, the app’s visuals, and timing of notifications. This study demonstrated that caregivers are willing to complete frequent surveys about themselves and their patients. The app is unique because it provides a remote method to collect caregivers’ observations about the patient that may be useful for clinical care. To our knowledge, TOGETHERCare is the first mobile app developed specifically to capture adult cancer patient symptoms from the informal caregiver’s perspective. Future research will examine whether use of this app can help improve patient outcomes.
174 Background: Patient-reported outcomes and wearable sensor measures of physical function can predict important outcomes in oncology. However, mobile and wearable-sensor apps collect vast information from patients and caregivers; indiscriminate reporting may increase provider burden and reduce data reliance. This study aimed to assess medical oncologists’ current practices in utilizing such information, and their data delivery preferences. Methods: Cross-sectional survey delivered by email to all Kaiser Permanente Northern California medical oncologists, February-March 2021. Results: Thirty-eight oncologists (30% of 127) responded to the survey. Most agreed that to reduce adverse events (AEs) it is important for the oncologist to know about the following measures: 1) patient/caregiver-reported physical symptoms (92% responded either very important or essential); 2) patient/caregiver-reported physical function (87%); and 3) objective measures of gait/balance (55%) and physical activity (50%) obtained from wearable sensors. Similarly, most respondents strongly consider these data when making decisions related to treatment intent, dosage, or visit frequency. All respondents routinely rely on information from caregivers, and in case of a discrepancy, more rely on the caregiver’s report (45%) than the patient’s report (8%), and some seek additional objective information (26%). Most respondents indicated that they prefer to receive electronic information on physical function and symptoms only for “critical values” and/or to have the information accessible “as needed” in the electronic chart, but not actively delivered to them (Table). Conclusions: Oncologists believe that patient/caregiver reports of symptoms and physical function can predict AEs, and strongly rely on them in clinical decision making. The majority of respondents would like to have access to physical function/symptoms data from mobile/wearable apps, with more providers wishing to receive information prior to a visit and/or in case of “critical values”. These findings may inform future implementations of mobile/wearable technologies to track symptoms and function of cancer patients.[Table: see text]
12026 Background: Informal caregivers are essential partners in the delivery of cancer care, and often can accurately identify and report symptoms and physical function of the patients they care for. We assessed whether such reporting by caregivers is predictive of adverse patient outcomes. Methods: In this prospective study, adult solid cancer patients on active intravenous systemic therapies and their informal caregivers were recruited from 18 Kaiser Permanente Northern California cancer centers. Using a study mobile app (TOGETHERCare), caregivers completed weekly surveys for 4 weeks, which were based on normalized NIH-PROMIS scores to report patients’ physical function and PRO-CTCAE to report patients’ symptoms. Patients’ adverse clinical outcomes were abstracted from the medical record and included: emergency department (ED) visits or hospitalizations, grade 3-4 adverse events (AEs), and treatment delays, up to 1 month following the 4-week study period, as well as mortality and hospice referrals up to 6 months following the study period. Simple univariate logistic regressions were used to correlate caregiver reports (either at baseline or most proximal preceding an adverse outcome) with mortality and hospice referrals, and quasi-Poisson regressions were used for the other adverse outcome measures. Results: Fifty-four patient-caregiver dyads were enrolled, and 52 were included in this analysis. A third of patients had breast cancer and almost 75% had stage 3 or 4 disease. Caregivers predominantly identified as male (61.5%), spouse/partner (76.9%), and non-Hispanic White (63.5%). At least one adverse outcome was experienced by 36.5% of the patients. Caregiver-reported PRO-CTCAE consistently predicted ED/hospitalizations and mortality, and caregiver-reported PROMIS scores predicted hospice referrals (see Table). Conclusions: The results suggest that caregiver reporting of patients’ symptoms and physical function could help provide early predictions of adverse patient outcomes.[Table: see text]
157 Background: There is increasing appreciation for the insight provided by combining low-burden home-based remote digital measurements with patient and observer reported outcomes. In this study, we assessed perspectives of cancer patients and their caregivers on the utility of a mobile app combined with a smartwatch for collection of specific outcomes and to provide clinically actionable data. Methods: In a decentralized clinical trial we consented and enrolled (10/12/2020-4/30/2021) dyads that consisted of a cancer patient and their informal caregiver. All participants had to own an Apple iPhone 6 or higher. Patients were provided with an Apple watch 3 or 4 and downloaded a patient informed mobile app (DigiBioMarC). Caregivers only download a caregiver informed mobile app (TOGETHERCare). Participants were asked to use their respective app for 28 days during which time specific surveys and activity requests were delivered through the mobile app; digital measures of physical activity were collected via the smartwatch. At the end of the app usage period, questions were asked in a video interview about the patient and caregiver perspectives on use of their respective apps and what they believed could be impacted if their doctor were to receive the app information. Respondents could select Strongly Agree, Agree, Neutral, Disagree, or Strongly Disagree. Results: Fifty-four dyads were enrolled; four were unable to continue due to a decline in health. Questions were drafted and IRB approved in time to be asked of 45 dyads. The Table lists some results and the percent of respondents that selected Strongly Agree or Agree. Conclusions: Patients and caregivers reported that both apps would encourage them to take better care of themselves/be more physically active and would improve emotional wellbeing. A high proportion of respondents also felt the apps would improve communication with their doctor and provide early important information for the doctor to act upon compared to usual care. Additional work in a large randomized trial is planned to evaluate specific care outcomes. [Table: see text]
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