There is much evidence supporting the efficacy of communication skills training; however, very little of this evidence comes from patient feedback. The primary aim of this pilot study was to evaluate whether the advanced communications skills training improves patients' experience of consultations. Healthcare professionals working in oncology and palliative care services from the North East of England were invited to participate in this study. Interactions between healthcare professionals (n = 21) and patients (n = 1103) were evaluated using the Consultation and Relational Empathy (CARE) Measure, which is a brief questionnaire designed to assess the patients' perceptions of relational empathy in the consultation. Additional demographic variables, such as patient age, length of consultation, familiarity with healthcare professional and overall satisfaction with consultation, were also collected. Healthcare professionals were either part of the intervention group who attended a 3-day communication skills training course or part of the control group who were on the waiting list for training. No differences in the patients' ratings on the CARE measure were found between Time 1 (before training) and Time 2 (after training) for the intervention group. Possible explanations for the findings are explored and implications for communication skills training are discussed.

Background Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life–focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app’s effectiveness in symptom control among cancer patients. Results mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users—patients or caregivers, LHWs, and members of the palliative care team—and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas.

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PURPOSE Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response. METHODS Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey. RESULTS Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women ( P = .07) and higher discharge morphine use ( P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types ( P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group ( P < .0001), and symptom severity decreased over time in both groups ( P = .0001); however, between-group change in overall symptoms over time did not vary significantly ( P = .34). Care satisfaction was generally high in both groups. CONCLUSION Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed.

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1584 Background: Cancer is a growing public health concern in Tanzania (and throughout sub-Saharan Africa), with a majority of cases presenting in late stage with associated distress, ie, pain. Access to specialty palliative care (PC) is a national priority in Tanzania; however, there are limited numbers of PC specialists (hereafter, specialists). Mobile health promises to extend the reach of a limited pool of specialists through inter-professional, community-based care coordination. This work assessed the effectiveness of a smartphone-/web-based application, mobile Palliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers (LHWs). Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated, scheduled mobile symptom assessment and response. Methods: Following consent, incurable adult cancer patients were randomized at hospital discharge from a large urban, government-supported Tanzanian cancer institute to one of two study arms—mPCL or phone-contact POS collection. Baseline sociodemographic, clinical and POS data were recorded. Twice-weekly POS responses were collected and managed via mPCL or by phone-contact with clinician study personnel for up to 4-months depending on respective study arm. Patient end-of-study care satisfaction was assessed via phone-survey. Results: Forty-nine patients per arm participated. Comparison of baseline characteristics showed a trend toward more women ( p= 0.07) and higher discharge morphine use ( p= 0.09) in the mPCL versus phone-contact groups, respectively, and significant between-group differences in cancer types ( p= 0.003). Proportion of deaths were near-equal comparing groups [26% ( n= 13) mPCL versus 28% ( n= 14) phone-contact]. Overall symptom severity was lower in the phone-contact group ( p <0.0001) and symptom severity decreased over time in both groups ( p= 0.0001); however, between-group change in overall symptoms over time did not vary ( p= 0.34). Care satisfaction was high overall in both groups with few between-groups differences, ie, greater provider response to questions and concerns in the phone-contact arm and greater provision of spiritual support in the mPCL arm. Conclusions: Higher symptom severity scores in the mPCL arm likely reflecting between-group sociodemographic/clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that, compared to phone-based support, mPCL may facilitate effective symptom-focused care in a more efficient and scalable manner. Study limitations include a small sample of patients from a single urban hospital and lack of a true usual care arm. Broader study of mPCL’s cost-efficiency and utility in Tanzania is needed. This work promises to close a large PC gap in under-resourced settings throughout Tanzania and other LMICs.

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