A Smartphone-Based Pain Management App for Adolescents With Cancer: Establishing System Requirements and a Pain Care Algorithm Based on Literature Review, Interviews, and Consensus

Abstract

BackgroundPain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required.ObjectiveTo develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer.MethodsA systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app.ResultsThe systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app. These results were used to build a detailed prototype algorithm capable of providing adolescents with pain management support based on their individual pain. Analysis of qualitative interviews with 9 multidisciplinary health care professionals and 10 adolescents resulted in 4 themes that helped to adapt the algorithm and requirements to the needs of adolescents. Specifically, themes were overall endorsement of the system, the need for a clinical expert, the need to individualize the system, and changes to the algorithm to improve potential clinical effectiveness.ConclusionsThis study used a phased and user-centered approach to develop a pain management algorithm for adolescents with cancer and the system requirements of an associated app. The smartphone software is currently being created and subsequent work will focus on the usability, feasibility, and effectiveness testing of the app for adolescents with cancer pain.

Persuasive Systems Design features in Promoting Medication Management for consumers

“…Tailoring. Seven out of 13 articles reviewed included aspects relating to the principle of tailoring [9][10][11][12][13][14]18]. Tailoring was implemented based on the medication and questionnaire answers, and feedback.…”

“…A cancer pain management application [14] provided tailored patient recommendations based on their own preferences. For example, the application might recommend the patient listen to music, if they have selected this as a pain management strategy [14].…”

“…For example, the application might recommend the patient listen to music, if they have selected this as a pain management strategy [14]. On the other hand a chronic pain management application [18] uses demographic patient information and their medical conditions to tailor an action plan for their medication management [18].…”

“…Self-monitoring. In the articles reviewed, six of the 13 include some aspect that is related to the principle of self-monitoring [9,11,12,14,17,18]. The FOCUS system [9] prompts the user to engage in a brief self-assessment each day.…”

“…Wireless sensors monitored the opening and closing of the pill box [12]. The cancer pain management application uses self-monitoring to allow the patient to self-assess and log their pain levels over time based on their pain medication intake [14]. The collaborative awareness system [17] which promotes self-monitored medication adherence for HIV patients, allows patients to self-report adherence and keep an updated record of their performance [17].…”