A survey of cancer care institutions in Nepal to inform design of a pain management mobile application

Abstract

Background One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs. Objectives This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application (‘app’) to scale-up implementation of existing locally developed PMG. Methods We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app. Findings Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39). Conclusions Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.

A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal

“…Whether this is more reflective of the SUS and MARS capturing different facets of the user experience, or truly represents a difference between institutional mobile app needs, requires further exploration—as was done with our modeling analysis (see below). One noteworthy finding from our prior survey ( 81 ) related to differences in permissibility of the use of mobile phones in the clinical work setting between physicians and nurses (nurses reported being less likely to be allowed to use mobile phones in the work setting). As our hospice participants were predominantly nurses ( n = 7, 88%), perhaps this impacted their experience testing the app and SUS scores.…”

“…Importantly, design of the beta version of the app was informed by a comprehensive survey of oncology healthcare providers from four diverse cancer care institutions within Nepal (the same four sites where we later pilot tested the app). The goal of this survey was to better understand barriers and facilitators to cancer pain management and to gather end-user feedback about design of the mobile app ( 81 ). For example, a finding from our survey was that a key barrier to pain management was a high volume of patients.…”

“…The final beta version of the app was deployed on Android study phones and a purposive quota sample of healthcare providers were recruited from four diverse study sites within Nepal (a public cancer hospital; a private cancer hospital; a public general hospital; and a hospice) to pilot test the app. These were the same 4 sites that also provided survey data that helped inform design of the app ( 81 ). The 4 study sites were carefully selected as each institution cares for adult patients with cancer and employed a key stakeholder of our study team affiliated with NAPCare, and also represented a diverse patient population and context.…”

Building a ‘Virtual Library’: continuing a global collaboration to strengthen research capacity within Nepal and other low- and middle-income countries

“…The primary aim of the NAPCare-UVA collaboration, consistent with the overall objective of the project’s funding mechanism [ 35 ], is to strengthen individual and institutional research capacity related to cancer care within Nepal. This aim was achieved by conducting a comprehensive survey of cancer care institutions within Nepal [ 36 ]; developing and pilot testing a mobile application to support healthcare providers in delivering evidence-based cancer pain management [ 37 ]; and creation of a ‘Virtual Library,’ (VL) which is the focus of this paper.…”

Co-constructing collaboration: An evidence-based approach to advance and evaluate equitable global public health research partnerships

“…Another key deliverable from the parent grant was the creation of a ‘Virtual Library’–a web-based repository of research-related resources designed to support clinical investigators in resource-constrained settings [ 24 ]. Results related to the design and pilot testing of the mobile app [ 25 , 26 ] and creation of the Virtual Library [ 27 ] have been previously reported.…”