A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study

Abstract

Background Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363

Evaluating Barriers and Facilitators to the Uptake of mHealth Apps in Cancer Care Using the Consolidated Framework for Implementation Research: Scoping Literature Review

“…The 91 studies included for analysis describe 73 mHealth apps, of which 29 (40%) were designed for supporting any cancer types [ 9 , 12 , 47 , 48 , 50 , 54 , 56 - 58 , 65 - 69 , 71 , 73 , 74 , 76 , 81 - 83 , 85 - 88 ,​ 90 , 91 , 93 , 105 - 109 , 111 - 113 , 116 , 117 , 121 , 122 , 125 , 128 ], followed by 17 (23%) on breast cancer [ 49 , 64 , 70 , 72 , 77 ,​ 78 , 80 , 95 - 98 , 103 , 114 , 115 , 118 , 124 , 126 , 129 - 131 ], 5 (7%) [ 52 , 53 , 63 , 99 , 101 , 102 ] on gastric and colon cancer types, 3 (4%) [ 75 , 79 , 89 , 119 ] on lung cancer, 3 (4%) on thyroid cancer [ 84 , 100 , 123 ] type, and 2 (3%) on hematological cancer types [ 9 , 55 , 56 ,…”

“…The most frequent treatment specifications were chemotherapy (15/73, 21%) [ 47 , 50 , 55 , 63 , 64 , 70 , 78 , 85 , 87 , 101 , 110 , 114 - 116 , 119 , 127 , 129 , 131 ], oral anticancer treatments (13/73, 18%) [ 9 , 48 , 52 ,​ 56 - 58 , 65 , 76 , 80 , 82 , 90 , 91 , 94 , 111 , 122 , 128 ], radiotherapy (3/73, 4%) [ 54 , 92 , 120 ], and others (8/73, 11%) [ 12 , 16 , 45 , 59 , 60 , 66 - 69 , 75 , 81 , 89 , 102 , 106 , 107 , 113 , 125 ], which included several treatment types, such as a combination of chemotherapy and radiotherapy. Nonpharmacological treatments include surgery (8/73, 11%) [ 8 , 49 , 61 , 79 , 96 , 109 , 123 , 130 ] and transplantation (3/73, 4%) [ 77 , 97 , 100 , 103 ].…”

“…This is the case for certain medication adherence apps that focus mainly on providing reminders to patients [ 65 , 76 , 79 , 80 , 82 , 99 , 111 ]. The remaining apps (8/73, 11%) [ 9 , 45 , 46 , 56 ,​ 57 , 62 , 74 , 90 , 109 , 118 ] had diverse combinations of end users with patients, clinicians, caregivers, and pharmacologists. The app functionalities are listed in Table 1 .…”

“…Regarding the intervention source, the literature reported that participating in the development phase increased the likelihood of later embracing the technology. Most analyzed apps have been developed collaboratively [8,53,[55][56][57][58]62,72,73,75,77,87,101,103,104,107,109,114,[116][117][118]122,127,131], often including HCPs, potential patients, and external technology partners responsible for actual software development [56,66,71,78,89,97,105,125,127,129,130]. For instance, the development of eOncoSalud was carefully planned during a series of 7 nominal consensus meetings involving a wide range of stakeholders [56].…”

“…,45,59,60,66-69,75,81,89,102,106,107,113,125], which included several treatment types, such as a combination of chemotherapy and radiotherapy. Nonpharmacological treatments include surgery (8/73, 11%)[8,49,61,79,96,109,123,130] and transplantation (3/73, 4%)[77,97,100,103]. mHealth users can be patients, clinicians, a broader pool of health care professionals (HCPs), or different combinations of users.…”