Adaptation and Implementation of a Mobile Phone–Based Remote Symptom Monitoring System for People With Cancer in Europe

Abstract

Background There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. Methods There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. Results The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. Conclusions Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.

Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives

“…High compliance in all countries and all cancer types - Technical issues with the Web-based platform. Resolved with additional training of physicians - Modifications in ASyMS: longer time frame to provide feedback; changes in symptom algorithm - ASyMS not feasible in 2 centers due to organizational issues: lack of staff and technology connectivity Furlong [ 31 ] RCT in progress 1108 Breast, colorectal, hematologic receiving first-line CT – – Maguire [ 32 ] Automated voice response (AVR) system Yes Phone-based Symptom management toolkit, completed a baseline interview. Symptoms questionnaires about: fatigue, pain, insomnia, poor appetite, constipation, nausea/vomiting, anxiety, cough, depression, diarrhea, mouth sores, shortness of breath, peripheral neuropathy, difficulty remembering, and weakness.…”

“…- Fewer studies have assessed the feasibility of digital solutions from the HCP perspective. The most important reasons for adoption reported by HCPs were the usability and usefulness of the tool [26,38,52,58], and the most commonly reported barrier was problems with technology or connectivity [31,75].…”

Implementation Science Meets Software Development to Create eHealth Components for an Integrated Care Model for Allogeneic Stem Cell Transplantation Facilitated by eHealth: The SMILe Study as an Example

“…Evidence supports eHealth's potential to fuel innovation. In particular, studies testing eHealth applications embedded within integrated care models (ICMs) for chronically ill persons have shown clear links to improved clinical, behavioral, and economic outcomes (Aapro et al, 2020;Barello et al, 2016;Elbert et al, 2014;Kuijpers, Groen, Aaronson, & van Harten, 2013;Michaud, Zhou, McCarthy, Siahpush, & Su, 2018;Warrington et al, 2019).…”

“…However, despite increasing empirical evidence supporting eHealth integration into care delivery, sustained implementations of eHealth solutions in routine clinical practice are rare: uptake is often insufficient, adoption rates low, and sustained use rates lower still (Bates & Wright, 2009; Elbert et al, 2014; Furlong et al, 2019; Widmer et al, 2015). Studies testing ready‐made eHealth tools commonly report serious adoption and sustainment problems, with 44% to 67% of patients prematurely discontinuing use (Jeffs et al, 2016; Simblett et al, 2018; Thies, Anderson, & Cramer, 2017).…”

Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review

“…In total, 17 web-based e-SRS were reported in 22 studies (22/33, 66%) [27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49], including 2 studies that integrated web-based platforms with patient portals and electronic health records (EHRs) [41,47]. A total of 9 studies presented 7 mobile app-based e-SRS (9/33, 27%) [30,[50][51][52][53][54][55][56][57], 1 study reported an interactive voice response system [58], and 1 study used only text messaging for symptom reporting [59]. The most commonly adopted symptom reporting instruments or questionnaires in home-based e-SRS were the National Cancer Institute-Common Terminology Criteria for Adverse Events or patient-reported outcome version of Common Terminology Criteria for Adverse Events (6/33, 19%) [27,28,30,38,46,48] [28,31,45,…”