Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation

Abstract

BackgroundLung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs).MethodsA user-centered design approach was used. Through semi-structured interviews (n = 10 LC patients and 6 HCPs), focus groups (n = 5 HCPs), and scenarios (n = 5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs.ResultsThe developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71 % of LC patients and 78 % of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score = 70, range 35–95) was rated acceptable.ConclusionsA telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine.

The patient perspective on the use of information and communication technologies and e-health in rehabilitation

“…A few studies investigated patient preferences for use of ICT in (rehabilitation) health care using a qualitative research design [7,24,25]. Therefore, frequency data found in the current study could not be compared to other literature.…”

“…Examples of e-Health in rehabilitation include virtual reality, computer games, assistive technology and online communication tools. Especially, long-term medical care needs could be addressed at significant lower expenditures [5], by means of improved accessibility to rehabilitation programs for clients with mobility impairments [6][7][8], expanded continuity of care and increased self-management by promoting personalized care, choice and personal autonomy [9]. Indeed, a number of studies showed that e-health is acceptable for subgroup of patients in rehabilitation care [9][10][11] and has the potential to support management of chronic conditions such as Alzheimer's/ dementia [12], diabetes [13,14] and COPD [15,16].…”

“…Despite the many advantages, limited uptake and non-use of ehealth interventions is still a common problem in health care [7,8]. The Normalization Process Theory explain problems with embedding an innovation in practice by the complex interplay between the new technology, individual actions and context [17].…”

“…Moreover, Vankatesh's Unified Theory of Acceptance and Use of Technology (UTAUT) explains current performance and use behaviour explain a large proportion of the variance in the intention to use a new technology [22,23]. In addition, a few studies identified patients' preferences for e-health in rehabilitation by using a qualitative research design [7,24,25]. These studies found that patients with cancer and diabetes were willing to use ICT in (rehabilitation) care for self-monitoring of symptoms, web-based physical exercise programs [7], communication with peers [24,25] and access to their health record [7].…”

“…In addition, a few studies identified patients' preferences for e-health in rehabilitation by using a qualitative research design [7,24,25]. These studies found that patients with cancer and diabetes were willing to use ICT in (rehabilitation) care for self-monitoring of symptoms, web-based physical exercise programs [7], communication with peers [24,25] and access to their health record [7]. However, a lack of studies with a quantitative design impaired generalization of results and so far it is unclear what usage preferences are for other patient groups in rehabilitation care.…”