Computer-Based Assessment of Symptoms and Mobility in Palliative Care: Feasibility and Challenges

Abstract

The aims of the study were to explore the ability of cancer patients who are primarily receiving palliative care to use a touchscreen computer for assessment of symptoms and mobility and to investigate which factors predicted the need for assistance during the assessment. Before the main data collection, a pilot study was conducted to explore the preferences of these patients toward using such a computerized assessment tool. Patients were recruited from nine different inpatient and outpatient palliative care and general cancer clinics in Norway. The patients responded to 60 items on symptoms and mobility directly on the computer. In the pilot study (n=20), 11 patients (55.0%) preferred computerized assessment over paper and pencil, whereas five (25.0%) had no preference. In the main data collection, 370 patients (52.7% men with mean age 62 years and mean Karnofsky Performance Status score of 70) completed the assessment. Eighty-six patients (23.2%) required assistance. Patients requiring assistance were significantly older, had worse performance status, and poorer cognitive function than those not requiring assistance. Predictors for requiring assistance were age (P<0.001) and performance status (P<0.001). Because higher age and worse performance status resulted in more need of assistance, assessment tools should be short and user-friendly to ensure good compliance in frail patients.

Development of a computer-administered mobility questionnaire

“…Furthermore, the respondents were not able to go to the next question until having completed the current one, thus avoiding missing responses. A concurrent feasibility study achieved a high completion rate and found no effect of gender or functional level on the rate of completion [35], and supported the use of computer-based questionnaires as feasible even in frail persons. Overall, cognitive function was not seriously affected in the sample.…”

Designing a reliable pain drawing tool: avoiding interaction flaws by better tailoring to patients’ impairments

“…Regarding physical function, we were able to differentiate between two patient categories, high and low KPS, that had different requirements for ergonomical adjustments for better interaction, e.g., in bed (low KPS) and at a table (high KPS). Other studies of similar patients have also suggested an impact of physical function when interacting with digital tools [13,16]. KPS provides an easy and unambiguous definition of the patients that are involved in the study, and we suggest the use of it to describe the informants.…”

“…In previous studies designed to measure feasibility with qualitative methods, details of the users who have informed the study are unknown [14,34]. The methods used in healthcare studies are often quantitative, and causality of reduced interaction can be hard to prove statistically, especially if we do not know what to look for [13,21]. In technology development studies, qualitative data are often quite well described, but the important traits, from a medical point of view (and possibly also from an interaction point of view), of the informants are often missing [14,34].…”

“…There were also indicators from viewing the completed CPBMs that made us suspect usability problems with the current program and platform. Existing evidence from similar programs tested in the same group of patients suggested that patients with physical impairment and old age were less able to use the tool [13].…”

Rehabilitation in end-of-life management

“…In this regard, the work of Fyllingen et al [18], Helbostad et al [19 ], and Pigott et al [20] is encouraging. These three research groups report on the development of tools for identifying patients' supportive care needs, including physical functioning and activities of daily living.…”