Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT).

Abstract

418 Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.

Pain coping, multidisciplinary care, and mHealth: Patients' views on managing advanced cancer pain

“…This work is a component of a larger research program intended to develop, refine, and test the STAMP + CBT mHealth app 24 . We used a semi‐structured interview guide (see online supplemental materials) to guide participant interviews (Figure 1).…”

“…mHealth apps can deliver accessible education and symptom management support to people with advanced cancer, whose symptom burden may preclude them from attending in‐person treatments or engaging with extended telehealth interventions. The app integrates opioid management support and pain‐cognitive behavioral therapy (pain‐CBT) as adjunctive treatments to improve advanced cancer pain management 24 . We took an iterative, patient‐centric approach to ensure that the app interface and pain‐CBT content was relevant, engaging, and useable for target users.…”

“…Accordingly, it is necessary to understand how to best integrate psychological therapies into cancer pain treatment as their traditional session‐based format remains infeasible for most. To achieve this, we solicited patients' participation as we developed psycho‐behavioral cancer pain education and refined a mobile health (mHealth) app designed for people with advanced cancer and pain 24 . mHealth apps can deliver accessible education and symptom management support to people with advanced cancer, whose symptom burden may preclude them from attending in‐person treatments or engaging with extended telehealth interventions.…”

Pain education research: Advances, innovations, and challenges

“…The economic cost of persistent pain on society is enormous. The total cost of chronic pain in 2018 in Australia was estimated at AUD$139.3 billion and 7% of total health system expenditure (cardiovascular disease accounted for 10% in a similar period), and up to $15 billion in New Zealand in 2016 (43,71,72). This cost included loss of productivity at work, burden of disease costs and healthcare costs, as well as welfare benefits and loss of taxation revenue (51,71).…”

Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults

“…Finally, with 40%–90% of patients with advanced cancer experiencing pain, improved access to behavioral pain treatment is needed. As one important step, Dr. Desiree Azizoddin and US colleagues have developed gamified CBT for the palliative context ( 86 ) and a CBT-based mobile health intervention (app) for patients with cancer ( 71 ). The initial results of the CBT app suggest favorable patient appraisal, and two efficacy trials are currently underway ( 87 , 88 ).…”