Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study

Abstract

Background Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use—adherence—is an essential factor of engagement. Objective This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a higher total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted higher usage of specific app functions for both patient groups. Patients’ experience of relevance and interactivity influenced their engagement positively.

Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings

“…This is consistent with previous findings using mobile applications for chronic and cancer pain management [ 38 , 66 ]. Recently, it was found that approximately 80% of participants respond to daily cancer symptom assessments, with adherence rates decreasing as the period of time using the app increased [ 67 ]. In light of the high adherence rates in the present study, it seems that patients need and appreciate being in constant contact with the clinicians.…”

People with cancer and their family caregivers’ personal experience of using supportive eHealth technology: A narrative review

“…Personalised information was particularly valued for guiding participants with cancer in their individual experiences and goals, as well as the personalised self-care activities they should engage with at home (Gustavell et al, 2020;Ownsworth et al, 2020;Whitehead et al, 2020). eHealth-delivered information was particularly helpful at the beginning of the cancer care trajectory when symptoms were unfamiliar, however, several studies highlighted that its value lessened as treatment progressed and participants become accustomed to their symptom experience (Crafoord et al, 2020;Ngo et al, 2020;Hauffman et al, 2020). Two of the studies identified (Huberty et al, 2020;Wang et al, 2020) looked at the experience of general health apps used amongst people with cancer and underlined that participants desired more cancer-specific information.…”

“…Several challenges were evident regarding the integration and engagement with eHealth technology within their daily routine. For participants receiving active treatment, engagement with eHealth technology to report symptoms did not always feel necessary or they felt too unwell to engage (Crafoord et al, 2020;Whitehead et al, 2020), Personal and family priorities during the cancer experience were often difficult to manage and the belief of having no time also inhibited their engagement with technology (Hu et al, 2020;Sandaunet et al, 2008;Wang et al, 2020). Two studies cited that care programs delivered through eHealth are time-consuming (MacDonald et al, 2020;Martin et al, 2021), while Fergus and colleagues' dyadic study (2014) highlighted how the relationship enhancement programme disrupted some couples' usual routine which interrupted their leisure time together.…”

“…Some partners of people with breast cancer referred to it as an obligation which could invoke guilt if they did not complete their assigned activities. Conversely, other studies found that technology was easily embedded in their daily routine and personal schedule (Maguire et al, 2020;Ngo et al, 2020;Hauffman et al, 2020), appreciating the option to engage at a time and pace that suited them (Song et al, 2015;Smith et al, 2020a;Drott et al, 2016) and enabled the person with cancer to plan their schedule (Mohsen et al, 2021;Crafoord et al, 2020). Participants with cancer also found benefit from eHealth technology in that they gained time in their own lives and did not have to travel to their treatment centre for supportive care, whereby people with cancer perceived an additionalreduced burden on their family caregivers (Dalby et al, 2021;Ownsworth et al, 2020).…”

“…Despite this connection, a resounding sentiment was evident regarding how participants did not want eHealth technology to replace their in-person, face-to-face contact with their healthcare team (Brennan et al, 2020;Dalby et al, 2021;Ownsworth et al, 2020). People with cancer cited that technology may inhibit their ability to detail their individual experienced issues (Dalby et al, 2021;Drott et al, 2016;Crafoord et al, 2020), telephone conversations can feel rushed or encounter language/accent comprehension difficulties (Dalby et al, 2021), written contact with healthcare professionals lack of body language and verbal nuances (Högberg et al, 2015) and pertinent topics may require further discussion such as fear of cancer recurrence (Drott et al, 2016;Smith et al, 2020a) which may be overlooked using technology. Within dyads of people with cancer and family caregivers, eHealth technology facilitated several inter-personal benefits including enhanced communication styles, meaningful discussion, relationship strengths affirmations, improved intimacy, learning of each other's fears and encouragement to work together for shared goals (Fergus et al, 2014;Lambert et al, 2020;Song et al, 2015).…”