Reducing pain in children with cancer at home: a feasibility study of the KLIK pain monitor app

Abstract

Purpose This study assessed adherence to, feasibility of, and barriers and facilitators of implementation of an app developed to monitor and follow-up with pain in children with cancer at home. Methods Children (8–18 years) receiving cancer treatment (all diagnoses) or their parents (of children aged 0–7 years) used the KLIK Pain Monitor app for 3 weeks. Pain was assessed twice daily using an 11-point numeric rating scale (NRS-11) (ranging from 0 to 10). Healthcare professionals (HCP’s) from the hospital’s Pediatric Pain Service were instructed to follow-up with clinically significant pain scores (≥ 4) within 120 min (scores 4–6) or 30 min (scores 7–10). Adherence, feasibility, and implementation outcomes were assessed using questionnaires, app log data, and interviews. Results Twenty-seven children (M age = 7.3 years, 51.8% male) and six HCP’s participated. Sixty-three percent (N = 17) of families used the app on a daily basis during three weeks, and 18.5% (N = 5) reported pain scores twice daily during that time (family adherence). Twelve out of 27 children (44.4%) reported a clinically significant pain score at least once. In 70% (14/20) of clinically significant pain scores, HCP’s followed-up with families within the set timeframe (HCP adherence). Outcomes reveal feasibility for the majority of app functions (i.e., positive evaluation by ≥ 70% families/HCP’s), and non-feasible aspects could be resolved. Identified barriers and facilitators were used to improve future implementation efforts. Conclusion Use of the KLIK Pain Monitor app seems feasible. Future research will determine its effectiveness in reducing pain in children with cancer at home.

Design strategies for the development of mHealth services in healthcare of adolescents with cancer

“…The key features that our research detected were the following: symptom tracker, pain-related symptom tracker, communication with medical staff, adherence to treatment, information provision, social support, and coping strategies. More specifically, in this review communication with medical staff seemed to be highly important as it was the most frequently applied feature with 18 articles confirming it (4,9,10,(12)(13)(14)17,18,20,21,(25)(26)(27)(28)(29)36,39,40). Subsequently, also 17 studies included the feature of adherence to treatment (7,10-12,14-17,19,24-26,29,36,37,39,40).…”

“…In addition, the symptom tracker was referred to 14 more articles (4,6,7,9,10,13,15,19,21,25,27,29,36). Also, throughout literature there are more 14 studies encompassed the feature of information provision (4,7,9,10,12,18,21,(24)(25)(26)(27)29,36,40). Furthermore, painrelated symptom tracker was the following used feature with 13 studies confirming it (2,7,10,(12)(13)(14)(15)(17)(18)(19)(20)25,28).…”

“…Also, throughout literature there are more 14 studies encompassed the feature of information provision (4,7,9,10,12,18,21,(24)(25)(26)(27)29,36,40). Furthermore, painrelated symptom tracker was the following used feature with 13 studies confirming it (2,7,10,(12)(13)(14)(15)(17)(18)(19)(20)25,28). Also, the facility of social support was found in 13 researches (4,7,9,10,21,23-25,27,32-34,36,40).…”

“…It is noteworthy that populations from lower socioeconomic status appear to have limited access to them, using smartphones up to 25%, a fact that could create selection bias, in terms of the benefits of mHealth interventions (9). effective pharmacological and non-pharmacological interventions (12). In particular, in the study of Simon et al (12), which included cases with clinically significant levels of pain presented that one-third of children receiving chemotherapy were not given analgesics at home (12).…”

“…effective pharmacological and non-pharmacological interventions (12). In particular, in the study of Simon et al (12), which included cases with clinically significant levels of pain presented that one-third of children receiving chemotherapy were not given analgesics at home (12). Pain management is a significant cost burden for the healthcare system, therefore it is necessary to find innovative treatment methods for chronic pain, with mHealth technologies being a promising alteration (12,18).…”