Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study

Kah Poh Loh, Erika Ramsdale, Eva Culakova, Jason H Mendler, Jane L Liesveld, Kristen M O'Dwyer, Colin McHugh, Maxence Gilles, Terri Lloyd, Molly Goodman, Heidi D Klepin, Karen M Mustian, Rebecca Schnall, Supriya G Mohile, Kah Poh Loh, Erika Ramsdale, Eva Culakova, Jason H Mendler, Jane L Liesveld, Kristen M O'Dwyer, Colin McHugh, Maxence Gilles, Terri Lloyd, Molly Goodman, Heidi D Klepin, Karen M Mustian, Rebecca Schnall, Supriya G Mohile

Abstract

Background: Older patients with cancer are at an increased risk of adverse outcomes. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality, and it can be used to guide interventions. However, the implementation of GA and GA-driven interventions is low due to resource and time limitations. GA-driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers.

Objective: We aimed to evaluate the feasibility and usability of a novel app (TouchStream) and to identify barriers to its use. As an exploratory aim, we gathered preliminary data on symptom burden, health care utilization, and satisfaction.

Methods: In a single-site pilot study, we included patients aged ≥65 years undergoing treatment for systemic cancer and their caregivers. TouchStream consists of a mobile app and a Web portal. Patients underwent a GA at baseline with the study team (on paper), and the results were used to guide interventions delivered through the app. A tablet preloaded with the app was provided for use at home for 4 weeks. Feasibility metrics included usability (system usability scale of >68 is considered above average), recruitment, retention (number of subjects consented who completed postintervention assessments), and percentage of days subjects used the app. For the last 8 patients, we assessed their symptom burden (severity and interference with 17-items scored from 0-10 where a higher score indicates worse symptoms) using a clinical symptom inventory, health care utilization from the electronic medical records, and satisfaction (6 items scored on a 5-point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction) using a modified satisfaction survey. Barriers to use were elicited through interviews.

Results: A total of 18 patients (mean age 76.8, range 68-87) and 13 caregivers (mean age 69.8, range 38-81) completed the baseline assessment. Recruitment and retention rates were 67% and 80%, respectively. The mean SUS score was 74.0 for patients and 72.2 for caregivers. Mean percentage of days the TouchStream app was used was 78.7%. Mean symptom severity and interference scores were 1.6 and 2.8 at preintervention, and 0.9 and 1.5 at postintervention, respectively. There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period (week 5-8). One patient was hospitalized during the intervention period (week 1-4) and two patients during the postintervention period (week 5-8). Mean satisfaction scores of patients and caregivers with the mobile app were 20.4 and 23.4, respectively. Barriers fell into 3 themes: general experience, design, and functionality.

Conclusions: TouchStream is feasible and usable for older patients on cancer treatment and their caregivers. Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion.

Keywords: Mobile health application; cancer; geriatric assessment; older adults.

Conflict of interest statement

Conflicts of Interest: None declared.

©Kah Poh Loh, Erika Ramsdale, Eva Culakova, Jason H Mendler, Jane L Liesveld, Kristen M O'Dwyer, Colin McHugh, Maxence Gilles, Terri Lloyd, Molly Goodman, Heidi D Klepin, Karen M Mustian, Rebecca Schnall, Supriya G Mohile. Originally published in JMIR Cancer (http://cancer.jmir.org), 29.10.2018.

Figures

Figure 1
Figure 1
Tablet showing the interface of the mobile application.
Figure 2
Figure 2
Interface of the Web portal

References

    1. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011 Sep 01;29(25):3457–65. doi: 10.1200/JCO.2011.34.7625.
    1. Mandilaras V, Wan-Chow-Wah D, Monette J, Gaba F, Monette M, Alfonso L. The impact of cancer therapy on cognition in the elderly. Front Pharmacol. 2013;4:48. doi: 10.3389/fphar.2013.00048. doi: 10.3389/fphar.2013.00048.
    1. Loh KP, Pandya C, Zittel J, Kadambi S, Flannery M, Reizine N, Magnuson A, Braganza G, Mustian K, Dale W, Duberstein P, Mohile SG. Associations of sleep disturbance with physical function and cognition in older adults with cancer. Support Care Cancer. 2017 Apr 28; doi: 10.1007/s00520-017-3724-6.
    1. Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, Feng T, Smith D, Sun C, De GN, Cohen HJ, Katheria V, Doan C, Zavala L, Levi A, Akiba C, Tew WP. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol. 2016 Dec 10;34(20):2366–71. doi: 10.1200/JCO.2015.65.4327.
    1. Rodin MB, Mohile SG. A practical approach to geriatric assessment in oncology. J Clin Oncol. 2007 May 10;25(14):1936–44. doi: 10.1200/JCO.2006.10.2954.
    1. Mohile SG, Velarde C, Hurria A, Magnuson A, Lowenstein L, Pandya C, O'Donovan A, Gorawara-Bhat R, Dale W. Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts. J Natl Compr Canc Netw. 2015 Sep;13(9):1120–30.
    1. Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC, Khorana AA, Klepin HD, Lichtman SM, Mustian KM, Tew WP, Hurria A. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018 Aug 01;36(22):2326–2347. doi: 10.1200/JCO.2018.78.8687.
    1. Kalsi T, Babic-Illman G, Ross PJ, Maisey NR, Hughes S, Fields P, Martin FC, Wang Y, Harari D. The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people. Br J Cancer. 2015 Apr 28;112(9):1435–44. doi: 10.1038/bjc.2015.120. doi: 10.1038/bjc.2015.120.
    1. Li CM, Chen CY, Li C, Wang WD, Wu SC. The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial. Arch Gerontol Geriatr. 2010 Feb;50 Suppl 1:S39–42. doi: 10.1016/S0167-4943(10)70011-X.
    1. Monteserin R, Brotons C, Moral I, Altimir S, San JA, Santaeugenia S, Sellarès J, Padrós J. Effectiveness of a geriatric intervention in primary care: a randomized clinical trial. Fam Pract. 2010 Jun;27(3):239–45. doi: 10.1093/fampra/cmp101.
    1. Nykänen I, Rissanen TH, Sulkava R, Hartikainen S. Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on nutritional status: a population-based intervention study. J Nutr Health Aging. 2014 Jan;18(1):54–8. doi: 10.1007/s12603-013-0342-y.
    1. Kenis C, Bron D, Libert Y, Decoster L, Van Puyvelde K, Scalliet P, Cornette P, Pepersack T, Luce S, Langenaeken C, Rasschaert M, Allepaerts S, Van Rijswijk R, Milisen K, Flamaing J, Lobelle J, Wildiers H. Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol. 2013 May;24(5):1306–12. doi: 10.1093/annonc/mds619.
    1. Kenis C, Decoster L, Flamaing J, Debruyne PR, De Groof I, Focan C, Cornélis F, Verschaeve V, Bachmann C, Bron D, Luce S, Debugne G, Van den Bulck H, Goeminne J, Schrijvers D, Geboers K, Petit B, Langenaeken C, Van Rijswijk R, Specenier P, Jerusalem G, Praet J, Vandenborre K, Lobelle J, Lycke M, Milisen K, Wildiers H. Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium. Ann Oncol. 2018 Sep 01;29(9):1987–1994. doi: 10.1093/annonc/mdy210.
    1. Joe J, Demiris G. Older adults and mobile phones for health: a review. J Biomed Inform. 2013 Oct;46(5):947–54. doi: 10.1016/j.jbi.2013.06.008.
    1. Loh K, McHugh C, Mohile S, Mustian K, Flannery M, Klepin H, Schnall Rebecca, Culakova Eva, Ramsdale Erika. Using Information Technology in the Assessment and Monitoring of Geriatric Oncology Patients. Curr Oncol Rep. 2018 Mar 06;20(3):25. doi: 10.1007/s11912-018-0672-3.
    1. McTavish FM, Gustafson DH, Owens BH, Wise M, Taylor JO, Apantaku FM, Berhe H, Thorson B. CHESS: An interactive computer system for women with breast cancer piloted with an under-served population. Proc Annu Symp Comput Appl Med Care. 1994:599–603.
    1. Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, Bennett AV, Dueck AC, Atkinson TM, Chou JF, Dulko D, Sit L, Barz A, Novotny P, Fruscione M, Sloan JA, Schrag D. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. J Clin Oncol. 2016 Feb 20;34(6):557–65. doi: 10.1200/JCO.2015.63.0830.
    1. Basch E, Deal AM, Dueck AC, Scher HI, Kris MG, Hudis C, Schrag D. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. JAMA. 2017 Jun 04; doi: 10.1001/jama.2017.7156.
    1. Kearney N, McCann L, Norrie J, Taylor L, Gray P, McGee-Lennon M, Sage M, Miller M, Maguire R. Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity. Support Care Cancer. 2009 Apr;17(4):437–44. doi: 10.1007/s00520-008-0515-0.
    1. Maguire R, Fox PA, McCann L, Miaskowski C, Kotronoulas G, Miller M, Furlong E, Ream E, Armes J, Patiraki E, Gaiger A, Berg GV, Flowerday A, Donnan P, McCrone P, Apostolidis K, Harris J, Katsaragakis S, Buick AR, Kearney N. The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer. BMJ Open. 2017 Jun 06;7(5):e015016. doi: 10.1136/bmjopen-2016-015016.
    1. Burhenn PS, Smudde J. Using tools and technology to promote education and adherence to oral agents for cancer. Clin J Oncol Nurs. 2015 Jun;19(3 Suppl):53–9. doi: 10.1188/15.S1.CJON.53-59.
    1. Uhm KE, Yoo JS, Chung SH, Lee JD, Lee I, Kim JI, Lee SK, Nam SJ, Park YH, Lee JY, Hwang JH. Effects of exercise intervention in breast cancer patients: is mobile health (mHealth) with pedometer more effective than conventional program using brochure? Breast Cancer Res Treat. 2017 Feb;161(3):443–452. doi: 10.1007/s10549-016-4065-8.
    1. Hong Y, Dahlke DV, Ory M, Hochhalter A, Reynolds J, Purcell NP, Talwar D, Eugene N. Designing iCanFit: A Mobile-Enabled Web Application to Promote Physical Activity for Older Cancer Survivors. JMIR Res Protoc. 2013;2(1):e12. doi: 10.2196/resprot.2440.
    1. Wu JM, Yu HJ, Ho TW, Su XY, Lin MT, Lai F. Tablet PC-enabled application intervention for patients with gastric cancer undergoing gastrectomy. Comput Methods Programs Biomed. 2015 Apr;119(2):101–9. doi: 10.1016/j.cmpb.2015.03.004.
    1. Jayani R, Hurria A. Caregivers of older adults with cancer. Semin Oncol Nurs. 2012 Nov;28(4):221–5. doi: 10.1016/j.soncn.2012.09.004.
    1. TouchStream Solutions. 2016. [2018-10-06].
    1. Whitelaw NA, Liang J. The structure of the OARS physical health measures. Med Care. 1991 Apr;29(4):332–47.
    1. Brorsson B, Asberg KH. Katz index of independence in ADL. Reliability and validity in short-term care. Scand J Rehabil Med. 1984;16(3):125–32.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994 Mar;49(2):M85–94.
    1. Davous P, Lamour Y, Debrand E, Rondot P. A comparative evaluation of the short orientation memory concentration test of cognitive impairment. J Neurol Neurosurg Psychiatry. 1987 Oct;50(10):1312–7.
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695–9. doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Stewart AL, Kamberg CJ. Stewart AL, Ware JE Jr., editors. Measuring functioning and well-being; the Medical Outcomes Study approach. Durham, NC: Duke University Press; 1992. Physical functioning measures; pp. 86–101.
    1. Flodin L, Svensson S, Cederholm T. Body mass index as a predictor of 1 year mortality in geriatric patients. Clin Nutr. 2000 Apr;19(2):121–5. doi: 10.1054/clnu.1999.0091.
    1. Gilmore SA, Robinson G, Posthauer ME, Raymond J. Clinical indicators associated with unintentional weight loss and pressure ulcers in elderly residents of nursing facilities. J Am Diet Assoc. 1995 Sep;95(9):984–92. doi: 10.1016/S0002-8223(95)00271-5.
    1. Marc LG, Raue PJ, Bruce ML. Screening performance of the 15-item geriatric depression scale in a diverse elderly home care population. Am J Geriatr Psychiatry. 2008 Nov;16(11):914–21. doi: 10.1097/JGP.0b013e318186bd67.
    1. Bangor A, Kortum PT, Miller JT. An Empirical Evaluation of the System Usability Scale. International Journal of Human-Computer Interaction. 2008 Jul 30;24(6):574–594. doi: 10.1080/10447310802205776.
    1. Ahn C, Cho Y, Oh J, Song Y, Lim TH, Kang H, Lee J. Evaluation of Smartphone Applications for Cardiopulmonary Resuscitation Training in South Korea. Biomed Res Int. 2016;2016:6418710. doi: 10.1155/2016/6418710. doi: 10.1155/2016/6418710.
    1. Robinson MD, Branham AR, Locklear A, Robertson S, Gridley T. Measuring Satisfaction and Usability of FaceTime for Virtual Visits in Patients with Uncontrolled Diabetes. Telemed J E Health. 2015 Aug 21; doi: 10.1089/tmj.2014.0238.
    1. Loh KP, Zittel J, Kadambi S, Pandya C, Xu H, Flannery M, Magnuson A, Bautista J, McHugh C, Mustian K, Dale W, Duberstein P, Mohile SG. Elucidating the associations between sleep disturbance and depression, fatigue, and pain in older adults with cancer. J Geriatr Oncol. 2018 Sep;9(5):464–468. doi: 10.1016/j.jgo.2018.02.006.
    1. Hsieh H, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005 Nov;15(9):1277–88. doi: 10.1177/1049732305276687.
    1. Perrin A, Duggan M. Pew Research Center. 2015. Jun 26, [2018-10-06]. Americans' Internet Access: 2000-2015
    1. Hui CY, Walton R, McKinstry B, Jackson T, Parker R, Pinnock H. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. J Am Med Inform Assoc. 2017 May 01;24(3):619–632. doi: 10.1093/jamia/ocw143.
    1. Wu Y, Yao X, Vespasiani G, Nicolucci A, Dong Y, Kwong J, Li L, Sun X, Tian H, Li S. Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy. JMIR Mhealth Uhealth. 2017 Mar 14;5(3):e35. doi: 10.2196/mhealth.6522.

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