Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study

Jennifer Huberty, Megan Puzia, Ryan Eckert, Linda Larkey, Jennifer Huberty, Megan Puzia, Ryan Eckert, Linda Larkey

Abstract

Background: There is a need for tools to decrease cancer patients' and survivors' long-term symptom burden. Complementary strategies, such as meditation, can accompany pharmacologic therapy to improve symptoms. Although support programs with targeted content have wider reach, higher adherence, and greater impact, there are no consumer-based meditation apps designed specifically for cancer.

Objective: This study aimed to gather information to advise the development of a cancer-specific meditation app in a small convenience sample of cancer patients and survivors who currently use the Calm app.

Methods: Adult cancer patients and survivors who are Calm users (N=82) were recruited through the Daily Calm Facebook page. Participants completed a Web-based survey related to Calm app use and satisfaction, interest in and ideas for a cancer-specific Calm app, and demographic characteristics. Open-ended responses were inductively coded.

Results: Participants were aged between 18 and 72 years (mean 48.60 years, SD 15.20), mostly female (77/82, 94%), white (65/79, 82%), and non-Hispanic (70/75, 93%), and reported using Calm at least 5 times per week (49/82, 60%). Although rates of satisfaction with current Calm components were high (65/82, 79%; and 51/81, 63%), only 49% (40/82) of participants used guided meditations that they felt specifically helped with their cancer-related symptoms and survivorship, and 40% (33/82) would prefer more cancer-related content, with guided meditations for cancer-specific anxieties (eg, fear of recurrence; n=15) and coping with strong emotions (n=12) being the most common suggestions. A majority of participants (51/82, 62%) reported that they would be interested in becoming a member of a Calm cancer community (eg, in-app discussion boards: 41/46, 89%; and social media communities: 35/42, 83%). Almost half of the participants (37/82, 45%) reported that they would benefit from features that tracked symptoms in concurrence with app usage, but respondents were divided on whether this information should be shared with health care providers through the app (49/82, 60% would share).

Conclusions: Responses suggest ways in which the current Calm app could be adapted to better fit cancer patients' and survivors' needs and preferences, including adding more cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation app and provide a framework for evaluating their effects.

Keywords: cancer; cancer survivors; consumer behavior; health; meditation; mental health; mindfulness; mobile apps.

Conflict of interest statement

Conflicts of Interest: JH is currently the Director of Science at Calm. JH has been conducting research with Calm as a partner for almost 5 years before becoming the Director of Science and serving on the Scientific Advisory Board. Her role is to ensure the quality of Calm’s science. There are no financial incentives from the growth of Calm for any author. The remaining authors declare no conflicts of interest.

©Jennifer Huberty, Megan Puzia, Ryan Eckert, Linda Larkey. Originally published in JMIR Cancer (http://cancer.jmir.org), 25.01.2020.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30. doi: 10.3322/caac.21332. doi: 10.3322/caac.21332.
    1. Prochaska JJ, Coughlin SS, Lyons EJ. Social media and mobile technology for cancer prevention and treatment. Am Soc Clin Oncol Educ Book. 2017;37:128–37. doi: 10.1200/EDBK_173841.
    1. Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors--a systematic review. Int J Psychiatry Med. 2010;40(2):163–81. doi: 10.2190/PM.40.2.c.
    1. West HJ. Complementary and alternative medicine in cancer care. JAMA Oncol. 2018 Jan 1;4(1):139. doi: 10.1001/jamaoncol.2017.3120.
    1. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012 Sep;11(3):187–203. doi: 10.1177/1534735411423920.
    1. Kabat-Zinn J, Hanh TN. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Bantam Books; 2009.
    1. Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B. Mind-body treatments for the pain-fatigue-sleep disturbance symptom cluster in persons with cancer. J Pain Symptom Manage. 2010 Jan;39(1):126–38. doi: 10.1016/j.jpainsymman.2009.05.022.
    1. Russell L, Orellana L, Ugalde A, Milne D, Krishnasamy M, Chambers R, Livingston PM. Exploring knowledge, attitudes, and practice associated with meditation among patients with melanoma. Integr Cancer Ther. 2018 Jun;17(2):237–47. doi: 10.1177/1534735417699514.
    1. Boxleitner G, Jolie S, Shaffer D, Pasacreta N, Bai M, McCorkle R. Comparison of two types of meditation on patients' psychosocial responses during radiation therapy for head and neck cancer. J Altern Complement Med. 2017 May;23(5):355–61. doi: 10.1089/acm.2016.0214.
    1. Victorson D, Hankin V, Burns J, Weiland R, Maletich C, Sufrin N, Schuette S, Gutierrez B, Brendler C. Feasibility, acceptability and preliminary psychological benefits of mindfulness meditation training in a sample of men diagnosed with prostate cancer on active surveillance: results from a randomized controlled pilot trial. Psychooncology. 2017 Aug;26(8):1155–63. doi: 10.1002/pon.4135.
    1. Carlson LE, Subnis UB, Piedalue KL, Vallerand J, Speca M, Lupichuk S, Tang P, Faris P, Wolever RQ. The ONE-MIND Study: Rationale and protocol for assessing the effects of ONlinE MINDfulness-based cancer recovery for the prevention of fatigue and other common side effects during chemotherapy. Eur J Cancer Care (Engl) 2019 Jul;28(4):e13074. doi: 10.1111/ecc.13074.
    1. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016 Jul;25(7):750–9. doi: 10.1002/pon.4150.
    1. van Waart H, van Harten WH, Buffart LM, Sonke GS, Stuiver MM, Aaronson NK. Why do patients choose (not) to participate in an exercise trial during adjuvant chemotherapy for breast cancer? Psychooncology. 2016 Aug;25(8):964–70. doi: 10.1002/pon.3936.
    1. Plaza I, Demarzo MM, Herrera-Mercadal P, García-Campayo J. Mindfulness-based mobile applications: literature review and analysis of current features. JMIR Mhealth Uhealth. 2013 Nov 1;1(2):e24. doi: 10.2196/mhealth.2733.
    1. Raghunathan NJ, Korenstein D, Li QS, Tonorezos ES, Mao JJ. Determinants of mobile technology use and smartphone application interest in cancer patients. Cancer Med. 2018 Nov;7(11):5812–9. doi: 10.1002/cam4.1660.
    1. Girault A, Ferrua M, Lalloué B, Sicotte C, Fourcade A, Yatim F, Hébert G, di Palma M, Minvielle E. Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients. Eur J Cancer. 2015 Mar;51(4):551–7. doi: 10.1016/j.ejca.2014.12.001.
    1. Huberty J, Eckert R, Larkey L, Kurka J, Rodríguez de Jesús SA, Yoo W, Mesa R. Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials. JMIR Form Res. 2019 Apr 29;3(2):e12662. doi: 10.2196/12662.
    1. Brouard B, Bardo P, Bonnet C, Mounier N, Vignot M, Vignot S. Mobile applications in oncology: is it possible for patients and healthcare professionals to easily identify relevant tools? Ann Med. 2016 Nov;48(7):509–15. doi: 10.1080/07853890.2016.1195010.
    1. Kumar S, Nilsen WJ, Abernethy A, Atienza A, Patrick K, Pavel M, Riley WT, Shar A, Spring B, Spruijt-Metz D, Hedeker D, Honavar V, Kravitz R, Lefebvre RC, Mohr DC, Murphy SA, Quinn C, Shusterman V, Swendeman D. Mobile health technology evaluation: the mHealth evidence workshop. Am J Prev Med. 2013 Aug;45(2):228–36. doi: 10.1016/j.amepre.2013.03.017.
    1. Zernicke KA, Campbell TS, Speca M, Ruff KM, Flowers S, Tamagawa R, Carlson LE. The eCALM trial: eTherapy for cancer applying mindfulness. exploratory analyses of the associations between online mindfulness-based cancer recovery participation and changes in mood, stress symptoms, mindfulness, posttraumatic growth, and spirituality. Mindfulness. 2016;7(5):1071–81. doi: 10.1007/s12671-016-0545-5.
    1. Huberty J, Vranceanu A, Carney C, Breus M, Gordon M, Puzia ME. Characteristics and usage patterns among 12,151 paid subscribers of the Calm meditation app: cross-sectional survey. JMIR Mhealth Uhealth. 2019 Nov 3;7(11):e15648. doi: 10.2196/15648.
    1. Adam R, McMichael D, Powell D, Murchie P. Publicly available apps for cancer survivors: a scoping review. BMJ Open. 2019 Sep 30;9(9):e032510. doi: 10.1136/bmjopen-2019-032510.
    1. Berkowitz CM, Zullig LL, Koontz BF, Smith SK. Prescribing an app? Oncology providers' views on mobile health apps for cancer care. JCO Clin Cancer Inform. 2017 Nov;1:1–7. doi: 10.1200/CCI.17.00107.
    1. Lippman H. How apps are changing family medicine. J Fam Pract. 2013 Jul;62(7):362–7.
    1. Jongerius C, Russo S, Mazzocco K, Pravettoni G. Research-tested mobile apps for breast cancer care: systematic review. JMIR Mhealth Uhealth. 2019 Feb 11;7(2):e10930. doi: 10.2196/10930.
    1. Rosen KD, Paniagua SM, Kazanis W, Jones S, Potter JS. Quality of life among women diagnosed with breast cancer: a randomized waitlist controlled trial of commercially available mobile app-delivered mindfulness training. Psychooncology. 2018 Aug;27(8):2023–30. doi: 10.1002/pon.4764.
    1. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M, Goodman M, Cox CE, Kip KE. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009 Dec;18(12):1261–72. doi: 10.1002/pon.1529.
    1. Wei M. Psychology Today. 2015. Aug 22, [2020-01-02]. What Mindfulness App is Right for You? .
    1. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth Uhealth. 2015 Aug 19;3(3):e82. doi: 10.2196/mhealth.4328.
    1. Duraimani SL. A cross-sectional and longitudinal study of the effects of a mindfulness meditation mobile application platform on reducing stress and anxiety. Int J Yoga. 2019;12(3):226–32. doi: 10.4103/ijoy.IJOY_56_18.
    1. Huberty J, Eckert R, Larkey L, Joeman L, Mesa R. Experiences of using a consumer-based mobile meditation app to improve fatigue in myeloproliferative patients: qualitative study. JMIR Cancer. 2019 Jul 22;5(2):e14292. doi: 10.2196/14292.
    1. Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008 Feb;31(1):23–33. doi: 10.1007/s10865-007-9130-7.
    1. Gethin R. The Foundations of Buddhism. Oxford, United Kingdom: Oxford University Press; 1998.
    1. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427–40. doi: 10.1007/s10608-012-9476-1.
    1. Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Song M, Anderson L, Campos C, Carrera P, Ostrove N, Peshkin BN, Schwartz MD, Ficca N, Cupertino A, Gonzalez N, Otero A, Huerta E, Sheppard VB. Developing a culturally targeted video to enhance the use of genetic counseling in Latina women at increased risk for hereditary breast and ovarian cancer. J Community Genet. 2019 May 18; doi: 10.1007/s12687-019-00423-w.
    1. Hou S, Roberson K. A systematic review on US-based community health navigator (CHN) interventions for cancer screening promotion--comparing community- versus clinic-based navigator models. J Cancer Educ. 2015 Mar;30(1):173–86. doi: 10.1007/s13187-014-0723-x.
    1. Børøsund E, Mirkovic J, Clark MM, Ehlers SL, Andrykowski MA, Bergland A, Westeng M, Solberg Nes L. A stress management app intervention for cancer survivors: design, development, and usability testing. JMIR Form Res. 2018 Sep 6;2(2):e19. doi: 10.2196/formative.9954.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Bower JE, Meyerowitz BE, Desmond KA, Bernaards CA, Rowland JH, Ganz PA. Perceptions of positive meaning and vulnerability following breast cancer: predictors and outcomes among long-term breast cancer survivors. Ann Behav Med. 2005 Jun;29(3):236–45. doi: 10.1207/s15324796abm2903_10.
    1. Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10(10):2143–51. doi: 10.1007/s12671-019-01182-y.
    1. O'Leary K, Dockray S. The effects of two novel gratitude and mindfulness interventions on well-being. J Altern Complement Med. 2015 Apr;21(4):243–5. doi: 10.1089/acm.2014.0119.
    1. Duprey EB, McKee LG, O'Neal CW, Algoe SB. Stressful life events and internalizing symptoms in emerging adults: The roles of mindfulness and gratitude. Ment Health Prev. 2018 Dec;12:1–9. doi: 10.1016/j.mhp.2018.08.003.
    1. Otto AK, Szczesny EC, Soriano EC, Laurenceau J, Siegel SD. Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors. Health Psychol. 2016 Dec;35(12):1320–8. doi: 10.1037/hea0000400.
    1. Sztachańska J, Krejtz I, Nezlek JB. Using a gratitude intervention to improve the lives of women with breast cancer: a daily diary study. Front Psychol. 2019;10:1365. doi: 10.3389/fpsyg.2019.01365. doi: 10.3389/fpsyg.2019.01365.
    1. Altschuler A, Rosenbaum E, Gordon P, Canales S, Avins AL. Audio recordings of mindfulness-based stress reduction training to improve cancer patients' mood and quality of life--a pilot feasibility study. Support Care Cancer. 2012 Jun;20(6):1291–7. doi: 10.1007/s00520-011-1216-7.
    1. Cheng KKF, Wong WH, Koh C. Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors. Support Care Cancer. 2016 May;24(5):2025–33. doi: 10.1007/s00520-015-2994-0.
    1. Rowland JH. Cancer survivorship: new challenge in cancer medicine. In: Bast RC, Croce CM, Hait WN, Hong WK, Kufe DW, Piccart–Gebart M, Pollock RE, Weichselbaum RR, Wang H, Holland JF, editors. Holland-Frei Cancer Medicine. Hoboken, NJ: Wiley; 2016. pp. 1–9.
    1. Wu H, Harden JK. Symptom burden and quality of life in survivorship: a review of the literature. Cancer Nurs. 2015;38(1):E29–54. doi: 10.1097/NCC.0000000000000135.
    1. Kim E, Han JY, Moon TJ, Shaw B, Shah DV, McTavish FM, Gustafson DH. The process and effect of supportive message expression and reception in online breast cancer support groups. Psychooncology. 2012 May;21(5):531–40. doi: 10.1002/pon.1942.
    1. Bender JL, Jimenez-Marroquin M, Jadad AR. Seeking support on Facebook: a content analysis of breast cancer groups. J Med Internet Res. 2011 Feb 4;13(1):e16. doi: 10.2196/jmir.1560.
    1. Zhang S, Bantum EO, Owen J, Bakken S, Elhadad N. Online cancer communities as informatics intervention for social support: conceptualization, characterization, and impact. J Am Med Inform Assoc. 2017 Mar 1;24(2):451–9. doi: 10.1093/jamia/ocw093.
    1. Min YH, Lee JW, Shin Y, Jo M, Sohn G, Lee J, Lee G, Jung KH, Sung J, Ko BS, Yu J, Kim HJ, Son BH, Ahn SH. Daily collection of self-reporting sleep disturbance data via a smartphone app in breast cancer patients receiving chemotherapy: a feasibility study. J Med Internet Res. 2014 May 23;16(5):e135. doi: 10.2196/jmir.3421.
    1. Egbring M, Far E, Roos M, Dietrich M, Brauchbar M, Kullak-Ublick GA, Trojan A. A mobile app to stabilize daily functional activity of breast cancer patients in collaboration with the physician: a randomized controlled clinical trial. J Med Internet Res. 2016 Sep 6;18(9):e238. doi: 10.2196/jmir.6414.
    1. Kim J, Lim S, Min YH, Shin Y, Lee B, Sohn G, Jung KH, Lee J, Son BH, Ahn SH, Shin S, Lee JW. Depression screening using daily mental-health ratings from a smartphone application for breast cancer patients. J Med Internet Res. 2016 Aug 4;18(8):e216. doi: 10.2196/jmir.5598.
    1. Kessel KA, Vogel MM, Schmidt-Graf F, Combs SE. Mobile apps in oncology: a survey on health care professionals' attitude toward telemedicine, mHealth, and oncological apps. J Med Internet Res. 2016 Nov 24;18(11):e312. doi: 10.2196/jmir.6399.
    1. Klasnja P, Hartzler A, Powell C, Pratt W. Supporting cancer patients' unanchored health information management with mobile technology. AMIA Annu Symp Proc. 2011;2011:732–41.
    1. Qudah B, Luetsch K. The influence of mobile health applications on patient - healthcare provider relationships: a systematic, narrative review. Patient Educ Couns. 2019 Jun;102(6):1080–9. doi: 10.1016/j.pec.2019.01.021.
    1. Tran C, Dicker AP, Jim HS. The emerging role of mobile health in oncology. J Target Ther Cancer. 2017
    1. Bhuyan SS, Kim H, Isehunwa OO, Kumar N, Bhatt J, Wyant DK, Kedia S, Chang CF, Dasgupta D. Privacy and security issues in mobile health: current research and future directions. Health Policy Technol. 2017;6(2):188–91. doi: 10.1016/j.hlpt.2017.01.004.
    1. Helm AM, Georgatos D. Privacy and mHealth: how mobile health apps fit into a privacy framework not limited to HIPAA. Syracuse Law Rev. 2014;64 UC Hastings Research Paper No. 108 .

Source: PubMed

3
購読する