@Article{info:doi/10.2196/71196,
author="Tian, Lv
and Wen, Yixuan
and Li, Jingmiao
and Guan, Jiexin
and Li, Tao
and Fan, Jun",
title="Effects of Remote Web-Based Interventions on the Physiological and Psychological States of Patients With Cancer: Systematic Review With Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jun",
day="12",
volume="13",
pages="e71196",
keywords="meta-analysis",
keywords="cancer patients",
keywords="pain",
keywords="depression",
keywords="anxiety",
keywords="quality of life",
keywords="remote web-based intervention",
keywords="PRISMA",
abstract="Background: Patients with cancer may experience physiological and psychological adverse reactions, such as fatigue, pain, anxiety, and depression, which seriously affect their quality of life. Research has shown that remote interventions based on apps or miniprograms may help improve the physiological and mental health of patients with cancer. However, due to the limited number of relevant studies, the impact of web-based interventions in cancer management remains unclear. Objective: We aimed to determine the efficacy of interventions based on apps, miniprograms, or other web-based tools on the physiological (body pain and fatigue) and psychological (anxiety and depression) states and the quality of life of patients with cancer. Methods: We conducted electronic literature searches in PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and EMBASE databases. The search period spanned from the inception of each database to October 15, 2024. Two researchers independently conducted literature retrieval and data extraction. The risk of bias was assessed with the Cochrane risk-of-bias tool, and the quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). All statistical analyses were performed using Review Manager version 5.4. Results: A total of 36 randomized controlled trials were included. The remote web-based interventions significantly improved the pain intensity (n=14, 39\% studies; standardized mean difference [SMD] --0.39, 95\% CI --0.64 to --0.14; I2=82\%; GRADE rating=low) and fatigue status (n=11, 31\% studies; SMD --0.52, 95\% CI --0.95 to --0.09; I2=95\%; GRADE rating=low) in patients with cancer. Regarding psychology, the results indicated that the remote web-based interventions significantly improved the anxiety (n=14, 39\% studies; SMD --0.60, 95\% CI --0.90 to --0.30; I2=91\%; GRADE rating=low) and depressive state (n=10, 28\% studies; SMD --0.36, 95\% CI --0.58 to --0.14; I2=81\%; GRADE rating=low) of patients with cancer. For quality of life, the results showed that the remote web-based interventions had a significant positive impact on the quality of life of patients with cancer (n=26, 72\% studies; SMD 0.63, 95\% CI 0.39-0.87; I2=92\%; GRADE rating=low). Conclusions: The remote web-based interventions were effective in reducing the intensity of physiological pain, relieving fatigue, improving depression and anxiety, and improving the quality of life of patients with cancer. However, due to the low certainty of evidence, more rigorous randomized controlled trials are needed to validate these findings further. Trial Registration: PROSPERO CRD42024611768; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024611768 ",
doi="10.2196/71196",
url="https://mhealth.jmir.org/2025/1/e71196"
}


@Article{info:doi/10.2196/66471,
author="Sterba, Katherine
and Graboyes, Evan
and Burris, Jessica
and Scallion, Megan
and Kinder, Hannah
and Olsen, Jama
and Toll, Benjamin
and Armeson, Kent
and Day, Terry
and Chera, Bhishamjit
and Ruggiero, Kenneth",
title="Development of a Mobile App to Support Head and Neck Cancer Caregiving: Mixed Methods Study",
journal="JMIR Cancer",
year="2025",
month="Jun",
day="10",
volume="11",
pages="e66471",
keywords="head and neck cancer",
keywords="cancer survivorship",
keywords="caregiving",
keywords="nutrition",
keywords="mobile health",
keywords="app development",
keywords="mixed methods",
abstract="Background: Survivors with head and neck cancer (HNC) face challenging treatment consequences that can lead to severe disruptions in swallowing and result in weight loss, malnutrition, and feeding tube dependence. Caregivers (family or friends who provide support), therefore, often encounter distressing nutritional caregiving burdens and feel unprepared to provide adequate support at home. Objective: The purpose of this mixed methods study was to develop a mobile support app to support HNC caregiving with an emphasis on nutritional support following treatment. Methods: We assessed perspectives on nutritional recovery challenges and mobile support app preferences in (1) a national panel of oncology dietitians using a web-based cross-sectional survey and (2) survivors with HNC completing treatment within the past 24 months and their nominated caregivers using dyadic semistructured interviews. Descriptive statistics for survey data were synthesized with thematic analysis of interview data to characterize nutrition-related perceptions and intervention preferences; results were integrated, and themes were translated to high-priority main menu domains and subdomains for a mobile app for caregivers. Results: Surveys were completed by dietitians (n=116, 100\%; female n=87, 50\%, with >10 years practice experience). Interviews included survivors with HNC (n=15; 12/15, 80\% male, and 6/15, 40\% with oropharynx cancer) and their caregivers (n=13; 11/13, 85\% female, and 10/13, 77\% spouses). Dietitians, survivors, and caregivers perceived that the majority of nutritional concerns assessed (eg, swallowing, feeding tube management, weight maintenance, and caregiver distress about nutrition) were very or extremely important to caregiving in the 6 months following treatment conclusion. The caregiving tasks rated highest in importance by dietitians included tracking nutritional concerns (n=113, 97\%), working together as a team on nutritional concerns (n=104, 90\%), and making care decisions (n=102, 88\%). Five themes emerged from dyadic interviews, including types of nutritional challenges faced, that competing symptoms were difficult to separate from nutritional challenges, the emotional challenges related to nutrition and recovery, the diverse set of medical and support tasks taken on by caregivers, and information and resource needs in caregivers. Qualitative interview and survey themes guided the content of the Healthy Eating and Recovery Together (HEART) app with an intake tracker and sections for nutrition recovery support, other competing caregiving tips, peer support, and caregiver self-care. Conclusions: Results pinpointed optimal content for a mobile app for caregivers of individuals with HNC and support the acceptability of implementing the HEART app following HNC treatment. ",
doi="10.2196/66471",
url="https://cancer.jmir.org/2025/1/e66471"
}


@Article{info:doi/10.2196/69115,
author="Wolff, Dominik
and Kupka, Thomas
and Reichert, Chiara
and Ammon, Nils
and Oeltze-Jafra, Steffen
and Vajen, Beate",
title="Personalized Support in Hereditary Breast and Ovarian Cancer After Genetic Counseling by the Chatbot-Based GENIE Mobile App: Proof-of-Concept Wizard of Oz Study",
journal="JMIR Form Res",
year="2025",
month="Jun",
day="5",
volume="9",
pages="e69115",
keywords="HBOC",
keywords="hereditary breast and ovarian cancer",
keywords="Wizard of Oz study",
keywords="mobile health",
keywords="evaluation",
keywords="hereditary diseases",
abstract="Background: The primary aim of genetic counseling at a human genetics center is to empower individuals at risk for hereditary diseases to make informed decisions regarding their health. In Germany, genetic counseling sessions typically last approximately 1 hour and provide highly personalized information by a specialist in human genetics. Despite this, many counselees report a need for additional support following the counseling session. Objective: This study introduces GENIE, a chatbot-based mobile app designed to assist individuals in the postcounseling phase, with a focus on hereditary breast and ovarian cancer. GENIE delivers expert-curated, personalized information tailored to the user's health and family circumstances. The content is presented through predefined dialogs between the user and the mobile assistant, aiming to extend the benefits of genetic counseling beyond the initial session. Methods: A Wizard of Oz study was conducted to evaluate a functional prototype of GENIE. A total of 6 patients with breast cancer, at least 2 years postdiagnosis, participated in the study. Participants were given access to the app for a minimum of 1 week. The evaluation was based on their interaction with GENIE, which was personalized using the details of a fictitious patient. Data collection included semistructured interviews and a 45-item questionnaire to assess usability and content quality. Results: The analysis of the interview and questionnaire data indicated high usability for GENIE, with a mean System Usability Score of 75.33 (SD 4.13). In total, 5 of the 6 participants used the app daily; 3 participants were willing to pay between US \$5 and US \$45 as a single purchase, while the other 3 participants agreed that the app should be free for the user and the costs should be directly covered by health insurance. Still, opinions on the app's appeal were divided. The layout was seen as moderately professional, a bit crowded, and slightly uninspiring. Nevertheless, participants highlighted the credibility and relevance of the content, noting its alignment with the fictitious patient's scenario. However, areas for improvement were identified, particularly concerning the app's design. All participants would recommend the app to other affected persons. Conclusions: The findings suggest that a mobile app like GENIE can provide valuable support to individuals in the postcounseling phase of genetic services. GENIE offers distinct advantages over large language models, as the information it provides is carefully curated by human experts, minimizing the risk of inaccuracies or hallucinations and significantly enhancing the system's credibility. This study highlights the need to involve the user group as early as possible in the development of a digital health app. Future work will focus on the implementation of a comprehensive personalization engine, redesign of the user interface, and the execution of a large-scale, 2-arm randomized intervention study to validate GENIE's effectiveness. ",
doi="10.2196/69115",
url="https://formative.jmir.org/2025/1/e69115"
}


@Article{info:doi/10.2196/66847,
author="Kochashvili, Mariam
and Guttoo, Parishma
and Sezgin, Emre
and Pai, Ahna
and Bajwa, Rajinder
and Landier, Wendy
and Gerhardt, Cynthia
and Skeens, Micah",
title="Supporting Medication Adherence in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplant Using the BMT4me mHealth App: Mixed Methods Usability Study",
journal="JMIR Cancer",
year="2025",
month="May",
day="29",
volume="11",
pages="e66847",
keywords="mHealth",
keywords="pediatric transplant",
keywords="digital health",
keywords="medication adherence",
keywords="usability",
keywords="hematopoietic stem cell transplant",
keywords="bone marrow transplant",
keywords="pediatric",
keywords="children",
keywords="hematopoietic stem cell",
keywords="HSC",
keywords="smartphone",
keywords="mobile health",
keywords="BMT4me",
keywords="digital health intervention",
keywords="descriptive statistics",
keywords="thematic analysis",
keywords="usability study",
keywords="mixed method",
keywords="social support",
keywords="health outcomes",
keywords="medication management",
keywords="symptom tracking",
keywords="electronic medical records",
keywords="user-friendly",
abstract="Background: Due to multifaceted outpatient regimens, children receiving hematopoietic stem cell transplants (HCTs) are at high risk of medication nonadherence, leading to life-threatening complications. Mobile health (mHealth) interventions have proven effective in improving adherence in various pediatric conditions; however, adherence intervention literature on HCT is limited. Objective: This study aimed to assess the usability of a mHealth intervention (BMT4me) designed to serve as a real-time, personalized tool for medication management or adherence, symptom tracking, and journal keeping. Methods: Following a mixed methods approach, 14 caregivers (n=11, 79\% female; n=10, 71\% White) of children aged 2?18 (mean age 8.51, SD 5.18) years in the acute phase (first 100 d) post-HCT were recruited. Caregivers were asked to use the BMT4me app for 100 days or until weaning of the immunosuppressant medications to measure usability. The System Usability Scale (assessing functionality and acceptability), reaction cards (assessing desirability), caregiver satisfaction (assessing satisfaction) with the app, and semistructured interviews (assessing participant experience using the app and feedback regarding features) were conducted at two time points, at enrollment and study completion. Results: The mean System Usability Scale score was 86.15 (SD 12.81) at enrollment and 73.13 (SD 16.13) at study completion, with most participants reporting the app easy to use and accepable during both time points. At enrollment, 80\% (n=12) of caregivers reported that the app was effective in motivating them to stay on schedule, and 87\% (n=13) indicated they would recommend it to others. At study completion, 75\% (n=6) of caregivers found the app helpful for tracking their child's medication schedule, and 64\% (n=5) would recommend it to others. Caregivers described the app as ``accessible,'' ``useful,'' and ``valuable.'' Qualitative interviews during both time points revealed caregivers' positive reactions to the app, particularly regarding medication reminders, tracking symptoms, and notes features, while also providing suggestions for improvements, such as integrating the BMT4me app with electronic medical records, incorporating educational content, adding fields for recording vital signs, and important phone numbers. Conclusions: The BMT4me app demonstrated promising usability as a mHealth intervention among pediatric patients undergoing HCT. Caregivers considered the app user-friendly and valuable, with positive feedback on its features, such as medication reminders and symptom tracking. Despite minor reported issues with app functionality, the overall acceptance of the app suggests its potential to support families in managing complex treatment. The findings from this study will inform the feasibility of testing in larger randomized controlled trials. Trial Registration: ClinicalTrials.gov NCT04976933; https://clinicaltrials.gov/ct2/show/NCT04976933 International Registered Report Identifier (IRRID): RR2-10.2196/39098 ",
doi="10.2196/66847",
url="https://cancer.jmir.org/2025/1/e66847"
}


@Article{info:doi/10.2196/69855,
author="Deutsch, M. Thomas
and Volmer, L. L{\'e}a
and Feisst, Manuel
and Bodenbeck, Laura
and Hassdenteufel, Kathrin
and Tretschock, Lara
and Breit, Christiane
and Stefanovic, Stefan
and Bauer, Armin
and Anders, Carolin
and Weinert, Lina
and Engler, Tobias
and Hartkopf, D. Andreas
and Pfeifer, Nico
and Escher, Pascal
and Mausch, Marc
and Heinze, Oliver
and Suetterlin, Marc
and Brucker, Y. Sara
and Schneeweiss, Andreas
and Wallwiener, Markus",
title="ENABLE---App-Based Digital Capture and Intervention of Patient-Reported Quality of Life, Adverse Events, and Treatment Satisfaction in Breast Cancer: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="May",
day="26",
volume="14",
pages="e69855",
keywords="breast cancer",
keywords="electronic patient-reported outcomes",
keywords="ePRO",
keywords="health-related quality of life",
keywords="HRQoL",
keywords="eHealth apps",
abstract="Background: In recent years, breast cancer treatment has taken the path toward personalized medicine. Based on individual tumor biology, therapy tailored to the particular subtype of cancer is increasingly being used. The aim here is to find the most suitable therapy for the disease. However, the success of therapy depends to a large extent on the patient's adherence to treatment. This, in turn, depends on how the therapy is tolerated and how the treatment team cares for the patient. Patient-centered care seeks to identify and address the individual needs of each patient and to find the best form of care for that person. Objective: In order to improve comprehensive oncological care of patients with breast cancer, the ENABLE trial digitally recorded the health-related quality of life (HRQoL), adverse events (AEs), and patient satisfaction using a mobile smartphone app. The trial provided individualized responses to reported AEs and offered assistance. Additionally, it assessed the impact of a patient-reported outcome--based intervention across various therapy settings. Methods: Patients with breast cancer were eligible to participate in the study before neoadjuvant, adjuvant, postneoadjuvant, or palliative systemic therapy against breast cancer was initiated at the Heidelberg, Mannheim, and Tuebingen, Germany, university hospitals. After 1:1 randomization into an intervention and a control group, HRQoL assessments were performed at six fixed time points during the therapy using validated questionnaires. In the intervention group, HRQoL was also assessed briefly every week using a visual analog scale (EQ-VAS). In cases of significant deterioration, therapy-associated side effects were assessed in a graduated manner, recommendations were sent to the patient, and the treatment team was informed. Additionally, the app served as an ``eHealth companion'' for education, training, and organizational support during therapy. Results: Recruitment started in March 2021; follow-up was completed in February 2024. In total, 606 patients were enrolled, and 592 patients participated in the study. Enrollment was completed in September 2023, and the last visit was in February 2024. The first results are expected to be published in Q2 2025. Conclusions: Participation in the intervention group is expected to improve treatment satisfaction, adherence, detection, and timely treatment of critical AEs. The close-meshed, weekly, brief HRQoL assessment will also be tested as a screening tool to detect relevant side effects during therapy. The study offers a more objective HRQoL assessment across treatment strategies. Trial Registration: Deutsches Register Klinischer Studien DRKS00025611; https://drks.de/search/en/trial/DRKS00025611 International Registered Report Identifier (IRRID): DERR1-10.2196/69855 ",
doi="10.2196/69855",
url="https://www.researchprotocols.org/2025/1/e69855"
}


@Article{info:doi/10.2196/56282,
author="Trieu, Phillip
and Fetzer, Dominique
and McLeod, Briana
and Schweickert, Kathryn
and Gutstein, Lauren
and Egleston, Brian
and Domchek, Susan
and Fleisher, Linda
and Wagner, Lynne
and Wen, Kuang-Yi
and Cacioppo, Cara
and Ebrahimzadeh, E. Jessica
and Falcone, Dana
and Langer, Claire
and Wood, Elisabeth
and Karpink, Kelsey
and Posen, Shelby
and Selmani, Enida
and Bradbury, R. Angela",
title="Developing the MyCancerGene Digital Health Portal to Improve Patients' Understanding of Germline Cancer Genetic Test Results: Development, User, and Usability Testing Study",
journal="JMIR Form Res",
year="2025",
month="May",
day="14",
volume="9",
pages="e56282",
keywords="genetic health portal",
keywords="digital intervention development",
keywords="health portal",
keywords="usability",
keywords="digital health",
keywords="germline cancer",
keywords="multigene panels",
keywords="clinical practice",
keywords="likelihood",
keywords="effectiveness",
keywords="medical history",
keywords="genetic medicine",
keywords="risk information",
keywords="digital tool",
keywords="intervention",
keywords="longitudinal care",
keywords="patient-centered content",
keywords="electronic information",
abstract="Background: The use of multigene panels has significantly increased the likelihood that genetic testing will leave patients with uncertainties regarding test interpretation, implications, and recommendations, which will change over time. Effective longitudinal care models are needed to provide patients with updated information and to obtain patient and family history updates. Objective: To bridge this gap, we aimed to develop a patient- and genetic provider--informed digital genetic health portal (GHP), MyCancerGene, to improve longitudinal patient understanding of and responses to genetic testing. Methods: We used a 5-step process to develop MyCancerGene. To better understand their interest in and willingness to use a digital GHP, we surveyed 307 patients who completed genetic testing (step 1). We completed qualitative interviews with 10 patients and a focus group with 17 genetic providers to inform the content and function of MyCancerGene (step 2). Next, we developed initial intervention content (step 3) and completed user testing of intervention content with 25 providers and 28 patients (step 4). After developing the prototype intervention, we completed usability testing with 8 patients for their feedback on the final content, functions, and ease of use (step 5). Results: In surveys conducted in step 1, 90\% of patients with positive results reported interest in a digital GHP, and over 75\% of participants with variants of uncertain significance or uninformative negative results reported similar interest. The most frequently reported advantages among patients were increasing accessibility, convenience, and efficiency (103/224, 46\%); keeping genetic information organized (54/224, 24.1\%); and increasing or maintaining patient understanding of the information (38/224, 17\%). In qualitative interviews (step 2), both patients and genetic providers endorsed the benefit of the tool for updating personal and family history and for providers to share new risk information, test interpretation, or other medical changes. Patient and provider input informed eight key components of the tool: (1) Landing Page, (2) Summary of Care page, (3) My Genetic Test Results page, (4) My Family History page, (5) Provide an Update page, (6) Review an Update page, (7) Resources page, and (8) the Screenings Tracker. They also recommended key functions, including the ability to download and print materials and the inclusion of reminders and engagement functions. Potential challenges identified by patients included privacy and security concerns (67/206, 32.5\%) and the potential for electronic information to generate distress (20/206, 9.7\%). While patients were comfortable with updates (ie, even variant reclassification upgrades or clinically significant results), 44\% (11/25) of genetic providers were uncomfortable sharing variant reclassification upgrades through MyCancerGene. Conclusions: MyCancerGene, a patient-centered digital GHP, was developed with extensive patient and genetic provider feedback and designed to enhance longitudinal patient understanding of and affective and behavioral responses to genetic testing, particularly in the era of evolving evidence and risk information. ",
doi="10.2196/56282",
url="https://formative.jmir.org/2025/1/e56282"
}


@Article{info:doi/10.2196/65960,
author="Le D{\^u}, Katell
and Chauchet, Adrien
and Sadot-Lebouvier, Sophie
and Fitoussi, Olivier
and Fontanet, Bijou
and Saint-Lezer, Arnaud
and Maloisel, Fr{\'e}d{\'e}ric
and Rossi, C{\'e}dric
and Carras, Sylvain
and Parcelier, Anne
and Balavoine, Magali
and Septans, Anne-Lise",
title="Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma)",
journal="JMIR Cancer",
year="2025",
month="May",
day="6",
volume="11",
pages="e65960",
keywords="patient-reported outcome measures",
keywords="lymphoma",
keywords="risk of relapse",
keywords="relapse",
keywords="randomized trial",
keywords="web-based",
keywords="quality of life",
keywords="survival",
keywords="detection",
keywords="progression",
keywords="T-cell lymphoma",
keywords="Hodgkin lymphoma",
abstract="Background: Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse. Objective: This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30\% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire. Methods: We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90\% to detect a 30\% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis. Results: A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3?25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7\%) compared with 30.2\% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8?20.6) months and 6.7 (range 1.9?16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled. Conclusions: The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines. Trial Registration: ClinicalTrials.gov NCT03154710; https://clinicaltrials.gov/ct2/show/NCT03154710 ",
doi="10.2196/65960",
url="https://cancer.jmir.org/2025/1/e65960"
}


@Article{info:doi/10.2196/60849,
author="Wienands, Linda
and Valenta, Sabine
and Leppla, Lynn
and De Geest, Sabina
and Kov{\'a}cs, L{\'a}szl{\'o}
and Teynor, Alexandra
and Krumme, Julia",
title="Examining Practices Related to Ethical Aspects in eHealth Evaluation Research: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="May",
day="5",
volume="14",
pages="e60849",
keywords="cancer",
keywords="cardiovascular",
keywords="eHealth",
keywords="remote patient monitoring",
keywords="ethics",
keywords="ethical aspects",
keywords="applied ethics",
keywords="evaluation designs",
keywords="evaluation research",
keywords="scoping review",
keywords="protocol",
abstract="Background: eHealth technologies, including remote patient monitoring (RPM) applications, have the potential to improve care for diseases such as cancer and cardiovascular conditions. However, they also raise ethical aspects that are often inadequately addressed in eHealth evaluation research. This is problematic, as evaluations guide decision-making at multiple levels. To improve evaluation practices, it is essential to understand how ethical aspects are addressed in terms of both content and methodology, enabling the development of tailored recommendations for enhancement. Objective: This scoping review systematically examines how ethical aspects are addressed in eHealth research, focusing on original studies evaluating RPM applications for cancer and cardiovascular diseases. Methods: Using Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, this review implemented a comprehensive search strategy with the terms ``cancer or cardiovascular diseases,'' ``eHealth or telemonitoring,'' and ``evaluation designs.'' Searches included MEDLINE, Embase, CINAHL, SocINDEX, Philosopher's Index, PsycINFO, and Google Scholar. Data extraction will emphasize ethical aspects and methodological approaches to consider them. The analysis will apply inductive-deductive qualitative content analysis. Results: Initial searches identified 3321 articles published between 2014 and August 2024. Screening and analysis will be completed in the first quarter of 2025, with results anticipated by summer 2025. Conclusions: Overlooking ethical aspects in evaluation studies can significantly impact eHealth practices. This scoping review will map ethical considerations in original evaluation research, identifying opportunities for more holistic integration of ethics and informing future practical guidance. Trial Registration: OSF Registries OSF.IO/7XAFV; https://osf.io/7xafv/ International Registered Report Identifier (IRRID): DERR1-10.2196/60849 ",
doi="10.2196/60849",
url="https://www.researchprotocols.org/2025/1/e60849"
}


@Article{info:doi/10.2196/64083,
author="Huebner, Hanna
and Wurmthaler, A. Lena
and Goossens, Chlo{\"e}
and Ernst, Mathias
and Mocker, Alexander
and Kr{\"u}ckel, Annika
and Kallert, Maximilian
and Geck, J{\"u}rgen
and Limpert, Milena
and Seitz, Katharina
and Ruebner, Matthias
and Kreis, Philipp
and Heindl, Felix
and H{\"o}rner, Manuel
and Volz, Bernhard
and Roth, Eduard
and Hack, C. Carolin
and Beckmann, W. Matthias
and Uhrig, Sabrina
and Fasching, A. Peter",
title="A Digital Home-Based Health Care Center for Remote Monitoring of Side Effects During Breast Cancer Therapy: Prospective, Single-Arm, Monocentric Feasibility Study",
journal="JMIR Cancer",
year="2025",
month="May",
day="2",
volume="11",
pages="e64083",
keywords="breast cancer",
keywords="digital medicine",
keywords="telehealth",
keywords="remote monitoring",
keywords="cyclin-dependent kinase 4/6 inhibitor",
keywords="CDK4/6 inhibitor",
keywords="mobile phone",
abstract="Background: The introduction of oral anticancer therapies has, at least partially, shifted treatment from clinician-supervised hospital care to patient-managed home regimens. However, patients with breast cancer receiving oral cyclin-dependent kinase 4/6 inhibitor therapy still require regular hospital visits to monitor side effects. Telemonitoring has the potential to reduce hospital visits while maintaining quality care. Objective: This study aims to develop a digital home-based health care center (DHHC) for acquiring electrocardiograms (ECGs), white blood cell (WBC) counts, side effect photo documentation, and patient-reported quality of life (QoL) data. Methods: The DHHC was set up using an Apple Watch Series 6 (ECG measurements), a HemoCue WBC DIFF Analyzer (WBC counts), an iPhone SE (QoL assessments and photo documentation), a TP-Link M7350-4G Wi-Fi router, and a Raspberry Pi 4 Model B. A custom-built app stored and synchronized remotely collected data with the clinic. The feasibility and acceptance of the DHHC among patients with breast cancer undergoing cyclin-dependent kinase 4/6 inhibitor therapy were evaluated in a prospective, single-arm, monocentric study. Patients (n=76) monitored side effects---ECGs, WBC counts, photo documentation, and QoL---at 3 predefined time points: study inclusion (on-site), day 14 (remote), and day 28 (remote). After the study completion, patients completed a comprehensive questionnaire on user perception and feasibility. Adherence to scheduled visits, the success rate of the data transfer, user perception and feasibility, and the clinical relevance of remote measurements were evaluated. Results: Mean adherence to the planned remote visits was 63\% on day 14 and 37\% on day 28. ECG measurements were performed most frequently (day 14: 57/76, 75\%; day 28: 31/76, 41\%). The primary patient-reported reason for nonadherence was device malfunction. The expected versus the received data transfer per patient was as follows: ECGs: 3 versus 3.04 (SD 1.9); WBC counts: 3 versus 2.14 (SD 1.14); QoL questionnaires: 3 versus 2.5 (SD 1.14); and photo documentation: 6 versus 4.4 (SD 3.36). Among patients, 81\% (55/68) found ECG measurements easy, 82\% (55/67) found photo documentation easy, and 48\% (33/69) found WBC measurements easy. Additionally, 61\% (40/66) of patients felt comfortable with self-monitoring and 79\% (54/68) were willing to integrate remote monitoring into their future cancer care. Therapy-induced decreased neutrophil count was successfully detected (P<.001; mean baseline: 4.3, SD 2.2, {\texttimes}109/L; on-treatment: 1.8, SD 0.8, {\texttimes}109/L). All-grade neutropenia and corrected QT interval prolongations were detected in 80\% (55/68) and 2\% (1/42) of patients, respectively. Conclusions: Adherence to scheduled remote visits was moderate, with nonadherence primarily attributed to device-related complications, which may have also affected the success rate of data transfer. Overall, patients considered remote monitoring useful and feasible. The prevalence of reported adverse events was comparable to existing literature, suggesting clinical potential. This initial feasibility study highlights the potential of the DHHC. ",
doi="10.2196/64083",
url="https://cancer.jmir.org/2025/1/e64083"
}


@Article{info:doi/10.2196/60169,
author="Mu{\~n}oz Olivar, Carolina
and Pineiro, Miguel
and G{\'o}mez Quintero, Sebasti{\'a}n Juan
and Avenda{\~n}o-V{\'a}squez, Javier Carlos
and Orme{\~n}o-Arriagada, Pablo
and Palma Rivadeneira, Silvia
and Taramasco Toro, Carla",
title="Education and Symptom Reporting in an mHealth App for Patients With Cancer: Mixed Methods Development and Validation Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="28",
volume="12",
pages="e60169",
keywords="cancer",
keywords="patient-reported outcome measures",
keywords="software design",
keywords="unpleasant symptom",
keywords="toxicity",
keywords="mHealth",
keywords="mobile health",
keywords="surveys and questionnaires",
keywords="application",
keywords="design",
keywords="evaluation",
keywords="chemotherapy",
keywords="health care communication",
keywords="mixed methods",
keywords="validation",
keywords="efficiency",
keywords="security",
abstract="Background: The widespread prevalence of cancer across the globe demands cutting-edge solutions for its treatment. Current cancer therapies, notably chemotherapy, pose challenges due to their side effects. The early detection and management of the side effects are vital but complex. This study introduces a mobile health app designed to bridge the communication gaps between patients with cancer and health care providers. Hence, it allows patients to report symptoms immediately and also enables proactive symptom management by health care providers. Objective: This study has 2 objectives: first, to design a cancer-focused mobile health app that integrates educational content and real-time symptom reporting for chemotherapy patients. Second, to validate and evaluate the app quality using the Mobile App Rating Scale (MARS). The app seeks to foster health care communication, reduce hospital readmissions, and optimize symptom management, contributing to a more impactful patient experience. Methods: This mixed-methods study details the development and validation of mobile health applications. The app was designed by a multidisciplinary team, including nurses, medical professionals, pharmaceutical chemists, computer engineers, and software developers, using agile methodologies. For validation, the app was assessed by 13 evaluators, including clinical professionals (nurses and physicians) and engineers. The evaluation included technical performance analysis using Google tools and quality assessment using the MARS, which measures engagement, functionality, aesthetics, and information quality. Results: Performance metrics highlighted areas for improvement, with loading times showing delays in displaying content. Meanwhile, the response time of the app was moderate, and visual stability remained excellent. The app achieved an overall MARS score of 3.75 (SD 0.42), indicating consistent quality, with functionality scoring the highest (4.35; SD 0.52) and engagement the lowest (3.31; SD 0.61). The reliability of the MARS was confirmed (interclass correlation coefficient: 0.84; 95\% CI: 0.72?0.92). Evaluators unanimously praised the app's potential benefits for patients and clinical professionals while identifying areas for improvement such as customization, onboarding guidance, and navigation. Conclusions: The CONTIGO app showed strengths in functionality, usability, and information quality, supported by robust security measures. However, areas such as user interactivity and engagement require improvement. Future refinements will integrate insights from patients with cancer to address user-specific needs and enhance the oncology care experience. ",
doi="10.2196/60169",
url="https://humanfactors.jmir.org/2025/1/e60169"
}


@Article{info:doi/10.2196/69398,
author="Hubel, J. Niclas
and Vorbach, M. Samuel
and de Ligt, M. Kelly
and Rathgeber, S. Ines
and Beyer, Katharina
and Wintner, M. Lisa
and Faller, Barbara
and Nemec, Jasmin
and Holzner, Bernhard
and Sztankay, Monika
and Lehmann, Jens",
title="Sustainability and Time Trends in Electronic Patient-Reported Outcome Assessment in Routine Cancer Care: Systematic Scoping Review and Follow-Up Survey",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="25",
volume="27",
pages="e69398",
keywords="patient-reported outcome measures",
keywords="cancer, clinical routine",
keywords="health-related quality of life",
keywords="quality of care",
keywords="mobile applications",
keywords="digital technology",
abstract="Background: Routine electronic assessment of patient-reported outcomes (ePROs) can improve cancer care; yet, its implementation in routine practice and long-term sustainability remain unclear. Understanding these aspects is critical to advancing the field. Objective: To review and describe the past and current status, time trends, and long-term sustainability of clinical ePRO applications in routine oncology care. Methods: We conducted a systematic review of publications on ePRO use in oncology care up to December 31, 2023, searching PubMed and Web of Science and extracting data on clinical ePRO applications. We included peer-reviewed studies including patients with cancer using ePRO assessments in clinical practice, excluding research letters and conference abstracts. Data from the review were analyzed using descriptive statistics and univariate regression models to evaluate time trends, with year of publication as the predictor. A follow-up survey was sent to authors of published ePRO applications to assess their current use of the application or reasons for discontinuation. Responses from the follow-up survey were analyzed descriptively. Results: For the review, we screened 2933 references, and 303 met inclusion criteria. Results showed that Europe was the most common region (n=141, 46.5\%), and study populations consisted mostly of adult patients (n=276, 91.1\%) under chemotherapy treatment (n=124, 40.9\%) assessed in an outpatient setting (n=261, 86.1\%). The EORTC (European Organisation for Research and Treatment of Cancer; n=77, 25.4\%) and PRO-CTCAE (Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events) questionnaires (n=65, 21.5\%) were most frequently integrated into ePRO applications. In the univariate analysis, we found that publications increased significantly over time (2003-2023, P<.001). Trends showed a rise in mobile app use (odds ratio [OR] 1.211, P<.001), remote assessments (OR 1.094, P=.002), and feedback provided to patients (OR 1.060, P=.04). Of the 303 studies, 221 unique clinical ePRO applications were identified, merging publications at the application level. The follow-up survey had a 35.3\% response rate (78/221), with 61.1\% of ePRO applications still in use, lasting a median of 5 years. The most common reason for discontinuation was a lack of funding and resources (42.9\%, 12/28). Conclusions: The field of ePRO assessment in oncology is rapidly evolving, with a shift toward remote, app-based tools and a growing emphasis on providing feedback to patients. We present, for the first time, data on the sustainability of ePRO use in routine care. While our findings offer valuable insights, they should be interpreted in light of potential response bias in the follow-up survey. Several ePRO applications remain in active use, highlighting potential for long-term integration into clinical practice. However, financial constraints, limited reimbursement models, and challenges with workflow integration continue to hinder broader and more sustainable adoption. Addressing these barriers will be essential to support the continued use of ePROs in clinical care. ",
doi="10.2196/69398",
url="https://www.jmir.org/2025/1/e69398"
}


@Article{info:doi/10.2196/57342,
author="Bonotis, Panos
and Angelidis, Pantelis
and Natsiavas, Pantelis",
title="Usability and User Experience Testing of a Co-Designed Electronic Patient-Reported Outcomes App (``MyPal for Adults'') for Palliative Cancer Care: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="24",
volume="12",
pages="e57342",
keywords="mHealth",
keywords="app",
keywords="digital intervention",
keywords="think-aloud test",
keywords="palliative care",
keywords="cancer care",
keywords="patient-reported outcomes",
keywords="usability evaluation",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Mobile health technologies have the potential to enhance the management, communication, and overall quality of life of patients with cancer. The MyPal project, using a participatory design approach, aims to provide palliative care support for patients with cancer through an electronic patient-reported outcomes eHealth platform. Objective: This study aims to evaluate the usability and user experience of ``MyPal for adults,'' a co-designed palliative care mobile app designed to support adults with cancer. Methods: Representative users participated in a 4-step usability study using a ``think-aloud'' protocol, complemented with feature satisfaction, difficulty perceived, and design impression surveys along with a short, structured interview. Participants were also asked to provide quantitative feedback via the postuse System Usability Scale, User Experience Questionnaire, and Post-Study System Usability Questionnaire. The data were analyzed along the lines of the International Organization for Standardization (ISO) 9241?210 framework. Results: All participants found the intervention content useful, and they reported satisfactory usability, with a mean Post-Study System Usability Questionnaire score of 2.458 (SD 1.08) and a System Usability Scale score of 68.9. All aspects of the User Experience Questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) surpassed usability quality benchmarks. The qualitative analysis identified 43 usability issues, primarily related to effectiveness and efficiency as defined in ISO 9241?210. Conclusions: In this study, we conducted a usability evaluation of the ``MyPal for adults'' app, a digital tool designed to enhance the palliative care experience. This approach identifies real-world usability issues, enabling iterative improvements in the eHealth platform's design. Our findings reveal a user-friendly interface and positive patient experiences. This study emphasizes the need to enhance mobile health platform usability, offering insights to improve digital palliative care. Trial Registration: ClinicalTrials.gov NCT04370457; https://www.clinicaltrials.gov/study/NCT04370457 ",
doi="10.2196/57342",
url="https://humanfactors.jmir.org/2025/1/e57342"
}


@Article{info:doi/10.2196/71684,
author="Pang, Yan
and He, Honggu
and Ng, Ruey-Pyng
and Lee, Luan Nicole Kim
and Htein, Win Me Me
and Zhao, Xiao-Xin
and Li, Ying-Hong
and Chan, Jiahui Elizabeth
and Zhu, Lixia
and Liu, Yu Guang
and Pikkarainen, Minna
and Lim, Swee-Ho",
title="Effectiveness of an Innovative Mobile-Based Perioperative Care Program for Women Undergoing Breast Cancer Surgery (iCareBreast): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="21",
volume="27",
pages="e71684",
keywords="breast cancer",
keywords="digital health",
keywords="mHealth",
keywords="mobile health",
keywords="psychosocial",
keywords="randomized controlled trial",
keywords="self-efficacy",
keywords="mobile phone",
abstract="Background: Breast cancer is one of the most prevalent cancers among women and significantly impacts psychological well-being and health-related quality of life (HR-QoL) during the perioperative period. Mobile health interventions offer a promising approach to providing education and psychosocial support, yet their effectiveness in this context remains underexplored. Objective: This study aimed to develop and evaluate the effectiveness of an innovative, mobile-based, perioperative care program for women undergoing breast cancer surgery (iCareBreast). The assessment focused on perioperative self-efficacy, anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. Methods: A two-group randomized control trial was conducted at a tertiary hospital in Singapore. The intervention group used the iCareBreast app, offering four main resources: perioperative care guidance, breast cancer and surgery education, psychological support, and social support. The control group received standard hospital care. Participants in the intervention group engaged with the fully automated app daily for 29 days (two weeks before surgery, on the day of surgery, and two weeks after surgery). Data were collected face-to-face or on the web at three time points: baseline, immediately after the intervention (T1; two weeks after surgery), and at a 2.5-month follow-up (T2; three months after surgery). The primary outcome was perioperative care self-efficacy, while secondary outcomes included anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. Results: A total of 123 patients with early-stage breast cancer scheduled for breast surgery were enrolled in the study, with 62 patients assigned to the iCareBreast group and 61 patients to the control group. The results showed no significant differences between the groups in the primary outcome---perioperative self-efficacy---at any time point. Baseline scores were similar (P=.80), and while the iCareBreast group showed slightly lower scores at T1 (mean difference [MD] --1.63, 95\% CI --3.43 to 0.18; P=.08) and T2 (MD --1.90, 95\% CI --4.06 to 0.26; P=.09), the differences were not statistically significant. Similarly, secondary outcomes, including anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction, showed no significant changes between groups (all P>.05). However, the iCareBreast group reported higher perioperative care satisfaction during the postintervention assessment. Satisfaction scores were comparable at T1 (P=.68), while at T2, the iCareBreast group showed a slight increase compared to the control group (MD 0.35, 95\% CI 0.04-0.73; P=.08), though the difference was not statistically significant. Conclusions: The mobile-based psychosocial intervention, although satisfied by users, did not demonstrate significant benefits compared to standard care. This highlights the need to refine the iCareBreast app in future iterations to enhance its effectiveness in addressing the targeted health outcomes. Future mobile health research should prioritize optimizing user engagement strategies and incorporating personalized approaches to better address the perioperative care needs of patients with breast cancer. Trial Registration: ClinicalTrials.gov NCT04172350; https://clinicaltrials.gov/study/NCT04172350 ",
doi="10.2196/71684",
url="https://www.jmir.org/2025/1/e71684"
}


@Article{info:doi/10.2196/65188,
author="Fleszar-Pavlovic, E. Sara
and Noriega Esquives, Blanca
and Lovan, Padideh
and Brito, E. Arianna
and Sia, Marie Ann
and Kauffman, Adelyn Mary
and Lopes, Maria
and Moreno, I. Patricia
and Koru-Sengul, Tulay
and Gong, Rui
and Wang, Trent
and Wieder, D. Eric
and Rueda-Lara, Maria
and Antoni, Michael
and Komanduri, Krishna
and Lesiuk, Teresa
and Penedo, J. Frank",
title="Development of an eHealth Mindfulness-Based Music Therapy Intervention for Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Qualitative Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="11",
volume="9",
pages="e65188",
keywords="allogeneic stem cell transplantation",
keywords="hematologic malignancy",
keywords="bone marrow transplant",
keywords="mindfulness-based music therapy",
keywords="mindfulness",
keywords="music therapy",
keywords="eHealth",
keywords="music therapy intervention",
keywords="adult",
keywords="adolescence",
keywords="allogeneic",
keywords="stem cell transplantation",
keywords="stem cell",
keywords="transplantation",
keywords="qualitative study",
keywords="treatment",
keywords="hematologic cancers",
keywords="psychological distress",
keywords="side effects",
keywords="mindfulness-based stress reduction",
keywords="stress reduction",
keywords="anxiety",
keywords="depression",
keywords="diagnosis",
keywords="blood sample collection",
keywords="eHealth tool",
keywords="quality of life",
keywords="cancer survivors",
abstract="Background: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients. Objective: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT. Methods: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the ``think aloud'' method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months. Results: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection. Conclusions: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation. Trial Registration: ClinicalTrials.gov NCT05968963; https://clinicaltrials.gov/study/NCT05968963 ",
doi="10.2196/65188",
url="https://formative.jmir.org/2025/1/e65188"
}


@Article{info:doi/10.2196/59228,
author="Yu, Kaitao
and Yin, Baobing
and Zhu, Ying
and Meng, Hongdao
and Zhu, Wenwei
and Lu, Lu
and Wang, Junqiao
and Chen, Shugeng
and Ni, Jun
and Lin, Yifang
and Jia, Jie",
title="Efficacy of a Digital Postoperative Rehabilitation Intervention in Patients With Primary Liver Cancer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="7",
volume="13",
pages="e59228",
keywords="digital health",
keywords="surgery",
keywords="exercise rehabilitation",
keywords="randomized controlled trial",
keywords="primary liver cancer",
abstract="Background: Rehabilitation is considered a fundamental component of cancer treatment, especially for patients undergoing cancer surgery. In contrast to conventional rehabilitation education, digital rehabilitation has the potential to improve patients' access to postoperative rehabilitation programs. While digital health has rapidly emerged to aid patients with various diseases, their clinical efficacy in the recovery of patients with primary liver cancer (PLC) undergoing hepatectomy remains inadequately investigated. Objective: This study aims to evaluate whether a digital postoperative rehabilitation intervention is efficient in improving physical fitness, enhancing exercise adherence, and alleviating fatigue among patients with PLC after hepatectomy. Methods: A randomized controlled trial was undertaken across 2 university-affiliated hospitals in Eastern China. A total of 100 participants were enrolled in this study and were allocated randomly to either the digital health (intervention group, n=50) or the rehabilitation manual-based group (control group, n=50) at a 1:1 ratio. Patients were unblinded and prospectively followed for the intervention of 3 weeks. Outcome measures included physical fitness, exercise adherence, and status of fatigue. Results: Overall, 91 out of 100 patients completed the research and were evaluated after 3 weeks of intervention. The digital health group showed better cardiopulmonary endurance than the control group. The mean difference in the change of 6-minute walk test distance from baseline between the groups was 70.21 (95\% CI 0.730-82.869) m (P=.05). No statistically significant effects were found for grip strength, 5-repetition-sit-to-stand test time, and fatigue. The exercise adherence in the digital health group was higher than that in the control group ($\chi$22=15.871, P<.001). Conclusions: The findings suggested that the implementation of digital health had a positive impact on recovery in exercise capacity after hepatectomy. In addition, rehabilitation exercise mode based on digital health has the potential to improve the exercise adherence of patients with PLC compared to conventional manual-based rehabilitation guidance. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052911; https://www.chictr.org.cn/showproj.html?proj=135351 ",
doi="10.2196/59228",
url="https://mhealth.jmir.org/2025/1/e59228"
}


@Article{info:doi/10.2196/67108,
author="Lin, Chen Yu
and Hagen, Ryan
and Powers, D. Benjamin
and Dineen, P. Sean
and Milano, Jeanine
and Hume, Emma
and Sprow, Olivia
and Diaz-Carraway, Sophia
and Permuth, B. Jennifer
and Deneve, Jeremiah
and Alishahi Tabriz, Amir
and Turner, Kea",
title="Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="7",
volume="11",
pages="e67108",
keywords="gastrointestinal cancer",
keywords="peritoneal disease",
keywords="cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy",
keywords="digital health intervention",
keywords="nutrition",
keywords="feasibility",
abstract="Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. Objective: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. Methods: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. Results: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59\% vs benchmark: 50\%), study assessment completion (9/10, 90\% vs benchmark: 60\%), dietitian appointment attendance (7/10, 70\% vs benchmark: 60\%), daily food intake logging adherence (6/10, 60\% vs benchmark: 60\%), and participant retention (10/10, 100\% vs benchmark: 60\%). Most participants rated the intervention as acceptable (8/10, 80\% vs benchmark: 70\%) and reported a high level of usability for dietitian services (10/10, 100\%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. Conclusions: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes. Trial Registration: ClinicalTrials.gov NCT05649969; https://clinicaltrials.gov/study/NCT05649969 ",
doi="10.2196/67108",
url="https://cancer.jmir.org/2025/1/e67108"
}


@Article{info:doi/10.2196/71865,
author="Kim, Minjin
and Kim, Ellie
and Lee, Hyeongsuk
and Piao, Meihua
and Rosen, Brittany
and Allison, J. Jeroan
and Zai, H. Adrian
and Nguyen, L. Hoa
and Shin, Dong-Soo
and Kahn, A. Jessica",
title="A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study",
journal="Asian Pac Isl Nurs J",
year="2025",
month="Apr",
day="7",
volume="9",
pages="e71865",
keywords="human papillomavirus",
keywords="HPV vaccination",
keywords="artificial intelligence",
keywords="AI",
keywords="chatbot intervention",
keywords="Korean Americans",
keywords="usability testing",
keywords="culturally tailored intervention",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)--powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville's usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1\%), second-generation individuals (n=13, 61.9\%), and single (n=20, 95.2\%). HPV awareness was high (n=19, 90.5\%), vaccine knowledge was also high (n=18, 81.8\%), but only 11 (52.4\%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. ",
doi="10.2196/71865",
url="https://apinj.jmir.org/2025/1/e71865"
}


@Article{info:doi/10.2196/52694,
author="Tak, Won Yae
and Kim, Junetae
and Chung, Haekwon
and Lee, Byul Sae
and Park, Ja In
and Lee, Won Sei
and Jo, Min-Woo
and Lee, Won Jong
and Baek, Seunghee
and Lee, Yura",
title="Analysis of Metabolic and Quality-of-Life Factors in Patients With Cancer for a New Approach to Classifying Walking Habits: Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="1",
volume="27",
pages="e52694",
keywords="telemedicine",
keywords="mobile phone",
keywords="physical activity",
keywords="mobile apps",
keywords="mobile health intervention",
keywords="cancer",
keywords="step count",
abstract="Background: As the number of people diagnosed with cancer continues to increase, self-management has become crucial for patients recovering from cancer surgery or undergoing chemotherapy. Technology has emerged as a key tool in supporting self-management, particularly through interventions that promote physical activity, which is important for improving health outcomes and quality of life for patients with cancer. Despite the growing availability of digital tools that facilitate physical activity tracking, high-level evidence of their long-term effectiveness remains limited. Objective: This study aimed to investigate the effect of long-term physical activity on patients with cancer by categorizing them into active and inactive groups based on step count time-series data using the mobile health intervention, the Walkon app (Swallaby Co, Ltd.). Methods: Patients with cancer who had previously used the Walkon app in a previous randomized controlled trial were chosen for this study. Walking step count data were acquired from the app users. Biometric measurements, including BMI, waist circumference, blood sugar levels, and body composition, along with quality of life (QOL) questionnaire responses (European Quality of Life 5 Dimensions 5 Level version and Health-related Quality of Life Instrument with 8 Items), were collected during both the baseline and 6-month follow-up at an outpatient clinic. To analyze step count patterns over time, the concept of sample entropy was used for patient clustering, distinguishing between the active walking group (AWG) and the inactive walking group (IWG). Statistical analysis was performed using the Shapiro-Wilk test for normality, with paired t tests for parametric data, Wilcoxon signed-rank tests for nonparametric data, and chi-square tests for categorical variables. Results: The proposed method effectively categorized the AWG (n=137) and IWG (n=75) based on step count trends, revealing significant differences in daily (4223 vs 5355), weekly (13,887 vs 40,247), and monthly (60,178 vs 174,405) step counts. Higher physical activity levels were observed in patients with breast cancer and younger individuals. In terms of biometric measurements, only waist circumference (P=.01) and visceral fat (P=.002) demonstrated a significant improvement exclusively within the AWG. Regarding QOL measurements, aspects such as energy (P=.01), work (P<.003), depression (P=.02), memory (P=.01), and happiness (P=.05) displayed significant improvements solely in the AWG. Conclusions: This study introduces a novel methodology for categorizing patients with cancer based on physical activity using step count data. Although significant improvements were noted in the AWG, particularly in QOL and specific physical metrics, differences in 6-month change between the AWG and IWG were statistically insignificant. These findings highlight the potential of digital interventions in improving outcomes for patients with cancer, contributing valuable insights into cancer care and self-management. Trial Registration: Clinical Research Information Service by Korea Centers for Diseases Control and Prevention, Republic of Korea KCT0005447; https://tinyurl.com/3zc7zvzz ",
doi="10.2196/52694",
url="https://www.jmir.org/2025/1/e52694"
}


@Article{info:doi/10.2196/65542,
author="Nasrudin, Nurfarhana
and Sazlina, Shariff-Ghazali
and Cheong, Theng Ai
and Lee, Yein Ping
and Teo, Soo-Hwang
and Aneesa, Rashid Abdul
and Teo, Hai Chin
and Rokhani, Zaman Fakhrul
and Haron, Azam Nuzul
and Harrun, Harzana Noor
and Ho, Kiau Bee
and Mohamed Isa, Salbiah",
title="Increasing the Uptake of Breast and Cervical Cancer Screening Via the MAwar Application: Stakeholder-Driven Web Application Development Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="28",
volume="9",
pages="e65542",
keywords="cancer screening",
keywords="stakeholder engagement",
keywords="Quality Function Deployment",
keywords="web health app",
abstract="Background: Digital health interventions such as web health applications significantly enhance screening accessibility and uptake, particularly for individuals with low literacy and income levels. By involving stakeholders---including health care professionals, patients, and technical experts---an intervention can be tailored to effectively meet the users' needs, ensuring contextual relevance for better acceptance and impact. Objective: The aim of this study is to prioritize the content and user interface appropriate for developing a web health application, known as the MAwar app, to promote breast and cervical cancer screening. Methods: A cross-sectional study for stakeholder engagement was conducted to develop a web-based application known as the MAwar app as part of a larger study entitled ``The Effectiveness of an Interactive Web Application to Motivate and Raise Awareness on Early Detection of Breast and Cervical Cancers (The MAwar study)''. The stakeholder engagement process was conducted in a public health district that oversees 12 public primary care clinics with existing cervical and breast cancer screening programs. We purposively selected the stakeholders for their relevant roles in breast and cervical cancer screening (health care staff, patients, and public representatives), as well as expertise in software and user interface design (technology experts). The Quality Function Deployment method was used to reflect the priorities of diverse stakeholders (health care, technology experts, patients, and public representatives) in its design. The Quality Function Deployment method facilitated the translation of stakeholder perspectives into app features. Stakeholders rated features on a scale from 1 (least important) to 5 (most important), ensuring the app's design resonated with user needs. The correlations between the ``WHATs'' (user requirements) and the ``HOWs'' (technical requirements) were scored using a 3-point ordinal scale, with 1 indicating weak correlation, 5 indicating medium correlation, and 9 indicating the strongest correlation. Results: A total of 13 stakeholders participated in the study, including women who had either underwent or never had health screening, a health administrator, a primary care physician, medical officers, nurses, and software designers. Stakeholder evaluations highlighted cost-free access (mean 4.64, SD 0.81), comprehensive cancer information (mean 4.55, SD 0.69), detailed screening benefits (mean 4.45, SD 0.68), detailed screening facilities (mean 4.45, SD 0.68) and personalized risk calculator for breast and cervical cancers (mean 4.45, SD 0.68) as essential priorities of the app. The highest-ranked features include detailed information on screening procedures (weighted score [WS]=367.84), information on treatment options (WS=345.80), benefits of screening (WS=333.75), information about breast and cervical cancers (WS=332.15), and frequently asked questions about the concerns around screening (WS=312.00). Conclusions: The MAwar app, conceived through a collaborative, stakeholder-driven process, represents a significant step in leveraging digital health solutions to tackle cancer screening disparities. By prioritizing accessibility, information quality, and clarity on benefits, the app promises to encourage early cancer detection and management for targeted communities. Trial Registration: ISRCTN Registry ISRCTN10403163; https://www.isrctn.com/ISRCTN10403163 ",
doi="10.2196/65542",
url="https://formative.jmir.org/2025/1/e65542"
}


@Article{info:doi/10.2196/63989,
author="Kim, Mi Sun
and Kim, Seul Da
and Jang, Yoonsung
and Kim, Kyoon Min
and Yu, Eun-Seung
and Han, Hyun Doug
and Kim, Jun Hee",
title="Evaluating the Effectiveness of a Mobile App for Breast Cancer Self-Management on Self-Efficacy: Nonrandomized Intervention Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="26",
volume="13",
pages="e63989",
keywords="breast cancer",
keywords="mobile health",
keywords="mHealth",
keywords="health education",
keywords="self-efficacy",
keywords="psychological adjustments",
keywords="mobile phone",
abstract="Background: Numerous mobile apps have been developed for patients with cancer. However, there is still no comprehensive app for patients with breast cancer that integrates evidence-based medical information, psychological support, and schedule management through a multidisciplinary medical approach. Objective: We aimed to investigate whether a mobile app designed to assist in the self-management of patients with breast cancer is feasible and positively affects their self-efficacy and other psychological aspects. Methods: The Cancer Manager (CAMA) app was developed to assist in the self-management of patients with breast cancer and survivors of cancer according to cancer trajectory. Its functionalities include providing evidence-based digitalized information created by experts, managing patients' medication and medical appointment schedules, and providing a delayed question and answer system for patients to query health care professionals. In this nonrandomized intervention trial, we analyzed data from 66 patients with breast cancer, divided into experimental (CAMA: n=34, 52\%) and control (treatment as usual: n=32, 48\%) groups. Group allocation was determined based on the patient's willingness to use the app and access to compatible smartphones. Outcome measures included the Korean version of the Cancer Survivor Self-Efficacy Scale, the Korean version of the Mini-Mental Adjustment to Cancer (K-Mini-MAC) Scale, the World Health Organization Quality of Life Brief Version, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Menopause Emotional Symptoms Questionnaire (MESQ). A user satisfaction survey was also conducted. Results: Throughout the intervention period, the CAMA group (vs treatment as usual group) demonstrated significant improvements in the seeking help and support subscale of the Korean version of the Cancer Survivor Self-Efficacy Scale (F1,64=5.09; P=.03), the psychological well-being subscale of the World Health Organization Quality of Life Brief Version (F1,64=5.48; P=.02), the anxious preoccupation subscale (F1,64=5.49; P=.02) and positive attitude subscale (F1,64=5.44; P=.02) of the K-Mini-MAC Scale, PHQ-9 (F1,64=4.83; P=.03), GAD-7 (F1,64=5.48; P=.02), and MESQ (F1,64=4.30; P=.04). Changes in the anxious preoccupation subscale of the K-Mini-MAC Scale scores were positively correlated with changes in the PHQ-9 (r=0.46; P=.007) and GAD-7 (r=0.41; P=.02) scores and negatively correlated with changes in the positive attitude subscale of the K-Mini-MAC Scale scores (r=--0.36; P=.04). Changes in the PHQ-9 scores were positively correlated with changes in the GAD-7 (r=0.66; P<.001) and MESQ (r=0.35; P=.04) scores. The user satisfaction survey offered insights into the CAMA app's positive impact; trust-building outcomes; and opportunities for enhancement, such as the inclusion of communication tools and continued content enrichment. Conclusions: The mobile app for breast cancer self-management, CAMA, was deemed feasible and showed promise in improving the patients' self-efficacy regarding seeking help and support, positive attitude toward cancer, and psychological well-being. In addition, its use might help reduce anxious preoccupation with cancer, depressive mood, anxiety, and menopausal emotional symptoms. Trial Registration: Clinical Research Information Service KCT0007917; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23348 ",
doi="10.2196/63989",
url="https://mhealth.jmir.org/2025/1/e63989"
}


@Article{info:doi/10.2196/53539,
author="Crafoord, Marie-Ther{\'e}se
and Ekstrand, Joakim
and Sundberg, Kay
and Nilsson, I. Marie
and Fjell, Maria
and Langius-Ekl{\"o}f, Ann",
title="Mobile Electronic Patient-Reported Outcomes and Interactive Support During Breast and Prostate Cancer Treatment: Health Economic Evaluation From Two Randomized Controlled Trials",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="11",
volume="11",
pages="e53539",
keywords="cost-effectiveness",
keywords="ePRO",
keywords="mHealth",
keywords="disease monitoring",
keywords="cancer",
keywords="RCT",
keywords="randomized controlled trial",
keywords="controlled trials",
keywords="digital intervention",
keywords="patient-reported outcomes",
keywords="management",
keywords="payers' perspective",
keywords="health care costs",
keywords="apps",
keywords="prostate cancer",
keywords="breast cancer",
abstract="Background: Digital interventions for supportive care during cancer treatment incorporating electronic patient-reported outcomes (ePROs) can enhance early detection of symptoms and facilitate timely symptom management. However, economic evaluations are needed. Objective: This study aims to conduct a cost-utility analysis of an app for ePRO and interactive support from the perspective of the payer (Region Stockholm Health Care Organization) and to explore its impact on patient health care utilization and costs. Methods: Two open-label randomized controlled trials (RCTs) were conducted, including patients undergoing neoadjuvant chemotherapy for breast cancer (B-RCT; N=149) and radiotherapy for prostate cancer (P-RCT; N=150), recruited from oncology clinics at 2 university hospitals in Stockholm, Sweden. EORTC QLQ-C30 scores were mapped to EQ-5D-3L to calculate quality-adjusted life years (QALYs). Intervention and implementation costs and health care costs, obtained from an administrative database, were used to calculate incremental cost-effectiveness ratios (ICERs) in 3 ways: including all health care costs (ICERa), excluding nonacute health care costs (ICERb), and excluding health care costs altogether (ICERc). Nonparametric bootstrapping was used to explore ICER uncertainty. Health care costs were analyzed by classifying them as disease-related or acute. Results: In both RCT intervention groups, fewer QALYs were lost compared with the control group (P<.001). In the B-RCT, the mean intervention cost was {\texteuro}92 (SD {\texteuro}2; {\texteuro}1=US \$1.03). The mean cost for the intervention and all health care was {\texteuro}36,882 (SD {\texteuro}1032) in the intervention group and {\texteuro}35,427 (SD {\texteuro}959) in the control group (P<.001), with an ICERa of {\texteuro}202,368 (95\% CI {\texteuro}152,008-{\texteuro}252,728). The mean cost for the intervention and acute health care was {\texteuro}3585 (SD {\texteuro}480) in the intervention group and {\texteuro}3235 (SD {\texteuro}494) in the control group (P<.001). ICERb was {\texteuro}49,903 (95\% CI {\texteuro}37,049-{\texteuro}62,758) and ICERc was {\texteuro}13,213 (95\% CI {\texteuro}11,145-{\texteuro}15,281); 22 out of 74 (30\%) intervention group patients and 24 out of 75 (32\%) of the control group patients required acute inpatient care for fever. In the P-RCT, the mean intervention cost was {\texteuro}43 (SD {\texteuro}0.2). The mean cost for the intervention and all health care was {\texteuro}3419 (SD {\texteuro}739) in the intervention group and {\texteuro}3537 (SD {\texteuro}689) in the control group (P<.001), with an ICERa of --{\texteuro}1,092,136 (95\% CI --{\texteuro}3,274,774 to {\texteuro}1,090,502). The mean cost for the intervention and acute health care was {\texteuro}1219 (SD {\texteuro}593) in the intervention group and {\texteuro}802 (SD {\texteuro}281) in the control group (P<.001). ICERb was {\texteuro}745,987 (95\% CI --{\texteuro}247,317 to {\texteuro}1,739,292) and ICERc was {\texteuro}13,118 (95\% CI --68,468 to {\texteuro}94,704). As many as 10 out of the 75 (13\%) intervention group patients had acute inpatient care, with the most common symptom being dyspnea, while 9 out of the 75 (12\%) control group patients had acute inpatient care, with the most common symptom being urinary tract infection. Conclusions: ePRO and interactive support via an app generated a small improvement in QALYs at a low intervention cost and may be cost-effective, depending on the costs considered. Considerable variability in patient health care costs introduced uncertainty around the estimates, preventing a robust determination of cost-effectiveness. Larger studies examining cost-effectiveness from a societal perspective are needed. The study provides valuable insights into acute health care utilization during cancer treatment. Trial Registration: ClinicalTrials.gov NCT02479607; https://clinicaltrials.gov/ct2/show/NCT02479607, ClinicalTrials.gov NCT02477137; https://clinicaltrials.gov/ct2/show/NCT02477137 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-017-3450-y ",
doi="10.2196/53539",
url="https://cancer.jmir.org/2025/1/e53539"
}


@Article{info:doi/10.2196/72477,
author="Lee, Yura
and Park, Ye-Eun",
title="Authors' Reply: Advancing Digital Health Integration in Oncology",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="7",
volume="27",
pages="e72477",
keywords="mHealth",
keywords="user experience",
keywords="cancer",
keywords="technology acceptance model",
keywords="structural equation modeling",
keywords="health care app",
keywords="mixed-method study",
keywords="medical care",
keywords="digital health care",
keywords="cancer survivors",
keywords="disparities",
keywords="health status",
keywords="behavioral intervention",
keywords="clinician",
doi="10.2196/72477",
url="https://www.jmir.org/2025/1/e72477",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053760"
}


@Article{info:doi/10.2196/70316,
author="Khan, Umar Rai Muhammad
and Tariq, Hassan",
title="Advancing Digital Health Integration in Oncology",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="7",
volume="27",
pages="e70316",
keywords="mHealth",
keywords="user experience",
keywords="cancer",
keywords="technology acceptance model",
keywords="structural equation modeling",
keywords="health care app",
keywords="mixed-method study",
keywords="medical care",
keywords="digital health care",
keywords="cancer survivors",
keywords="disparities",
keywords="health status",
keywords="behavioral intervention",
keywords="clinician",
doi="10.2196/70316",
url="https://www.jmir.org/2025/1/e70316",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053796"
}


@Article{info:doi/10.2196/60115,
author="Li, Guangqi
and Zhou, Xueyan
and Deng, Junyue
and Wang, Jiao
and Ai, Ping
and Zeng, Jingyuan
and Ma, Xuelei
and Liao, Hu",
title="Digital Therapeutics--Based Cardio-Oncology Rehabilitation for Lung Cancer Survivors: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="25",
volume="13",
pages="e60115",
keywords="cardio-oncology rehabilitation",
keywords="digital therapeutics",
keywords="telerehabilitation",
keywords="non-small cell lung cancer",
keywords="exercise prescription",
keywords="cardiology",
keywords="oncology",
keywords="rehabilitation",
keywords="cardiorespiratory fitness",
keywords="cardiopulmonary",
keywords="cancer",
keywords="physical activity",
keywords="digital health",
keywords="digital technology",
keywords="randomized controlled trial",
keywords="wearable",
keywords="app",
keywords="quality of life",
keywords="survivor",
abstract="Background: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice. Objective: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL). Methods: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence--driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band--based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax -- HRresting] {\texttimes} [?40\%-60\%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL. Results: A total of 40 (85\%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2\%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (--0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (--8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (--0.31, SD 0.44 vs --0.05, SD 0.29; P=.048), and daytime dysfunction (--0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period. Conclusions: The 5-month, digital therapeutics--based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594 ",
doi="10.2196/60115",
url="https://mhealth.jmir.org/2025/1/e60115"
}


@Article{info:doi/10.2196/64145,
author="Bargas-Ochoa, Miguel
and Zulbaran-Rojas, Alejandro
and Finco, G. M.
and Costales, B. Anthony
and Flores-Camargo, Areli
and Bara, O. Rasha
and Pacheco, Manuel
and Phan, Tina
and Khichi, Aleena
and Najafi, Bijan",
title="Development and Implementation of a Personal Virtual Assistant for Patient Engagement and Communication in Postsurgical Cancer Care: Feasibility Cohort Study",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="18",
volume="11",
pages="e64145",
keywords="digital health",
keywords="personal virtual assistant",
keywords="remote patient monitoring",
keywords="surgical oncology",
keywords="posthospital discharge",
keywords="postoperative support",
keywords="medication adherence postsurgery",
keywords="patient engagement",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Cancer-care complexity heightens communication challenges between health care providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge in patients undergoing surgical procedures. Digital health tools offer potential solutions to address communication challenges seen in current discharge protocols. We aim to explore the usability and acceptability of an interactive health platform among discharged patients who underwent oncology-related procedures. Methods: A 4-week exploratory cohort study was conducted. Following hospital discharge, a tablet equipped with an integrated Personal Virtual Assistant (PVA) system was provided to patients who underwent oncology-related procedures. The PVA encompasses automated features that provide personalized care plans, developed through collaboration among clinicians, researchers, and engineers from various disciplines. These plans include guidance on daily specific assignments that were divided into 4 categories: medication intake, exercise, symptom surveys, and postprocedural specific tasks. The aim was to explore the acceptability of the PVA by quantification of dropout rate and assessing adherence to each care plan category throughout the study duration. The secondary aim assessed acceptability of the PVA through a technology acceptance model (TAM) questionnaire that examined ease of use, usefulness, attitude toward use, and privacy concerns. Results: In total, 17 patients were enrolled. However, 1 (5.8\%) patient dropped out from the study after 3 days due to health deterioration, leaving 16/17 (94.2\%) completing the study (mean age 54.5, SD 12.7, years; n=9, 52\% Caucasian; n=14, 82\% with a gynecological disease; n=3, 18\% with a hepatobiliary disease). At the study end point, adherence to care plan categories were 78\% (SD 25\%) for medications, 81\% (SD 24\%) for exercises, 61\% (SD 30\%) for surveys, and 58\% (SD 44\%) for specific tasks such as following step-by step wound care instructions, managing drains, administering injectable medications independently, and performing pelvic baths as instructed. There was an 80\% patient endorsement (strongly agree or agree) across all TAM categories. Conclusion: This study suggests the potential acceptability of the PVA among patients discharged after oncology-related procedures, with a dropout rate of less than 6\% and fair-to-good adherence to tasks such as medication intake and exercise. However, these findings are preliminary due to the small sample size and highlight the need for further research with larger cohorts to validate and refine the system. ",
doi="10.2196/64145",
url="https://cancer.jmir.org/2025/1/e64145"
}


@Article{info:doi/10.2196/67043,
author="Jacob, Christine
and M{\"u}ller, Roman
and Sch{\"u}ler, Sonja
and Rey, Alix
and Rey, Guillaume
and Armenian, Berj
and Vonlaufen, Alain
and Drepper, Michael
and Zimmerli, Marius",
title="Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="12",
volume="12",
pages="e67043",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="technology assessment",
keywords="technology adoption",
keywords="technology implementation",
keywords="usability study",
keywords="colonoscopy",
keywords="app",
keywords="application",
keywords="examinations",
keywords="smartphone",
keywords="usability",
abstract="Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25\% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100\% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. ",
doi="10.2196/67043",
url="https://humanfactors.jmir.org/2025/1/e67043"
}


@Article{info:doi/10.2196/59161,
author="Lee, Kyungmi
and Azuero, Andres
and Engler, Sally
and Kumar, Sidharth
and Puga, Frank
and Wright, A. Alexi
and Kamal, Arif
and Ritchie, S. Christine
and Demiris, George
and Bakitas, A. Marie
and Odom, Nicholas J.",
title="Exploring the Relationship Between Smartphone GPS Patterns and Quality of Life in Patients With Advanced Cancer and Their Family Caregivers: Longitudinal Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e59161",
keywords="cancer",
keywords="digital phenotyping",
keywords="global positioning system",
keywords="quality of life",
keywords="smartphone",
keywords="mobile phone",
keywords="family caregiver",
abstract="Background: Patients with advanced cancer and their family caregivers often experience poor quality of life (QOL). Self-report measures are commonly used to quantify QOL of family caregivers but may have limitations such as recall bias and social desirability bias. Variables derived from passively obtained smartphone GPS data are a novel approach to measuring QOL that may overcome these limitations and enable detection of early signs of mental and physical health (PH) deterioration. Objective: This study explored the feasibility of a digital phenotyping approach by assessing participant adherence and examining correlations between smartphone GPS data and QOL levels among family caregivers and patients with advanced cancer. Methods: This was a secondary analysis involving 7 family caregivers and 4 patients with advanced cancer that assessed correlations between GPS sensor data captured by a personally owned smartphone and QOL self-report measures over 12 weeks through linear correlation coefficients. QOL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 was collected at baseline, 6, and 12 weeks. Using a Beiwe smartphone app, GPS data were collected and processed into variables including total distance, time spent at home, transition time, and number of significant locations. Results: The study identified relevant temporal correlations between QOL and smartphone GPS data across specific time periods. For instance, in terms of PH, associations were observed with the total distance traveled (12 and 13 wk, with r ranging 0.37 to 0.38), time spent at home (?4 to ?2 wk, with r ranging from ?0.41 to ?0.49), and transition time (?4 to ?2 wk, with r ranging ?0.38 to ?0.47). Conclusions: This research offers insights into using passively obtained smartphone GPS data as a novel approach for assessing and monitoring QOL among family caregivers and patients with advanced cancer, presenting potential advantages over traditional self-report measures. The observed correlations underscore the potential of this method to detect early signs of deteriorating mental health and PH, providing opportunities for timely intervention and support. ",
doi="10.2196/59161",
url="https://formative.jmir.org/2025/1/e59161"
}


@Article{info:doi/10.2196/63403,
author="Ezeigwe, Juliet Ogochukwu
and Nwosu, Samuel Kenechukwu Obumneme
and Afolayan, Kunle Oladipo
and Ojaruega, Amanda Akpevwe
and Echere, Jovita
and Desai, Manali
and Onigbogi, Olajumoke Modupe
and Oladoyin, Ope Olajumoke
and Okoye, Chioma Nnenna
and Fwelo, Pierre",
title="Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e63403",
keywords="cancer intervention",
keywords="digital health and wellness apps",
keywords="cancer management",
keywords="telehealth",
keywords="mobile health",
keywords="mhealth",
keywords="decision-making",
keywords="United States",
keywords="cross-sectional study",
keywords="adult",
keywords="logistic regression",
keywords="regression analysis",
keywords="digital health",
keywords="young adult",
keywords="cancer screening",
keywords="knowledge seeking",
keywords="barrier",
keywords="utilization",
keywords="engagement",
keywords="digital health engagement",
keywords="diversity",
keywords="cancer information",
keywords="health seeking behavior",
keywords="mobile phone",
abstract="Background: Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making. Objective: This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States. Methods: We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors. Results: A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9\% (n=2705) were health and wellness app users, while 19.1\% (n=793) were nonusers. In the final adjusted model, participants with household incomes ?US \$50,000 had 49\% higher adjusted odds of using these apps than those with incomes <US \$50,000 (adjusted odds ratio [aOR]=1.49, 95\% CI 1.02-2.14). College graduates and those with higher educational levels were avid users compared to those with a high school diploma or less (aOR=1.87, 95\% CI 1.30-2.67). Internet users had over 3 times the odds of using these apps compared to nonusers (aOR=3.28, 95\% CI 1.70-6.33). Participants within the age group 18-34 years were 3.70 times more likely (aOR=3.70, 95\% CI 1.90-7.23) to use a health and wellness app compared to participants within the age group of 75 years and older. Conclusions: Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps. ",
doi="10.2196/63403",
url="https://www.jmir.org/2025/1/e63403"
}


@Article{info:doi/10.2196/50662,
author="Ng, Shin Krystal Lu
and Munisamy, Murallitharan
and Lim, Yin Joanne Bee
and Alshagga, Mustafa",
title="The Effect of Nutritional Mobile Apps on Populations With Cancer: Systematic Review",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="5",
volume="11",
pages="e50662",
keywords="cancer",
keywords="mobile app",
keywords="nutrition",
keywords="body composition",
keywords="quality of life",
keywords="mobile health",
keywords="mHealth",
keywords="diet",
keywords="intervention",
keywords="mobile phone",
keywords="PRISMA",
abstract="Background: Limited access to nutrition support among populations with cancer is a major barrier to sustainable and quality cancer care. Increasing use of mobile health in health care has raised concerns about its validity and health impacts. Objective: This systematic review aimed to determine the effectiveness of commercial or cancer-specific nutritional mobile apps among people living with cancer. Methods: A systematic search of the CENTRAL, Embase, PubMed (MEDLINE), and Scopus databases was carried out in May 2024. All types of intervention studies were included, except observational studies, gray literature, and reference lists of key systematic reviews. Studies were eligible for inclusion if they involved (1) patients with or survivors of cancer and (2) nutrition-related mobile apps. Studies were excluded if the nutrition intervention was not delivered via mobile app or the app intervention was accompanied by dietary counseling. The review process was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Risk of Bias 2 and Risk of Bias in Nonrandomized Studies tools were used to assess the study quality. The Cochrane Review Manager (version 5.4) software was used to synthesize the results of the bias assessment. Results: A total of 13 interventions were included, comprising 783 adults or teenagers with cancer. Most studies focused on breast cancer (6/13, 46\%), overweight (6/13, 46\%), and survivors (9/13, 69\%). Data on anthropometry and body composition (7/13, 54\%; 387 participants), nutritional status (3/13, 23\%; 249 participants), dietary intake (7/13, 54\%; 352 participants), and quality of life (6/13, 46\%; 384 participants) were gathered. Experimental groups were more likely to report significant improvements in body weight or composition, dietary compliance, nutritional status, and quality of life than control groups. Conclusions: Although mobile app platforms are used to deliver nutrition interventions, the evidence for long-term efficacy, particularly in populations with cancer, remains elusive. More robust randomized controlled trials with larger sample sizes, as well as more homogeneous population characteristics and outcome measures, are warranted. Trial Registration: PROSPERO CRD42023330575; https://tinyurl.com/55v56yaj ",
doi="10.2196/50662",
url="https://cancer.jmir.org/2025/1/e50662"
}


@Article{info:doi/10.2196/65615,
author="Chen, Ciao-Sin
and Dorsch, P. Michael
and Alsomairy, Sarah
and Griggs, J. Jennifer
and Jagsi, Reshma
and Sabel, Michael
and Stino, Amro
and Callaghan, Brian
and Hertz, L. Daniel",
title="Remote Monitoring of Chemotherapy-Induced Peripheral Neuropathy by the NeuroDetect iOS App: Observational Cohort Study of Patients With Cancer",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e65615",
keywords="chemotherapy-induced peripheral neuropathy",
keywords="smartphone",
keywords="mobile health",
keywords="gait",
keywords="balance",
keywords="manual dexterity",
keywords="mobile phone",
keywords="chemotherapy",
keywords="peripheral neuropathy",
keywords="CIPN",
keywords="neurotoxic chemotherapy",
keywords="monitoring",
keywords="detection",
keywords="patient-reported outcomes",
keywords="mHealth",
keywords="application",
abstract="Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of neurotoxic chemotherapy characterized by symptoms such as numbness, tingling, and weakness. Effective monitoring and detection of CIPN are crucial for avoiding progression to irreversible symptoms. Due to the inconvenience of clinic-based objective assessment, CIPN detection relies primarily on patients' reporting of subjective symptoms, and patient-reported outcomes are used to facilitate CIPN detection. Our previous study found evidence that objective functional assessments completed within a smartphone app may differentiate patients with and those without CIPN after treatment. Objective: This prospective, longitudinal observational cohort study aimed to determine the feasibility and accuracy of app-based remote monitoring of CIPN in patients with cancer undergoing neurotoxic chemotherapeutic treatment and to conduct exploratory comparisons of app-based functional CIPN monitoring versus patient-reported outcome--only monitoring. Methods: The NeuroDetect app (Medable Inc) includes subjective EORTC (European Organization for Research and Treatment of Cancer) Quality of Life Questionnaire (QLQ)--20-item scale (CIPN20) and 6 objective functional assessments that use smartphone sensors to mimic neurological examinations, such as walking, standing, and manual dexterity tests. The functional assessment data were collected from patients with cancer undergoing neurotoxic chemotherapy, and a neurological examination was conducted at the end of treatment to diagnose CIPN in the feet (CIPN-f) or CIPN in the hands (CIPN-h). Various classification models including NeuroDetect features only (NeuroDetect Model) CIPN20-only (CIPN20 Model) or a combination of both (Combined Model) were trained and evaluated for accuracy in predicting CIPN probability. Results: Of the 45 patients who completed functional assessments and neurological examinations, 24 had CIPN-f, and 29 had CIPN-h. The NeuroDetect Model could discriminate between patients with and those without CIPN-f (area under the curve=83.8\%, comparison with no information rate P=.02) but not CIPN-h (area under the curve=67.9\%, P=.18). The rolling rotation features from the eyes-closed phase of the Romberg Stance assessment showed the greatest contribution to CIPN-f (40\% of total variable importance) and the Finger Tapping assessment showed the greatest contribution to CIPN-h (85\% of total variable importance). The NeuroDetect Model had numerically, and at some time points statistically, superior performance to the CIPN20 Model in both CIPN-f and CIPN-h, particularly before and early in treatment. The Combined Model numerically, though not statistically, outperformed either assessment strategy individually, indicating that the combination of functional and patient-reported assessment within a smartphone may be optimal to CIPN detection. Conclusions: Our findings demonstrate the feasibility of integrating subjective and objective CIPN assessment into a smartphone app for remote, longitudinal CIPN monitoring. Studies of larger patient cohorts are needed to refine the app-based CIPN detection models and determine whether their use in practice improves CIPN detection. ",
doi="10.2196/65615",
url="https://www.jmir.org/2025/1/e65615"
}


@Article{info:doi/10.2196/63597,
author="Thiessen, Maclean
and Jewitt, Kellie
and Stromberg, Raina
and Lamontagne, Marie Janelle
and Richardson Tanguay, Genevieve
and Albo, Annette
and Thurston, Chantale
and McMillan, E. Diana",
title="Constructing TheKeep.Ca With Thrivers of Cancer in Manitoba, Canada, in Support of Enhancing Patient Engagement: Protocol for a Pragmatic Multimethods Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="29",
volume="14",
pages="e63597",
keywords="patient engagement",
keywords="patient empowerment",
keywords="translational research",
keywords="patient recruitment",
keywords="development and research",
keywords="protocol",
keywords="Manitoba",
keywords="Canada",
keywords="cancer",
keywords="patient advisor",
keywords="website",
keywords="research platform",
keywords="thematic analysis",
keywords="semi-structured interview",
keywords="online infrastructure",
abstract="Background: TheKeep.Ca was built to facilitate engagement with those experiencing cancer in Manitoba, Canada. Constructed between 2020 and 2024 with a group of patient advisors, the website includes information on engagement activities including research participation, the patient advisor role, and how those experiencing cancer can access these Manitoba activities. A link allows visitors to register to be contacted about activities that match their demographics, cancer history, and activity preferences. After TheKeep.Ca was constructed, this protocol was developed to establish TheKeep.Ca as a platform for scientific research focused on optimally engaging those experiencing cancer. Objective: We asked the following questions: (1) What was the patient advisors' experience who participated in developing TheKeep.Ca? (2) What are the baseline characteristics of website traffic and registrants at TheKeep.Ca? (3) How does registering with TheKeep.Ca impact the cancer experience? Methods: The planned launch date for the website and initiation of research activities is January 2025. For objective 1, the active patient advisors (N=6) participating in the website project will be invited to participate in project activities including with responses to a question prompt sheet, semistructured audio-recorded interviews, or both. Responses and interviews will be analyzed using reflexive thematic analysis to understand and inform practices for patient engagement on projects. At the website launch, TheKeep.Ca will become publicly accessible and indexable on internet search engines, but no additional promotional interventions will take place in the initial 6 months resulting in visitors primarily from web search traffic. For objective 2, Google Analytics and website registrant data collected during the first six months will be analyzed to obtain baseline characteristics of website visitors. For objective 3, an online survey will be emailed to registrants six months after the website launch characterizing their website experience, the activities they participated in, and collecting feedback on the website. For objectives 2 and 3, quantitative data will be analyzed using both descriptive and inferential statistics, and qualitative data from open-ended questions will be analyzed using thematic analysis guided by an inductive descriptive semantic approach. Results: This study was approved by the University of Manitoba Health Research Ethics Board on December 12, 2024 (HS26614-H2024L263). Institutional approval from CancerCare Manitoba is pending as of December 23, 2024. Findings from objective 1 are expected to be finalized within the first six months after the website launch. Those from objectives 2 and 3 are expected by the 12-month mark. Reporting will include peer-reviewed journals, conferences, and a lay-language summary on TheKeep.Ca. Conclusions: The research outlined in this protocol will facilitate understanding patient advisors' experience in developing TheKeep.Ca. It will also characterize the website' effectiveness and its impact on the cancer experience, providing a baseline and direction for future research and development. International Registered Report Identifier (IRRID): PRR1-10.2196/63597 ",
doi="10.2196/63597",
url="https://www.researchprotocols.org/2025/1/e63597"
}


@Article{info:doi/10.2196/60585,
author="Mazzella-Ebstein, Marie Ann
and Daly, Robert
and Huang, Jennie
and Bernal, Camila
and Wilhelm, Clare
and Panageas, S. Katherine
and Holland, Jessie
and Salvaggio, Rori
and Ackerman, Jill
and Cracchiolo, Jennifer
and Kuperman, Gilad
and Mao, Jun
and Begue, Aaron
and Barton-Burke, Margaret",
title="Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="24",
volume="12",
pages="e60585",
keywords="cancer",
keywords="oncology",
keywords="clinician end users",
keywords="remote patient monitoring",
keywords="digital health",
keywords="implementation science",
keywords="patient monitoring",
keywords="patient access",
keywords="care",
keywords="communication",
keywords="usability",
keywords="functionality",
keywords="survey",
keywords="interview",
keywords="efficiency",
keywords="workflow",
keywords="user",
keywords="clinician support",
abstract="Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31\% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30\% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians' workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program's utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. ",
doi="10.2196/60585",
url="https://humanfactors.jmir.org/2025/1/e60585"
}


@Article{info:doi/10.2196/55043,
author="Hemler, R. Jennifer
and Wagner, B. Rachel
and Sullivan, Brittany
and Macenat, Myneka
and Tagai, K. Erin
and Vega, L. Jazmarie
and Hernandez, Enrique
and Miller, M. Suzanne
and Wen, Kuang-Yi
and Ayers, A. Charletta
and Einstein, H. Mark
and Hudson, V. Shawna
and Kohler, E. Racquel",
title="A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="14",
volume="9",
pages="e55043",
keywords="cervical cancer screening",
keywords="colposcopy",
keywords="HPV",
keywords="human papillomavirus",
keywords="mHealth",
keywords="health communication",
keywords="qualitative research",
keywords="cancer screening",
keywords="cancer",
keywords="cervical cancer",
keywords="screening",
keywords="women",
keywords="clinic staff",
keywords="barrier",
keywords="messaging",
keywords="privacy",
keywords="text message",
keywords="qualitative",
keywords="colposcopic",
keywords="mhealth intervention",
keywords="mobile phone",
abstract="Background: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. Objective: This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Methods: Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Results: Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Conclusions: Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial. ",
doi="10.2196/55043",
url="https://formative.jmir.org/2025/1/e55043",
url="http://www.ncbi.nlm.nih.gov/pubmed/39808485"
}


@Article{info:doi/10.2196/62711,
author="Bartel, Christianna
and Chen, Leeann
and Huang, Weiyu
and Li, Qichang
and Li, Qingyang
and Fedor, Jennifer
and Durica, C. Krina
and Low, A. Carissa",
title="Design and Use of Patient-Facing Electronic Patient-Reported Outcomes and Sensor Data Visualizations During Outpatient Chemotherapy",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="10",
volume="11",
pages="e62711",
keywords="oncology",
keywords="cancer",
keywords="data visualization",
keywords="remote monitoring",
keywords="mobile technology",
keywords="patients",
keywords="outpatient",
keywords="chemotherapy",
keywords="symptoms",
keywords="side effects",
keywords="cancer treatment",
keywords="electronic patient-reported outcome",
keywords="online",
keywords="monitoring",
keywords="self-management",
doi="10.2196/62711",
url="https://cancer.jmir.org/2025/1/e62711"
}


@Article{info:doi/10.2196/60420,
author="Su, Jianwei
and Ye, Cuiling
and Zhang, Qian
and Liang, Yi
and Wu, Jianwei
and Liang, Guixi
and Cheng, Yalan
and Yang, Xiaojuan",
title="Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="1",
volume="14",
pages="e60420",
keywords="thoracic surgery",
keywords="rehabilitation medicine",
keywords="patient-reported outcome measures",
keywords="patient participation",
keywords="telemedicine",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management through electronic patient-reported outcomes (ePROs) offers a potential solution to improve adherence by enabling more effective monitoring and intervention. Objective: This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery for lung cancer. Methods: In this single-center, prospective, randomized controlled trial, 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomly assigned 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and postdischarge days 3, 7, 14, 21, and 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, and fatigue) scored ?4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is the rehabilitation exercise adherence rate. Secondary outcomes include postdischarge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction. Results: The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data have been collected and thoroughly reviewed. Conclusions: This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence after video-assisted thoracic surgery for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings. Trial Registration: ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946 International Registered Report Identifier (IRRID): DERR1-10.2196/60420 ",
doi="10.2196/60420",
url="https://www.researchprotocols.org/2025/1/e60420",
url="http://www.ncbi.nlm.nih.gov/pubmed/39610048"
}


@Article{info:doi/10.2196/48170,
author="Lally, Phillippa
and May, N. Christine
and Mitchell, Siobhan E.
and McCallum, Meaghan
and Michaelides, Andreas
and Fisher, Abigail",
title="Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="20",
volume="10",
pages="e48170",
keywords="breast cancer",
keywords="self-management",
keywords="app",
keywords="health behaviors",
keywords="weight",
keywords="prototype",
keywords="user experience",
keywords="development",
keywords="application",
keywords="coaching",
keywords="peer support",
keywords="oncology",
abstract="Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ?18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88\%) were white, 6 (75\%) had a graduate degree or above, and 6 (75\%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. ",
doi="10.2196/48170",
url="https://cancer.jmir.org/2024/1/e48170"
}


@Article{info:doi/10.2196/55176,
author="Park, Ye-Eun
and Tak, Won Yae
and Kim, Inhye
and Lee, Jeong Hui
and Lee, Bok Jung
and Lee, Won Jong
and Lee, Yura",
title="User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="18",
volume="26",
pages="e55176",
keywords="mHealth",
keywords="user experience",
keywords="cancer",
keywords="technology acceptance model",
keywords="structural equation modeling",
keywords="health care app",
keywords="mixed-method study",
keywords="medical care",
keywords="digital health care",
keywords="cancer survivors",
keywords="disparities",
keywords="health status",
keywords="behavioral intervention",
keywords="clinician",
abstract="Background: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients' abilities and health status on the adoption of these interventions. Objective: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). Methods: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. Results: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness ($\beta$=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. Conclusions: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care. ",
doi="10.2196/55176",
url="https://www.jmir.org/2024/1/e55176"
}


@Article{info:doi/10.2196/59426,
author="Nuseibeh, Zenk Betsey
and Johns, A. Shelley
and Shih, C. Patrick
and Lewis, F. Gregory
and Gowan, M. Tayler
and Jordan, J. Evan",
title="Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="9",
volume="8",
pages="e59426",
keywords="breast cancer survivors",
keywords="acceptance and commitment therapy",
keywords="mHealth app",
keywords="user-centered design",
keywords="depression",
keywords="anxiety",
keywords="therapy",
keywords="app",
keywords="breast cancer",
keywords="expert",
keywords="designer",
keywords="psychosocial",
keywords="need",
keywords="co-design",
keywords="MOSAIC",
keywords="mobile acceptance and commitment therapy stress intervention",
keywords="interviews",
abstract="Background: Breast cancer is the world's most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91\%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer--specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. ",
doi="10.2196/59426",
url="https://formative.jmir.org/2024/1/e59426"
}


@Article{info:doi/10.2196/57964,
author="Hawkes, E. Rhiannon
and Pegington, Mary
and Davies, Alan
and Mueller, Julia
and Howell, Anthony
and Evans, Gareth D.
and Howell, J. Sacha
and French, P. David
and Harvie, Michelle",
title="Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study",
journal="JMIR Cancer",
year="2024",
month="Nov",
day="25",
volume="10",
pages="e57964",
keywords="breast cancer",
keywords="health behavior",
keywords="weight gain",
keywords="weight control",
keywords="BMI",
keywords="app",
keywords="acceptability",
keywords="feasibility",
abstract="Background: Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. Objective: This nested qualitative substudy explored women's views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. Methods: A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. Results: The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A ``missed opportunity'' in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. Conclusions: There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics. ",
doi="10.2196/57964",
url="https://cancer.jmir.org/2024/1/e57964"
}


@Article{info:doi/10.2196/58873,
author="Jing, Shu
and Wu, Yijin
and Dai, Zhenwei
and Tang, Shenglan
and Su, Xiaoyou
and Qiao, Youlin",
title="The Effect of Interventions Based on the Information-Motivation-Behavioral Skills Model on the Human Papillomavirus Vaccination Rate Among 11-13-Year-Old Girls in Central and Western China: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="19",
volume="13",
pages="e58873",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="vaccine hesitancy",
keywords="information-motivation-behavioral skills model",
keywords="HPV vaccination rate",
keywords="randomized controlled trial",
keywords="vaccination rate",
keywords="China",
abstract="Background: Persistent infection of high-risk human papillomavirus (HPV) can lead to cervical intraepithelial neoplasia, cervical cancer, and even death. HPV vaccination for girls aged 9-14 years can effectively prevent the occurrence of cervical cancer. Some Chinese provinces and cities have launched free HPV vaccination programs for school-age girls; however, due to the lack of supportive government policies, the high price and supply shortage of HPV vaccines, and vaccine hesitancy, some parents refuse to vaccinate their daughters. Objective: This protocol reports the design of a randomized controlled trial (RCT) aiming to explore the efficacy of a digital HPV vaccination education intervention based on the information-motivation-behavioral skills (IMB) model in improving the HPV vaccination rate among 11-13-year-old girls in central and western China. Methods: A multicenter intervention study based on an online applet will be conducted in December 2024, and about 750 eligible parents of 11-13-year-old girls will be assigned in a 1:1 ratio to an intervention group receiving 7-day digital HPV vaccination education based on the IMB model or a control group using non-HPV publicity materials. Free HPV vaccination pilot projects will be carried out among this population by our research team in central and western China (some parents might refuse to vaccinate their daughters). All participants will be asked to complete online questionnaires at baseline; postintervention; and 1 week, 1 month, and 3 months after the intervention. Results: The primary outcome of this study will be receipt of the first HPV vaccination within 3 months. Data will be analyzed based on an intention-to-treat approach, and Stata 16.0 will be used for statistical analysis. Conclusions: This study aims to improve the HPV vaccination rate among 11-13-year-old girls and will examine the impact of a digital HPV vaccination education intervention based on the IMB model. The findings of this study may offer promising intervention measures for HPV vaccine hesitancy in low-health-resource areas in the future. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2300067402; https://tinyurl.com/v5zt4hc9 International Registered Report Identifier (IRRID): PRR1-10.2196/58873 ",
doi="10.2196/58873",
url="https://www.researchprotocols.org/2024/1/e58873"
}


@Article{info:doi/10.2196/57510,
author="Geeraerts, Joran
and Pivodic, Lara
and Rosquin, Lise
and Naert, Eline
and Crombez, Geert
and De Ridder, Mark
and Van den Block, Lieve",
title="Uncovering the Daily Experiences of People Living With Advanced Cancer Using an Experience Sampling Method Questionnaire: Development, Content Validation, and Optimization Study",
journal="JMIR Cancer",
year="2024",
month="Nov",
day="5",
volume="10",
pages="e57510",
keywords="cancer",
keywords="quality of life",
keywords="ecological momentary assessment",
keywords="experience sampling method",
keywords="telemedicine",
keywords="mHealth",
keywords="eHealth",
keywords="patient outcome assessment",
keywords="validated instruments",
abstract="Background: The experience sampling method (ESM), a self-report method that typically uses multiple assessments per day, can provide detailed knowledge of the daily experiences of people with cancer, potentially informing oncological care. The use of the ESM among people with advanced cancer is limited, and no validated ESM questionnaires have been developed specifically for oncology. Objective: This study aims to develop, content validate, and optimize the digital Experience Sampling Method for People Living With Advanced Cancer (ESM-AC) questionnaire, covering multidimensional domains and contextual factors. Methods: A 3-round mixed methods study was designed in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and the European Organization for Research and Treatment of Cancer guidelines. The study included semistructured interviews with 43 people with stage IV breast cancer or stage III to IV lung cancer and 8 health care professionals. Round 1 assessed the appropriateness, relative importance, relevance, and comprehensiveness of an initial set of ESM items that were developed based on the existing questionnaires. Round 2 tested the comprehensibility of ESM items. Round 3 tested the usability of the digital ESM-AC questionnaire using the m-Path app. Analyses included descriptive statistics and qualitative content analysis. Results: Following the first round, we developed an initial core set of 68 items (to be used with all patients) and a supplementary set (optional; patients select items), both covering physical, psychological, social, spiritual-existential, and global well-being domains and concurrent contexts in which experiences occur. We categorized items to be assessed multiple times per day as momentary items (eg, ``At this moment, I feel tired''), once a day in the morning as morning items (eg, ``Last night, I slept well''), or once a day in the evening as evening items (eg, ``Today, I felt hopeful''). We used participants' evaluations to optimize the questionnaire items, the digital app, and its onboarding manual. This resulted in the ESM-AC questionnaire, which comprised a digital core questionnaire containing 31 momentary items, 2 morning items, and 7 evening items and a supplementary set containing 39 items. Participants largely rated the digital questionnaire as ``easy to use,'' with an average score of 4.5 (SD 0.5) on a scale from 1 (``completely disagree'') to 5 (``completely agree''). Conclusions: We developed the ESM-AC questionnaire, a content-validated digital questionnaire for people with advanced breast or lung cancer. It showed good usability when administered on smartphone devices. Future research should evaluate the potential of this ESM tool to uncover daily experiences of people with advanced breast or lung cancer, explore its clinical utility, and extend its validation to other populations with advanced diseases. ",
doi="10.2196/57510",
url="https://cancer.jmir.org/2024/1/e57510"
}


@Article{info:doi/10.2196/52128,
author="Mueller, L. Emily
and Cochrane, R. Anneli
and Campbell, E. Madison
and Nikkhah, Sarah
and Holden, J. Richard
and Miller, D. Andrew",
title="An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Beta Stage Usability Study",
journal="JMIR Cancer",
year="2024",
month="Oct",
day="17",
volume="10",
pages="e52128",
keywords="oncology",
keywords="supportive care",
keywords="mHealth",
keywords="children",
keywords="caregivers",
keywords="mobile phones",
abstract="Background: Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app (Commissioning Agents, Inc) resulted in improvements in the ability to track symptoms, manage medications, and prepare for urgent medical needs. Objective: This study aims to engage caregivers of children with cancer in beta testing of a smartphone app for the medical management of children with cancer, assess acceptance, identify caregivers' perceptions and areas for improvement, and validate the app's design concepts and use cases. Methods: In this pilot, study caregivers of children with cancer used the Cope 360 mHealth app for 1 week, with the goal of daily logging. Demographics and a technology acceptance survey were obtained from each participant. Recorded semistructured interviews were transcribed and analyzed iteratively using NVivo (version 12, QSR International) and analyzed for information on usage, perceptions, and suggestions for improvement. Results: A total of 10 caregivers participated in beta testing, primarily women (n=8, 80\%), married, with some college education, and non-Hispanic White (n=10, 100\%). The majority of participants (n=7, 70\%) had children with acute lymphocytic leukemia who were being treated with chemotherapy only (n=8, 80\%). Overall, participants had a favorable opinion of Cope 360. Almost all participants (n=9, 90\%) believed that using the app would improve their ability to manage their child's medical needs at home. All participants reported that Cope 360 was easy to use, and most would use the app if given the opportunity (n=8, 80\%). These values indicate that the app had a high perceived ease of use with well-perceived usefulness and behavioral intention to use. Key topics for improvement were identified including items that were within the scope of change and others that were added to a future wish list. Changes that were made based on caregiver feedback included tracking or editing all oral and subcutaneous medications and the ability to change the time of a symptom tracked or medication administered if unable to do so immediately. Wish list items included adding a notes section, monitoring skin changes, weight and nutrition tracking, and mental health tracking. Conclusions: The Cope 360 app was well received by caregivers of children with cancer. Our validation testing suggests that the Cope 360 app is ready for testing in a randomized controlled trial to assess outcome improvements. ",
doi="10.2196/52128",
url="https://cancer.jmir.org/2024/1/e52128"
}


@Article{info:doi/10.2196/50028,
author="Thomson, D. Maria
and Shahab, H. Guleer
and Cooper-McGill, A. Chelsey
and Sheppard, B. Vanessa
and Hill, S. Sherrick
and Preston, Michael
and Keen II, Larry",
title="Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="10",
volume="8",
pages="e50028",
keywords="colorectal cancer",
keywords="cancer screening",
keywords="mHealth",
keywords="screening",
keywords="Black men",
keywords="early detection",
keywords="health disparities",
keywords="design thinking",
abstract="Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25\% (24/98) of them did not see a doctor and 16.3\% (16/98) of them did not have a regular doctor. Regarding CRC, 27\% (26/98) and 38\% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge--based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 ",
doi="10.2196/50028",
url="https://formative.jmir.org/2024/1/e50028"
}


@Article{info:doi/10.2196/48465,
author="Campbell, B. Grace
and Kim, Hansol
and Klinedinst, C. Tara
and Klinger, Julie
and Lee, Ji Young
and Donovan, S. Heidi",
title="Needs of Patients With Gynecologic Cancer and Their Caregivers for Obtaining mHealth-Supported Self-Management: Focus Group Study",
journal="JMIR Cancer",
year="2024",
month="Oct",
day="3",
volume="10",
pages="e48465",
keywords="gynecologic oncology",
keywords="gynecologic cancer",
keywords="self-management support",
keywords="user-centered design",
keywords="cancer distress",
keywords="self-management",
keywords="caregiver support",
keywords="cancer information",
keywords="women's health",
keywords="family support",
keywords="informal caregivers",
keywords="informal care",
keywords="mhealth",
abstract="Background: Family caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. Objective: We sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. Methods: We conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified ``closest support person'' (caregiver). A semistructured focus group guide was used to elicit information on patients' and caregivers' perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. Results: A total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93\%) were White and married. For caregivers (n=22), 15 (68\%) identified as male and 7 (32\%) as female, with ages ranging between 19 and 81 years. Overall, 59\% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1---gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2---desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3---interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others' knowledge; patients and caregivers desire having control over sharing of information with other family members. Conclusions: Designing a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers. ",
doi="10.2196/48465",
url="https://cancer.jmir.org/2024/1/e48465",
url="http://www.ncbi.nlm.nih.gov/pubmed/39361371"
}


@Article{info:doi/10.2196/58101,
author="Skeens, A. Micah
and Jackson, I. Daniel
and Sutherland-Foggio, S. Malcolm
and Sezgin, Emre",
title="mHealth Apps in the Digital Marketplace for Pediatric Patients With Cancer: Systematic Search and Analysis",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="1",
volume="7",
pages="e58101",
keywords="mHealth",
keywords="mobile health",
keywords="mobile application",
keywords="mobile apps",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="smartphones",
keywords="cancer",
keywords="oncology",
keywords="pediatric cancer",
keywords="paediatric cancer",
keywords="pediatric oncology",
keywords="paediatric oncology",
keywords="systematic analysis",
keywords="systematic analyses",
keywords="review",
keywords="mobile phone",
abstract="Background: The substantial increase in smartphone ownership has led to a rise in mobile health (mHealth) app use. Developing tailored features through mHealth apps creates a pathway to address the health care needs of pediatric patients with cancer and their families who have complex care needs. However, few apps are designed specifically to integrate with pediatric cancer care. Objective: This study reports a systematic search and analysis of mHealth apps available on the Apple App (iOS) and Google Play (Android) stores designed for pediatric cancer through a list of features that serve (1) patients, (2) caregivers, or (3) both audiences. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed apps for pediatric patients with cancer and caregivers available as of January 30, 2024. We searched the Apple App and Google Play stores with a list of keyword combinations focusing on pediatric cancer care. The inclusion criteria were (1) specifically apps targeted toward pediatric patients with cancer, their families, or both; (2) available in either app store; and (3) available in English. Apps were assessed using the Mobile Application Rating Scale (MARS). The MARS is a quality assessment for mHealth apps, including components of engagement, functionality, aesthetics, and informational quality (5-point Likert scale items---1: low and 5: high quality). Results: In total, 22 apps were identified and 17 of those apps were available on both platforms. The most popular features (n=12) were resource sharing, symptom tracking, reminders, care team connections, journaling, community support, medication tracking, data visualizations, and appointment tracking. Features and interfaces were designed for caregivers (n=9) more frequently than the patients (n=7) while a subset of apps created options for both users (n=6). A total of 16 apps received positive reviews (mean 4.4, SD 0.59; Min=3.1, Max=5.0). A small subset (n=3) achieved over 5000 downloads; however, the majority (n=15) had fewer than 500. More than half (n=12) of the apps were not available in English. Apps requested access to a range of device functionalities to operate (mean 2.72, SD 3.13; Min=0, Max=10). Out of 22, a total of 17 apps were publicly accessible. The mean MARS scores for the apps ranged from 1.71 (SD 0.75) to 4.33 (SD 0.82). Overall, apps scored high on functionality (mean 3.72, SD 0.54) but low on engagement (mean 3.02, SD 0.93). Conclusions: Our review highlights the promising yet underdeveloped potential of mHealth apps in pediatric oncology care, underscoring the need for more inclusive, comprehensive, and integrative digital health solutions. Future developments should actively involve key stakeholders from the pediatric oncology community, including patients, families, and health care professionals, to ensure the apps meet specific needs while addressing linguistic and cultural barriers. ",
doi="10.2196/58101",
url="https://pediatrics.jmir.org/2024/1/e58101"
}


@Article{info:doi/10.2196/51061,
author="Jin, William
and Montoya, Christopher
and Rich, James Benjamin
and Taswell, Seldon Crystal
and Noy, Miguel
and Kwon, Deukwoo
and Spieler, Benjamin
and Mahal, Brandon
and Abramowitz, Matthew
and Yechieli, Raphael
and Pollack, Alan
and Dal Pra, Alan",
title="A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability",
journal="JMIR Cancer",
year="2024",
month="Sep",
day="10",
volume="10",
pages="e51061",
keywords="digital therapeutics",
keywords="behavioral intervention",
keywords="digital health",
keywords="prostate cancer",
keywords="radiation",
keywords="smart water bottle",
keywords="companion app",
keywords="oncology",
keywords="prostate",
keywords="privacy",
keywords="radiation therapy",
keywords="bladder",
keywords="compliance",
keywords="smartphone-based behavioral intervention",
keywords="mobile phone",
abstract="Background: Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). Objective: Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. Methods: In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80\%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75\% of the simulation's volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80\% (15/18) of patients used the device >50\% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. Results: QLC was 100\% in 375 out of 398 (94.2\%) total treatments, while QNC was 88.9\% in 341 out of 398 (85.7\%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83\% (15/18) of patients used the SBI on >50\% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). Conclusions: This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. Trial Registration: ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214 ",
doi="10.2196/51061",
url="https://cancer.jmir.org/2024/1/e51061"
}


@Article{info:doi/10.2196/59222,
author="Chung, H. Kaitlin
and Youngblood, M. Shari
and Clingan, L. Carin
and Deighton, C. Dana
and Jump, A. Virginia
and Manuweera, Thushini
and McGeorge, M. Nicolette
and Renn, L. Cynthia
and Rosenblatt, Y. Paula
and Winder, T. Aaron
and Zhu, Shijun
and Kleckner, R. Ian
and Kleckner, S. Amber",
title="Digitizing Survivorship Care Plans Through the POST-Treatment Health Outcomes of Cancer Survivors (POSTHOC) Mobile App: Protocol for a Phase II Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="5",
volume="13",
pages="e59222",
keywords="mobile health",
keywords="mHealth",
keywords="symptoms",
keywords="clinical trial",
keywords="posttreatment",
keywords="oncology",
keywords="mobile phone",
abstract="Background: Survivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient's diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient's health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. Objective: A mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. Methods: We will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. Results: This trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. Conclusions: This study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health--delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. Trial Registration: ClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663 International Registered Report Identifier (IRRID): DERR1-10.2196/59222 ",
doi="10.2196/59222",
url="https://www.researchprotocols.org/2024/1/e59222",
url="http://www.ncbi.nlm.nih.gov/pubmed/39235855"
}


@Article{info:doi/10.2196/57276,
author="Garcia-Saiso, Sebastian
and Marti, Myrna
and Pesce, Karina
and Luciani, Silvana
and Mujica, Oscar
and Hennis, Anselm
and D'Agostino, Marcelo",
title="Artificial Intelligence as a Potential Catalyst to a More Equitable Cancer Care",
journal="JMIR Cancer",
year="2024",
month="Aug",
day="12",
volume="10",
pages="e57276",
keywords="digital health",
keywords="public health",
keywords="cancer",
keywords="artificial intelligence",
keywords="AI",
keywords="catalyst",
keywords="cancer care",
keywords="cost",
keywords="costs",
keywords="demographic",
keywords="epidemiological",
keywords="change",
keywords="changes",
keywords="healthcare",
keywords="equality",
keywords="health system",
keywords="mHealth",
keywords="mobile health",
doi="10.2196/57276",
url="https://cancer.jmir.org/2024/1/e57276",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133537"
}


@Article{info:doi/10.2196/53180,
author="Bachman, L. Shelby
and Gomes, Emma
and Aryal, Suvekshya
and Cella, David
and Clay, Ieuan
and Lyden, Kate
and Leach, J. Heather",
title="Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis",
journal="JMIR Cancer",
year="2024",
month="Jul",
day="15",
volume="10",
pages="e53180",
keywords="accelerometer",
keywords="cancer survivorship",
keywords="cancer survivors",
keywords="digital health technology",
keywords="health-related quality of life",
keywords="physical behavior",
keywords="physical function",
abstract="Background: As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. Objective: In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. Methods: Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants' real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. Results: Spearman correlation analyses indicated that 6 (86\%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps?.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps?.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps?.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps?.08). Conclusions: In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. Trial Registration: ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154 ",
doi="10.2196/53180",
url="https://cancer.jmir.org/2024/1/e53180",
url="http://www.ncbi.nlm.nih.gov/pubmed/39008350"
}


@Article{info:doi/10.2196/50783,
author="Jiang, Lulu
and Xu, Jiehui
and Wu, Yanwei
and Liu, Yanyan
and Wang, Xiyi
and Hu, Yun",
title="Effects of the ``AI-TA'' Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="4",
volume="12",
pages="e50783",
keywords="mobile app",
keywords="artificial intelligence",
keywords="interactivity",
keywords="breast cancer",
keywords="psychological symptoms",
keywords="self-efficacy",
keywords="social support",
keywords="quality of life",
abstract="Background: Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps' intelligent features in addressing psychological distress with these apps. Objective: This study aims to evaluate the effectiveness of a mobile app with intelligent design called ``AI-TA'' on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Methods: Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants' background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). Results: A total of 124 participants were randomly allocated to the control group (n=62, 50\%) or intervention group (n=62, 50\%). In total, 92.7\% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). Conclusions: The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195 ",
doi="10.2196/50783",
url="https://mhealth.jmir.org/2024/1/e50783",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833298"
}


@Article{info:doi/10.2196/52386,
author="Schl{\"a}pfer, Sonja
and Schneider, Fabian
and Santhanam, Prabhakaran
and Eicher, Manuela
and Kowatsch, Tobias
and Witt, M. Claudia
and Barth, J{\"u}rgen",
title="Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial",
journal="JMIR Cancer",
year="2024",
month="May",
day="31",
volume="10",
pages="e52386",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="eHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="implementation",
keywords="adherence",
keywords="self-guided",
keywords="unguided",
keywords="fully automated",
keywords="conversational agent",
keywords="chatbot",
keywords="behavior change",
keywords="tailoring",
keywords="self-care",
keywords="cancer",
keywords="app development",
abstract="Background: Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. Objective: This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. Methods: The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). Results: In week 10, a total of 62\% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88\% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52\%) expressed positive app experiences. At the macro level, 28.12\% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. Conclusions: The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12\%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels. ",
doi="10.2196/52386",
url="https://cancer.jmir.org/2024/1/e52386",
url="http://www.ncbi.nlm.nih.gov/pubmed/38819907"
}


@Article{info:doi/10.2196/52577,
author="Scott, E. Suzanne
and Thompson, J. Matthew",
title="``Notification! You May Have Cancer.'' Could Smartphones and Wearables Help Detect Cancer Early?",
journal="JMIR Cancer",
year="2024",
month="May",
day="20",
volume="10",
pages="e52577",
keywords="wearables",
keywords="early diagnosis",
keywords="cancer",
keywords="challenges",
keywords="diagnosis",
keywords="wearable",
keywords="detect",
keywords="detection",
keywords="smartphone",
keywords="cancer diagnosis",
keywords="symptoms",
keywords="monitoring",
keywords="monitor",
keywords="implementation",
keywords="anxiety",
keywords="health care service",
keywords="mobile phone",
doi="10.2196/52577",
url="https://cancer.jmir.org/2024/1/e52577",
url="http://www.ncbi.nlm.nih.gov/pubmed/38767941"
}


@Article{info:doi/10.2196/53163,
author="Sien, Sang-Wha
and Kobekyaa, Kyerepagr Francis
and Puts, Martine
and Currie, Leanne
and Tompson, Margaret
and Hedges, Penelope
and McGrenere, Joanna
and Mariano, Caroline
and Haase, R. Kristen",
title="Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing",
journal="JMIR Aging",
year="2024",
month="May",
day="8",
volume="7",
pages="e53163",
keywords="cancer",
keywords="aging",
keywords="self-management",
keywords="usability testing",
keywords="design thinking",
keywords="design",
keywords="oncology",
keywords="develop",
keywords="development",
keywords="usability",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="symptom",
keywords="symptoms",
keywords="comorbidity",
keywords="comorbidities",
keywords="comorbid",
keywords="multimorbidity",
keywords="multimorbidities",
keywords="co-design",
abstract="Background: Globally, cancer predominates in adults aged older than 60 years, and 70\% of older adults have ?1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a ``home base'' for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. ",
doi="10.2196/53163",
url="https://aging.jmir.org/2024/1/e53163",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717806"
}


@Article{info:doi/10.2196/52957,
author="Innominato, F. Pasquale
and Macdonald, H. Jamie
and Saxton, Wendy
and Longshaw, Laura
and Granger, Rachel
and Naja, Iman
and Allocca, Carlo
and Edwards, Ruth
and Rasheed, Solah
and Folkvord, Frans
and de Batlle, Jordi
and Ail, Rohit
and Motta, Enrico
and Bale, Catherine
and Fuller, Claire
and Mullard, P. Anna
and Subbe, P. Christian
and Griffiths, Dawn
and Wreglesworth, I. Nicholas
and Pecchia, Leandro
and Fico, Giuseppe
and Antonini, Alessio",
title="Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="30",
volume="13",
pages="e52957",
keywords="cancer",
keywords="survivorship",
keywords="artificial intelligence",
keywords="remote monitoring",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="circadian",
keywords="actigraphy",
keywords="mobile phone",
abstract="Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled ``GATEKEEPER,'' conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50\% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 ",
doi="10.2196/52957",
url="https://www.researchprotocols.org/2024/1/e52957",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687985"
}


@Article{info:doi/10.2196/49002,
author="Owens-Jasey, Constance
and Chen, Jinying
and Xu, Ran
and Angier, Heather
and Huebschmann, G. Amy
and Ito Fukunaga, Mayuko
and Chaiyachati, H. Krisda
and Rendle, A. Katharine
and Robien, Kim
and DiMartino, Lisa
and Amante, J. Daniel
and Faro, M. Jamie
and Kepper, M. Maura
and Ramsey, T. Alex
and Bressman, Eric
and Gold, Rachel",
title="Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="30",
volume="10",
pages="e49002",
keywords="cancer prevention",
keywords="health information technology",
keywords="implementation",
keywords="implementation strategies",
keywords="scoping review",
abstract="Background: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. Objective: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. Methods: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2\%) involved electronic health record--based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2\%), followed by studies related to breast cancer screening (28/101, 27.7\%), and cervical cancer screening (19/101, 18.8\%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67\% of colorectal cancer--relevant studies; 9/14, 64\% of breast cancer--relevant studies; and 7/10, 70\% of cervical cancer--relevant studies). Most studies (79/101, 78.2\%) reported on the reach of certain interventions, while 17.8\% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8\% (24/101) of the included studies. Conclusions: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations. ",
doi="10.2196/49002",
url="https://cancer.jmir.org/2024/1/e49002",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687595"
}


@Article{info:doi/10.2196/55402,
author="Arring, Noel
and Barton, L. Debra
and Lafferty, Carolyn
and Cox, Bryana
and Conroy, A. Deirdre
and An, Lawrence",
title="Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="26",
volume="8",
pages="e55402",
keywords="cognitive behavioral therapy",
keywords="insomnia",
keywords="mobile health",
keywords="breast cancer",
keywords="prostate cancer",
keywords="colon cancer",
keywords="cancer survivor",
abstract="Background: Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. Objective: This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. Methods: A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. Results: In total, 30 participants were enrolled, with 100\% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80\% (n=24) to 93\% (n=28) of the 30 participants. Furthermore, 27 (90\%) participants were satisfied with the Mi Sleep Coach app and 28 (93\%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83\%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13\%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23\%) at baseline to 1 (3\%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47\%) at baseline to 9 (30\%; P=.03) at week 7. Conclusions: The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. Trial Registration: ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459 ",
doi="10.2196/55402",
url="https://formative.jmir.org/2024/1/e55402",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669678"
}


@Article{info:doi/10.2196/51949,
author="Springer, Franziska
and Maier, Ayline
and Friedrich, Michael
and Raue, Simon Jan
and Finke, Gandolf
and Lordick, Florian
and Montgomery, Guy
and Esser, Peter
and Brock, Hannah
and Mehnert-Theuerkauf, Anja",
title="Digital Therapeutic (Mika) Targeting Distress in Patients With Cancer: Results From a Nationwide Waitlist Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="25",
volume="26",
pages="e51949",
keywords="digital therapeutic",
keywords="digital health",
keywords="mobile health",
keywords="app",
keywords="cancer",
keywords="randomized controlled trial",
keywords="supportive care",
keywords="oncology",
keywords="access to care",
keywords="distress",
keywords="depression",
keywords="anxiety",
keywords="fatigue",
keywords="mobile phone",
abstract="Background: Distress is highly prevalent among patients with cancer, but supportive care needs often go unmet. Digital therapeutics hold the potential to overcome barriers in cancer care and improve health outcomes. Objective: This study conducted a randomized controlled trial to investigate the efficacy of Mika, an app-based digital therapeutic designed to reduce distress across the cancer trajectory. Methods: This nationwide waitlist randomized controlled trial in Germany enrolled patients with cancer across all tumor entities diagnosed within the last 5 years. Participants were randomized into the intervention (Mika plus usual care) and control (usual care alone) groups. The participants completed web-based assessments at baseline and at 2, 6, and 12 weeks. The primary outcome was the change in distress from baseline to week 12, as measured by the National Comprehensive Cancer Network Distress Thermometer. Secondary outcomes included depression, anxiety (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and quality of life (Clinical Global Impression-Improvement Scale). Intention-to-treat and per-protocol analyses were performed. Analyses of covariance were used to test for outcome changes over time between the groups, controlling for baseline. Results: A total of 218 patients (intervention: n=99 and control: n=119) were included in the intention-to-treat analysis. Compared with the control group, the intervention group reported greater reductions in distress (P=.03; $\eta$p{\texttwosuperior}=0.02), depression (P<.001; $\eta$p{\texttwosuperior}=0.07), anxiety (P=.03; $\eta$p{\texttwosuperior}=0.02), and fatigue (P=.04; $\eta$p{\texttwosuperior}=0.02). Per-protocol analyses revealed more pronounced treatment effects, with the exception of fatigue. No group difference was found for quality of life. Conclusions: Mika effectively diminished distress in patients with cancer. As a digital therapeutic solution, Mika offers accessible, tailored psychosocial and self-management support to address the unmet needs in cancer care. Trial Registration: German Clinical Trials Register (DRKS) DRKS00026038; https://drks.de/search/en/trial/DRKS00026038 ",
doi="10.2196/51949",
url="https://www.jmir.org/2024/1/e51949",
url="http://www.ncbi.nlm.nih.gov/pubmed/38663007"
}


@Article{info:doi/10.2196/53301,
author="Short, E. Camille
and Rawstorn, C. Jonathan
and Jones, L. Tamara
and Edbrooke, Lara
and Hayes, C. Sandra
and Maddison, Ralph
and Nightingale, Sophie
and Ismail, Hilmy
and De Boer, Richard
and Hegi-Johnson, Fiona
and Sverdlov, L. Aaron
and Bell, Robyn
and Halligan, Irene
and Denehy, Linda",
title="Evaluating a Remotely Delivered Cardio-Oncology Rehabilitation Intervention for Patients With Breast Cancer (REMOTE-COR-B): Protocol for a Single-Arm Feasibility Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="5",
volume="13",
pages="e53301",
keywords="breast cancer survivor",
keywords="breast cancer",
keywords="cancer survivor",
keywords="cancer",
keywords="cardiac rehabilitation",
keywords="cardiac",
keywords="cardiotoxicity",
keywords="cardiovascular disease",
keywords="digital health",
keywords="efficacy",
keywords="exercise",
keywords="feasibility",
keywords="fitness",
keywords="rehabilitation intervention",
keywords="rehabilitation",
keywords="safety",
abstract="Background: Exercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. Objective: This study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. Methods: We will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). Results: Recruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. Conclusions: The REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/53301 ",
doi="10.2196/53301",
url="https://www.researchprotocols.org/2024/1/e53301",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578682"
}


@Article{info:doi/10.2196/46979,
author="Dang, Ha Thu
and Wickramasinghe, Nilmini
and Forkan, Mohammad Abdur Rahim
and Jayaraman, Prakash Prem
and Burbury, Kate
and O'Callaghan, Clare
and Whitechurch, Ashley
and Schofield, Penelope",
title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="3",
volume="10",
pages="e46979",
keywords="cancer",
keywords="behavioral science",
keywords="design science research",
keywords="digital",
keywords="medication adherence",
keywords="mobile solution",
keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology",
keywords="SAMSON",
keywords="mobile phone",
abstract="Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78\%). The app was engaging (18/27, 67\%), informative, increased user interactions, and well organized (19/27, 70\%). Most of the participants (21/27, 78\%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63\%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. ",
doi="10.2196/46979",
url="https://cancer.jmir.org/2024/1/e46979",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569178"
}


@Article{info:doi/10.2196/51522,
author="Adler, F. Rachel
and Baez, Kevin
and Morales, Paulina
and Sotelo, Jocelyn
and Victorson, David
and Magasi, Susan",
title="Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="2",
volume="11",
pages="e51522",
keywords="mobile health",
keywords="mHealth",
keywords="apps",
keywords="usability",
keywords="cancer survivors",
keywords="accessibility",
keywords="disabilities",
keywords="cancer",
keywords="oncology",
keywords="heuristics",
keywords="empowerment",
keywords="advocacy",
keywords="mindfulness",
keywords="problem-solving",
abstract="Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen's 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app's design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. ",
doi="10.2196/51522",
url="https://humanfactors.jmir.org/2024/1/e51522",
url="http://www.ncbi.nlm.nih.gov/pubmed/38564261"
}


@Article{info:doi/10.2196/50926,
author="Anders, Carolin
and Moorthy, Preetha
and Svensson, Laura
and M{\"u}ller, Julia
and Heinze, Oliver
and Knaup, Petra
and Wallwiener, Markus
and Deutsch, M. Thomas
and Le, Thao-Vy
and Weinert, Lina",
title="Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="5",
volume="11",
pages="e50926",
keywords="mobile health",
keywords="mHealth",
keywords="usability",
keywords="breast cancer",
keywords="eye tracking",
keywords="user interface",
keywords="mixed methods",
keywords="mobile phone",
abstract="Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app's content regularly, and self-administration. In contrast to the app's current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients' feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. ",
doi="10.2196/50926",
url="https://humanfactors.jmir.org/2024/1/e50926",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441959"
}


@Article{info:doi/10.2196/50528,
author="Ni, Chenxu
and Wang, Yi-fu
and Zhang, Yun-ting
and Yuan, Min
and Xu, Qing
and Shen, Fu-ming
and Li, Dong-Jie
and Huang, Fang",
title="A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="29",
volume="8",
pages="e50528",
keywords="WeChat applet",
keywords="usability testing",
keywords="utility testing",
keywords="cancer patients",
keywords="patients",
keywords="cancer",
keywords="qualitative study",
abstract="Background: Medication adherence and the management of adverse drug reactions (ADRs) are crucial to the efficacy of antitumor drugs. A WeChat applet, also known as a ``Mini Program,'' is similar to the app but has marked advantages. The development and use of a WeChat applet makes follow-up convenient for patients with cancer. Objective: This study aimed to assess the usability and utility of a newly developed WeChat applet, ``DolphinCare,'' among patients with cancer in Shanghai. Methods: A qualitative methodology was used to obtain an in-depth understanding of the experiences of patients with cancer when using DolphinCare from the usability and utility aspects. The development phase consisted of 2 parts: alpha and beta testing. Alpha testing combined the theory of the Fogg Behavior Model and the usability model. Alpha testing also involved testing the design of DolphinCare using a conceptual framework, which included factors that could affect medication adherence and ADRs. Beta testing was conducted using in-depth interviews. In-depth interviews allowed us to assist the patients in using DolphinCare and understand whether they liked or disliked DolphinCare and found it useful. Results: We included participants who had an eHealth Literacy Scale (eHEALS) score of ?50\%, and a total of 20 participants were interviewed consecutively. The key positive motivators described by interviewers were to be reminded to take their medications and to alleviate their ADRs. The majority of the patients were able to activate and use DolphinCare by themselves. Most patients indicated that their trigger to follow-up DolphinCare was the recommendation of their known and trusted health care professionals. All participants found that labels containing the generic names of their medication and the medication reminders were useful, including timed pop-up push notifications and text alerts. The applet presented the corresponding information collection forms of ADRs to the patient to fill out. The web-based consultation system enables patients to consult pharmacists or physicians in time when they have doubts about medications or have ADRs. The applet had usabilities and utilities that could improve medication adherence and the management of ADRs among patients with cancer. Conclusions: This study provides preliminary evidence regarding the usability and utility of this type of WeChat applet among patients with cancer, which is expected to be promoted for managing follow-up among other patients with other chronic disease. ",
doi="10.2196/50528",
url="https://formative.jmir.org/2024/1/e50528",
url="http://www.ncbi.nlm.nih.gov/pubmed/38421700"
}


@Article{info:doi/10.2196/47745,
author="Orasud, Siritorn Ariel
and Uchiyama, Mai
and Pagano, Ian
and Bantum, Erin",
title="Mobile Mindfulness Meditation for Cancer-Related Anxiety and Neuropathy: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="12",
volume="13",
pages="e47745",
keywords="cancer",
keywords="cancer survivorship",
keywords="mindfulness meditation",
keywords="mHealth",
keywords="well-being",
keywords="quality of life",
keywords="mobile health",
keywords="coaching",
keywords="coach",
keywords="mindfulness",
keywords="meditation",
keywords="survivor",
keywords="survivorship",
keywords="oncology",
keywords="mental health",
keywords="anxiety",
keywords="neuropathy",
keywords="survivors",
keywords="RCT",
keywords="randomized",
keywords="clinical trial",
keywords="clinical trials",
abstract="Background: Anxiety- and cancer-related neuropathy are two persistent effects related to treatment for cancer. Mindfulness meditation has been used with substantial impact as a nonpharmacologic intervention to mitigate side and late effects of treatment. Mobile apps are ubiquitous for most of the general population, yet have a particular relevance for cancer survivors, given that physical and geographic limitations can be present. Objective: This study aims to describe an ongoing trial of the Mindfulness Coach mobile app for cancer survivors. Methods: In this randomized waitlist controlled trial, cancer survivors experiencing anxiety- or cancer-related neuropathy (200 for neuropathy and 200 for anxiety) and who had finished primary cancer treatment were invited to participate. Data were collected at 3 time points regardless of randomization condition: baseline, 8 weeks, and 16 weeks. Both face-to-face and web-based recruitment strategies were used. The trial was opened for 2 separate primary outcomes (anxiety- or cancer-related neuropathy). The goal was not to compare these groups but to compare treatment and waitlist groups for each condition. In addition to evaluating the impact of mobile mindfulness on reported anxiety- or cancer-related neuropathy, other pain, fatigue, trauma, sleep, and satisfaction with the Mindfulness Coach app will also be assessed. Results: Outcomes of the study are expected in early 2024.  Conclusions: Mindfulness meditation has become widely practiced, and the use of mobile technology has become ubiquitous. Finding ways to deliver mindfulness meditation to people who have been treated for cancer allows for the intervention to be accessible to a larger number of survivors. The results of this intervention could have implications for further understanding the impact of mindfulness meditation on 2 persistent side and late effects of treatment of cancer, namely anxiety- and cancer-related neuropathy. Trial Registration: ClinicalTrials.gov NCT03581357; https://ClinicalTrials.gov/study/NCT03581357 International Registered Report Identifier (IRRID): DERR1-10.2196/47745 ",
doi="10.2196/47745",
url="https://www.researchprotocols.org/2024/1/e47745",
url="http://www.ncbi.nlm.nih.gov/pubmed/38345843"
}


@Article{info:doi/10.2196/48428,
author="Alhuwail, Dari
and Alhouti, Aisha
and Alsarhan, Latifah",
title="Assessing the Quality, Privacy, and Security of Breast Cancer Apps for Arabic Speakers: Systematic Search and Review of Smartphone Apps",
journal="JMIR Cancer",
year="2024",
month="Jan",
day="16",
volume="10",
pages="e48428",
keywords="apps",
keywords="Arabic",
keywords="awareness",
keywords="breast cancer",
keywords="consumer health informatics",
keywords="education",
keywords="mHealth",
keywords="mobile health",
keywords="privacy",
keywords="quality",
keywords="security",
keywords="smartphone",
keywords="women",
abstract="Background: Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. Objective: This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. Methods: Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: ????? ????? -- ??? ????? ????? -- ???? ????? ????? -- ??? ????? ????? -- ????? ????? ????? -- ??? ????? (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google's search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. Results: Only 9 apps were included, with most (6/9, 67\%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89\%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. Conclusions: The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps. ",
doi="10.2196/48428",
url="https://cancer.jmir.org/2024/1/e48428",
url="http://www.ncbi.nlm.nih.gov/pubmed/38227353"
}


@Article{info:doi/10.2196/46481,
author="Gregory, E. Megan
and Cao, Weidan
and Rahurkar, Saurabh
and Jonnalagadda, Pallavi
and Stock, C. James
and Ghazi, M. Sanam
and Reid, Endia
and Berk, L. Abigail
and Hebert, Courtney
and Li, Lang
and Addison, Daniel",
title="Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="12",
volume="9",
pages="e46481",
keywords="cancer, cardiology, implementation science, mobile app, oncology",
keywords="mobile phone",
keywords="cancer patient",
keywords="patient care",
keywords="mobile health application",
keywords="application",
keywords="implementation",
keywords="design",
keywords="development",
keywords="symptom tracking",
keywords="cardiotoxicity",
keywords="cancer therapy",
keywords="symptom",
keywords="primary care",
abstract="Background: Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. Objective: We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. Methods: We conducted semistructured interviews of >50\% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. Results: Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100\%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. Conclusions: Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed. ",
doi="10.2196/46481",
url="https://cancer.jmir.org/2023/1/e46481",
url="http://www.ncbi.nlm.nih.gov/pubmed/38085565"
}


@Article{info:doi/10.2196/49735,
author="Bentsen, Line
and Hangh{\o}j, Signe
and Hjerming, Maiken
and Bergmann, Buur Mette
and Thycosen, Marianne
and Borup, Anette
and Larsen, Camilla
and Pappot, Helle",
title="Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="4",
volume="9",
pages="e49735",
keywords="adolescent",
keywords="young adult",
keywords="cancer",
keywords="quality of life",
keywords="eHealth",
keywords="smartphone application",
keywords="application",
keywords="development",
keywords="interventional study",
keywords="youth",
keywords="grief",
keywords="symptom tracker",
keywords="social community",
keywords="Denmark",
keywords="physical functioning",
keywords="treatment",
keywords="mobile phone",
abstract="Background: Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. Objective: This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. Methods: Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. Results: Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: ``Role functioning'' (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33;?P=.04) and ``Pain'' (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33;?P=.04). The ``Global health/Overall QoL'' scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00;?P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: ``Physical functioning'' (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00;?P=.03), ``Cognitive functioning'' (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00;?P=.02), and ``Social functioning'' (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00;?P=.05), as well as in the ``Global health/Overall QoL'' scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73;?P<.001). Conclusions: In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. International Registered Report Identifier (IRRID): RR2-10.2196/10098 ",
doi="10.2196/49735",
url="https://cancer.jmir.org/2023/1/e49735",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048144"
}


@Article{info:doi/10.2196/48040,
author="Mallafr{\'e}-Larrosa, Meritxell
and Papi, Ginevra
and Trilla, Antoni
and Ritchie, David",
title="Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="28",
volume="9",
pages="e48040",
keywords="adolescent health",
keywords="cancer prevention",
keywords="digital health",
keywords="ECAC",
keywords="European Code Against Cancer",
keywords="health promotion",
keywords="mHealth",
keywords="mobile app",
keywords="mobile health",
keywords="NCD",
keywords="noncommunicable disease",
keywords="primary prevention",
abstract="Background: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods: The WASABY app's content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app's 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app's user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion,?app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7\%). Most app users identified themselves as nonsmokers (689/748, 92.1\%), reported either no or infrequent alcohol consumption (432/748, 57.8\% and 250/748, 33.4\%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5\%). In aggregate, the app's content garnered substantial interest, as evidenced by 40.8\% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app's content (odds ratio 0.878, 95\% CI 0.809-0.954 and odds ratio 0.835, 95\% CI 0.735-0.949, respectively). Conclusions: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe's Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention. ",
doi="10.2196/48040",
url="https://cancer.jmir.org/2023/1/e48040",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015612"
}


@Article{info:doi/10.2196/45968,
author="Taramasco, Carla
and Rimassa, Carla
and No{\"e}l, Ren{\'e}
and Bravo Storm, Loreto Mar{\'i}a
and S{\'a}nchez, C{\'e}sar",
title="Co-design of a Mobile App for Engaging Breast Cancer Patients in Reporting Health Experiences: Qualitative Case Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="27",
volume="25",
pages="e45968",
keywords="cancer",
keywords="registration systems",
keywords="patient-reported outcome measures",
keywords="patient-reported experience measures",
keywords="software analysis and design",
keywords="cancer patient report",
keywords="adverse event reporting",
keywords="quality of life",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
abstract="Background: The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients' adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people. Objective: We present a qualitative case study documenting the process of identifying the information needs of breast cancer patients and health care professionals during the treatment process in a Chilean cancer institution. The study aims to identify patients' information requirements for integration into a mobile app that accompanies patients throughout their treatment while also providing features for reporting adverse symptoms. Methods: We conducted focus groups with breast cancer patients who were undergoing chemotherapy (n=3) or who completed chemotherapy between 3 months and 1 year (n=1). We also surveyed health care professionals (n=9) who were involved in patient care and who belonged to the oncology committee of the cancer center where the study took place. Content analysis was applied to the responses to categorize the information needs and the means to satisfy them. A user interface was designed according to the findings of the focus groups and was assessed by 3 trained information system and user interaction design experts from 2 countries, using heuristic evaluation guidelines for mobile apps. Results: Patients' information needs were classified into 4 areas: an overview of the disease, information on treatment and day-to-day affairs, assistance on the normality and abnormality of symptoms during treatment, and symptoms relevant to report. Health care professionals required patients to be provided with information on the administrative and financial process. We noted that the active involvement of the following 4 main actors is required to satisfy the information needs: patients, caregivers, social network moderators, and health professionals. Seven usability guidelines were extracted from the heuristic evaluation recommendations. Conclusions: A mobile app that seeks to accompany breast cancer patients to report symptoms requires the involvement of multiple participants to handle the reports and day-to-day information needs. User interfaces must be designed with consideration of the patient's social conventions and the emotional load of the disease information. ",
doi="10.2196/45968",
url="https://www.jmir.org/2023/1/e45968",
url="http://www.ncbi.nlm.nih.gov/pubmed/38010791"
}


@Article{info:doi/10.2196/49939,
author="Lin, Huicong
and Ye, Mingzhu
and Lin, Yanjuan
and Chen, Fuhong
and Chan, Sally
and Cai, Hongxia
and Zhu, Jiemin",
title="Mobile App for Gynecologic Cancer Support for Patients With Gynecologic Cancer Receiving Chemotherapy in China: Multicenter Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="13",
volume="25",
pages="e49939",
keywords="mobile app",
keywords="gynecologic cancer",
keywords="uncertainty in illness",
keywords="quality of life",
keywords="symptom distress",
keywords="social support",
keywords="cancer care",
keywords="gynecologic",
keywords="application",
keywords="chemotherapy",
keywords="support",
keywords="women",
keywords="well-being",
keywords="emotional well-being",
keywords="cancer",
keywords="mobile phone",
abstract="Background: Patients with gynecologic cancer receiving chemotherapy often report unmet supportive care needs. Compared with traditional face-to-face clinical interventions, mobile health can increase access to supportive care and may address patients' needs. Although app-based support programs have been developed to support patients with gynecologic cancer, their efficacy has not been adequately tested. Objective: The aim of this study was to examine the efficacy of a mobile app for gynecologic cancer support (MGCS) for patients with gynecologic cancer receiving chemotherapy in China. Methods: A multicenter randomized controlled trial was conducted in 2 university-affiliated hospitals in China. A total of 168 Chinese patients with gynecologic cancer were recruited and randomized to receive routine care or MGCS program plus routine care for 24 weeks. The Mishel uncertainty in illness theory guided the development of MGCS program, which has 4 modules: weekly topics, emotional care, discussion center, and health consultation. The primary outcome of this program was the assessment of the uncertainty in illness. The secondary outcomes were quality of life, symptom distress, and social support. All health outcomes were evaluated at baseline (T0), 12 weeks (T1), and 24 weeks (T2). Repeated measures analysis of covariance was used to assess the efficacy of the MGCS program. Results: In this trial, 67 patients in the control group and 69 patients in the intervention group completed 2 follow-up assessments (response rate, 136/168, 81\%). At 12 weeks, no significant differences were observed in any of the health outcomes between the 2 groups. At 24 weeks, compared to patients in the control group, those in the intervention group reported significant decreased uncertainty in illness (P<.001; d=--0.60; adjusted mean difference --7.69, 95\% CI --11.31 to --4.07) and improved quality of life (P=.04; d=0.30; adjusted mean difference 4.77, 95\% CI 0.12-9.41). Conclusions: The MGCS program demonstrated efficacy in supporting patients with gynecologic cancer receiving chemotherapy. This trial illustrates that an app-based program can be incorporated into routine care to support patients with cancer and suggests that allocation of more resources (grants, manpower, etc) to mobile health in clinics is warranted. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033678; https://www.chictr.org.cn/showproj.html?proj=54807 ",
doi="10.2196/49939",
url="https://www.jmir.org/2023/1/e49939",
url="http://www.ncbi.nlm.nih.gov/pubmed/37955943"
}


@Article{info:doi/10.2196/51090,
author="Moorthy, Preetha
and Weinert, Lina
and Harms, Christian Bendix
and Anders, Carolin
and Siegel, Fabian",
title="German Version of the mHealth App Usability Questionnaire in a Cohort of Patients With Cancer: Translation and Validation Study",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="1",
volume="10",
pages="e51090",
keywords="usability",
keywords="mobile health",
keywords="mHealth app",
keywords="questionnaire validation",
keywords="questionnaire translation",
keywords="mHealth App Usability Questionnaire",
keywords="MAUQ",
keywords="mobile phone",
abstract="Background: Good usability is important for the adoption and continued use of mobile health (mHealth) apps. In particular, high usability can support intuitive use by patients, which improves compliance and increases the app's effectiveness. However, many usability studies do not use adequate tools to measure perceived usability. The mHealth App Usability Questionnaire (MAUQ) was developed specifically for end users in a medical context. MAUQ is a relatively new but increasingly used questionnaire to evaluate mHealth apps, but it is not yet available in German. Objective: This study aims to translate MAUQ into German and determine its internal consistency, reliability, and construct validity. Methods: This validation study was conducted as part of a usability evaluation project for an mHealth app used as a therapy support tool during breast cancer chemotherapy. MAUQ was translated into German through a rigorous forward-backward translation process, ensuring semantic and conceptual equivalence. Patient responses to MAUQ and System Usability Scale (SUS) were analyzed for validation. Descriptive analysis was performed for the MAUQ subscales and SUS standard scores. Significance tests and correlation coefficients assessed the relationship between the SUS and MAUQ results, confirming construct validity. Internal consistency was assessed for item reliability and consistency in measuring the target construct. Free-text questions assessed translation comprehensibility, with responses analyzed descriptively and qualitatively using content analysis. Results: In this study, 133 participants responded to the questionnaire, and the validation analysis showed substantially positive correlations between the overall MAUQ score and its subscales: ease of use (r=0.56), interface and satisfaction (r=0.75), and usefulness (r=0.83). These findings support the construct validity of MAUQ and emphasize the importance of these subscales in assessing the usability of the Enable app. The correlation coefficients ranging from 0.39 to 0.68 for the items further validate the questionnaire by aligning with the overall score and capturing the intended concept. The high internal consistency reliability of MAUQ (Cronbach $\alpha$=.81) and its subscales further enhances the instrument's robustness in accurately evaluating the usability of mHealth apps. Conclusions: We successfully validated the German translation of the MAUQ for stand-alone apps using a standardized approach in a cohort of patients with breast cancer. In our validation study, MAUQ exhibited strong internal consistency reliability (Cronbach $\alpha$=.81) across its subscales, indicating reliable and consistent measurement. Furthermore, a significant positive correlation (P<.001) was found between the subscales and the overall score, supporting their consistent measurement of the intended construct. Therefore, MAUQ can be considered a reliable instrument for assessing the usability of mHealth apps among German-speaking adults. The availability of the German version of MAUQ will help other researchers in conducting usability studies of mHealth apps in German-speaking cohorts and allow for international comparability of their results. ",
doi="10.2196/51090",
url="https://humanfactors.jmir.org/2023/1/e51090",
url="http://www.ncbi.nlm.nih.gov/pubmed/37910144"
}


@Article{info:doi/10.2196/44777,
author="Zaidi, Maryum
and Gazarian, Priscilla
and Mattie, Heather
and Sheldon, Kennedy Lisa
and Gakumo, Ann C.",
title="Examining the Impact of Selected Sociodemographic Factors and Cancer-Related Fatalistic Beliefs on Patient Engagement via Health Information Technology Among Older Adults: Cross-Sectional Analysis",
journal="JMIR Aging",
year="2023",
month="Oct",
day="20",
volume="6",
pages="e44777",
keywords="health information technology",
keywords="patient portals",
keywords="older adults",
keywords="digital health",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Despite the role of health information technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults with a high burden of chronic diseases such as cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT use for patient engagement in adults aged ?65 years. We controlled for cancer diagnosis to account for its potential influence on patient engagement. Objective: This study has 2 aims: to investigate the role of sociodemographic factors such as race, education, poverty index, and psychosocial factors of cancer fatalistic beliefs in accessing and using HIT in older adults and to examine the association between access and use of HIT in the self-management domain of patient activation that serves as a precursor to patient engagement. Methods: This is a secondary data analysis of a subset of the Health Information National Trend Survey (Health Information National Trend Survey 4, cycle 3). The subset included individuals aged ?65 years with and without a cancer diagnosis. The relationships between access to and use of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic and linear regression models were fit to study these associations. Results: This study included 180 individuals aged ?65 years with a cancer diagnosis and 398 without a diagnosis. This analysis indicated that having less than a college education level (P=<.001), being an individual from an ethnic and minority group (P=<.001), and living in poverty (P=.001) were significantly associated with decreased access to HIT. Reduced HIT use was associated with less than a college education (P=.001) and poverty(P=.02). This analysis also indicated that fatalistic beliefs about cancer were significantly associated with lower HIT use (P=.03). Specifically, a 1-point increase in the cancer fatalistic belief score was associated with a 36\% decrease in HIT use. We found that controlling for cancer diagnosis did not affect the outcomes for sociodemographic variables or fatalistic beliefs about cancer. However, patients with access to HIT had a self-management domain of patient activation (SMD) score of 0.21 points higher (P=.003) compared with patients who did not have access. SMD score was higher by 0.28 points (P=.002) for individuals who used HIT and 0.14 points higher (P=.04) who had a prior diagnosis of cancer. Conclusions: Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and use in older adults, regardless of prior cancer diagnosis. Among older adults, HIT users report higher self-management, which is essential for patient activation and engagement. ",
doi="10.2196/44777",
url="https://aging.jmir.org/2023/1/e44777",
url="http://www.ncbi.nlm.nih.gov/pubmed/37655786"
}


@Article{info:doi/10.2196/49471,
author="Abahussin, A. Asma
and West, M. Robert
and Wong, C. David
and Ziegler, E. Lucy
and Allsop, J. Matthew",
title="Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach",
journal="JMIR Cancer",
year="2023",
month="Oct",
day="9",
volume="9",
pages="e49471",
keywords="pain",
keywords="cancer",
keywords="behavior change",
keywords="capability, opportunity, motivation, and behavior model",
keywords="COM-B model",
keywords="Behavior Change Wheel",
keywords="BCW",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="pain self-management",
keywords="evidence-based",
keywords="intervention design",
keywords="theory",
abstract="Background: To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer. Objective: This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app's active features. Methods: The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1. Results: The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app. Conclusions: This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention's underlying mechanisms and support future replication. ",
doi="10.2196/49471",
url="https://cancer.jmir.org/2023/1/e49471",
url="http://www.ncbi.nlm.nih.gov/pubmed/37812491"
}


@Article{info:doi/10.2196/44985,
author="Beutter, L. Chantal N.
and Zeller, Katharina
and Martens, M. Uwe
and Pfleiderer, Bettina
and Fegeler, Christian",
title="User-Centered Development of a Mobile App to Assess the Quality of Life of Patients With Cancer: Iterative Investigation and Usability Testing",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="26",
volume="9",
pages="e44985",
keywords="quality of life",
keywords="cancer",
keywords="mHealth",
keywords="mobile health",
keywords="patient empowerment",
keywords="user-centered design",
keywords="user",
keywords="user centered",
keywords="design",
keywords="physical well-being",
keywords="well-being",
keywords="mental health",
keywords="monitoring",
keywords="development",
keywords="usability",
abstract="Background: The treatment for cancer can have a negative impact not only on physical well-being but also on mental health and the quality of life (QoL). Health apps enable the monitoring of different parameters, but to date, there are only few that support patients with cancer and none that focuses on the assessment of QoL. Furthermore, patients as stakeholders are often only integrated at the late stage of the development process, if at all. Objective: The aim of this research was to develop and evaluate a smartphone app (Lion-App) to enable patients with cancer to autonomously measure the QoL with an iterative, user-centered approach. Methods: Patients with cancer were involved in a 3-stage process from conceptualization to the point when the app was available on the tester's private device. First, focus groups with members (N=21) of cancer support groups were conducted to understand their expectations and needs. Thereafter, individual tests were performed. After developing a prototype that incorporated findings from the focus groups, a second test cycle was conducted, followed by a beta test lasting 2 months. In our app, the QoL can be assessed via a patient diary and an integrated questionnaire. Through all stages, usability was evaluated using the modular extended version of the User Experience Questionnaire (UEQ+), including the calculation of a key performance indicator (KPI). If possible, the impact of sex on the results was evaluated. As part of the beta test, usage rates as well as age-dependent differences were also assessed. Results: A total of 21 participants took part in the initial 3 focus groups. In the subsequent usability testing (N=18), 17 (94\%) participants rated their impression through the UEQ+, with a mean KPI of 2.12 (SD 0.64, range: --3 to 3). In the second usability test (N=14), the mean KPI increased to 2.28 (SD=0.49). In the beta test, the usage rate of 19 participants was evaluated, of whom 14 (74\%) also answered the UEQ+ (mean KPI 1.78, SD 0.84). An influence of age on the number of questionnaire responses in Lion-App was observed, with a decrease in responses with increasing age (P=.02). Sex-dependent analyses were only possible for the first usability test and the beta test. The main adjustments based on user feedback were a restructuring of the diary as well as integration of a shorter questionnaire to assess the QoL. Conclusions: The iterative, user-centered approach for development and usability testing resulted in positive evaluations of Lion-App. Our app was rated as suitable for everyday use to monitor the QoL of patients with cancer. Initial results indicated that the sex and age of participants seem to play only a minor role. ",
doi="10.2196/44985",
url="https://cancer.jmir.org/2023/1/e44985",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751285"
}


@Article{info:doi/10.2196/48737,
author="Oyedele, K. Natasha
and Lansey, G. Dina
and Chiew, Calvin
and Chan, Cupid
and Quon, Harry
and Dean, T. Lorraine",
title="Development and Testing of a Mobile App to Collect Social Determinants of Health Data in Cancer Settings: Interview Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="14",
volume="7",
pages="e48737",
keywords="social determinants of health",
keywords="mobile apps",
keywords="medical oncology",
keywords="mobile phone",
abstract="Background: Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems' current technological solutions for identifying and managing patients' SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify. Objective: We developed and tested a patient-centric SDOH screening tool designed for use on patients' personal mobile phone that preserves patient privacy and confidentiality, collects information about the unmet social needs of patients with cancer, and communicates them to the provider. Methods: We interviewed 22 patients with cancer, oncologists, and social workers associated with a US-based comprehensive cancer center to better understand how patients' SDOH information is collected and reported. After triangulating data obtained from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed an SDOH screening tool mobile app and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members at the same cancer center. We collected patient SDOH data using 36 survey items covering 7 SDOH domains and used validated scales and follow-up interviews to assess the app's usability and acceptability among patients and cancer care team members. Results: Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources could be useful and valuable. In the pilot study, 25\% (4/16) of app-using patients reported having at least one of the abovementioned social needs; the most common social need was social isolation (7/16, 44\%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy but suggested that the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app. Conclusions: Use of a brief, patient-centric, mobile app--based SDOH screening tool can effectively capture SDOH of patients with cancer for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs. ",
doi="10.2196/48737",
url="https://formative.jmir.org/2023/1/e48737",
url="http://www.ncbi.nlm.nih.gov/pubmed/37707880"
}


@Article{info:doi/10.2196/42044,
author="Kanodia, Sweekrity
and Thalabard, Christophe Jean
and Lhoste, Kevin",
title="Categorization and Analysis of Primary Care mHealth Apps Related to Breast Health and Breast Cancer: Systematic Search in App Stores and Content Analysis",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="7",
volume="9",
pages="e42044",
keywords="breast cancer",
keywords="breast self-examination",
keywords="BSE",
keywords="primary care",
keywords="mobile applications",
keywords="mobile apps",
keywords="breast health",
keywords="early diagnosis",
abstract="Background: Breast cancer is the most common cause of cancer mortality among women globally. The use of mobile health tools such as apps and games is increasing rapidly, even in low- and middle-income countries, to promote early diagnosis and to manage care and support of survivors and patients. Objective: The primary objective of this review was to categorize selected mobile health apps related to breast health and prevention of breast cancer, based on features such as breast self-examination (BSE) training and reminders, and to analyze their current dissemination. An ancillary objective was to highlight the limitations of existing tools and suggest ways to improve them. Methods: We defined strict inclusion and exclusion criteria, which required apps to have titles or descriptions that suggest that they were designed for the general public, and not for patients with breast cancer or health workers. Apps that focused on awareness and primary care via self-check were included, while those that focused on topics such as alternative treatments and medical news were excluded. Apps that were not specifically related to breast cancer were also excluded. Apps (in any language) that appeared in the search with keywords were included. The database consisted of apps from AppAgg and Google Play Store. Only 85 apps met the inclusion criteria. Selected apps were categorized on the basis of their alleged interactive features. Descriptive statistics were obtained, and available language options, the number of downloads, and the cost of the apps were the main parameters reviewed. Results: The selected apps were categorized on the basis of the following features: education, BSE training, reminders, and recording. Of the 85 selected apps, 72 (84.7\%) focused on disseminating breast cancer information. BSE training was provided by only 47\% (n=40) of the apps, and very few had reminder (n=26, 30.5\%) and recording (n=11, 12.9\%) features. The median number of downloads was the highest for apps with recording features (>1000 downloads) than those with education, BSE training, reminder, and recording features (>5000 downloads). Most of these apps (n=74, 83.5\%) were monolingual, and around 80.3\% (n=49) of these apps were in English. Almost all the apps on Google Play Store were free of charge. Conclusions: Although there exist several apps on Google Play Store to promote awareness about breast health and cancer, the usefulness of most of them appears debatable. To provide a complete breast health package to the users, such apps must have all of the following features: reminders or notifications and symptom recording and tracking. There is still an urgent need to scientifically evaluate existing apps in the target populations in order to make them more functional and user-friendly. ",
doi="10.2196/42044",
url="https://cancer.jmir.org/2023/1/e42044",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676704"
}


@Article{info:doi/10.2196/46571,
author="Siglen, Elen
and Vetti, H{\o}berg Hildegunn
and Augestad, Mirjam
and Steen, M. Vidar
and Lunde, {\AA}shild
and Bjorvatn, Cathrine",
title="Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="1",
volume="25",
pages="e46571",
keywords="chatbot",
keywords="chatbots",
keywords="genetic",
keywords="trust",
keywords="acceptability",
keywords="perception",
keywords="perceived",
keywords="genetic counseling",
keywords="hybrid health care",
keywords="digital health tool",
keywords="digital information tool",
keywords="digital health technology",
keywords="virtual assistant",
keywords="hereditary breast and ovarian cancer",
keywords="hereditary",
keywords="genetic testing",
keywords="technology",
keywords="genetic clinic",
keywords="digital tool",
keywords="ovarian cancer",
keywords="breast cancer",
keywords="information retrieval",
keywords="women's health",
keywords="breast",
keywords="ovarian",
keywords="cancer",
keywords="oncology",
keywords="mobile phone",
abstract="Background: Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective: Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods: Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9\% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26\%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results: The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: ``Anytime, anywhere''; ``In addition, not instead''; and ``Trustworthy and true.'' All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions: Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling. ",
doi="10.2196/46571",
url="https://www.jmir.org/2023/1/e46571",
url="http://www.ncbi.nlm.nih.gov/pubmed/37656502"
}


@Article{info:doi/10.2196/48357,
author="Nervil, Gede Gustav
and Ternov, Kvorning Niels
and Vestergaard, Tine
and S{\o}lvsten, Henrik
and Chakera, Hougaard Annette
and Tolsgaard, Gr{\o}nneb{\ae}k Martin
and H{\"o}lmich, Rosenkrantz Lisbet",
title="Improving Skin Cancer Diagnostics Through a Mobile App With a Large Interactive Image Repository: Randomized Controlled Trial",
journal="JMIR Dermatol",
year="2023",
month="Aug",
day="9",
volume="6",
pages="e48357",
keywords="dermoscopy",
keywords="nevi",
keywords="skin neoplasms",
keywords="benign skin tumors",
keywords="melanoma",
keywords="skin cancer",
keywords="medical education",
keywords="eLearning",
keywords="digital learning",
keywords="diagnostic test",
keywords="mHealth",
keywords="mobile app",
keywords="recognition training",
keywords="skin lesions",
abstract="Background: Skin cancer diagnostics is challenging, and mastery requires extended periods of dedicated practice. Objective: The aim of the study was to determine if self-paced pattern recognition training in skin cancer diagnostics with clinical and dermoscopic images of skin lesions using a large-scale interactive image repository (LIIR) with patient cases improves primary care physicians' (PCPs') diagnostic skills and confidence. Methods: A total of 115 PCPs were randomized (allocation ratio 3:1) to receive or not receive self-paced pattern recognition training in skin cancer diagnostics using an LIIR with patient cases through a quiz-based smartphone app during an 8-day period. The participants' ability to diagnose skin cancer was evaluated using a 12-item multiple-choice questionnaire prior to and 8 days after the educational intervention period. Their thoughts on the use of dermoscopy were assessed using a study-specific questionnaire. A learning curve was calculated through the analysis of data from the mobile app. Results: On average, participants in the intervention group spent 2 hours 26 minutes quizzing digital patient cases and 41 minutes reading the educational material. They had an average preintervention multiple choice questionnaire score of 52.0\% of correct answers, which increased to 66.4\% on the postintervention test; a statistically significant improvement of 14.3 percentage points (P<.001; 95\% CI 9.8-18.9) with intention-to-treat analysis. Analysis of participants who received the intervention as per protocol (500 patient cases in 8 days) showed an average increase of 16.7 percentage points (P<.001; 95\% CI 11.3-22.0) from 53.9\% to 70.5\%. Their overall ability to correctly recognize malignant lesions in the LIIR patient cases improved over the intervention period by 6.6 percentage points from 67.1\% (95\% CI 65.2-69.3) to 73.7\% (95\% CI 72.5-75.0) and their ability to set the correct diagnosis improved by 10.5 percentage points from 42.5\% (95\% CI 40.2\%-44.8\%) to 53.0\% (95\% CI 51.3-54.9). The diagnostic confidence of participants in the intervention group increased on a scale from 1 to 4 by 32.9\% from 1.6 to 2.1 (P<.001). Participants in the control group did not increase their postintervention score or their diagnostic confidence during the same period. Conclusions: Self-paced pattern recognition training in skin cancer diagnostics through the use of a digital LIIR with patient cases delivered by a quiz-based mobile app improves the diagnostic accuracy of PCPs. Trial Registration: ClinicalTrials.gov NCT05661370; https://classic.clinicaltrials.gov/ct2/show/NCT05661370 ",
doi="10.2196/48357",
url="https://derma.jmir.org/2023/1/e48357",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624707"
}


@Article{info:doi/10.2196/45541,
author="Wanberg, J. Lindsey
and Kim, Angela
and Vogel, I. Rachel
and Sadak, Thomas Karim
and Teoh, Deanna",
title="Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="8",
volume="7",
pages="e45541",
keywords="cancer screening",
keywords="cervical cancer screening",
keywords="cervical cancer",
keywords="Game-based Learning Avatar-navigated mobile",
keywords="health care app",
keywords="mixed methods study",
keywords="mobile health",
keywords="mobile technology",
keywords="Pap test",
keywords="usability testing",
keywords="young adult health care",
abstract="Background: Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies. Objective: We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults. Methods: This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening--eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented. Results: A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91\%) and White (18/23, 78\%), and 83\% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20). Conclusions: Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app's ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial. ",
doi="10.2196/45541",
url="https://formative.jmir.org/2023/1/e45541",
url="http://www.ncbi.nlm.nih.gov/pubmed/37552527"
}


@Article{info:doi/10.2196/40891,
author="Weis, Joachim
and Wolf, Raphaela Lucy
and Boerries, Melanie
and Kassahn, Daniela
and Boeker, Martin
and Dresch, Carolin",
title="Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study",
journal="JMIR Cancer",
year="2023",
month="Jul",
day="27",
volume="9",
pages="e40891",
keywords="cancer",
keywords="mobile app",
keywords="mHealth",
keywords="mobile health",
keywords="needs assessment",
keywords="patient-centered care",
keywords="PROM",
keywords="patient-reported outcome measures",
keywords="qualitative methods",
abstract="Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients' needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients' perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 ",
doi="10.2196/40891",
url="https://cancer.jmir.org/2023/1/e40891",
url="http://www.ncbi.nlm.nih.gov/pubmed/37498653"
}


@Article{info:doi/10.2196/42852,
author="Saevarsdottir, Rut Saeunn
and Gudmundsdottir, Lara Sigridur",
title="Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="26",
volume="25",
pages="e42852",
keywords="mobile health",
keywords="mHealth",
keywords="breast cancer",
keywords="quality of life",
keywords="review",
keywords="systematic review",
keywords="cancer treatment",
keywords="mobile app",
keywords="patient care",
keywords="survivorship",
keywords="digital health intervention",
keywords="lifestyle intervention",
keywords="mobile phone",
abstract="Background: Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed. Objective: The aim of this review was to provide an overview of breast cancer--specific, mobile app--driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app--driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool. Results: A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41\%) delivered an app-only intervention, and 10 (59\%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35\%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65\%) focused on survivorship. The majority of the studies (14/17, 82\%) observed some positive effects on QOL or well-being measures. Conclusions: The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors. ",
doi="10.2196/42852",
url="https://www.jmir.org/2023/1/e42852",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494111"
}


@Article{info:doi/10.2196/47851,
author="Roh, Soonhee
and Lee, Yeon-Shim
and Kenyon, B. DenYelle
and Elliott, J. Amy
and Petereit, G. Daniel
and Gaba, Anu
and Lee, Yun Hee",
title="Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study",
journal="JMIR Form Res",
year="2023",
month="Jul",
day="20",
volume="7",
pages="e47851",
keywords="American Indian women",
keywords="breast cancer",
keywords="mammogram",
keywords="mHealth",
keywords="mobile web app intervention",
abstract="Background: Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. Objective: This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Methods: Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. Results: A significantly higher proportion of women who received the wMammogram intervention (26/62, 42\%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20\%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=?5.22; P<.001), increase in knowledge (t120=?4.75; P<.001), and satisfaction with the intervention (t120=?3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100\% vs 51/60, 85\%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4\% vs 54/60, 90\%) with statistically significant differences. Conclusions: This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. Trial Registration: ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603 ",
doi="10.2196/47851",
url="https://formative.jmir.org/2023/1/e47851",
url="http://www.ncbi.nlm.nih.gov/pubmed/37471115"
}


@Article{info:doi/10.2196/44533,
author="LeBlanc, R. Matthew
and LeBlanc, W. Thomas
and Yang, Qing
and McLaughlin, Jennifer
and Irish, Kerry
and Smith, K. Sophia",
title="A Mobile App to Support Self-Management in Patients with Multiple Myeloma or Chronic Lymphocytic Leukemia: Pilot Randomized Controlled Trial",
journal="JMIR Cancer",
year="2023",
month="Jul",
day="6",
volume="9",
pages="e44533",
keywords="chronic lymphocytic leukemia",
keywords="distress",
keywords="intervention",
keywords="leukemia",
keywords="mHealth",
keywords="mobile application",
keywords="multiple myeloma",
keywords="post-traumatic stress",
keywords="self-management",
keywords="symptoms",
keywords="treatment",
abstract="Background: Patients with blood cancer experience serious physical and emotional symptoms throughout their cancer journey. Objective: Building on previous work, we aimed to develop an app designed to help patients with multiple myeloma and chronic lymphocytic leukemia self-manage symptoms and test it for acceptability and preliminary efficacy. Methods: We developed our Blood Cancer Coach app with input from clinicians and patients. Our 2-armed randomized controlled pilot trial recruited participants from Duke Health and nationally in partnerships with the Association of Oncology Social Work, Leukemia and Lymphoma Society, and other patient groups. Participants were randomized to the attention control (Springboard Beyond Cancer website) arm or the Blood Cancer Coach app intervention arm. The fully automated Blood Cancer Coach app included symptom and distress tracking with tailored feedback, medication reminders and adherence tracking, multiple myeloma and chronic lymphocytic leukemia education resources, and mindfulness activities. Patient-reported data were collected at baseline, 4 weeks, and 8 weeks for both arms through the Blood Cancer Coach app. Outcomes of interest were global health (Patient Reported Outcomes Measurement Information System Global Health), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and cancer symptoms (Edmonton Symptom Assessment System Revised). Among participants in the intervention arm, satisfaction surveys and usage data were used to evaluate acceptability. Results: Among 180 patients who downloaded the app, 49\% (89) of them consented to participate and 40\% (72) of them completed baseline surveys. Of those who completed baseline surveys, 53\% (38) of them completed week 4 surveys (16 intervention and 22 control) and 39\% (28) of them completed week 8 surveys (13 intervention and 15 control). Most participants found the app at least moderately effective at helping manage symptoms (87\%), feeling more comfortable seeking help (87\%), increasing awareness of resources (73\%), and reported being satisfied with the app overall (73\%). Participants completed an average of 248.5 app tasks over the 8-week study period. The most used functions within the app were medication log, distress tracking, guided meditations, and symptom tracking. There were no significant differences between the control and intervention arms at week 4 or 8 on any outcomes. We also saw no significant improvement over time within the intervention arm. Conclusions: The results of our feasibility pilot were promising in which most participants found the app to be helpful in managing their symptoms, reported satisfaction with the app, and that it was helpful in several important areas. We did not, however, find significantly reduced symptoms or improved global mental and physical health over 2 months. Recruitment and retention were challenging for this app-based study, an experience echoed by others. Limitations included a predominantly White and college educated sample. Future studies would do well to include self-efficacy outcomes, target those with more symptoms, and emphasize diversity in recruitment and retention. Trial Registration: ClinicalTrials.gov NCT05928156; https://clinicaltrials.gov/study/NCT05928156 ",
doi="10.2196/44533",
url="https://cancer.jmir.org/2023/1/e44533",
url="http://www.ncbi.nlm.nih.gov/pubmed/37410541"
}


@Article{info:doi/10.2196/37330,
author="Vaffis, Shannon
and Whaley, Soluna
and Axon, Rhys David
and Hall-Lipsy, Elizabeth
and Hincapie, Ana
and Slack, Marion
and Warholak, Terri",
title="Features of Cancer mHealth Apps and Evidence for Patient Preferences: Scoping Literature Review",
journal="JMIR Cancer",
year="2023",
month="Apr",
day="28",
volume="9",
pages="e37330",
keywords="scoping review",
keywords="mHealth",
keywords="mobile health",
keywords="health app",
keywords="cancer",
keywords="oncology",
keywords="disease self-management",
keywords="self-management",
keywords="chronic disease",
keywords="tablet",
keywords="smartphone",
keywords="digital health",
keywords="eHealth",
keywords="feature",
abstract="Background: Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness. Additionally, oral anticancer therapies, as opposed to intravenous chemotherapy, are now available for an increasing number of cancer indications. Mobile health (mHealth) apps for use on mobile devices (eg, smartphones or tablets) are designed to help patients with medication adherence, symptom tracking, and disease management. Several previous literature reviews have been conducted regarding mHealth apps for cancer. However, these studies did not address patient preferences for the features of cancer mHealth apps. Objective: The primary aim was to review the scientific literature that describes the features and functions of mHealth apps designed for cancer self-management. Methods: As the purpose of this review was to explore the depth and breadth of research on mHealth app features for cancer self-management, a scoping review methodology was adopted. Four databases were used for this review: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO. Citation and reference searches were conducted for manuscripts meeting the inclusion criteria. A gray literature search was also conducted. Data?extracted from manuscripts?included author, title, publication date, study type, sampling type, cancer type, treatment, age of participants, features, availability (free or subscription), design input, and patient preferences. Finally, the features listed for each app were compared, highlighting similarities across platforms as well as features unique to each app. Results: After the removal of duplicates, 522 manuscripts remained for the title and abstract review, with 51 undergoing full-text review. A total of 7 manuscripts (referred to as studies hereafter) were included in the final scoping review. App features described in each study varied from 2 to 11, with a median of 4 features per app. The most reported feature was a symptom or side effect tracker, which was reported in 6 studies. Two apps specified the inclusion of patients and health care providers during the design, while 1 app noted that IT and communications experts provided design input. The utility of the apps for end users was measured in several ways, including acceptability (measuring the end users' experience), usability (assessing the functionality and performance by observing real users completing tasks), or qualitative data (reports from end users collected from interviews or focus groups). Conclusions: This review explored the literature on cancer mHealth apps. Popular features within these mHealth apps include symptom trackers, cancer education, and medication trackers. However, these apps and features are often developed with little input from patients. Additionally, there is little information regarding patient preferences for the features of existing apps. While the number of cancer-related apps available for download continues to increase, further exploration of patient preferences for app features could result in apps that better meet patient disease self-management needs. ",
doi="10.2196/37330",
url="https://cancer.jmir.org/2023/1/e37330",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115587"
}


@Article{info:doi/10.2196/45475,
author="Reis, Joaquim
and Travado, Luzia
and Scherrer, Alexander
and Kosmidis, Thanos
and Venios, Stefanos
and Laras, Emmanouil Paris
and Oestreicher, Gabrielle
and Moehler, Markus
and Parolini, Margherita
and Passardi, Alessandro
and Meggiolaro, Elena
and Martinelli, Giovanni
and Petracci, Elisabetta
and Zingaretti, Chiara
and Diamantopoulos, Sotiris
and Plakia, Maria
and Vassiliou, Charalampos
and Mousa, Suheib
and Zifrid, Robert
and Sullo, Giulio Francesco
and Gallio, Chiara",
title="Digital Guardian Angel Supported by an Artificial Intelligence System to Improve Quality of Life, Well-being, and Health Outcomes of Patients With Cancer (ONCORELIEF): Protocol for a Single Arm Prospective Multicenter Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="21",
volume="12",
pages="e45475",
keywords="eHealth",
keywords="artificial intelligence",
keywords="quality of life and well-being",
keywords="supportive cancer care",
keywords="mobile phone",
keywords="cancer support",
keywords="artificial intelligence--based recommendations",
abstract="Background: According to Europe's Beating Cancer Plan, the number of cancer survivors is growing every year and is now estimated at over 12 million in Europe. A main objective of the European Commission is to ensure that cancer survivors can enjoy a high quality of life, underlining the role of digital technology and eHealth apps and tools to achieve this. Objective: The main objective of this study is the development of a user-centered artificial intelligence system to facilitate the input and integration of patient-related biopsychosocial data to improve posttreatment quality of life, well-being, and health outcomes and examine the feasibility of this digitally assisted workflow in a real-life setting in patients with colorectal cancer and acute myeloid leukemia. Methods: A total of 60 patients with colorectal cancer and 30 patients with acute myeloid leukemia will be recruited from 2 clinical centers: Universit{\"a}tsmedizin der Johannes Gutenberg-Universit{\"a}t Mainz (Mainz, Germany) and IRCCS Istituto Romagnolo per lo Studio dei Tumori ``Dino Amadori'' (IRST, Italy). Psychosocial data (eg, emotional distress, fatigue, quality of life, subjective well-being, sleep problems, and appetite loss) will be collected by questionnaires via a smartphone app, and physiological data (eg, heart rate, skin temperature, and movement through step count) will be collected by a customizable smart wrist-worn sensor device. Each patient will be assessed every 2 weeks over their 3-month participation in the ONCORELIEF study. Inclusion criteria include patients with the diagnosis of acute myeloid leukemia or colorectal cancer, adult patients aged 18 years and older, life expectancy greater than 12 months, Eastern Cooperative Oncology Group performance status ?2, and patients who have a smartphone and agree to use it for the purpose of the study. Exclusion criteria include patients with a reduced cognitive function (such as dementia) or technological illiteracy and other known active malignant neoplastic diseases (patients with a medical history of treated neoplastic disease are included). Results: The pilot study started on September 1, 2022. As of January 2023, we enrolled 33 patients with colorectal cancer and 7 patients with acute myeloid leukemia. As of January 2023, we have not yet started the data analysis. We expect to get all data in June 2023 and expect the results to be published in the second semester of 2023. Conclusions: Web-based and mobile apps use methods from mathematical decision support and artificial intelligence through a closed-loop workflow that connects health professionals and patients. The ONCORELIEF system has the potential of continuously identifying, collecting, and processing data from diverse patient dimensions to offer health care recommendations, support patients with cancer to address their unmet needs, and optimize survivorship care. Trial Registration: German Clinical Trials Register (DRKS) 00027808; https://drks.de/search/en/trial/DRKS00027808 International Registered Report Identifier (IRRID): DERR1-10.2196/45475 ",
doi="10.2196/45475",
url="https://www.researchprotocols.org/2023/1/e45475",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083563"
}


@Article{info:doi/10.2196/42092,
author="Ardito, Vittoria
and Golubev, Georgi
and Ciani, Oriana
and Tarricone, Rosanna",
title="Evaluating Barriers and Facilitators to the Uptake of mHealth Apps in Cancer Care Using the Consolidated Framework for Implementation Research: Scoping Literature Review",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="30",
volume="9",
pages="e42092",
keywords="mobile health",
keywords="mHealth",
keywords="smartphones",
keywords="mobile",
keywords="oncology",
keywords="cancer",
keywords="implementation science",
keywords="consolidated framework for implementation research",
keywords="CFIR",
keywords="mobile phones",
abstract="Background: Mobile health (mHealth) solutions have proven to be effective in a wide range of patient outcomes and have proliferated over time. However, a persistent challenge of digital health technologies, including mHealth, is that they are characterized by early dropouts in clinical practice and struggle to be used outside experimental settings or on larger scales. Objective: This study aimed to explore barriers and enablers to the uptake of mHealth solutions used by patients with cancer undergoing treatment, using a theory-guided implementation science model, that is, the Consolidated Framework for Implementation Research (CFIR). Methods: A scoping literature review was conducted using PubMed (MEDLINE), Web of Science, and ScienceDirect databases in March 2022. We selected studies that analyzed the development, evaluation, and implementation of mHealth solutions for patients with cancer that were used in addition to the standard of care. Only empirical designs (eg, randomized controlled trials, observational studies, and qualitative studies) were considered. First, information on the study characteristics, patient population, app functionalities, and study outcomes was extracted. Then, the CFIR model was used as a practical tool to guide data collection and interpretation of evidence on mHealth uptake. Results: Overall, 91 papers were included in the data synthesis. The selected records were mostly randomized controlled trials (26/91, 29\%) and single-arm, noncomparative studies (52/91, 57\%). Most of the apps (42/73, 58\%) were designed for both patients and clinicians and could be used to support any type of cancer (29/73, 40\%) and a range of oncological treatments. Following the CFIR scheme (intervention, outer setting, inner setting, individuals, process), multistakeholder co-design, codevelopment, and testing of mHealth interventions were identified as key enablers for later uptake. A variety of external drivers emerged, although the most relevant outer incentive fostering mHealth use was addressing patient needs. Among organizational factors likely to influence technology uptake, interoperability was the most prominent, whereas other providers' dimensions such as managerial attitudes or organizational culture were not systematically discussed. Technology-related impediments that could hamper the use of mHealth at the individual level were considered least often. Conclusions: The hype surrounding mHealth in cancer care is hindered by several factors that can affect its use in real world and nonexperimental settings. Compared with the growing evidence on mHealth efficacy, knowledge to inform the uptake of mHealth solutions in clinical cancer care is still scarce. Although some of our findings are supported by previous implementation research, our analysis elaborates on the distinguishing features of mHealth apps and provides an integrated perspective on the factors that should be accounted for implementation efforts. Future syntheses should liaise these dimensions with strategies observed in successful implementation initiatives. ",
doi="10.2196/42092",
url="https://cancer.jmir.org/2023/1/e42092",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995750"
}


@Article{info:doi/10.2196/41441,
author="McCann, Lisa
and Hewitt, Christopher
and McMillan, A. Kathryn",
title="Developing an e-Prehabilitation System of Care for Young Adults Diagnosed With Cancer: User-Centered Design Study",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="30",
volume="9",
pages="e41441",
keywords="digital health",
keywords="human factors",
keywords="user-centered",
keywords="prehabilitation",
keywords="young adults",
keywords="cancer",
abstract="Background: A diagnosis of cancer in adolescence or young adulthood can pose many different and unique challenges for individuals, as well as their families and friends. Drawing on the concept of prehabilitation, the provision of high-quality, accessible, timely, reliable, and appropriate information, care, and support for young adults with cancer and their families is critical to ensure that they feel equipped and empowered to make informed decisions relating to their treatment and care. Increasingly, digital health interventions offer opportunities to augment current health care information and support provision. Co-designing these digital health interventions can help to ensure that they are meaningful and relevant to the patient cohort, thereby maximizing their accessibility and acceptability. Objective: This study had 4 primary interlinked objectives: understand the support needs of young adults with cancer at the time of diagnosis, understand the potential role of a digital health solution to assist in the delivery of prehabilitation for young adults with cancer, identify appropriate technologies and technological platforms for a digital prehabilitation system of care, and develop a prototype for a digital prehabilitation system of care. Methods: This was a qualitative study using interviews and surveys. Young adults aged 16 to 26 years diagnosed with cancer within the last 3 years were invited to participate in individual user-requirement interviews or surveys. Health care professionals specializing in the treatment and care of young adults with cancer and digital health professionals working in the industry were also interviewed or completed a survey. Consensus feedback interviews were conducted with 3 young adults and 2 health care professionals after the development of the first generation of the prototype app. Results: In total, 7 individual interviews and 8 surveys were completed with young adults with a range of cancer diagnoses. Moreover, 6 individual interviews and 9 surveys were completed with health care professionals, and 3 digital health professionals participated in one-on-one interviews. A prototype app with the working name of Cancer Helpmate was developed based on these collective participant data. Overall, feedback from participants across the data collection activities suggests that the concept for the app was positive during these developmental stages. Further insightful ideas for the app's future development were also identified. Conclusions: Young adults with cancer and health care professionals are responsive to the need for more digitally driven services to be developed. Further development of an app such as Cancer Helpmate, which incorporates key features and functionalities directly informed by users, could help to augment the support provided to young adults with cancer. ",
doi="10.2196/41441",
url="https://cancer.jmir.org/2023/1/e41441",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995740"
}


@Article{info:doi/10.2196/39645,
author="Levitz, E. Carly
and Kuo, Elena
and Guo, Monica
and Ruiz, Esmeralda
and Torres-Ozadali, Evelyn
and Brar Prayaga, Rena
and Escaron, Anne",
title="Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="7",
volume="9",
pages="e39645",
keywords="colorectal cancer screening",
keywords="texting campaign",
keywords="patient navigation",
keywords="fotonovela",
keywords="fecal immunochemical test kit",
keywords="FIT kit",
keywords="screening",
keywords="cancer",
keywords="colorectal cancer",
keywords="CRC",
keywords="bidirectional texting",
keywords="health text messaging",
keywords="health promotion",
keywords="participation",
keywords="comics",
abstract="Background: Colorectal cancer (CRC) is currently the second leading cause of cancer-related deaths in the United States; however, it is mostly preventable with appropriate screening and is often treatable when detected at early stages. Many patients enrolled in an urban Federally Qualified Health Center (FQHC) clinic were found to be past due for CRC screening. Objective: This study described a quality improvement (QI) project to improve CRC screening rates. This project used bidirectional texting with fotonovela comics and natural language understanding (NLU) to encourage patients to mail fecal immunochemical test (FIT) kits back to the FQHC. Methods: The FQHC mailed FIT kits to 11,000 unscreened patients in July 2021. Consistent with the usual care, all patients received 2 text messages and a patient navigator call within the first month of mailing. As part of a QI project, 5241 patients who did not return their FIT kit within 3 months, aged 50-75 years, and spoke either English or Spanish were randomized to either usual care (no further intervention) or intervention (4-week texting campaign with a fotonovela comic and remailing kits if requested) groups. The fotonovela was developed to address known barriers to CRC screening. The texting campaign used NLU to respond to patients' texts. A mixed methods evaluation used data from SMS text messages and electronic medical records to understand the impact of the QI project on CRC screening rates. Open-ended text messages were analyzed for themes, and interviews were completed with a convenience sample of patients to understand barriers to screening and impact of the fotonovela. Results: Of the 2597 participants, 1026 (39.5\%) in the intervention group engaged with bidirectional texting. Participating in bidirectional texting was related to language preference ($\chi$22=11.0; P=.004) and age group ($\chi$22=19.0; P<.001). Of the 1026 participants who engaged bidirectionally, 318 (31\%) clicked on the fotonovela. Furthermore, 54\% (32/59) of the patients clicked on the fotonovela and responded that they loved it, and 36\% (21/59) of patients responded that they liked it. The intervention group was more likely to get screened (487/2597, 18.75\%) than those in usual care (308/2644, 11.65\%; P<.001), and this pattern held, regardless of demographic subgroup (sex, age, screening history, preferred language, and payer type). Interview data (n=16) indicated that the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Interviewees noted several important barriers to CRC screening and offered suggestions for reducing barriers and increasing screening. Conclusions: Texting using NLU and fotonovela is valuable in increasing CRC screening as observed by the FIT return rate for patients in the intervention group. There were patterns in which patients did not engage bidirectionally; future work should investigate how to ensure that populations are not left out of screening campaigns. ",
doi="10.2196/39645",
url="https://cancer.jmir.org/2023/1/e39645",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881466"
}


@Article{info:doi/10.2196/42250,
author="Ayyoubzadeh, Mohammad Seyed
and Baniasadi, Tayebeh
and Shirkhoda, Mohammad
and Rostam Niakan Kalhori, Sharareh
and Mohammadzadeh, Niloofar
and Roudini, Kamran
and Ghalehtaki, Reza
and Memari, Fereidoon
and Jalaeefar, Amirmohsen",
title="Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things--Based Device: Development and Usability Study",
journal="JMIR Cancer",
year="2023",
month="Feb",
day="15",
volume="9",
pages="e42250",
keywords="eHealth",
keywords="telemedicine",
keywords="colorectal cancer",
keywords="cancer survivor",
keywords="IoT",
keywords="mHealth",
keywords="patient monitoring",
keywords="remote monitoring",
keywords="postdischarge care",
keywords="cancer",
keywords="patient care",
keywords="cancer care",
keywords="postoperative complications",
abstract="Background: Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. Objective: This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. Methods: This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen's usability principles. Results: A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. Conclusions: Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system's implementation in clinic settings and hospitals is required to understand the probable barriers and limitations. ",
doi="10.2196/42250",
url="https://cancer.jmir.org/2023/1/e42250",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790851"
}


@Article{info:doi/10.2196/39544,
author="Reilly, Felicity
and Wani, Nuha
and Hall, Susan
and Morgan, May Heather
and Allan, Julia
and Constable, Lynda
and Ntessalen, Maria
and Murchie, Peter",
title="User Experiences in a Digital Intervention to Support Total Skin Self-examination by Melanoma Survivors: Nested Qualitative Evaluation Embedded in a Randomized Controlled Trial",
journal="JMIR Dermatol",
year="2023",
month="Feb",
day="13",
volume="6",
pages="e39544",
keywords="mobile apps",
keywords="melanoma",
keywords="early detection of cancer",
keywords="qualitative interviews",
keywords="cancer survivorship",
abstract="Background: Melanoma is a relatively common cancer type with a high survival rate, but survivors risk recurrences or second primaries. Consequently, patients receive regular hospital follow-up, but this can be burdensome to attend and not optimally timed to detect arising problems. Total skin self-examination (TSSE) supports improved clinical outcomes from melanoma via earlier detection of recurrences and second primaries, and digital technology has the potential to support TSSE. Recent research with app-based interventions aimed at improving the well-being of older adults has found that they can use the technology and benefit from it, supporting the use of digital health care in diverse demographic groups. Thus, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) digital health care intervention was developed. The intervention provided melanoma survivors with a monthly prompt to perform a TSSE as well as access to a dermatology nurse who provided them with feedback on photographs and descriptions of their skin. Objective: We aimed to explore participants' attitudes, beliefs, and experiences regarding TSSE practices. Furthermore, we explored how participants experienced technology and how it influenced their practice of TSSE. Finally, we explored the practical and technical experiences of ASICA users. Methods: This was a nested qualitative evaluation within a dual-center randomized controlled trial of the ASICA intervention. We conducted semistructured telephone interviews with the participants during a randomized controlled trial. The participants were purposively sampled to achieve a representative sample with representative proportions by age, sex, and residential geography. Interviews were transcribed verbatim and analyzed using a framework analysis approach applied within NVivo 12. Results: A total of 22 interviews were conducted with participants from both groups. In total, 40\% (9/22) of the interviewed participants were from rural areas, and 60\% (13/22) were from urban areas; 60\% (13/22) were from the intervention group, and 40\% (9/22) were from the control group. Themes evolved around skin-checking behavior, other people's input into skin checking, contribution of health care professionals outside ASICA and its value, ideas around technology, practical experiences, and potential improvements. ASICA appeared to change participants' perceptions of skin checking. Users were more likely to report routinely performing TSSE thoroughly. There was some variation in beliefs about skin checking and using technology for health care. Overall, ASICA was experienced positively by participants. Several practical suggestions were made for the improvement of ASICA. Conclusions: The ASICA intervention appeared to have positively influenced the attitudes and TSSE practices of melanoma survivors. This study provides important qualitative information about how a digital health care intervention is an effective means of prompting, recording, and responding to structured TSSE by melanoma survivors. Technical improvements are required, but the app offers promise for technologically enhanced melanoma follow-up in future. Trial Registration: ClinicalTrials.gov NCT03328247; https://clinicaltrials.gov/ct2/show/NCT03328247?term=ASICA\&rank=1 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3453-x ",
doi="10.2196/39544",
url="https://derma.jmir.org/2023/1/e39544",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632942"
}


@Article{info:doi/10.2196/38333,
author="Lee, Kyunghwa
and Kim, Sanghee
and Kim, Hyun Soo
and Yoo, Sung-Hee
and Sung, Hyun Ji
and Oh, Geum Eui
and Kim, Nawon
and Lee, Jiyeon",
title="Digital Health Interventions for Adult Patients With Cancer Evaluated in Randomized Controlled Trials: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="6",
volume="25",
pages="e38333",
keywords="digital health",
keywords="adult",
keywords="neoplasms",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements. Objective: The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer. Methods: A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions. Results: A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81\%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2\%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9\%), followed by those with the self-manage function (67/231, 29\%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6\%) or patients with advanced or metastatic cancer (22/231, 9.5\%). Conclusions: This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research. ",
doi="10.2196/38333",
url="https://www.jmir.org/2023/1/e38333",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607712"
}


@Article{info:doi/10.2196/39799,
author="Qin, Minghui
and Chen, Bo
and Sun, Shaohua
and Liu, Xiaodong",
title="Effect of Mobile Phone App--Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="19",
volume="24",
number="12",
pages="e39799",
keywords="mobile health app",
keywords="mHealth app",
keywords="quality of life",
keywords="psychological symptoms",
keywords="cancer survivors",
keywords="systematic review and meta-analysis",
keywords="mobile phone",
abstract="Background: Most patients with cancer experience psychological or physical distress, which can adversely affect their quality of life (QOL). Smartphone app interventions are increasingly being used to improve QOL and psychological outcomes in patients with cancer. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. Objective: In this systematic review and meta-analysis, we investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in adult patients with cancer, with a special focus on intervention duration, type of cancer, intervention theory, treatment strategy, and intervention delivery format. Methods: We conducted a literature search of PubMed, Web of Science, the Cochrane Library, Embase, Scopus, China National Knowledge Infrastructure, and WanFang to identify studies involving apps that focused on cancer survivors and QOL or psychological symptoms published from inception to October 30, 2022. We selected only randomized controlled trials that met the inclusion criteria and performed systematic review and meta-analysis. The standardized mean difference (SMD) with a 95\% CI was pooled when needed. Sensitivity and subgroup analyses were also conducted. Results: In total, 30 randomized controlled trials with a total of 5353 participants were included in this meta-analysis. Compared with routine care, app interventions might improve QOL (SMD=0.39, 95\% CI 0.27-0.51; P<.001); enhance self-efficacy (SMD=0.15, 95\% CI 0.02-0.29; P=.03); and alleviate anxiety (SMD=?0.64, 95\% CI ?0.73 to ?0.56; P<.001), depression (SMD=?0.33, 95\% CI ?0.58 to ?0.08; P=.009), and distress (SMD=?0.34, 95\% CI ?0.61 to ?0.08; P=.01). Short-term (duration of ?3 months), physician-patient interaction (2-way communication using a smartphone app), and cognitive behavioral therapy interventions might be the most effective for improving QOL and alleviating adverse psychological effects. Conclusions: Our study showed that interventions using mobile health apps might improve QOL and self-efficacy as well as alleviate anxiety, depression, and distress in adult cancer survivors. However, these results should be interpreted with caution because of the heterogeneity of the interventions and the study design. More rigorous trials are warranted to confirm the suitable duration and validate the different intervention theories as well as address methodological flaws in previous studies. Trial Registration: PROSPERO CRD42022370599; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=370599 ",
doi="10.2196/39799",
url="https://www.jmir.org/2022/12/e39799",
url="http://www.ncbi.nlm.nih.gov/pubmed/36534460"
}


@Article{info:doi/10.2196/41246,
author="Pegington, Mary
and Davies, Alan
and Mueller, Julia
and Cholerton, Rachel
and Howell, Anthony
and Evans, Gareth D.
and Howell, J. Sacha
and French, P. David
and Harvie, Michelle",
title="Evaluating the Acceptance and Usability of an App Promoting Weight Gain Prevention and Healthy Behaviors Among Young Women With a Family History of Breast Cancer: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="16",
volume="11",
number="12",
pages="e41246",
keywords="breast cancer",
keywords="weight",
keywords="BMI",
keywords="weight gain",
keywords="health behavior",
keywords="weight maintenance",
keywords="women",
keywords="app",
keywords="ehealth",
keywords="interview",
keywords="mobile app",
keywords="women's health",
keywords="mHealth",
abstract="Background: Breast cancer is the most common form of cancer in women, and around 20\% of cases are associated with factors such as adult weight gain, overweight and obesity, and potentially modifiable health behaviors including high alcohol intake, smoking, lack of physical activity, and breastfeeding. Significant weight gain occurs between the ages of 18 and 35 years; hence, this age group could benefit from weight gain prevention interventions. Population studies have reported that women at increased risk of breast cancer account for a disproportionate amount of cases. Thus, there is a particular need to target weight gain prevention and other health behavior interventions for women at increased risk. A literature review identified no evidence-based apps that cover all relevant health behaviors. With patient and participant involvement from the target population, we have developed a new app to promote healthy behaviors among young women at increased risk of breast cancer. Alongside the app, a Facebook group provides peer support, and a virtual welcome event provides an overview of the project and the opportunity to meet the research team and other study participants. The aim of the intervention is to prevent weight gain via changes to eating habits and physical activity levels, and improve other health behaviors associated with breast cancer. The app includes goal setting and self-monitoring of health behaviors and provides education about breast cancer. Objective: This study aims to assess the acceptability and usability of the app in young women at increased risk of breast cancer, and the feasibility of the study procedures for a future, larger efficacy study. Methods: Young women (n=35, age 18-35 years) at increased risk of breast cancer (>17\% lifetime risk) will be recruited via 2 recruitment procedures: mailed invite from the local breast cancer family history, risk and prevention clinic, and advertisements on social media and websites. Participants will have access to the app and the private Facebook group for 2 months. They will complete questionnaires regarding their health behaviors and breast cancer risk belief at the start and end of the study, complete app rating scales in the middle and at the end of the study, and be invited to give feedback on the app during the study period. Approximately 20 participants will have a semistructured interview at the end of the study regarding their views on the app and trial procedures. Results: The trial is ongoing, and the publication of results is anticipated in 2023. Conclusions: The trial will provide evidence regarding the acceptability and usability of the newly developed app for young women at increased risk of breast cancer. Feedback obtained will be used to improve the app. The trial will also assess the feasibility of the study procedures and how these can be refined for a future efficacy study. Trial Registration: ClinicalTrials.gov NCT05460650; https://clinicaltrials.gov/ct2/show/NCT05460650 International Registered Report Identifier (IRRID): PRR1-10.2196/41246 ",
doi="10.2196/41246",
url="https://www.researchprotocols.org/2022/12/e41246",
url="http://www.ncbi.nlm.nih.gov/pubmed/36525287"
}


@Article{info:doi/10.2196/36197,
author="Orumaa, Madleen
and Campbell, Suzanne
and St{\o}er, C. Nathalie
and Castle, E. Philip
and Sen, Sagar
and Trop{\'e}, Ameli
and Adedimeji, Adebola
and Nyg{\aa}rd, Mari",
title="Impact of the Mobile Game FightHPV on Cervical Cancer Screening Attendance: Retrospective Cohort Study",
journal="JMIR Serious Games",
year="2022",
month="Dec",
day="13",
volume="10",
number="4",
pages="e36197",
keywords="mobile app",
keywords="gamification",
keywords="empowering",
keywords="health literacy",
keywords="cervical cancer screening",
keywords="cancer prevention",
abstract="Background: The wide availability of mobile phones has made it easy to disseminate health-related information and make it accessible. With gamification, mobile apps can nudge people to make informed health choices, including attending cervical cancer screening. Objective: This matched retrospective cohort study examined the association between exposure to the FightHPV mobile app gamified educational content and having a cervical exam in the following year. Methods: Women aged 20 to 69 years who signed an electronic consent form after downloading the FightHPV app in 2017 (intervention group) were matched 1:6 with women of the same age and with the same screening history (reference group) in 2015. To estimate the impact of exposure to the FightHPV app, we estimated cumulative incidence and hazard ratios (HRs) with 95\% CIs. We used data from the Norwegian Cervical Cancer Screening Program database and Statistics Norway to determine screening participation and outcomes, respectively. Results: We matched 3860 women in the control group to 658 women in the intervention group; 6 months after enrollment, 29.6\% (195/658) of the women in the intervention group and 15.21\% (587/3860) of those in the reference group underwent a cervical exam (P<.01). Women exposed to the FightHPV app were 2 times more likely to attend screening (adjusted HR 2.3, 95\% CI 2.0-2.7), during which they were 13 times more likely to be diagnosed with high-grade abnormality (adjusted HR 12.7, 95\% CI 5.0-32.5) than the women in the reference group. Conclusions: Exposure to the FightHPV app significantly increased cervical cancer screening attendance across the various analyses and improved detection of women with high risk for cervical cancer. For the first time, we demonstrated the effectiveness of gamification combined with mobile technology in cancer prevention by empowering women to make active health-related decisions. Gamification can significantly improve the understanding of complicated scientific concepts behind interventions and increase the acceptance of proposed cancer control measures. ",
doi="10.2196/36197",
url="https://games.jmir.org/2022/4/e36197",
url="http://www.ncbi.nlm.nih.gov/pubmed/36512401"
}


@Article{info:doi/10.2196/40352,
author="van der Linden, W. Manouk J.
and Nahar van Venrooij, W. Lenny M.
and Verdaasdonk, G. Emiel G.",
title="Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study",
journal="JMIR Perioper Med",
year="2022",
month="Dec",
day="13",
volume="5",
number="1",
pages="e40352",
keywords="eHealth",
keywords="fitness trackers",
keywords="diet records",
keywords="colorectal neoplasm",
keywords="colorectal cancer",
keywords="surgery",
keywords="self management",
keywords="patient care",
keywords="physical activity",
keywords="tracking",
keywords="activity tracking",
keywords="self-monitoring",
keywords="feasibility",
keywords="usability",
abstract="Background: The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake. Objective: This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery. Methods: This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range --100 to +100). Results: In total, 28 persons were included (n=16, 57\% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and--7 (postoperative). Conclusions: The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased. ",
doi="10.2196/40352",
url="https://periop.jmir.org/2022/1/e40352",
url="http://www.ncbi.nlm.nih.gov/pubmed/36512385"
}


@Article{info:doi/10.2196/39271,
author="Skiba, B. Meghan
and Harker, Graham
and Guidarelli, Carolyn
and El-Gohary, Mahmoud
and Horak, Fay
and Roeland, J. Eric
and Silbermann, Rebecca
and Hayes-Lattin, Brandon
and Winters-Stone, Kerri",
title="Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study",
journal="JMIR Cancer",
year="2022",
month="Dec",
day="8",
volume="8",
number="4",
pages="e39271",
keywords="wearable inertial sensor",
keywords="mobility",
keywords="gait",
keywords="induction chemotherapy",
keywords="autologous hematopoietic stem cell transplant",
keywords="autoHSCT",
keywords="chemotherapy-related symptoms",
abstract="Background: Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. Objective: We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Methods: Patients scheduled to receive autoHSCT (78/156, 50\%) and controls (78/156, 50\%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group--Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale--short form), and depression (Center for Epidemiological Studies--Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Results: Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability ({\ss}=.001; P=.005) and heel strike angle ({\ss}=?.088; P=.02). Pain was associated with worse gait speed ({\ss}=?.003; P=.003), stride time variability ({\ss}=.012; P=.02), stride length ({\ss}=?.002; P=.004), and distance traveled ({\ss}=?.786; P=.005). Nausea and pain explained 17\% to 33\% and 14\% to 36\% of gait variance measured in patients, respectively. Conclusions: Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term. ",
doi="10.2196/39271",
url="https://cancer.jmir.org/2022/4/e39271",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480243"
}


@Article{info:doi/10.2196/39012,
author="Lima, Souza Vivian Cristina Gama
and Soares, Souza Raquel de
and Santos, dos Willian Alves
and Alves, Paulo
and Fuly, Claro Patricia dos Santos",
title="Scientific Publications on Nursing for COVID-19 in Patients With Cancer: Scoping Review",
journal="JMIR Cancer",
year="2022",
month="Nov",
day="25",
volume="8",
number="4",
pages="e39012",
keywords="COVID-19",
keywords="review",
keywords="nursing",
keywords="coronavirus infection",
keywords="oncology nursing",
abstract="Background: The needs of patients with cancer must be met, especially in times of crisis. The advent of the pandemic triggered a series of strategic actions by the nursing team to preserve the health of patients and professionals---hence the importance of studies on nursing care actions provided to patients with cancer during the COVID-19 pandemic. It is known that these patients are susceptible to severe COVID-19. However, no previous review has summarized the findings of scientific studies on nursing for COVID-19 in patients with cancer. Objective: This study aims to map the topics addressed in scientific studies on nursing for COVID-19 in patients with cancer. Methods: A scoping review was conducted using the methodology described in the Joanna Briggs Institute Reviewers' Manual 2015. The research question was elaborated using the population, concept, and context framework: What topics have been studied in nursing publications about COVID-19 in adult patients with cancer? The searches were carried out in 8 databases between April and November 2021 without time restrictions. Results: In total, 973 publications were identified using the search strategies in the databases, and 12 papers were retrieved by consulting the references. A total of 31 (3.2\%) publications were included in the final analysis, generating 4 thematic categories on the subject: ``restructuring the services: how oncology nursing was adapted during the pandemic,'' ``experiences of patients and performance of the nursing team during the COVID-19 pandemic,'' ``protocols and recommendations for dealing with the COVID-19 pandemic,'' and ``challenges and the role of oncology nurses facing the COVID-19 pandemic.'' Conclusions: Several strategies used by oncology nurses to face the COVID-19 pandemic in the international scenario were identified. Reports about the restructuring of services and the team's reactions to the pandemic predominated. However, there is a lack of reports regarding emotional support strategies for health care professionals. Another gap identified was the scarcity of clinical studies on the activities developed by oncology nurses. Therefore, there is a need for clinical research in the oncology area and emotional coping strategies to support oncology nurses. ",
doi="10.2196/39012",
url="https://cancer.jmir.org/2022/4/e39012",
url="http://www.ncbi.nlm.nih.gov/pubmed/36219752"
}


@Article{info:doi/10.2196/39228,
author="Huberty, Jennifer
and Bhuiyan, Nishat
and Puzia, Megan
and Joeman, Lynda
and Larkey, Linda
and Mesa, Ruben",
title="Meditation Mobile App Developed for Patients With and Survivors of Cancer: Feasibility Randomized Controlled Trial",
journal="JMIR Cancer",
year="2022",
month="Nov",
day="23",
volume="8",
number="4",
pages="e39228",
keywords="cancer",
keywords="mobile health",
keywords="mHealth",
keywords="meditation",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: To address the unmet need for a commercial cancer-specific meditation app, we leveraged a long-standing partnership with a consumer-based app (ie, Calm) to develop the first commercial meditation app prototype adapted specifically for the needs of patients with cancer. Input was obtained at both the individual user and clinic levels (ie, patients with and survivors of cancer and health care providers). Objective: This study aimed to determine the feasibility of a cancer-specific meditation app prototype. Methods: Patients with and survivors of cancer who were recruited and enrolled in the feasibility randomized controlled trial were asked to use the prototype app daily (?70 minutes per week) for 4 weeks. Participants completed web-based weekly questionnaires and a final poststudy questionnaire and were asked to participate in an optional web-based poststudy interview. The questionnaires and interviews covered the following feasibility categories: acceptability, demand, practicality, and adaptation. Results: A total of 36 patients with and survivors of cancer completed the baseline questionnaire, 18 completed the final questionnaire, and 6 completed the optional interviews. Weekly and poststudy questionnaires indicated high overall enjoyment, ease of use, and satisfaction with the app content, aesthetics, and graphics. The objective use data indicated that the average total app use rate was 73.39 (SD 7.12) minutes per week. Interviews (N=6) revealed positive and mixed responses to the app prototype and informative differences related to preferences for narrators, emotional content, and meditation teaching but an overall appreciation for the variety of options. Conclusions: The most likely candidates for moving from cancer-specific meditation apps to dissemination are through partnering with the industry, in which name recognition and market distribution are already established (even showing a base of users from the targeted population with cancer). This study established the feasibility of a cancer-specific mobile meditation app prototype for patients with and survivors of cancer, using a commercially available app. The quantitative and qualitative data demonstrated the acceptability, demand, practicality, and adaptation of the prototype. Improvements suggested by the participants will be considered in the final app design before testing the efficacy of the app in a future study. Trial Registration: Clinicaltrials.gov NCT05459168; https://clinicaltrials.gov/ct2/show/record/NCT05459168 ",
doi="10.2196/39228",
url="https://cancer.jmir.org/2022/4/e39228",
url="http://www.ncbi.nlm.nih.gov/pubmed/36416880"
}


@Article{info:doi/10.2196/40718,
author="Nannini, Simon
and Penel, Nicolas
and Bompas, Emmanuelle
and Willaume, Thibault
and Kurtz, Jean-Emmanuel
and Gantzer, Justine",
title="Shortening the Time Interval for the Referral of Patients With Soft Tissue Sarcoma to Expert Centers Using Mobile Health: Retrospective Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Nov",
day="9",
volume="10",
number="11",
pages="e40718",
keywords="sarcoma",
keywords="apps",
keywords="mHealth",
keywords="mobile health",
keywords="health app",
keywords="mobile app",
keywords="referral",
keywords="consultation",
keywords="care coordination",
keywords="tumor",
keywords="cancer",
keywords="oncology",
keywords="soft tissue",
keywords="connective tissue",
keywords="prognosis",
keywords="communication",
keywords="interprofessional",
keywords="patient management",
keywords="physician",
keywords="doctor",
keywords="health care provider",
keywords="specialist",
keywords="general practitioner",
keywords="GP",
abstract="Background: According to guidelines, all patients with sarcoma must be managed from initial diagnosis at expert sarcoma centers. However, in everyday practice, the time interval to an expert center visit can be long, which delays presentation to an expert multidisciplinary tumor board and increases the risk of inappropriate management, negatively affecting local tumor control and prognosis. The advent of mobile health offers an easy way to facilitate communication and cooperation between general health care providers (eg, general practitioners and radiologists) and sarcomas experts. We developed a mobile app (Sar'Connect) based on the algorithm designed by radiologists from the French Sarcoma Group. Through a small number of easy-to-answer questions, Sar'Connect provides personalized advice for the management of patients and contact information for the closest expert center. Objective: This retrospective study is the first to assess this mobile app's potential benefits in reducing the time interval for patient referral to an expert center according to the initial clinical characteristics of the soft tissue tumor. Methods: From May to December 2021, we extracted tumor mass data for 78 patients discussed by the multidisciplinary tumor boards at 3 centers of the French Sarcoma Group. We applied the Sar'Connect algorithm to these data and estimated the time interval between the first medical description of the soft tissue mass and the referral to expert center. We then compared this estimated time interval with the observed time interval. Results: We found that the use of Sar'Connect could potentially shorten the time interval to an expert center by approximately 7.5 months (P<.001). Moreover, for half (31/60, 52\%) of the patients with a malignant soft tissue tumor, Sar'Connect could have avoided inappropriate management outside of the reference center. We did not identify a significant determinant for shortening the time interval for referral. Conclusions: Overall, promoting the use of a simple mobile app is an innovative and straightforward means to potentially accelerate both the referral and management of patients with soft tissue sarcoma at expert centers. ",
doi="10.2196/40718",
url="https://mhealth.jmir.org/2022/11/e40718",
url="http://www.ncbi.nlm.nih.gov/pubmed/36350680"
}


@Article{info:doi/10.2196/39764,
author="Gudmundsson, Haukur G.
and M{\'e}sz{\'a}ros, Judit
and Bj{\"o}rnsd{\'o}ttir, E. {\'A}g{\'u}sta
and {\'A}mundad{\'o}ttir, L. Mar{\'i}a
and Thorvardardottir, E. Gudrun
and Magnusdottir, Erna
and Helgadottir, Halla
and Oddsson, Saemundur",
title="Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="13",
volume="6",
number="10",
pages="e39764",
keywords="cancer",
keywords="lifestyle",
keywords="quality of life",
keywords="mobile app",
keywords="digital therapeutics",
keywords="self-management",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. Objective: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. Methods: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. Results: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97\% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72\% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72\%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96\%) were still logging their steps, with 19 (68\%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89\%) were likely to recommend the program, 23 (82\%) said the program helped them deal with the disease, and 24 (86\%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50\% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. Conclusions: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention. ",
doi="10.2196/39764",
url="https://formative.jmir.org/2022/10/e39764",
url="http://www.ncbi.nlm.nih.gov/pubmed/36227639"
}


@Article{info:doi/10.2196/34471,
author="Obro, Faurholt Louise
and Osther, Sloth Palle J{\"o}rn
and Ammentorp, Jette
and Pihl, Thybo Gitte
and Heiselberg, Kvols Kasper
and Krogh, Gall Peter
and Handberg, Charlotte",
title="An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients' Experiences and Perspectives",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="8",
volume="6",
number="9",
pages="e34471",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="prostate cancer",
keywords="self-management",
keywords="health coaching",
keywords="coaching",
abstract="Background: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90\% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients' self-management of health behaviors and improve well-being. Objective: This study aims to explore patients' experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. Methods: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. Results: Our analysis suggested that patients' self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients' individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. Conclusions: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness. ",
doi="10.2196/34471",
url="https://formative.jmir.org/2022/9/e34471",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925751"
}


@Article{info:doi/10.2196/38367,
author="Ha, Lauren
and Wakefield, E. Claire
and Mizrahi, David
and Diaz, Claudio
and Cohn, J. Richard
and Signorelli, Christina
and Yacef, Kalina
and Simar, David",
title="A Digital Educational Intervention With Wearable Activity Trackers to Support Health Behaviors Among Childhood Cancer Survivors: Pilot Feasibility and Acceptability Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="17",
volume="8",
number="3",
pages="e38367",
keywords="childhood cancer",
keywords="survivorship",
keywords="physical activity",
keywords="exercise",
keywords="activity tracker",
keywords="eHealth",
keywords="education",
keywords="behavior change",
abstract="Background: Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines. Objective: The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors' physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program. Methods: We recruited survivors aged 8 to 13 years who were ?12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24). Results: In total, 30 participants opted in, of whom 27 (90\%) completed baseline assessments, and 23 (77\%) commenced iBounce. Our opt-in rate was 59\% (30/51), and most (19/23, 83\%) of the survivors completed the intervention. More than half (13/23, 57\%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70\%) and activity tracker compliance (15/19, 79\%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75\%; ease-of-use score 86\%), but lower satisfaction with the activity tracker (median enjoyment score 60\%). Parents reported the program activities to be acceptable (median score 70\%), and their overall satisfaction was 60\%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27\%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56\%) stayed in the same cluster; and 2 (18\%) moved to a less active cluster. The survivors' mean aerobic fitness percentiles increased after completing iBounce (change +17, 95\% CI 1.7-32.1; P=.03) but not at follow-up (P=.39). Conclusions: We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842 ",
doi="10.2196/38367",
url="https://cancer.jmir.org/2022/3/e38367",
url="http://www.ncbi.nlm.nih.gov/pubmed/35976683"
}


@Article{info:doi/10.2196/36316,
author="Schliemann, D{\'e}sir{\'e}e
and Tan, Min Min
and Hoe, Kok Wilfred Mok
and Mohan, Devi
and Taib, Aishah Nur
and Donnelly, Michael
and Su, Tin Tin",
title="mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="15",
volume="24",
number="8",
pages="e36316",
keywords="mobile health",
keywords="mHealth",
keywords="cancer screening",
keywords="scoping review of reviews",
keywords="cancer",
keywords="cancer detection",
keywords="oncology",
keywords="digital health",
keywords="scoping review",
keywords="review",
keywords="mobile phone",
abstract="Background: Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival. Objective: The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening. Methods: The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review. Results: Our initial search identified 1981 titles, of which 12 (0.61\%) reviews met the inclusion criteria (systematic reviews: n=6, 50\%; scoping reviews: n=4, 33\%; rapid reviews: n=1, 8\%; narrative reviews: n=1, 8\%). Most (57/67, 85\%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth. Conclusions: mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective. ",
doi="10.2196/36316",
url="https://www.jmir.org/2022/8/e36316",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969450"
}


@Article{info:doi/10.2196/37368,
author="Lamaj, Ganimete
and Pablo-Trinidad, Alberto
and Butterworth, Ian
and Bell, Nolan
and Benasutti, Ryan
and Bourquard, Aurelien
and Sanchez-Ferro, Alvaro
and Castro-Gonzalez, Carlos
and Jim{\'e}nez-Ubieto, Ana
and Baumann, Tycho
and Rodriguez-Izquierdo, Antonia
and Pottier, Elizabeth
and Shelton, Anthony
and Martinez-Lopez, Joaquin
and Sloan, Mark John",
title="Usability Evaluation of a Noninvasive Neutropenia Screening Device (PointCheck) for Patients Undergoing Cancer Chemotherapy: Mixed Methods Observational Study",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="9",
volume="24",
number="8",
pages="e37368",
keywords="digital health",
keywords="usability",
keywords="patient-centered care",
keywords="remote monitoring",
keywords="decision support systems",
keywords="white blood cells",
keywords="diagnosis",
keywords="medical device",
keywords="cancer",
keywords="chemotherapy",
keywords="infection",
keywords="white blood cell",
keywords="technology",
abstract="Background: Patients with cancer undergoing cytotoxic chemotherapy face an elevated risk of developing serious infection as a consequence of their treatment, which lowers their white blood cell count and, more specifically, their absolute neutrophil count. This condition is known as neutropenia. Neutropenia accompanied by a fever is referred to as febrile neutropenia, a common side effect of chemotherapy with a high mortality rate. The timely detection of severe neutropenia (<500 absolute neutrophil count/$\mu$L) is critical in detecting and managing febrile neutropenia. Current methods rely on blood draws, which limit them to clinical settings and do not allow frequent or portable monitoring. In this study, we demonstrated the usability of PointCheck, a noninvasive device for neutropenia screening, in a simulated home environment without clinical supervision. PointCheck automatically performs microscopy through the skin of the finger to image the blood flowing through superficial microcapillaries and enables the remote monitoring of neutropenia status, without requiring venipuncture. Objective: This study aimed to evaluate the usability of PointCheck, a noninvasive optical technology for screening severe neutropenia, with the goal of identifying potential user interface, functionality, and design issues from the perspective of untrained users. Methods: We conducted a multicenter study using quantitative and qualitative approaches to evaluate the usability of PointCheck across 154 untrained participants. We used a mixed method approach to gather usability data through user testing observations, a short-answer qualitative questionnaire, and a standardized quantitative System Usability Scale (SUS) survey to assess perceived usability and satisfaction. Results: Of the 154 participants, we found that 108 (70.1\%) scored above 80.8 on the SUS across all sites, with a mean SUS score of 86.1 across all sites. Furthermore, the SUS results indicated that, out of the 151 users who completed the SUS survey, 145 (96\%) found that they learned how to use PointCheck very quickly, and 141 (93.4\%) felt very confident when using the device. Conclusions: We have shown that PointCheck, a novel technology for noninvasive, home-based neutropenia detection, can be safely and effectively operated by first-time users. In a simulated home environment, these users found it easy to use, with a mean SUS score of 86.1, indicating an excellent perception of usability and placing this device within the top tenth percentile of systems evaluated for usability by the SUS. Trial Registration: ClinicalTrials.gov NCT04448314; https://clinicaltrials.gov/ct2/show/NCT04448314 (Hospital Universitario 12 de Octubre registration) and NCT04448301; https://clinicaltrials.gov/ct2/show/NCT04448301 (Boston Medical Center registration) ",
doi="10.2196/37368",
url="https://www.jmir.org/2022/8/e37368",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943786"
}


@Article{info:doi/10.2196/37502,
author="Austin, Judith
and Drossaert, C. Constance H.
and van Dijk, Jelle
and Sanderman, Robbert
and B{\o}r{\o}sund, Elin
and Mirkovic, Jelena
and Schotanus-Dijkstra, Marijke
and Peeters, J. Nienke
and Van 't Klooster, R. Jan-Willem J.
and Schroevers, J. Maya
and Bohlmeijer, T. Ernst",
title="Integrating Top-down and Bottom-up Requirements in eHealth Development: The Case of a Mobile Self-compassion Intervention for People With Newly Diagnosed Cancer",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="1",
volume="8",
number="3",
pages="e37502",
keywords="eHealth",
keywords="cancer",
keywords="self-compassion",
keywords="co-design",
keywords="requirements",
keywords="evidence-based",
keywords="mobile phone",
abstract="Background: Psychosocial eHealth interventions for people with cancer are promising in reducing distress; however, their results in terms of effects and adherence rates are quite mixed. Developing interventions with a solid evidence base while still ensuring adaptation to user wishes and needs is recommended to overcome this. As most models of eHealth development are based primarily on examining user experiences (so-called bottom-up requirements), it is not clear how theory and evidence (so-called top-down requirements) may best be integrated into the development process. Objective: This study aims to investigate the integration of top-down and bottom-up requirements in the co-design of eHealth applications by building on the development of a mobile self-compassion intervention for people with newly diagnosed cancer. Methods: Four co-design tasks were formulated at the start of the project and adjusted and evaluated throughout: explore bottom-up experiences, reassess top-down content, incorporate bottom-up and top-down input into concrete features and design, and synergize bottom-up and top-down input into the intervention context. These tasks were executed iteratively during a series of co-design sessions over the course of 2 years, in which 15 people with cancer and 7 nurses (recruited from 2 hospitals) participated. On the basis of the sessions, a list of requirements, a final intervention design, and an evaluation of the co-design process and tasks were yielded. Results: The final list of requirements included intervention content (eg, major topics of compassionate mind training such as psychoeducation about 3 emotion systems and main issues that people with cancer encounter after diagnosis such as regulating information consumption), navigation, visual design, implementation strategies, and persuasive elements. The final intervention, Compas-Y, is a mobile self-compassion training comprising 6 training modules and several supportive functionalities such as a mood tracker and persuasive elements such as push notifications. The 4 co-design tasks helped overcome challenges in the development process such as dealing with conflicting top-down and bottom-up requirements and enabled the integration of all main requirements into the design. Conclusions: This study addressed the necessary integration of top-down and bottom-up requirements into eHealth development by examining a preliminary model of 4 co-design tasks. Broader considerations regarding the design of a mobile intervention based on traditional intervention formats and merging the scientific disciplines of psychology and design research are discussed. ",
doi="10.2196/37502",
url="https://cancer.jmir.org/2022/3/e37502",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916691"
}


@Article{info:doi/10.2196/39007,
author="Huberty, Jennifer
and Bhuiyan, Nishat
and Eckert, Ryan
and Larkey, Linda
and Petrov, Megan
and Todd, Michael
and Mesa, Ruben",
title="Insomnia as an Unmet Need in Patients With Chronic Hematological Cancer: Protocol for a Randomized Controlled Trial Evaluating a Consumer-Based Meditation App for Treatment of Sleep Disturbance",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="1",
volume="11",
number="7",
pages="e39007",
keywords="hematological cancers",
keywords="mobile health",
keywords="mHealth",
keywords="meditation",
keywords="sleep disturbance",
keywords="mobile phone",
abstract="Background: To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population. Objective: This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer. Methods: In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention---the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-$\alpha$, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks. Results: This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame. Conclusions: This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance. Trial Registration: ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991 International Registered Report Identifier (IRRID): PRR1-10.2196/39007 ",
doi="10.2196/39007",
url="https://www.researchprotocols.org/2022/7/e39007",
url="http://www.ncbi.nlm.nih.gov/pubmed/35776489"
}


@Article{info:doi/10.2196/39669,
author="Horgan, Z. Olivia
and Crane, T. Nicole
and Forman, M. Evan
and Milliron, Brandy-Joe
and Simone, L. Nicole
and Zhang, Fengqing
and Butryn, L. Meghan",
title="Optimizing an mHealth Intervention to Change Food Purchasing Behaviors for Cancer Prevention: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="24",
volume="11",
number="6",
pages="e39669",
keywords="mHealth",
keywords="cancer prevention",
keywords="grocery shopping",
keywords="diet",
keywords="eating",
keywords="mobile phone",
abstract="Background: Dietary intake is a powerful modifiable factor that influences cancer risk; however, most US adults do not adhere to dietary guidelines for cancer prevention. One promising pathway for improving dietary adherence is targeting grocery shopping habits. Interventions might facilitate healthy grocery choices, with a combination of mHealth and traditional methods, by promoting the salience of dietary goals while shopping, enhancing motivation to make dietary changes, and increasing household support for healthy food purchasing. Objective: This pilot study will assess feasibility and acceptability of intervention components designed to improve adherence to dietary guidelines for cancer prevention (preliminary aim). The primary aim of the study is to quantify the effect of each intervention component, individually and in combination, on dietary intake (primary aim) and grocery store food purchases (exploratory aim). Mediation analyses will be conducted to understand the mechanisms of action (goal salience, motivation, and household support---secondary aims). The overarching goal is to optimize an mHealth intervention to be tested in a future fully powered clinical trial. Methods: The study enrolled adults (N=62) with low adherence to dietary recommendations for cancer prevention. In a 20-week program, all participants attend a nutrition education workshop and receive weekly educational messages through an app. A factorial design is used to test 4 intervention components: (1) location-triggered messages: educational messages are delivered when arriving at grocery stores; (2) reflections on the benefits of change: content is added to messages to encourage reflection on anticipated benefits of healthy eating, and participants attend an additional workshop session and 3 coach calls on this topic; (3) coach monitoring: food purchases are monitored digitally by a coach who sends personalized weekly app messages and conducts 3 coaching calls that focus on feedback about purchases; and (4) household support: another adult in the household receives messages designed to elicit support for healthy food purchasing, and support is addressed in 3 coach calls and an extra workshop session attended by the index participant and household member. Assessments are completed at weeks 0, 10, and 20 using self-report measures, as well as objective capture of grocery data from the point of purchase using store loyalty accounts. Results: The National Cancer Institute funded this study (R21CA252933) on July 7, 2020. Participant recruitment began in the spring of 2021 and concluded with the successful enrollment of 62 participants. Data collection is expected to be completed in the summer of 2022, and results are expected to be disseminated in the summer of 2023. Conclusions: The results of this study will inform the development of scalable interventions to lower cancer risk via changes in dietary intake. Trial Registration: ClinicalTrials.gov NCT04947150; https://clinicaltrials.gov/ct2/show/NCT04947150 International Registered Report Identifier (IRRID): DERR1-10.2196/39669 ",
doi="10.2196/39669",
url="https://www.researchprotocols.org/2022/6/e39669",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749216"
}


@Article{info:doi/10.2196/33849,
author="Al-Mondhiry, Jafar
and D'Ambruoso, Sarah
and Pietras, Christopher
and Strouse, Thomas
and Benzeevi, Dikla
and Arevian, C. Armen
and Wells, B. Kenneth",
title="Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="23",
volume="6",
number="6",
pages="e33849",
keywords="mobile phone",
keywords="mobile apps",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="palliative care",
keywords="quality of life",
keywords="survivorship",
keywords="patient advocacy",
keywords="oncology",
keywords="patient-reported outcomes",
keywords="PRO",
keywords="community-partnered participatory research",
keywords="CPPR",
abstract="Background: Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation. Objective: This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer. Methods: In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback. Results: Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement. Conclusions: The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation. ",
doi="10.2196/33849",
url="https://formative.jmir.org/2022/6/e33849",
url="http://www.ncbi.nlm.nih.gov/pubmed/35737441"
}


@Article{info:doi/10.2196/30712,
author="Baglione, N. Anna
and Cai, Lihua
and Bahrini, Aram
and Posey, Isabella
and Boukhechba, Mehdi
and Chow, I. Philip",
title="Understanding the Relationship Between Mood Symptoms and Mobile App Engagement Among Patients With Breast Cancer Using Machine Learning: Case Study",
journal="JMIR Med Inform",
year="2022",
month="Jun",
day="2",
volume="10",
number="6",
pages="e30712",
keywords="breast cancer",
keywords="digital intervention",
keywords="mobile intervention",
keywords="mobile health",
keywords="mHealth",
keywords="app engagement",
keywords="user engagement",
keywords="mental health",
keywords="depression",
keywords="anxiety",
abstract="Background: Health interventions delivered via smart devices are increasingly being used to address mental health challenges associated with cancer treatment. Engagement with mobile interventions has been associated with treatment success; however, the relationship between mood and engagement among patients with cancer remains poorly understood. A reason for this is the lack of a data-driven process for analyzing mood and app engagement data for patients with cancer. Objective: This study aimed to provide a step-by-step process for using app engagement metrics to predict continuously assessed mood outcomes in patients with breast cancer. Methods: We described the steps involved in data preprocessing, feature extraction, and data modeling and prediction. We applied this process as a case study to data collected from patients with breast cancer who engaged with a mobile mental health app intervention (IntelliCare) over 7 weeks. We compared engagement patterns over time (eg, frequency and days of use) between participants with high and low anxiety and between participants with high and low depression. We then used a linear mixed model to identify significant effects and evaluate the performance of the random forest and XGBoost classifiers in predicting weekly mood from baseline affect and engagement features. Results: We observed differences in engagement patterns between the participants with high and low levels of anxiety and depression. The linear mixed model results varied by the feature set; these results revealed weak effects for several features of engagement, including duration-based metrics and frequency. The accuracy of predicting depressed mood varied according to the feature set and classifier. The feature set containing survey features and overall app engagement features achieved the best performance (accuracy: 84.6\%; precision: 82.5\%; recall: 64.4\%; F1 score: 67.8\%) when used with a random forest classifier. Conclusions: The results from the case study support the feasibility and potential of our analytic process for understanding the relationship between app engagement and mood outcomes in patients with breast cancer. The ability to leverage both self-report and engagement features to analyze and predict mood during an intervention could be used to enhance decision-making for researchers and clinicians and assist in developing more personalized interventions for patients with breast cancer. ",
doi="10.2196/30712",
url="https://medinform.jmir.org/2022/6/e30712",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653183"
}


@Article{info:doi/10.2196/36654,
author="Mangsbacka, Maria
and Gustavell, Tina",
title="Nurses' Experiences Using an Interactive System to Assess and Manage Treatment-Related Symptoms of Patients With Pancreatic Cancer: Interview Study",
journal="JMIR Nursing",
year="2022",
month="May",
day="16",
volume="5",
number="1",
pages="e36654",
keywords="app",
keywords="health care professionals",
keywords="mobile health",
keywords="mHealth",
keywords="nurses",
keywords="pancreatic cancer",
keywords="person-centered care",
keywords="symptom-management",
keywords="qualitative interview",
keywords="nursing",
keywords="interview",
abstract="Background: Treatment for pancreatic cancer entails symptom distress and a high burden of self-care. Patient-reported outcomes, collected with the support of mobile health (mHealth), have shown positive effects on symptom management, patient satisfaction, and quality of life for patients with cancer. For mHealth tools to become an integral part of clinical routine, experiences from health care professionals are needed. Objective: The aim of this paper is to describe nurses' experiences of integrating an interactive system (Interaktor) for symptom assessment and management into daily practice, when caring for patients following pancreaticoduodenectomy and during chemotherapy treatment due to pancreatic cancer. Methods: Patients reported symptoms via the Interaktor app daily for 6 months. In the event of alarming symptoms, an alert was triggered to the patient's nurse who then called the patient to offer advice and support. All nurses (n=8) who assessed patients were interviewed either individually or in a group. Transcribed interviews were analyzed using qualitative thematic analysis. Results: mHealth can facilitate person-centered care by offering nurses a way to gain knowledge about patients and to build relationships. Further, obstacles to implementation could be seen due to a lack of structural prerequisites and uncertainty about multiple ways to interact with patients. Conclusions: The Interaktor system can provide person-centered care. However, to implement mHealth tools as a clinical routine, focus needs to be placed on creating the necessary organizational conditions. ",
doi="10.2196/36654",
url="https://nursing.jmir.org/2022/1/e36654",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576577"
}


@Article{info:doi/10.2196/33594,
author="Gelgoot, Noah Eden
and Kruglova, Katya
and Chan, Peter
and Lo, Kirk
and Rosberger, Zeev
and Chown, Philippa
and Kazdan, Jordana
and O'Connell, Laura Siobhan Bernadette
and Zelkowitz, Phyllis",
title="Evaluation of a Mobile Health App Offering Fertility Information to Male Patients With Cancer: Usability Study",
journal="JMIR Cancer",
year="2022",
month="May",
day="4",
volume="8",
number="2",
pages="e33594",
keywords="mobile app",
keywords="eHealth",
keywords="male",
keywords="cancer",
keywords="infertility",
keywords="fertility preservation",
keywords="psycho-oncology",
abstract="Background: Cancer and its treatment can adversely affect male fertility. Although sperm banking is an effective fertility preservation method, there is an unmet need for information and support surrounding these issues. Objective: This usability study evaluates a mobile health app providing male patients with cancer with credible information about the impact of cancer and its treatment on fertility and fertility preservation. Methods: Participants were recruited by a market research firm. Eligibility criteria were men who were 18-45 years of age, identified as male, diagnosed with new or recurring cancer within 1 year, not in fertility treatment, able to read and write in English or French, and had internet access. App usage was tracked for 2 weeks. After app use, participants provided qualitative feedback about their experiences using the app as well as quantitative data regarding their sperm banking decisions, perceived change in fertility knowledge, evaluation of the app's information on the Information Assessment Method, and the app's quality on the user version of the Mobile App Rating Scale. Results: The sample included 40 men aged 27-45 years. Approximately 68\% (27/40) indicated that no one had previously spoken to them about the impact of cancer on fertility, and 85\% (34/40) had not received information on fertility preservation. Approximately 83\% (33/40) found the app's information relevant, and 85\% (34/40) said that it increased their fertility knowledge. Approximately 23\% (9/40) made a decision about sperm banking after using the app. Participants rated the app's quality highly, with mean scores (out of 5) of 4.14 for information, 4.06 for functionality, 3.84 for aesthetics, and 3.63 for engagement. Conclusions: The app proved to be useful for male patients with cancer, suggesting that mobile health resources could be beneficial to incorporate into clinical care to enable shared decision-making about fertility. ",
doi="10.2196/33594",
url="https://cancer.jmir.org/2022/2/e33594",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507408"
}


@Article{info:doi/10.2196/36788,
author="Yazdanian, Azade
and Mehdizadeh, Hamed
and Balaghafari, Azita
and Kahouei, Mahdi
and Masoudinezhad, Maede",
title="Mobile-Based Self-management Application Requirements for Patients With Gastric Cancer: Quantitative Descriptive Study of Specialist and Patient Perspectives",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="27",
volume="8",
number="2",
pages="e36788",
keywords="digital health, eHealth",
keywords="telehealth",
keywords="mHealth",
keywords="mobile app",
keywords="self-management",
keywords="patient education",
keywords="needs assessment, requirements analysis, stomach neoplasm, gastric cancer",
abstract="Background: Gastric cancer is one of the most common gastrointestinal cancers. Patients with gastric cancer experience disabilities and complications that lead to reduced quality of life. Empowering these patients by providing them with information and self-management skills can help reduce side effects and improve their quality of life. Objective: The aim of this study was to identify the user requirements for developing a mobile-based self-management app to support patients with gastric cancer. Methods: Data were analyzed using descriptive statistics and frequency distribution reports using IBM SPSS Statistics software. Results: All of the data elements and functional requirements except ``data recording times'' and ``weight changes in graphs'' were identified as essential by clinical experts and patients. Among the functional requirements required in a gastric cancer self-management app, the capabilities related to informing, announcing warnings, and reminders are included. In the demographic data section, most patients (14/26, 53\%) did not comment on the importance of recording data such as name, surname, and place of residence, and the demographic data section was met with less agreement from patients than clinicians. Conclusions: Applying the requirements mentioned in this study can improve the self-management of patients with gastric cancer. Such apps can play an important role in empowering patients and improving their quality of life. However, the apps need to be designed and implemented to see how they can meet users' requirements. ",
doi="10.2196/36788",
url="https://cancer.jmir.org/2022/2/e36788",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475920"
}


@Article{info:doi/10.2196/36721,
author="Mehdizadeh, Hamed
and Asadi, Farkhondeh
and Emami, Hassan
and Mehrvar, Azim
and Nazemi, Eslam",
title="An mHealth Self-management System for Support Children With Acute Lymphocytic Leukemia and Their Caregivers: Qualitative Co-design Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="15",
volume="6",
number="4",
pages="e36721",
keywords="digital health",
keywords="eHealth",
keywords="mHealth",
keywords="mobile app",
keywords="smartphone",
keywords="mobile phone",
keywords="self-management",
keywords="patient education",
keywords="children",
keywords="caregivers",
keywords="acute lymphocytic leukemia",
keywords="user-centered design",
abstract="Background: The unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country). Objective: This study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers. Methods: This study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK's Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version. Results: A total of 35 people (n=24, 69\% parents and n=11, 31\% children) volunteered to participate in the study. However, only 63\% (15/24) of parents and 73\% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users' symptoms and answer their questions. Conclusions: The CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies. ",
doi="10.2196/36721",
url="https://formative.jmir.org/2022/4/e36721",
url="http://www.ncbi.nlm.nih.gov/pubmed/35228195"
}


@Article{info:doi/10.2196/29492,
author="Aronoff-Spencer, Eliah
and McComsey, Melanie
and Chih, Ming-Yuan
and Hubenko, Alexandra
and Baker, Corey
and Kim, John
and Ahern, K. David
and Gibbons, Christopher Michael
and Cafazzo, A. Joseph
and Nyakairu, Pia
and Vanderpool, C. Robin
and Mullett, W. Timothy
and Hesse, W. Bradford",
title="Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="12",
volume="24",
number="4",
pages="e29492",
keywords="cancer care",
keywords="distress screening",
keywords="human-centered design",
keywords="participatory design",
keywords="Appalachia",
keywords="mobile phone",
abstract="Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=--0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. ",
doi="10.2196/29492",
url="https://www.jmir.org/2022/4/e29492",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412457"
}


@Article{info:doi/10.2196/33152,
author="Mueller, L. Emily
and Cochrane, R. Anneli
and Campbell, E. Madison
and Nikkhah, Sarah
and Miller, D. Andrew",
title="An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="16",
volume="8",
number="1",
pages="e33152",
keywords="child",
keywords="adolescent",
keywords="oncology",
keywords="supportive care",
keywords="mHealth",
keywords="mobile health",
keywords="cancer",
keywords="pediatrics",
keywords="children",
keywords="digital health",
keywords="health applications",
keywords="parent",
keywords="caregiver",
abstract="Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50\%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95\% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. ",
doi="10.2196/33152",
url="https://cancer.jmir.org/2022/1/e33152",
url="http://www.ncbi.nlm.nih.gov/pubmed/35293867"
}


@Article{info:doi/10.2196/35768,
author="Ma, Zhuo
and Huang, Sijia
and Wu, Xiaoqing
and Huang, Yinying
and Chan, Wai-Chi Sally
and Lin, Yilan
and Zheng, Xujuan
and Zhu, Jiemin",
title="Development of a Prognostic App (iCanPredict) to Predict Survival for Chinese Women With Breast Cancer: Retrospective Study",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="9",
volume="24",
number="3",
pages="e35768",
keywords="app",
keywords="breast cancer",
keywords="survival prediction model",
keywords="iCanPredict",
abstract="Background: Accurate prediction of survival is crucial for both physicians and women with breast cancer to enable clinical decision making on appropriate treatments. The currently available survival prediction tools were developed based on demographic and clinical data obtained from specific populations and may underestimate or overestimate the survival of women with breast cancer in China. Objective: This study aims to develop and validate a prognostic app to predict the overall survival of women with breast cancer in China. Methods: Nine-year (January 2009-December 2017) clinical data of women with breast cancer who received surgery and adjuvant therapy from 2 hospitals in Xiamen were collected and matched against the death data from the Xiamen Center of Disease Control and Prevention. All samples were randomly divided (7:3 ratio) into a training set for model construction and a test set for model external validation. Multivariable Cox regression analysis was used to construct a survival prediction model. The model performance was evaluated by receiver operating characteristic (ROC) curve and Brier score. Finally, by running the survival prediction model in the app background thread, the prognostic app, called iCanPredict, was developed for women with breast cancer in China. Results: A total of 1592 samples were included for data analysis. The training set comprised 1114 individuals and the test set comprised 478 individuals. Age at diagnosis, clinical stage, molecular classification, operative type, axillary lymph node dissection, chemotherapy, and endocrine therapy were incorporated into the model, where age at diagnosis (hazard ratio [HR] 1.031, 95\% CI 1.011-1.051; P=.002), clinical stage (HR 3.044, 95\% CI 2.347-3.928; P<.001), and endocrine therapy (HR 0.592, 95\% CI 0.384-0.914; P=.02) significantly influenced the survival of women with breast cancer. The operative type (P=.81) and the other 4 variables (molecular classification [P=.91], breast reconstruction [P=.36], axillary lymph node dissection [P=.32], and chemotherapy [P=.84]) were not significant. The ROC curve of the training set showed that the model exhibited good discrimination for predicting 1- (area under the curve [AUC] 0.802, 95\% CI 0.713-0.892), 5- (AUC 0.813, 95\% CI 0.760-0.865), and 10-year (AUC 0.740, 95\% CI 0.672-0.808) overall survival. The Brier scores at 1, 5, and 10 years after diagnosis were 0.005, 0.055, and 0.103 in the training set, respectively, and were less than 0.25, indicating good predictive ability. The test set externally validated model discrimination and calibration. In the iCanPredict app, when physicians or women input women's clinical information and their choice of surgery and adjuvant therapy, the corresponding 10-year survival prediction will be presented. Conclusions: This survival prediction model provided good model discrimination and calibration. iCanPredict is the first tool of its kind in China to provide survival predictions to women with breast cancer. iCanPredict will increase women's awareness of the similar survival rate of different surgeries and the importance of adherence to endocrine therapy, ultimately helping women to make informed decisions regarding treatment for breast cancer. ",
doi="10.2196/35768",
url="https://www.jmir.org/2022/3/e35768",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262503"
}


@Article{info:doi/10.2196/29124,
author="Hibler, A. Elizabeth
and Fought, J. Angela
and Kershaw, N. Kiarri
and Molsberry, Rebecca
and Nowakowski, Virginia
and Lindner, Deborah",
title="Novel Interactive Tool for Breast and Ovarian Cancer Risk Assessment (Bright Pink Assess Your Risk): Development and Usability Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="24",
volume="24",
number="2",
pages="e29124",
keywords="breast cancer",
keywords="ovarian cancer",
keywords="risk assessment",
keywords="genetic testing",
abstract="Background: The lifetime risk of breast and ovarian cancer is significantly higher among women with genetic susceptibility or a strong family history. However, current risk assessment tools and clinical practices may identify only 10\% of asymptomatic carriers of susceptibility genes. Bright Pink developed the Assess Your Risk (AYR) tool to estimate breast and ovarian cancer risk through a user-friendly, informative web-based quiz for risk assessment at the population level. Objective: This study aims to present the AYR tool, describe AYR users, and present evidence that AYR works as expected by comparing classification using the AYR tool with gold standard genetic testing guidelines. Methods: The AYR is a recently developed population-level risk assessment tool that includes 26 questions based on the National Comprehensive Cancer Network (NCCN) guidelines and factors from other commonly used risk assessment tools. We included all women who completed the AYR between November 2018 and January 2019, with the exception of self-reported cancer or no knowledge of family history. We compared AYR classifications with those that were independently created using NCCN criteria using measures of validity and the McNemar test. Results: There were 143,657 AYR completions, and most participants were either at increased or average risk for breast cancer or ovarian cancer (137,315/143,657, 95.59\%). Using our estimates of increased and average risk as the gold standard, based on the NCCN guidelines, we estimated the sensitivity and specificity for the AYR algorithm--generated risk categories as 100\% and 89.9\%, respectively (P<.001). The specificity improved when we considered the additional questions asked by the AYR to define increased risk, which were not examined by the NCCN criteria. By race, ethnicity, and age group; we found that the lowest observed specificity was for the Asian race (85.9\%) and the 30 to 39 years age group (87.6\%) for the AYR-generated categories compared with the NCCN criteria. Conclusions: These results demonstrate that Bright Pink's AYR is an accurate tool for use by the general population to identify women at increased risk of breast and ovarian cancer. We plan to validate the tool longitudinally in future studies, including the impact of race, ethnicity, and age on breast and ovarian cancer risk assessment. ",
doi="10.2196/29124",
url="https://www.jmir.org/2022/2/e29124",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200148"
}


@Article{info:doi/10.2196/30340,
author="Becker, RB Elisabeth
and Shegog, Ross
and Savas, S. Lara
and Frost, L. Erica
and Coan, P. Sharon
and Healy, Mary C.
and Spinner, W. Stanley
and Vernon, W. Sally",
title="Parents' Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="21",
volume="5",
number="1",
pages="e30340",
keywords="human papillomavirus",
keywords="vaccination",
keywords="user experience",
keywords="parent",
keywords="mHealth",
keywords="HPV",
keywords="vaccine",
keywords="HPV vaccine",
keywords="parenting",
keywords="pediatrics",
keywords="sexual health",
keywords="cervical cancer",
keywords="adolescents",
keywords="app",
keywords="application",
abstract="Background: Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. Objective: We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. Methods: Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. Results: The 98 parents were mainly female (n=94, 96\%), 41 (5.67) years of age, college educated (n=55, 56\%), and White and non-Hispanic (n=55, 56\%) and had private health insurance for their children (n=75, 77\%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47\%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17\%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88\%), knowledge (84/95, 88\%), and HPV vaccination intentions (64/95, 67\%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73\%-94\%]). Parents also agreed that HPVCF is clear (86/95, 91\%), accurate (86/95, 91\%), and more helpful than other HPV vaccine information they had received (89/95, 94\%) and that they would recommend it to others (81/95, 85\%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. Conclusions: HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education. ",
doi="10.2196/30340",
url="https://pediatrics.jmir.org/2022/1/e30340",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188469"
}


@Article{info:doi/10.2196/16128,
author="Graf, Joachim
and Sickenberger, Nina
and Brusniak, Katharina
and Matthies, Maria Lina
and Deutsch, M. Thomas
and Simoes, Elisabeth
and Plappert, Claudia
and Keilmann, Lucia
and Hartkopf, Andreas
and Walter, Barbara Christina
and Hahn, Markus
and Engler, Tobias
and Wallwiener, Stephanie
and Schuetz, Florian
and Fasching, A. Peter
and Schneeweiss, Andreas
and Brucker, Yvonne Sara
and Wallwiener, Markus",
title="Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="8",
volume="24",
number="2",
pages="e16128",
keywords="eHealth",
keywords="electronic patient-reported outcomes",
keywords="evaluation",
keywords="acceptability",
keywords="breast cancer",
abstract="Background: One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective: The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods: Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results: Patients regarded the ePRO assessment as more suitable (80/106, 75.5\%), less stressful (73/106, 68.9\%), and less difficult (69/106, 65.1\%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1\%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app's evaluation parameters. Conclusions: The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills. ",
doi="10.2196/16128",
url="https://www.jmir.org/2022/2/e16128",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133288"
}


@Article{info:doi/10.2196/29485,
author="Fu, Rosemary Mei
and Axelrod, Deborah
and Guth, A. Amber
and Scagliola, Joan
and Rampertaap, Kavita
and El-Shammaa, Nardin
and Qiu, M. Jeanna
and McTernan, L. Melissa
and Frye, Laura
and Park, S. Christopher
and Yu, Gary
and Tilley, Charles
and Wang, Yao",
title="A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="17",
volume="8",
number="1",
pages="e29485",
keywords="pain",
keywords="lymphatic exercises",
keywords="symptoms",
keywords="lymphedema",
keywords="breast cancer",
keywords="health behavior",
keywords="mHealth",
abstract="Background: The-Optimal-Lymph-Flow (TOLF) is a patient-centered, web- and mobile-based mHealth system that delivers safe, easy, and feasible digital therapy of lymphatic exercises and limb mobility exercises. Objective: The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web- and mobile-based TOLF system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference measured by infrared perometer, BMI, and quality of life (QOL) related to pain. We hypothesized that participants in the intervention group would have improved pain and symptom experiences, limb volume difference, BMI, and QOL. Methods: A parallel RCT with a control--experimental, pre- and posttest, and repeated-measures design were used. A total of 120 patients were recruited face-to-face at the point of care during clinical visits. Patients were randomized according to pain in a 1:1 ratio into either the arm precaution (AP) control group to improve limb mobility and arm protection or The-Optimal-Lymph flow (TOLF) intervention group to promote lymph flow and limb mobility. Trial outcomes were evaluated at baseline and at week 12 after the intervention. Descriptive statistics, Fisher exact tests, Wilcoxon rank-sum tests, t test, and generalized linear mixed effects models were performed for data analysis. Results: At the study endpoint of 12 weeks, significantly fewer patients in the TOLF intervention group compared with the AP control group reported chronic pain (45\% [27/60] vs 70\% [42/60]; odds ratio [OR] 0.39, 95\% CI 0.17-0.90; P=.02). Patients who received the TOLF intervention were significantly more likely to achieve a complete reduction in pain (50\% [23/46] vs 22\% [11/51]; OR 3.56, 95\% CI 1.39-9.76; P=.005) and soreness (43\% [21/49] vs 22\% [11/51]; OR 2.60, 95\% CI 1.03-6.81; P=.03). Significantly lower median severity scores were found in the TOLF group for chronic pain (MedTOLF=0, IQR 0-1 vs MedAP=1, IQR 0-2; P=.02) and general bodily pain (MedTOLF=1, IQR=0-1.5 vs MedAP=1, IQR 1-3; P=.04). Compared with the AP control group, significantly fewer patients in the TOLF group reported arm/hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited movement in shoulder (P=.02) and arm (P=.03). No significant differences between the TOLF and AP groups were found in complete reduction of aching (P=.12) and tenderness (P=.65), mean numbers of lymphedema symptom reported (P=.11), ?5\% limb volume differences (P=.48), and BMI (P=.12). Conclusions: The TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, arm/hand swelling, heaviness, and impaired limb mobility. The intervention resulted in a 13\% reduction (from 40\% [24/60] to 27\% [16/60]) in proportions of patients who took pain medications compared with the AP control group, which had a 5\% increase (from 40\% [24/60] to 45\% [27/60]). A 12\% reduction (from 27\% [16/60] to 15\% [9/60]) in proportions of patients with ?5\% limb volume differences was found in the TOLF intervention, while a 5\% increase in the AP control group (from 40\% [24/60] to 45\% [27/60]) was found. In conclusion, the TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. Trial Registration: Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5104 ",
doi="10.2196/29485",
url="https://cancer.jmir.org/2022/1/e29485",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037883"
}


@Article{info:doi/10.2196/32458,
author="Huberty, Jennifer
and Bhuiyan, Nishat
and Neher, Taylor
and Joeman, Lynda
and Mesa, Ruben
and Larkey, Linda",
title="Leveraging a Consumer-Based Product to Develop a Cancer-Specific Mobile Meditation App: Prototype Development Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="14",
volume="6",
number="1",
pages="e32458",
keywords="cancer patients/survivors",
keywords="meditation",
keywords="mHealth",
keywords="app development",
keywords="qualitative research",
abstract="Background: Mobile meditation apps may offer a long-term, accessible, and effective solution for ongoing symptom management in cancer patients/survivors. However, there are currently no commercial cancer-specific meditation apps that reflect cancer specialist expertise, input from cancer patients/survivors, and features and content specific to cancer patients'/survivors' needs. Objective: The aim of this study was to gain insight (via surveys, daily journals, and focus groups) from cancer patients/survivors, health care providers, and current subscribers of Calm (a consumer-based mobile meditation app) who were patients/survivors to develop a prototype of a mobile meditation app specifically designed for cancer patients/survivors. Methods: Participants were recruited via prior partnerships, word-of-mouth referrals, and recruitment posts on Facebook and Instagram. Cancer patients/survivors and health care providers were instructed to download and use the Calm app for at least 10 minutes a day for 7 days, complete an online daily journal for 7 days, and participate in a virtual focus group (one for cancer patients/survivors and one for providers). Current Calm subscribers who were cancer patients/survivors completed an online survey about different aspects of the Calm app and participated in a third virtual focus group. Data were qualitatively analyzed using a combination of deductive and inductive coding. Results: A total of 27 participants (11 cancer patients/survivors, 10 health care providers, 6 current Calm subscribers) completed the study. Similar themes and subthemes were found across surveys, daily journals, and focus groups, and fell into two major categories, content and functionality, with cancer-specific and noncancer-specific themes identified within each category. The majority of content preferences and suggestions that arose were cancer-specific, such as content related to negative emotions or feelings (eg, anxiety, grief, trauma/posttraumatic stress disorder, fear of recurrence, isolation), positive feelings and finding meaning (eg, gratitude, storytelling, acceptance), scenarios and experiences (eg, waiting, treatment-specific mediations), type and stage of cancer journey, and movement modifications. Some of the noncancer-specific themes under app content included sleep, music, and visualizations. In terms of app functionality, the majority of participants expressed interest in having a section/tab/area of the app that was specifically geared toward cancer patients/survivors. Preferences and suggestions for cancer-specific functionality features included options based on symptoms or journey, being able to communicate with other patients or survivors to share suggestions for specific meditations, and having an emergency toolkit for patients/survivors. Conclusions: Findings from cancer patients/survivors, health care providers, and current Calm subscribers who were patients/survivors to be incorporated into the development of the prototype fell into two major categories: (1) content of the app and (2) functionality of the app. The prototype's form and function will be pilot-tested among 30 cancer patients/survivors in a 4-week study, and the resulting feasibility data will be used to inform the final app design and an efficacy study. ",
doi="10.2196/32458",
url="https://formative.jmir.org/2022/1/e32458",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029528"
}


@Article{info:doi/10.2196/18083,
author="Ayyoubzadeh, Mohammad Seyed
and Shirkhoda, Mohammad
and R Niakan Kalhori, Sharareh
and Mohammadzadeh, Niloofar
and Zakerabasali, Somayyeh",
title="A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="5",
volume="8",
number="1",
pages="e18083",
keywords="eHealth",
keywords="app",
keywords="colorectal cancer",
keywords="survivors",
keywords="requirements analysis",
keywords="MoSCoW",
abstract="Background: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. Objective: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors' and clinical experts' views. Methods: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won't have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. Results: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (--0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors' perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. Conclusions: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients' and health care providers' communication and interaction. ",
doi="10.2196/18083",
url="https://cancer.jmir.org/2022/1/e18083",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989685"
}


@Article{info:doi/10.2196/28709,
author="Wilson-Howard, Danyell
and Vilaro, J. Melissa
and Neil, M. Jordan
and Cooks, J. Eric
and Griffin, N. Lauren
and Ashley, T. Taylor
and Tavassoli, Fatemeh
and Zalake, S. Mohan
and Lok, C. Benjamin
and Odedina, T. Folakemi
and Modave, Francois
and Carek, J. Peter
and George, J. Thomas
and Krieger, L. Janice",
title="Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="24",
volume="5",
number="12",
pages="e28709",
keywords="telehealth",
keywords="digital health",
keywords="eHealth",
keywords="colorectal cancer",
keywords="Black men",
keywords="virtual human",
keywords="technology",
keywords="cancer screening",
keywords="app",
keywords="cancer",
keywords="prevention",
keywords="development",
abstract="Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one's home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user's psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established.  The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as ``brother-doctor,'' and participants stated ``wanting to interact with ALEX over their regular doctor.'' Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. ",
doi="10.2196/28709",
url="https://formative.jmir.org/2021/12/e28709",
url="http://www.ncbi.nlm.nih.gov/pubmed/34780346"
}


@Article{info:doi/10.2196/27639,
author="Luo, Yuanhui
and Xia, Wei
and Cheung, Tan Ankie
and Ho, Kwan Laurie Long
and Zhang, Jingping
and Xie, Jianhui
and Xiao, Pin
and Li, William Ho Cheung",
title="Effectiveness of a Mobile Device--Based Resilience Training Program in Reducing Depressive Symptoms and Enhancing Resilience and Quality of Life in Parents of Children With Cancer: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="29",
volume="23",
number="11",
pages="e27639",
keywords="depressive symptoms",
keywords="pediatric cancer",
keywords="parents",
keywords="quality of life",
keywords="resilience",
keywords="mobile phone",
abstract="Background: Caring for children with cancer can be a stressful experience for parents and may have negative effects on their physical and psychological well-being. Although evidence has shown that resilience is associated with positive psychological well-being, few interventions have been specifically designed to enhance the resilience of parents of children with cancer. Objective: The aim of this study is to examine the effectiveness of a mobile device--based resilience training program in reducing depressive symptoms and enhancing resilience and quality of life (QoL) in parents of children with cancer. Methods: Parents of children diagnosed with cancer were recruited from the pediatric oncology wards of 3 tertiary hospitals in China. The participants were randomly assigned to either the experimental group (52/103, 50.5\%) to undergo an 8-week mobile device--based resilience training program or to the control group (51/103, 49.5\%) to receive an 8-week program of placebo information. The study outcomes included resilience, depressive symptoms, and QoL, as measured by the Connor--Davidson Resilience Scale, the Self-Rating Depression Scale, and the Short Form of the 6-Dimension Health Survey, respectively. All data were collected at baseline and at 2 and 6 months of follow-up. The data analysis followed the intention-to-treat principle. A generalized estimating equation was used to examine the effects of the intervention. Results: The participants were mostly female (72/103, 69.9\%), and their mean age was 33.6 (SD 5.2) years. The participants in the experimental group showed significantly higher levels of resilience (mean 67.96, SD 15.8 vs mean 58.27, SD 19.0; P<.001) and lower levels of depressive symptoms (mean 40.17, SD 9.9 vs mean 46.04, SD 10.9; P<.001) than those in the control group at 6 months of follow-up. The intervention showed statistically significant effects in improving resilience ($\beta$=6.082; P=.01) and decreasing depressive symptoms ($\beta$=?2.772; P=.04) relative to the control group. The QoL score in the experimental group was higher than that in the control group at 6 months of follow-up (mean 0.79, SD 0.2 vs mean 0.76, SD 0.3; P=.07); however, no statistically significant intervention effect was detected ($\beta$=.020; P=.38). Conclusions: The mobile device--based resilience training program effectively enhanced resilience and alleviated depressive symptoms in parents of children with cancer. It is highly recommended that health care professionals incorporate this resilience training program when providing psychological care to parents of children with cancer. Trial Registration: Clinical.Trials.gov NCT04038242; http://clinicaltrials.gov/ct2/show/NCT04038242 ",
doi="10.2196/27639",
url="https://www.jmir.org/2021/11/e27639",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847060"
}


@Article{info:doi/10.2196/22931,
author="Ghods, Alireza
and Shahrokni, Armin
and Ghasemzadeh, Hassan
and Cook, Diane",
title="Remote Monitoring of the Performance Status and Burden of Symptoms of Patients With Gastrointestinal Cancer Via a Consumer-Based Activity Tracker: Quantitative Cohort Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="26",
volume="7",
number="4",
pages="e22931",
keywords="step count",
keywords="performance status",
keywords="symptom",
keywords="wearable",
keywords="activity tracker",
keywords="gastrointestinal cancer",
keywords="monitoring",
keywords="cancer",
keywords="gastrointestinal",
keywords="burden",
abstract="Background: The number of older patients with gastrointestinal cancer is increasing due to an aging global population. Minimizing reliance on an in-clinic patient performance status test to determine a patient's prognosis and course of treatment can improve resource utilization. Further, current performance status measurements cannot capture patients' constant changes. These measurements also rely on self-reports, which are subjective and subject to bias. Real-time monitoring of patients' activities may allow for a more accurate assessment of patients' performance status while minimizing resource utilization. Objective: This study investigates the validity of consumer-based activity trackers for monitoring the performance status of patients with gastrointestinal cancer. Methods: A total of 27 consenting patients (63\% male, median age 58 years) wore a consumer-based activity tracker 7 days before chemotherapy and 14 days after receiving their first treatment. The provider assessed patients using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale and Memorial Symptom Assessment Scale-Short Form (MSAS-SF) before and after chemotherapy visits. The statistical correlations between ECOG-PS and MSAS-SF scores and patients' daily step counts were assessed. Results: The daily step counts yielded the highest correlation with the patients' ECOG-PS scores after chemotherapy (P<.001). The patients with higher ECOG-PS scores experienced a higher fluctuation in their step counts. The patients who walked more prechemotherapy (mean 6071 steps per day) and postchemotherapy (mean 5930 steps per day) had a lower MSAS-SF score (lower burden of symptoms) compared to patients who walked less prechemotherapy (mean 5205 steps per day) and postchemotherapy (mean 4437 steps per day). Conclusions: This study demonstrates the feasibility of using inexpensive, consumer-based activity trackers for the remote monitoring of performance status in the gastrointestinal cancer population. The findings need to be validated in a larger population for generalizability. ",
doi="10.2196/22931",
url="https://cancer.jmir.org/2021/4/e22931",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842527"
}


@Article{info:doi/10.2196/31966,
author="Lo, Jonathon
and Ballurkar, Kieran
and Fox, Simonie
and Tynan, Kate
and Luu, Nghiep
and Boyer, Michael
and Murali-Ganesh, Raghav",
title="A Digital Coaching Intervention for Cancer Survivors With Job Loss: Retrospective Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="23",
volume="7",
number="4",
pages="e31966",
keywords="cancer survivors",
keywords="employment",
keywords="absenteeism",
keywords="mobile app",
keywords="software",
keywords="return to work",
abstract="Background: Returning to work is a key unmet need for working-age cancer survivors. Objective: This study sought to evaluate return-to-work outcomes of a multidisciplinary intervention provided as routine employee support. Methods: In a retrospective cohort analysis, patients with cancer and more than 3 months of absence from work were provided with an intervention consisting of digital resources and calls with a health coach. Propensity score matching was used to define a similar cohort of cancer patients absent from work, who were not offered the coaching intervention. The return-to-work rate as a percentage of all participants and secondary outcomes, such as the rate of death, were measured. The median time to return to work was compared between the cohorts using the Kaplan-Meier method. Results: A total of 220 participants were enrolled in the intervention, of which 125 met the criteria for analysis. The median follow-up from cancer diagnosis was 79 weeks (IQR 60-106 weeks). In the matched control group, 22 (17.6\%) participants returned to work compared with 38 (30.4\%) in the intervention group (P=.02). Additionally, 19 (15.2\%) matched controls died prior to claim closure compared with 13 (10.4\%) in the intervention group (P=.26). The Kaplan-Meier estimated median time for the first 15\% of the cohort to return to work was 87.1 weeks (95\% CI 60.0-109.1 weeks) for the matched control group compared with 70.6 weeks (95\% CI 52.6-79.6 weeks; P=.08) for the intervention group. Conclusions: Patients receiving a remotely delivered coaching program in a real-world setting returned to work at a higher frequency than did control participants receiving usual care. ",
doi="10.2196/31966",
url="https://cancer.jmir.org/2021/4/e31966",
url="http://www.ncbi.nlm.nih.gov/pubmed/34710853"
}


@Article{info:doi/10.2196/22140,
author="Su, Zhaohui
and Li, Xiaoshan
and McDonnell, Dean
and Fernandez, A. Andrea
and Flores, E. Bertha
and Wang, Jing",
title="Technology-Based Interventions for Cancer Caregivers: Concept Analysis",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="16",
volume="7",
number="4",
pages="e22140",
keywords="concept analysis",
keywords="caregivers",
keywords="cancer",
keywords="oncology",
keywords="technology-based interventions",
keywords="mobile phone",
abstract="Background: Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective: This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods: The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results: The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions: This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively. ",
doi="10.2196/22140",
url="https://cancer.jmir.org/2021/4/e22140",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783664"
}


@Article{info:doi/10.2196/24722,
author="Marthick, Michael
and McGregor, Deborah
and Alison, Jennifer
and Cheema, Birinder
and Dhillon, Haryana
and Shaw, Tim",
title="Supportive Care Interventions for People With Cancer Assisted by Digital Technology: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="29",
volume="23",
number="10",
pages="e24722",
keywords="digital health",
keywords="telehealth",
keywords="eHealth",
keywords="neoplasm",
keywords="supportive care",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Although relatively new, digital health interventions are demonstrating rapid growth because of their ability to facilitate access and overcome issues of location, time, health status, and most recently, the impact of a major pandemic. With the increased uptake of digital technologies, digital health has the potential to improve the provision of supportive cancer care. Objective: This systematic review aims to evaluate digital health interventions for supportive cancer care. Methods: Published literature between 2000 and 2020 was systematically searched in MEDLINE, PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and Scopus. Eligible publications were randomized controlled trials of clinician-led digital health interventions to support adult cancer patients. The interventions included were determined by applying a digital health conceptual model. Studies were appraised for quality using the revised Cochrane risk of bias tool. Results: Twenty randomized controlled trials met the inclusion criteria for the analysis. Interventions varied by duration, frequency, degree of technology use, and applied outcome measures. Interventions targeting a single tumor stream, predominantly breast cancer, and studies involving the implementation of remote symptom monitoring have dominated the results. In most studies, digital intervention resulted in significant positive outcomes in patient-reported symptoms, levels of fatigue and pain, health-related quality of life, functional capacity, and depression levels compared with the control. Conclusions: Digital health interventions are helpful and effective for supportive care of patients with cancer. There is a need for high-quality research. Future endeavors could focus on the use of valid, standardized outcome measures, maintenance of methodological rigor, and strategies to improve patient and health professional engagement in the design and delivery of supportive digital health interventions. Trial Registration: PROSPERO CRD42020149730; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=149730 ",
doi="10.2196/24722",
url="https://www.jmir.org/2021/10/e24722",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714246"
}


@Article{info:doi/10.2196/24865,
author="Cruz, da Fl{\'a}via Oliveira de Almeida Marques
and Faria, Tostes Edison
and Ghobad, Cardelino Pabblo
and Alves, Mano Leandro Yukio
and Reis, dos Paula Elaine Diniz",
title="A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="13",
volume="23",
number="10",
pages="e24865",
keywords="mobile applications",
keywords="health education",
keywords="nursing care",
keywords="oncology nursing",
keywords="educational technology",
keywords="breast neoplasms",
keywords="radiation therapy",
abstract="Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80\% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80\%. Conclusions: The mobile app titled ``AMOR Mama'' was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. ",
doi="10.2196/24865",
url="https://www.jmir.org/2021/10/e24865",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643531"
}


@Article{info:doi/10.2196/26545,
author="Weinstein, S. Ronald
and Holcomb, J. Michael
and Mo, Julia
and Yonsetto, Peter
and Bojorquez, Octavio
and Grant, Marcia
and Wendel, S. Christopher
and Tallman, J. Nancy
and Ercolano, Elizabeth
and Cidav, Zuleyha
and Hornbrook, C. Mark
and Sun, Virginia
and McCorkle, Ruth
and Krouse, S. Robert",
title="An Ostomy Self-management Telehealth Intervention for Cancer Survivors: Technology-Related Findings From a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="27",
volume="23",
number="9",
pages="e26545",
keywords="telehealth",
keywords="telemedicine",
keywords="cloud computing",
keywords="ostomy",
keywords="cancer survivors",
keywords="family caregivers",
keywords="self-management",
keywords="patient education",
keywords="videoconferencing",
keywords="mobile phone",
abstract="Background: An Ostomy Self-management Telehealth (OSMT) intervention by nurse educators and peer ostomates can equip new ostomates with critical knowledge regarding ostomy care. A telehealth technology assessment aim was to measure telehealth engineer support requirements for telehealth technology--related (TTR) incidents encountered during OSMT intervention sessions held via a secure cloud-based videoconferencing service, Zoom for Healthcare. Objective: This paper examines technology-related challenges, issues, and opportunities encountered in the use of telehealth in a randomized controlled trial intervention for cancer survivors living with a permanent ostomy. Methods: The Arizona Telemedicine Program provided telehealth engineering support for 105 OSMT sessions, scheduled for 90 to 120 minutes each, over a 2-year period. The OSMT groups included up to 15 participants, comprising 4-6 ostomates, 4-6 peer ostomates, 2 nurse educators, and 1 telehealth engineer. OSMT-session TTR incidents were recorded contemporaneously in detailed notes by the research staff. TTR incidents were categorized and tallied. Results: A total of 97.1\% (102/105) OSMT sessions were completed as scheduled. In total, 3 OSMT sessions were not held owing to non--technology-related reasons. Of the 93 ostomates who participated in OSMT sessions, 80 (86\%) completed their OSMT curriculum. TTR incidents occurred in 36.3\% (37/102) of the completed sessions with varying disruptive impacts. No sessions were canceled or rescheduled because of TTR incidents. Disruptions from TTR incidents were minimized by following the TTR incident prevention and incident response plans. Conclusions: Telehealth videoconferencing technology can enable ostomates to participate in ostomy self-management education by incorporating dedicated telehealth engineering support. Potentially, OSMT greatly expands the availability of ostomy self-management education for new ostomates. Trial Registration: ClinicalTrials.gov NCT02974634; https://clinicaltrials.gov/ct2/show/NCT02974634 ",
doi="10.2196/26545",
url="https://www.jmir.org/2021/9/e26545",
url="http://www.ncbi.nlm.nih.gov/pubmed/34086595"
}


@Article{info:doi/10.2196/27576,
author="Yu, Jing
and Wu, Jiayi
and Huang, Ou
and Chen, Xiaosong
and Shen, Kunwei",
title="A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e27576",
keywords="breast cancer",
keywords="adherence",
keywords="multidisciplinary treatment",
keywords="adjuvant treatment",
keywords="smartphone-based app",
keywords="mobile phone",
abstract="Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28\%), 861 (19.24\%), and 648 (14.48\%) patients, respectively. Overall, 15.53\% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4\% (75/273) in 2013 to 8.8\% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95\% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95\% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95\% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. ",
doi="10.2196/27576",
url="https://www.jmir.org/2021/9/e27576",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528890"
}


@Article{info:doi/10.2196/30549,
author="Denis, Fabrice
and Krakowski, Ivan",
title="How Should Oncologists Choose an Electronic Patient-Reported Outcome System for Remote Monitoring of Patients With Cancer?",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="9",
volume="23",
number="9",
pages="e30549",
keywords="ePRO",
keywords="cancer",
keywords="remote monitoring",
keywords="quality",
keywords="effectiveness",
keywords="security",
keywords="digital monitoring",
keywords="digital health",
keywords="cancer patients",
keywords="patients with cancer",
keywords="oncology",
doi="10.2196/30549",
url="https://www.jmir.org/2021/9/e30549",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499046"
}


@Article{info:doi/10.2196/30430,
author="Bandala-Jacques, Antonio
and Castellanos Esquivel, Daniel Kevin
and P{\'e}rez-Hurtado, Fernanda
and Hern{\'a}ndez-Silva, Cristobal
and Reynoso-Nover{\'o}n, Nancy",
title="Prostate Cancer Risk Calculators for Healthy Populations: Systematic Review",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="3",
volume="7",
number="3",
pages="e30430",
keywords="prostate cancer",
keywords="risk calculator",
keywords="risk reduction",
abstract="Background: Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients' individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources Objective: The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models' overall performance. Methods: We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model's overall accuracy. Results: We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history. Conclusions: Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population's sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented. Trial Registration: PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=242110 ",
doi="10.2196/30430",
url="https://cancer.jmir.org/2021/3/e30430",
url="http://www.ncbi.nlm.nih.gov/pubmed/34477564"
}


@Article{info:doi/10.2196/21088,
author="Keum, Jiyoung
and Chung, Jae Moon
and Kim, Youngin
and Ko, Hyunyoung
and Sung, Je Min
and Jo, Hyun Jung
and Park, Youp Jeong
and Bang, Seungmin
and Park, Woo Seung
and Song, Young Si
and Lee, Seung Hee",
title="Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="31",
volume="9",
number="8",
pages="e21088",
keywords="pancreatic ductal adenocarcinoma",
keywords="mobile app",
keywords="nutritional support",
keywords="quality of life",
keywords="chemotherapy",
abstract="Background: Approximately 80\% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective: We aimed to evaluate the efficacy of a mobile app--based program, Noom, in patients receiving chemotherapy for PDAC. Methods: We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results: Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08{\textpm}12.27 cm2/m2 to 46.08{\textpm}10.55 cm2/m2; non-Noom users, 50.60{\textpm}9.05 cm2/m2 to 42.97{\textpm}8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96\% vs. -3.27\%; P=.11). Conclusions: This pilot study demonstrates that a mobile app--based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration: ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495. ",
doi="10.2196/21088",
url="https://mhealth.jmir.org/2021/8/e21088",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463630"
}


@Article{info:doi/10.2196/28695,
author="Yang, Kyungmi
and Oh, Dongryul
and Noh, Myoung Jae
and Yoon, Gyul Han
and Sun, Jong-Mu
and Kim, Kwan Hong
and Zo, Ill Jae
and Shim, Mog Young
and Ko, Hyunyoung
and Lee, Jungeun
and Kim, Youngin",
title="Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e28695",
keywords="esophageal cancer",
keywords="malnutrition",
keywords="muscle loss",
keywords="sarcopenia",
keywords="mobile app",
keywords="mHealth",
abstract="Background: Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective: In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods: Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results: Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70\% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (--6.7 vs --9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (?SMI/50 days >10\%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions: For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition. ",
doi="10.2196/28695",
url="https://www.jmir.org/2021/8/e28695",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448714"
}


@Article{info:doi/10.2196/27824,
author="van de Water, F. Lo{\"i}s
and van den Boorn, G. H{\'e}ctor
and Hoxha, Florian
and Henselmans, Inge
and Calff, M. Mart
and Sprangers, G. Mirjam A.
and Abu-Hanna, Ameen
and Smets, A. Ellen M.
and van Laarhoven, M. Hanneke W.",
title="Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e27824",
keywords="prediction tool",
keywords="communication skills training",
keywords="shared decision-making",
keywords="risk communication",
keywords="treatment outcomes",
keywords="esophageal cancer",
keywords="gastric cancer",
keywords="patient-physician communication",
abstract="Background: Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. Objective: This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. Methods: We designed a web-based, physician-assisted prediction tool---Source---to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds---a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. Results: The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. Conclusions: The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making. ",
doi="10.2196/27824",
url="https://www.jmir.org/2021/8/e27824",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448703"
}


@Article{info:doi/10.2196/22909,
author="Haggenm{\"u}ller, Sarah
and Krieghoff-Henning, Eva
and Jutzi, Tanja
and Trapp, Nicole
and Kiehl, Lennard
and Utikal, Sven Jochen
and Fabian, Sascha
and Brinker, Josef Titus",
title="Digital Natives' Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="27",
volume="9",
number="8",
pages="e22909",
keywords="artificial intelligence",
keywords="skin cancer",
keywords="skin cancer screening",
keywords="diagnostics",
keywords="digital natives",
keywords="acceptance",
keywords="concerns",
keywords="preferences",
keywords="online survey",
abstract="Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels---Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants' attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants' preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5\%, 484/728; 95\% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ?65\%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants' demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. ",
doi="10.2196/22909",
url="https://mhealth.jmir.org/2021/8/e22909",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448722"
}


@Article{info:doi/10.2196/26703,
author="van der Zander, W. Quirine E.
and Reumkens, Ankie
and van de Valk, Bas
and Winkens, Bjorn
and Masclee, M. Ad A.
and de Ridder, J. Rogier J.",
title="Effects of a Personalized Smartphone App on Bowel Preparation Quality: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="19",
volume="9",
number="8",
pages="e26703",
keywords="colonoscopy",
keywords="laxatives",
keywords="bowel preparation",
keywords="smartphone application",
keywords="smartphone",
keywords="patient satisfaction",
keywords="randomized controlled trial",
keywords="mobile phone",
keywords="mHealth",
abstract="Background: Adequate bowel preparation is essential for the visualization of the colonic mucosa during colonoscopy. However, the rate of inadequate bowel preparation is still high, ranging from 18\% to 35\%; this may lead to a higher risk of missing clinically relevant lesions, procedural difficulties, prolonged procedural time, an increased number of interval colorectal carcinomas, and additional health care costs. Objective: The aims of this study are to compare bowel preparation instructions provided via a personalized smartphone app (Prepit, Ferring B V) with regular written instructions for bowel preparation to improve bowel preparation quality and to evaluate patient satisfaction with the bowel preparation procedure. Methods: Eligible patients scheduled for an outpatient colonoscopy were randomized to a smartphone app group or a control group. Both the groups received identical face-to-face education from a research physician, including instructions about the colonoscopy procedure, diet restrictions, and laxative intake. In addition, the control group received written information, whereas the smartphone app group was instructed to use the smartphone app instead of the written information for the actual steps of the bowel preparation schedule. All patients used bisacodyl and sodium picosulfate with magnesium citrate as laxatives. The quality of bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) by blinded endoscopists. Patient satisfaction was measured using the Patient Satisfaction Questionnaire-18. Results: A total of 87 patients were included in the smartphone app group and 86 in the control group. The mean total BBPS score was significantly higher in the smartphone app group (mean 8.3, SD 0.9) than in the control group (mean 7.9, SD 1.2; P=.03). The right colon showed a significantly higher bowel preparation score in the smartphone app group (mean 2.7, SD 0.5 vs mean 2.5, SD 0.6; P=.04). No significant differences were observed in segment scores for the mean transverse colon (mean 2.8, SD 0.4 vs mean 2.8, SD 0.4; P=.34) and left colon (mean 2.8, SD 0.4 vs mean 2.6, SD 0.5; P=.07). General patient satisfaction was high for the smartphone app group (mean 4.4, SD 0.7) but showed no significant difference when compared with the control group (mean 4.3, SD 0.8; P=.32). Conclusions: Our personalized smartphone app significantly improved bowel preparation quality compared with regular written instructions for bowel preparation. In particular, in the right colon, the BBPS score improved, which is of clinical relevance because the right colon is considered more difficult to clean and the polyp detection rate in the right colon improves with improvement of bowel cleansing of the right colon. No further improvement in patient satisfaction was observed compared with patients receiving regular written instructions. Trial Registration: ClinicalTrials.gov NCT03677050; https://clinicaltrials.gov/ct2/show/NCT03677050 ",
doi="10.2196/26703",
url="https://mhealth.jmir.org/2021/8/e26703",
url="http://www.ncbi.nlm.nih.gov/pubmed/34420924"
}


@Article{info:doi/10.2196/24555,
author="Zhang, Lu
and McLeod, L. Howard
and Liu, Ke-Ke
and Liu, Wen-Hui
and Huang, Hang-Xing
and Huang, Ya-Min
and Sun, Shu-Sen
and Chen, Xiao-Ping
and Chen, Yao
and Liu, Fang-Zhou
and Xiao, Jian",
title="Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="16",
volume="9",
number="8",
pages="e24555",
keywords="cancer pain",
keywords="self-management",
keywords="ambulatory setting",
keywords="digital health",
keywords="physician-pharmacist",
abstract="Background: Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective: We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods: Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results: A total of 100 patients were included, with 51 (51\%) in the intervention group and 49 (49\%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43\% to 63\% in the intervention group, compared with an increase of 33\% to 51\% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions: The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901 ",
doi="10.2196/24555",
url="https://mhealth.jmir.org/2021/8/e24555",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398796"
}


@Article{info:doi/10.2196/22583,
author="Habgood, Emily
and McCormack, Christopher
and Walter, M. Fiona
and Emery, D. Jon",
title="Patients' Experiences of Using Skin Self-monitoring Apps With People at Higher Risk of Melanoma: Qualitative Study",
journal="JMIR Dermatol",
year="2021",
month="Aug",
day="13",
volume="4",
number="2",
pages="e22583",
keywords="melanoma",
keywords="skin cancer",
keywords="early detection",
keywords="mobile apps",
keywords="qualitative",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Melanoma is the fourth most commonly diagnosed cancer in Australia. Up to 75\% of melanomas are first detected by patients or their family or friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients' views and experiences of using these apps. Objective: This study aims to understand patients' views and experiences of using commercially available melanoma skin self-monitoring mobile apps for a period of 3 months. Methods: This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and secondary care (where patients had a previous diagnosis of melanoma, stages T0-T3a). Participants downloaded 2 of the 4 mobile apps for skin self-monitoring (SkinVision, UMSkinCheck, Mole Monitor, or MySkinPal) and were encouraged to use them for 3 months. After 3 months, a semistructured interview was conducted with participants to discuss their experiences of using the skin self-monitoring mobile apps. Results: A total of 54 participants were recruited in the study, with 37\% (20) of participants from primary care and 62\% (34) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants did not use the apps at all (n=12) or tried them once but did not continue (n=14). Only 8 participants used the apps to assist with skin self-monitoring for the entire duration of the study. Patients discussed the apps in the context of the importance of early detection and their current skin self-monitoring behaviors. A range of features of perceived quality of each app affected engagement to support skin self-monitoring. Participants described their skin self-monitoring routines and potential mismatches with the app reminders. They also described the technical and practical difficulties experienced when using the apps for skin self-monitoring. The app's positioning within existing relationships with health care providers was crucial to understand the use of the apps. Conclusions: This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support skin self-monitoring. The results highlight the wide-ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about skin self-monitoring routines and relationships with health care providers. ",
doi="10.2196/22583",
url="https://derma.jmir.org/2021/2/e22583",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632821"
}


@Article{info:doi/10.2196/22608,
author="Oakley-Girvan, Ingrid
and Davis, Watkins Sharon
and Kurian, Allison
and Rosas, G. Lisa
and Daniels, Jena
and Palesh, Gronskaya Oxana
and Mesia, J. Rachel
and Kamal, H. Arif
and Longmire, Michelle
and Divi, Vasu",
title="Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="13",
volume="5",
number="8",
pages="e22608",
keywords="cancer",
keywords="oncology",
keywords="mHealth",
keywords="caregiver",
keywords="cancer survivor",
keywords="mobile app",
keywords="smartphone",
keywords="feasibility",
keywords="caregiver burden",
keywords="symptom reporting",
abstract="Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 ",
doi="10.2196/22608",
url="https://formative.jmir.org/2021/8/e22608",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398787"
}


@Article{info:doi/10.2196/26759,
author="Ruco, Arlinda
and Dossa, Fahima
and Tinmouth, Jill
and Llovet, Diego
and Jacobson, Jenna
and Kishibe, Teruko
and Baxter, Nancy",
title="Social Media and mHealth Technology for Cancer Screening: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="30",
volume="23",
number="7",
pages="e26759",
keywords="social media",
keywords="mHealth",
keywords="cancer screening",
keywords="digital health",
keywords="mass screening",
keywords="mobile phone",
abstract="Background: Cancer is a leading cause of death, and although screening can reduce cancer morbidity and mortality, participation in screening remains suboptimal. Objective: This systematic review and meta-analysis aims to evaluate the effectiveness of social media and mobile health (mHealth) interventions for cancer screening. Methods: We searched for randomized controlled trials and quasi-experimental studies of social media and mHealth interventions promoting cancer screening (breast, cervical, colorectal, lung, and prostate cancers) in adults in MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Communication \& Mass Media Complete from January 1, 2000, to July 17, 2020. Two independent reviewers screened the titles, abstracts, and full-text articles and completed the risk of bias assessments. We pooled odds ratios for screening participation using the Mantel-Haenszel method in a random-effects model. Results: We screened 18,008 records identifying 39 studies (35 mHealth and 4 social media). The types of interventions included peer support (n=1), education or awareness (n=6), reminders (n=13), or mixed (n=19). The overall pooled odds ratio was 1.49 (95\% CI 1.31-1.70), with similar effect sizes across cancer types. Conclusions: Screening programs should consider mHealth interventions because of their promising role in promoting cancer screening participation. Given the limited number of studies identified, further research is needed for social media interventions. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019139615; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=139615 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035411 ",
doi="10.2196/26759",
url="https://www.jmir.org/2021/7/e26759",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328423"
}


@Article{info:doi/10.2196/22510,
author="Resnick, Daniel
and Schapira, M. Marilyn
and Smith, M. Jazmine
and Bautista, Allison
and Xu, Chang
and Jones, Liz
and Aysola, Jaya",
title="Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="14",
volume="5",
number="7",
pages="e22510",
keywords="mHealth",
keywords="cancer prevention",
keywords="goal setting",
keywords="social networks",
keywords="health disparities",
keywords="mobile phone",
abstract="Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app's acceptability by qualitatively analyzing open-ended responses regarding participants' overall experience with the app. We assessed participants' engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76\% (31/41) were women. App use data were captured from all participants, and 83\% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app's ease of use and health behavior--promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76\% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal--setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. ",
doi="10.2196/22510",
url="https://formative.jmir.org/2021/7/e22510",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259162"
}


@Article{info:doi/10.2196/27502,
author="Chen, Ciao-Sin
and Kim, Judith
and Garg, Noemi
and Guntupalli, Harsha
and Jagsi, Reshma
and Griggs, J. Jennifer
and Sabel, Michael
and Dorsch, P. Michael
and Callaghan, C. Brian
and Hertz, L. Daniel",
title="Chemotherapy-Induced Peripheral Neuropathy Detection via a Smartphone App: Cross-sectional Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="5",
volume="9",
number="7",
pages="e27502",
keywords="chemotherapy-induced peripheral neuropathy",
keywords="smartphone",
keywords="mobile health",
keywords="gait",
keywords="balance",
keywords="9-Hole Peg Test",
abstract="Background: Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. Objective: The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy. Methods: A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app. Results: Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ?2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download. Conclusions: Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care. ",
doi="10.2196/27502",
url="https://mhealth.jmir.org/2021/7/e27502",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260403"
}


@Article{info:doi/10.2196/25069,
author="Poort, Hanneke
and Ryan, Annelise
and MacDougall, Katelyn
and Malinowski, Paige
and MacDonald, Anna
and Markin, Zach
and Pirl, William
and Greer, Joseph
and Fasciano, Karen",
title="Feasibility and Acceptability of a Mobile Phone App Intervention for Coping With Cancer as a Young Adult: Pilot Trial and Thematic Analysis",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="11",
volume="23",
number="6",
pages="e25069",
keywords="mobile phone",
keywords="mobile phone application",
keywords="cancer",
keywords="feasibility",
abstract="Background: Many young adult patients do not receive adequate psychosocial services to help them cope with cancer. Objective: This study aims to assess the feasibility and acceptability of a smartphone app (iaya) intervention that was designed to create an engaged community of young adult patients and help them learn emotional coping skills. Methods: For this single-group pilot trial, 25 young adult patients aged 18-39 years who were receiving active cancer treatment were asked to use the iaya app for 12 weeks. To collect app use data, we used Mixpanel, an analytics platform for apps. Feasibility was assessed through rates of app sessions and the number of coping exercises engaged, and intervention acceptability was evaluated by using an app usability questionnaire and through qualitative interviews at study completion. We collected patient-reported outcome data at baseline and at week 12 to explore self-efficacy for coping with cancer, self-efficacy for managing emotions, perceived emotional support, and quality of life. Results: Baseline patient-reported outcome data indicated that participants scored relatively low on perceived emotional support but reasonably high on self-efficacy for coping with cancer and managing emotions as well as quality of life. Participants had a mean of 13 app sessions (SD 14) and 2 coping exercises (SD 3.83) in 12 weeks. Only 9\% (2/23) of participants met our combined feasibility definition of ?10 app sessions and ?3 coping skills from different categories. The participants' mean usability score was 73.7\% (SD 10.84), which exceeded our predefined threshold of ?70\%, and qualitative feedback was generally positive. Conclusions: Although perceived acceptable by patients, the iaya smartphone app did not meet the a priori feasibility criteria as a stand-alone app intervention. Future studies should screen participants for unmet coping needs and consider integrating the app as part of psychosocial care for young adult patients. ",
doi="10.2196/25069",
url="https://www.jmir.org/2021/6/e25069",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114957"
}


@Article{info:doi/10.2196/26264,
author="Kim, Sue
and Aceti, Monica
and Baroutsou, Vasiliki
and B{\"u}rki, Nicole
and Caiata-Zufferey, Maria
and Cattaneo, Marco
and Chappuis, O. Pierre
and Ciorba, M. Florina
and Graffeo-Galbiati, Rossella
and Heinzelmann-Schwarz, Viola
and Jeong, Joon
and Jung, M. MiSook
and Kim, Sung-Won
and Kim, Jisun
and Lim, Cheol Myong
and Ming, Chang
and Monnerat, Christian
and Park, Seok Hyung
and Park, Hyung Sang
and Pedrazzani, A. Carla
and Rabaglio, Manuela
and Ryu, Min Jai
and Saccilotto, Ramon
and Wieser, Simon
and Z{\"u}rrer-H{\"a}rdi, Ursina
and Katapodi, C. Maria",
title="Using a Tailored Digital Health Intervention for Family Communication and Cascade Genetic Testing in Swiss and Korean Families With Hereditary Breast and Ovarian Cancer: Protocol for the DIALOGUE Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="11",
volume="10",
number="6",
pages="e26264",
keywords="HBOC",
keywords="proportion of informed at-risk relatives",
keywords="coping",
keywords="communicating",
keywords="decisional conflict",
keywords="cultural and linguistic adaptation",
keywords="implementation",
keywords="RE-AIM",
keywords="mobile phone",
abstract="Background: In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50\% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. Objective: The aims of this study are to develop the K-CASCADE (Korean--Cancer Predisposition Cascade Genetic Testing) cohort in Korea by expanding an infrastructure developed by the CASCADE (Cancer Predisposition Cascade Genetic Testing) Consortium in Switzerland; develop a digital health intervention to support the communication of cancer predisposition for Swiss and Korean HBOC families, based on linguistic and cultural adaptation of the Family Gene Toolkit; evaluate its efficacy on primary (family communication of genetic results and cascade testing) and secondary (psychological distress, genetic literacy, active coping, and decision making) outcomes; and explore its translatability using the reach, effectiveness, adoption, implementation, and maintenance framework. Methods: The digital health intervention will be available in French, German, Italian, Korean, and English and can be accessed via the web, mobile phone, or tablet (ie, device-agnostic). K-CASCADE cohort of Korean HBOC mutation carriers and relatives will be based on the CASCADE infrastructure. Narrative data collected through individual interviews or mini focus groups from 20 to 24 HBOC family members per linguistic region and 6-10 health care providers involved in genetic services will identify the local cultures and context, and inform the content of the tailored messages. The efficacy of the digital health intervention against a comparison website will be assessed in a randomized trial with 104 HBOC mutation carriers (52 in each study arm). The translatability of the digital health intervention will be assessed using survey data collected from HBOC families and health care providers. Results: Funding was received in October 2019. It is projected that data collection will be completed by January 2023 and results will be published in fall 2023. Conclusions: This study addresses the continuum of translational research, from developing an international research infrastructure and adapting an existing digital health intervention to testing its efficacy in a randomized controlled trial and exploring its translatability using an established framework. Adapting existing interventions, rather than developing new ones, takes advantage of previous valid experiences without duplicating efforts. Culturally sensitive web-based interventions that enhance family communication and understanding of genetic cancer risk are timely. This collaboration creates a research infrastructure between Switzerland and Korea that can be scaled up to cover other hereditary cancer syndromes. Trial Registration: ClinicalTrials.gov NCT04214210; https://clinicaltrials.gov/ct2/show/NCT04214210 and CRiS KCT0005643; https://cris.nih.go.kr/cris/ International Registered Report Identifier (IRRID): PRR1-10.2196/26264 ",
doi="10.2196/26264",
url="https://www.researchprotocols.org/2021/6/e26264",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114954"
}


@Article{info:doi/10.2196/23884,
author="Donevant, Sara
and Heiney, P. Sue
and Wineglass, Cassandra
and Schooley, Benjamin
and Singh, Akanksha
and Sheng, Jingxi",
title="Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="11",
volume="5",
number="6",
pages="e23884",
keywords="mHealth",
keywords="breast cancer survivors",
keywords="medication adherence",
keywords="cultural considerations",
keywords="mobile health applications",
abstract="Background: Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. Objective: The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. Methods: We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. Results: Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. Conclusions: Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy. ",
doi="10.2196/23884",
url="https://formative.jmir.org/2021/6/e23884",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114955"
}


@Article{info:doi/10.2196/23350,
author="Rossman, H. Andrea
and Reid, W. Hadley
and Pieters, M. Michelle
and Mizelle, Cecelia
and von Isenburg, Megan
and Ramanujam, Nimmi
and Huchko, J. Megan
and Vasudevan, Lavanya",
title="Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research",
journal="J Med Internet Res",
year="2021",
month="May",
day="27",
volume="23",
number="5",
pages="e23350",
keywords="cervical cancer",
keywords="digital health",
keywords="mobile phones",
keywords="low- and middle-income countries",
keywords="colposcopy",
keywords="uterine cervical neoplasms",
keywords="telemedicine or mobile apps",
keywords="cell phones",
keywords="developing countries",
abstract="Background: Nearly 90\% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system--level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. Objective: We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. Methods: A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. Results: In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. Conclusions: Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies. ",
doi="10.2196/23350",
url="https://www.jmir.org/2021/5/e23350",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042592"
}


@Article{info:doi/10.2196/19262,
author="Ghanbari, Elaheh
and Yektatalab, Shahrzad
and Mehrabi, Manoosh",
title="Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="18",
volume="9",
number="5",
pages="e19262",
keywords="anxiety",
keywords="breast cancer",
keywords="education",
keywords="mobile app",
keywords="self-esteem",
abstract="Background: Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. Objective: This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. Methods: An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. Results: A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95\% CI --17.44 to --8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95\% CI --9.20 to --4.21, P<.001, d=0.88 and trait anxiety: 95\% CI --8.50 to --4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95\% CI 1.28 to 2.82, P<.001). Conclusions: This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. Trial Registration: Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882 ",
doi="10.2196/19262",
url="https://mhealth.jmir.org/2021/5/e19262",
url="http://www.ncbi.nlm.nih.gov/pubmed/34003138"
}


@Article{info:doi/10.2196/26096,
author="Holl{\"a}nder-Mieritz, Cecilie
and Vogelius, R. Ivan
and Kristensen, A. Claus
and Green, Allan
and Rindum, L. Judith
and Pappot, Helle",
title="Using Biometric Sensor Data to Monitor Cancer Patients During Radiotherapy: Protocol for the OncoWatch Feasibility Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="13",
volume="10",
number="5",
pages="e26096",
keywords="biometric sensor technology",
keywords="cancer",
keywords="head and neck cancer",
keywords="home monitoring",
keywords="patient-generated health data",
keywords="radiotherapy",
keywords="sensor",
keywords="smartwatch",
abstract="Background: Patients with head and neck cancer (HNC) experience severe side effects during radiotherapy (RT). Ongoing technological advances in wearable biometric sensors allow for the collection of objective data (eg, physical activity and heart rate), which might, in the future, help detect and counter side effects before they become severe. A smartwatch such as the Apple Watch allows for objective data monitoring outside the hospital with minimal effort from the patient. To determine whether such tools can be implemented in the oncological setting, feasibility studies are needed. Objective: This protocol describes the design of the OncoWatch 1.0 feasibility study that assesses the adherence of patients with HNC to an Apple Watch during RT. Methods: A prospective, single-cohort trial will be conducted at the Department of Oncology, Rigshospitalet (Copenhagen, Denmark). Patients aged ?18 years intended for primary or postoperative curatively intended RT for HNC will be recruited. Consenting patients will be asked to wear an Apple Watch on the wrist during and until 2 weeks after RT. The study will include 10 patients. Data on adherence, data acquisition, and biometric data will be collected. Demographic data, objective toxicity scores, and hospitalizations will be documented. Results: The primary outcome is to determine if it is feasible for the patients to wear a smartwatch continuously (minimum 12 hours/day) during RT. Furthermore, we will explore how the heart rate and physical activity change over the treatment course. Conclusions: The study will assess the feasibility of using the Apple Watch for home monitoring of patients with HNC. Our findings may provide novel insights into the patient's activity levels and variations in heart rate during the treatment course. The knowledge obtained from this study will be essential for further investigating how biometric data can be used as part of symptom monitoring for patients with HNC. Trial Registration: ClinicalTrials.gov NCT04613232; https://clinicaltrials.gov/ct2/show/NCT04613232 International Registered Report Identifier (IRRID): PRR1-10.2196/26096 ",
doi="10.2196/26096",
url="https://www.researchprotocols.org/2021/5/e26096",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983123"
}


@Article{info:doi/10.2196/16156,
author="Peltola, Kristiina Maria
and Poikonen-Saksela, Paula
and Mattson, Johanna
and Parkkari, Timo",
title="A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability",
journal="JMIR Form Res",
year="2021",
month="May",
day="6",
volume="5",
number="5",
pages="e16156",
keywords="electronic patient-reported outcome",
keywords="adverse events",
keywords="patients with cancer",
abstract="Background: As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective: In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods: The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona's suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results: A total of 41/44 (93\%) patients and 15/17 (88\%) professionals reported that the program was easy or quite easy to use; 38/44 (86\%) patients and 11/17 (65\%) professionals found Noona reliable, and 38/44 (86\%) patients and 10/17 (59\%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions: The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient's symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice. ",
doi="10.2196/16156",
url="https://formative.jmir.org/2021/5/e16156",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955841"
}


@Article{info:doi/10.2196/23671,
author="Richards, Rebecca
and Kinnersley, Paul
and Brain, Kate
and Wood, Fiona",
title="Cancer Clinicians' Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study",
journal="JMIR Cancer",
year="2021",
month="May",
day="6",
volume="7",
number="2",
pages="e23671",
keywords="education, medical",
keywords="medical information exchange",
keywords="smartphone",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients' needs and can provide further insight into the type of app and features that might be most beneficial. Objective: This study aims to explore cancer clinicians' views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored.  Methods: A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis.  Results: Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians' workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients' age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition. Conclusions: This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process. ",
doi="10.2196/23671",
url="https://cancer.jmir.org/2021/2/e23671",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955836"
}


@Article{info:doi/10.2196/27975,
author="Low, A. Carissa
and Li, Meng
and Vega, Julio
and Durica, C. Krina
and Ferreira, Denzil
and Tam, Vernissia
and Hogg, Melissa
and Zeh III, Herbert
and Doryab, Afsaneh
and Dey, K. Anind",
title="Digital Biomarkers of Symptom Burden Self-Reported by Perioperative Patients Undergoing Pancreatic Surgery: Prospective Longitudinal Study",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="27",
volume="7",
number="2",
pages="e27975",
keywords="mobile sensing",
keywords="symptom",
keywords="cancer",
keywords="surgery",
keywords="wearable device",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Cancer treatments can cause a variety of symptoms that impair quality of life and functioning but are frequently missed by clinicians. Smartphone and wearable sensors may capture behavioral and physiological changes indicative of symptom burden, enabling passive and remote real-time monitoring of fluctuating symptoms Objective: The aim of this study was to examine whether smartphone and Fitbit data could be used to estimate daily symptom burden before and after pancreatic surgery. Methods: A total of 44 patients scheduled for pancreatic surgery participated in this prospective longitudinal study and provided sufficient sensor and self-reported symptom data for analyses. Participants collected smartphone sensor and Fitbit data and completed daily symptom ratings starting at least two weeks before surgery, throughout their inpatient recovery, and for up to 60 days after postoperative discharge. Day-level behavioral features reflecting mobility and activity patterns, sleep, screen time, heart rate, and communication were extracted from raw smartphone and Fitbit data and used to classify the next day as high or low symptom burden, adjusted for each individual's typical level of reported symptoms. In addition to the overall symptom burden, we examined pain, fatigue, and diarrhea specifically. Results: Models using light gradient boosting machine (LightGBM) were able to correctly predict whether the next day would be a high symptom day with 73.5\% accuracy, surpassing baseline models. The most important sensor features for discriminating high symptom days were related to physical activity bouts, sleep, heart rate, and location. LightGBM models predicting next-day diarrhea (79.0\% accuracy), fatigue (75.8\% accuracy), and pain (79.6\% accuracy) performed similarly. Conclusions: Results suggest that digital biomarkers may be useful in predicting patient-reported symptom burden before and after cancer surgery. Although model performance in this small sample may not be adequate for clinical implementation, findings support the feasibility of collecting mobile sensor data from older patients who are acutely ill as well as the potential clinical value of mobile sensing for passive monitoring of patients with cancer and suggest that data from devices that many patients already own and use may be useful in detecting worsening perioperative symptoms and triggering just-in-time symptom management interventions. ",
doi="10.2196/27975",
url="https://cancer.jmir.org/2021/2/e27975",
url="http://www.ncbi.nlm.nih.gov/pubmed/33904822"
}


@Article{info:doi/10.2196/24254,
author="Phillips, Siobhan
and Solk, Payton
and Welch, Whitney
and Auster-Gussman, Lisa
and Lu, Marilyn
and Cullather, Erin
and Torre, Emily
and Whitaker, Madelyn
and Izenman, Emily
and La, Jennifer
and Lee, Jungwha
and Spring, Bonnie
and Gradishar, William",
title="A Technology-Based Physical Activity Intervention for Patients With Metastatic Breast Cancer (Fit2ThriveMB): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="23",
volume="10",
number="4",
pages="e24254",
keywords="physical activity",
keywords="metastatic breast cancer",
keywords="technology",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However, there is a paucity of research on PA in patients with metastatic breast cancer, and existing PA interventions have exhibited low feasibility because of their focus on intense PA and/or requirement of on-site visits. Mobile health (mHealth)--based PA interventions may be particularly useful for patients with metastatic breast cancer because they allow for remote monitoring, which facilitates individual tailoring of PA recommendations to patients' abilities and may minimize participant burden. However, no studies have examined mHealth PA interventions in patients with metastatic breast cancer. Objective: We aim to address these critical research gaps by testing a highly tailored technology-based intervention to promote PA of any intensity (ie, light, moderate, or vigorous) by increasing daily steps in patients with metastatic breast cancer. The primary aim of this study is to test the feasibility and acceptability of the Fit2ThriveMB intervention. We will also examine outcome patterns suggesting the efficacy of Fit2ThriveMB on symptom burden, quality of life, and functional performance. Methods: The Fit2ThriveMB trial is a two-arm pilot randomized controlled trial that will compare the effects of a smartphone-delivered, home-based PA intervention and an attention-control education condition on PA and quality of life in low-active female patients with metastatic breast cancer. A subsample (n=25) will also complete functional performance measures. This innovative trial will recruit 50 participants who will be randomized into the study's intervention or control arm. The intervention will last 12 weeks. The Fit2ThriveMB intervention consists of a Fitbit, coaching calls, and the Fit2ThriveMB smartphone app that provides self-monitoring, a tailored goal-setting tool, real-time tailored feedback, app notifications, and a group message board. Assessments will occur at baseline and post intervention. Results: The Fit2ThriveMB study is ongoing. Data collection ended in February 2021. Conclusions: Data from this study will provide the preliminary effect sizes needed to assemble an intervention that is to be evaluated in a fully powered trial. In addition, these data will provide essential evidence to support the feasibility and acceptability of using a technology-based PA promotion intervention, a scalable strategy that could be easily integrated into care, among patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT04129346; https://clinicaltrials.gov/ct2/show/NCT04129346 International Registered Report Identifier (IRRID): DERR1-10.2196/24254 ",
doi="10.2196/24254",
url="https://www.researchprotocols.org/2021/4/e24254",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890857"
}


@Article{info:doi/10.2196/23304,
author="Lim, Young Ji
and Kim, Kwang Jong
and Kim, Yoon
and Ahn, So-Yeon
and Yu, Jonghan
and Hwang, Hye Ji",
title="A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="13",
volume="5",
number="4",
pages="e23304",
keywords="breast cancer",
keywords="mobile health",
keywords="rehabilitation",
keywords="cancer continuum",
abstract="Background: Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective: This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods: The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results: We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions: The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum. ",
doi="10.2196/23304",
url="https://formative.jmir.org/2021/4/e23304",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847589"
}


@Article{info:doi/10.2196/24062,
author="Morse, S. Robert
and Lambden, Kaley
and Quinn, Erin
and Ngoma, Twalib
and Mushi, Beatrice
and Ho, Xian Yun
and Ngoma, Mamsau
and Mahuna, Habiba
and Sagan, B. Sarah
and Mmari, Joshua
and Miesfeldt, Susan",
title="A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="23",
volume="7",
number="1",
pages="e24062",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="palliative care",
keywords="pain",
keywords="cancer",
keywords="sub-Saharan Africa",
keywords="mobile phone",
abstract="Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life--focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users---patients or caregivers, LHWs, and members of the palliative care team---and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. ",
doi="10.2196/24062",
url="https://cancer.jmir.org/2021/1/e24062",
url="http://www.ncbi.nlm.nih.gov/pubmed/33755022"
}


@Article{info:doi/10.2196/23927,
author="Martin, Elise
and Di Meglio, Antonio
and Charles, Cecile
and Ferreira, Arlindo
and Gbenou, Arnauld
and Blond, Marine
and Fagnou, Benoit
and Arvis, Johanna
and Pistilli, Barbara
and Saghatchian, Mahasti
and Vaz Luis, Ines",
title="Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="22",
volume="7",
number="1",
pages="e23927",
keywords="mHealth",
keywords="physical activity",
keywords="breast cancer",
keywords="cancer-related fatigue",
keywords="qualitative study",
keywords="survivorship",
abstract="Background: Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. Objective: In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. Methods: This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. Results: Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. Conclusions: mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer. ",
doi="10.2196/23927",
url="https://cancer.jmir.org/2021/1/e23927",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749606"
}


@Article{info:doi/10.2196/24667,
author="Teckie, Sewit
and Solomon, Jeffrey
and Kadapa, Karthik
and Sanchez, Keisy
and Orner, David
and Kraus, Dennis
and Kamdar, P. Dev
and Pereira, Lucio
and Frank, Douglas
and Diefenbach, Michael",
title="A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="19",
volume="5",
number="3",
pages="e24667",
keywords="mHealth",
keywords="ePROs",
keywords="head and neck cancer",
keywords="mobile phone",
abstract="Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80\% of the enrolled participants for the duration of the study period), adherence (>50\% of the participants completing 100\% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87\%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81\% [26/32] male). Overall, 375 of 512 (73.2\%) questionnaires were completed, with 17 (53\%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95\% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. ",
doi="10.2196/24667",
url="https://formative.jmir.org/2021/3/e24667",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739291"
}


@Article{info:doi/10.2196/26950,
author="Trojan, Andreas
and B{\"a}ttig, Basil
and Mannhart, Meinrad
and Seifert, Burkhardt
and Brauchbar, N. Mathis
and Egbring, Marco",
title="Effect of Collaborative Review of Electronic Patient-Reported Outcomes for Shared Reporting in Breast Cancer Patients: Descriptive Comparative Study",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="17",
volume="7",
number="1",
pages="e26950",
keywords="cancer",
keywords="Consilium Care",
keywords="smartphone app",
keywords="eHealth",
keywords="electronic patient-reported outcomes",
keywords="Common Terminology Criteria for Adverse Events",
abstract="Background: Digital monitoring of treatment-related symptoms and self-reported patient outcomes is important for the quality of care among cancer patients. As mobile devices are ubiquitous nowadays, the collection of electronic patient-reported outcomes (ePROs) is gaining momentum. So far, data are lacking on the modalities that contribute to the quantity and quality of ePROs. Objective: The objective of our study was to compare the utilization of two versions of a subsequently employed mobile app for electronic monitoring of PROs and to test our hypothesis that a shared review of symptoms in patient-physician collaboration has an impact on the number of data entries. Methods: The Consilium Care app engages cancer patients to standardize reporting of well-being and treatment-related symptoms in outpatient settings. For descriptive comparison of the utilization of two slightly different app versions, data were obtained from an early breast cancer trial (version 1 of the app, n=86) and an ongoing study including patients with advanced disease (version 2 of the app, n=106). In both app versions, patients and doctors were allowed to share the information from data entries during consultations. Version 2 of the app, however, randomly selected symptoms that required a detailed and shared regular patient-doctor review in order to focus on the collection and appropriate interpretation regarding awareness and guidance for severity grading. The numbers and types of symptom entries, satisfaction with both app versions, and patients' perceived effects during consultations were included for analysis. Results: Symptom severity grading was performed according to the Common Terminology Criteria for Adverse Events (CTCAE) using a horizontal slider and was indicated in descriptive terminology in both apps, while a graphical display facilitated the illustration of symptom history charts. In total, 192 patients electronically reported 11,437 data entries on well-being and 33,380 data entries on individual symptoms. Overall, 628 (of 872 intended) requested patient-doctor symptom reviews were performed in version 2 of the app. Both the amount of data entries per patient and day for well-being (version 1 vs version 2: 0.3 vs 1.0; P<.001) and symptoms (version 1 vs version 2: 1.3 vs 1.9; P=.04) appeared significantly increased in version 2 of the app. Overall satisfaction with both app versions was high, although version 2 of the app was perceived to be more helpful in general. Conclusions: Version 2 of the app showed much better results than version 1 of the app. A request for collaborative patient-doctor symptom review is likely to affect the number of digital symptom data entries. This app shows high potential to improve the patient-doctor experience. Trial Registration: ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 and ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731 ",
doi="10.2196/26950",
url="https://cancer.jmir.org/2021/1/e26950",
url="http://www.ncbi.nlm.nih.gov/pubmed/33729162"
}


@Article{info:doi/10.2196/23979,
author="Furness, Kate
and Huggins, Elizabeth Catherine
and Truby, Helen
and Croagh, Daniel
and Haines, Peter Terry",
title="Attitudes of Australian Patients Undergoing Treatment for Upper Gastrointestinal Cancers to Different Models of Nutrition Care Delivery: Qualitative Investigation",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="12",
volume="5",
number="3",
pages="e23979",
keywords="qualitative",
keywords="upper gastrointestinal",
keywords="cancer",
keywords="nutrition",
keywords="mobile phone",
abstract="Background: Adults diagnosed with cancers of the stomach, esophagus, and pancreas are at high risk of malnutrition. In many hospital-based health care settings, there is a lack of systems in place to provide the early and intensive nutritional support that is required by these high-risk cancer patients. Our research team conducted a 3-arm parallel randomized controlled trial to test the provision of an early and intensive nutrition intervention to patients with upper gastrointestinal cancers using a synchronous telephone-based delivery approach versus an asynchronous mobile app--based approach delivered using an iPad compared with a control group to address this issue. Objective: This study aims to explore the overall acceptability of an early and intensive eHealth nutrition intervention delivered either via a synchronous telephone-based approach or an asynchronous mobile app--based approach. Methods: Patients who were newly diagnosed with upper gastrointestinal cancer and who consented to participate in a nutrition intervention were recruited. In-depth, semistructured qualitative interviews were conducted by telephone and transcribed verbatim. Data were analyzed using deductive thematic analysis using the Theoretical Framework of Acceptability in NVivo Pro 12 Plus. Results: A total of 20 participants were interviewed, 10 from each intervention group (synchronous or asynchronous delivery). Four major themes emerged from the qualitative synthesis: participants' self-efficacy, low levels of burden, and intervention comprehension were required for intervention effectiveness and positive affect; participants sought a sense of support and security through relationship building and rapport with their dietitian; knowledge acquisition and learning-enabled empowerment through self-management; and convenience, flexibility, and bridging the gap to hard-to-reach individuals. Conclusions: Features of eHealth models of nutrition care delivered via telephone and mobile app can be acceptable to those undergoing treatment for upper gastrointestinal cancer. Convenience, knowledge acquisition, improved self-management, and support were key benefits for the participants. Future interventions should focus on home-based interventions delivered with simple, easy-to-use technology. Providing participants with a choice of intervention delivery mode (synchronous or asynchronous) and allowing them to make individual choices that align to their individual values and capabilities may support improved outcomes. Trial Registration: Australian and New Zealand Clinical Trial Registry (ACTRN) 12617000152325; https://tinyurl.com/p3kxd37b. ",
doi="10.2196/23979",
url="https://formative.jmir.org/2021/3/e23979",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709939"
}


@Article{info:doi/10.2196/18325,
author="Wolbers, Roos
and Bode, Christina
and Siemerink, Ester
and Siesling, Sabine
and Pieterse, Marcel",
title="Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="10",
volume="5",
number="3",
pages="e18325",
keywords="breast cancer",
keywords="cognitive bias modification",
keywords="eHealth",
keywords="fatigue",
keywords="oncology",
keywords="psychology",
keywords="vitality",
abstract="Background: More than 50\% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients. ",
doi="10.2196/18325",
url="https://formative.jmir.org/2021/3/e18325",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688833"
}


@Article{info:doi/10.2196/24893,
author="Heneghan, B. Mallorie
and Hussain, Tasmeen
and Barrera, Leonardo
and Cai, W. Stephanie
and Haugen, Maureen
and Morgan, Elaine
and Rossoff, Jenna
and Weinstein, Joanna
and Hijiya, Nobuko
and Cella, David
and Badawy, M. Sherif",
title="Access to Technology and Preferences for an mHealth Intervention to Promote Medication Adherence in Pediatric Acute Lymphoblastic Leukemia: Approach Leveraging Behavior Change Techniques",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="18",
volume="23",
number="2",
pages="e24893",
keywords="acute lymphoblastic leukemia",
keywords="medication adherence",
keywords="behavior change technique",
keywords="oral chemotherapy",
keywords="mHealth",
keywords="patient-centered",
abstract="Background: Suboptimal adherence to 6-mercaptopurine (6-MP) is prevalent in pediatric acute lymphoblastic leukemia (ALL) and associated with increased risk of relapse. Rapid uptake of personal technology makes mobile health (mHealth) an attractive platform to promote adherence. Objective: Study objectives were to examine access to mobile technology and preferences for an mHealth intervention to improve medication adherence in pediatric ALL. Methods: A cross-sectional survey was administered in oncology clinic to parents of children with ALL as well as adolescents and young adults (AYAs) with ALL receiving maintenance chemotherapy. Results: A total of 49 parents (median age [IQR] 39 [33-42] years; female 76\% [37/49]) and 15 patients (median age [IQR] 17 [16-19]; male 80\% [12/15]) participated. All parents and AYAs owned electronic tablets, smartphones, or both. Parents' most endorsed mHealth app features included a list of medications (71\%, 35/49), information about 6-MP (71\%, 35/49), refill reminders (71\%, 35/49), and reminders to take 6-MP (71\%, 35/49). AYAs' most endorsed features included refill reminders (73\%, 11/15), reminders to take 6-MP (73\%, 11/15), and tracking 6-MP (73\%, 11/15). Conclusions: Parents and AYAs reported ubiquitous access to mobile technology and strong interest in multiple adherence-specific mHealth app features. Parents and AYAs provided valuable insight into preferred features for a multifunctional behavioral intervention (mHealth app) to promote medication adherence in pediatric ALL. ",
doi="10.2196/24893",
url="http://www.jmir.org/2021/2/e24893/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599621"
}


@Article{info:doi/10.2196/18288,
author="Groarke, M. Jenny
and Richmond, Janice
and Mc Sharry, Jenny
and Groarke, AnnMarie
and Harney, M. Owen
and Kelly, Grace Mary
and Walsh, C. Jane",
title="Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="16",
volume="9",
number="2",
pages="e18288",
keywords="mHealth",
keywords="self-management",
keywords="text messaging",
keywords="activity tracker",
keywords="exercise",
keywords="diet",
keywords="overweight",
keywords="obesity",
keywords="cancer survivors",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97\%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17\%) or low (5/36, 14\%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94\%). Most respondents said that they understood how the intervention works (35/36, 97\%), and qualitative data show that participants' understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID): RR2-10.2196/13214 ",
doi="10.2196/18288",
url="http://mhealth.jmir.org/2021/2/e18288/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591290"
}


@Article{info:doi/10.2196/16785,
author="Mikolasek, Michael
and Witt, Margitta Claudia
and Barth, J{\"u}rgen",
title="Effects and Implementation of a Mindfulness and Relaxation App for Patients With Cancer: Mixed Methods Feasibility Study",
journal="JMIR Cancer",
year="2021",
month="Jan",
day="13",
volume="7",
number="1",
pages="e16785",
keywords="mobile app",
keywords="mobile phone",
keywords="mindfulness",
keywords="relaxation",
keywords="cancer",
keywords="qualitative research",
keywords="implementation science",
keywords="mHealth",
keywords="evaluation study",
keywords="patient compliance",
keywords="patient participation",
keywords="patient preference",
abstract="Background: Cancer diagnosis and cancer treatment can cause high levels of distress, which is often not sufficiently addressed in standard medical care. Therefore, a variety of supportive nonpharmacological treatments have been suggested to reduce distress in patients with cancer. However, not all patients use these interventions because of limited access or lack of awareness. To overcome these barriers, mobile health may be a promising way to deliver the respective supportive treatments. Objective: The aim of this study is to evaluate the effects and implementation of a mindfulness and relaxation app intervention for patients with cancer as well as patients' adherence to such an intervention. Methods: In this observational feasibility study with a mixed methods approach, patients with cancer were recruited through the web and through hospitals in Switzerland. All enrolled patients received access to a mindfulness and relaxation app. Patients completed self-reported outcomes (general health, health-related quality of life, anxiety, depression, distress, mindfulness, and fear of progression) at baseline and at weeks 4, 10, and 20. The frequency of app exercise usage was gathered directly through the app to assess the adherence of patients. In addition, we conducted interviews with 5 health professionals for their thoughts on the implementation of the app intervention in standard medical care. We analyzed patients' self-reported outcomes using linear mixed models (LMMs) and qualitative data with content analysis. Results: A total of 100 patients with cancer (74 female) with a mean age of 53.2 years (SD 11.6) participated in the study, of which 25 patients used the app regularly until week 20. LMM analyses revealed improvements in anxiety (P=.04), distress (P<.001), fatigue (P=.01), sleep disturbance (P=.02), quality of life (P=.03), and mindfulness (P<.001) over the course of 20 weeks. Further LMM analyses revealed a larger improvement in distress (P<.001), a moderate improvement in anxiety (P=.001), and a larger improvement in depression (P=.03) in patients with high levels of symptoms at baseline in the respective domains. The interviews revealed that the health professionals perceived the app as a helpful addition to standard care. They also made suggestions for improvements, which could facilitate the implementation of and adherence to such an app. Conclusions: This study indicates that a mindfulness and relaxation app for patients with cancer can be a feasible and effective way to deliver a self-care intervention, especially for highly distressed patients. Future studies should investigate if the appeal of the app can be increased with more content, and the effectiveness of such an intervention needs to be tested in a randomized controlled trial. ",
doi="10.2196/16785",
url="https://cancer.jmir.org/2021/1/e16785",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439132"
}


@Article{info:doi/10.2196/19727,
author="Vogel, E. Marco M.
and Eitz, A. Kerstin
and Combs, E. Stephanie",
title="Web-Based Patient Self-Reported Outcome After Radiotherapy in Adolescents and Young Adults With Cancer: Survey on Acceptance of Digital Tools",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="11",
volume="9",
number="1",
pages="e19727",
keywords="mHealth",
keywords="eHealth",
keywords="young adults",
abstract="Background: eHealth and mobile health (mHealth) are an evolving trend in the medical field. The acceptance of digital tools is high, and the need is growing. Objective: Young adults (18-40 years) confronted with a cancer diagnosis present unique needs and require special care. They often have a strong affinity and are familiar with modern technology. On that account, we implemented a web-based symptom and quality of life (QoL) assessment to address patients' attitudes and willingness to use mHealth tools. The study also aims to evaluate sociodemographic parameters that could influence patients' opinions. Methods: A total of 380 young patients aged 18-40 treated with radiotherapy between 2002 and 2017 were included in the trial. We assessed QoL via the European Organization for Research and Treatment of Cancer-Core 30 (EORTC C30) questionnaire and added general questions about mHealth technology. The added questions inquired patients' opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, data transfer, and app-specific features. The survey was conducted for 12 months. Participation was voluntary and pseudonymized; prior written consent was obtained. Results: We achieved a participation rate of 57.6\% (219/380) and a completion rate of 50.2\% (110/219). The median age was 33 years (range 18-40). Of all participants, 89.1\% (98/110) considered new technologies in medicine as positive; 10.9\% (12/110) answered with neutral. Nearly all patients (96.4\%, 106/110) stated that they would send further data via a web-based platform. Of all, 96.4\% (106/110) considered the provided pseudonymization of their data as safe. We further asked the patients if they would use a mobile app for symptom and QoL assessment similar to the present web-based system: 74.5\% (82/110) answered with yes and 25.5\% (28/110) said they would not use a mobile app in the future. We tested the willingness to use an app on several sociodemographic parameters, such as age, gender, education, health insurance status, and cancer-related parameters: tumor stage, time since radiation treatment, and treatment intention. None of these parameters correlated with app use in this group of young adults. Patients who were generally positive regarding using an app rated several possible functions of a future app. The 3 most requested features were appointment reminders (89.0\%, 73/82), contact overview of all involved clinics and physicians (87\%, 71/82), and making an appointment via app (78\%, 64/82). Conclusions: eHealth and mHealth tools should be available as an integrated part of a comprehensive cancer care approach. It provides automated, thorough documentation of health parameters during therapy and follow-up for doctors, medical staff, and tumor patients to optimize treatment. With this study, we could show that young adults are the ideal patient population to use eHealth/mHealth tools. Such tools offer further digital support and improve the patients' need for constant QoL during cancer care. ",
doi="10.2196/19727",
url="http://mhealth.jmir.org/2021/1/e19727/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427669"
}


@Article{info:doi/10.2196/20636,
author="Kongshaug, Nina
and Skolbekken, John-Arne
and Faxvaag, Arild
and Hofsli, Eva",
title="Cancer Patients' Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy:  Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="6",
volume="5",
number="1",
pages="e20636",
keywords="mhealth",
keywords="mobile app",
keywords="smartphone app",
keywords="oral chemotherapy",
keywords="patient safety",
keywords="home-based cancer treatment",
abstract="Background: Oral anticancer therapies can be self-administered by patients outside the hospital setting, which poses challenges of adherence to a drug plan and monitoring of side effects. Modern information technology may be developed and implemented to address these pertinent issues. Objective: The aim of this study was to explore how a smartphone app developed through a stepwise, iterative process can help patients using oral chemotherapy to take their drug, and to report adherence and side effects in a reliable and verifiable manner. Methods: Fourteen patients starting capecitabine treatment were included in this study and used the smartphone app in addition to regular follow up of capecitabine treatment. Nine of these patients fulfilled the treatment plan and were interviewed based on a semistructured interview guide and the System Usability Scale (SUS). In addition, two focus groups were completed with 7 oncologists and 7 oncology nurses, respectively. Interview data were analyzed in accordance with the principles of systematic text condensation. Features of the app were also assessed. Results: The smartphone app provided the patients with a feeling of reassurance regarding correct adherence of their oral chemotherapy treatment. They used the app as a memory tool about their treatment and possible serious side effects, as well as for treatment education. Patients expressed concerns about using the app to report side effects that were not considered to be obviously serious, fearing overreporting. The health personnel expressed an overall positive attitude to integrate this new tool in their everyday work. Conclusions: Patients on oral chemotherapy treatment at home felt safe and found the app to be helpful. The app promoted learning about their treatment and made the patients more independent of the cancer clinic, reducing the need for the clinic's limited resources for follow up of patients on oral anticancer medications. ",
doi="10.2196/20636",
url="https://formative.jmir.org/2021/1/e20636",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404505"
}


@Article{info:doi/10.2196/16322,
author="Chen, Alan I-Hsuan
and Chu, Chi-Hsiang
and Lin, Jen-Tai
and Tsai, Jeng-Yu
and Yu, Chia-Cheng
and Sridhar, Narasimha Ashwin
and Sooriakumaran, Prasanna
and Loureiro, V. Rui C.
and Chand, Manish",
title="Prostate Cancer Risk Calculator Apps in a Taiwanese Population Cohort: Validation Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="18",
volume="22",
number="12",
pages="e16322",
keywords="diagnosis",
keywords="mHealth",
keywords="mobile apps",
keywords="prostate cancer",
keywords="prostate-specific antigen",
keywords="risk calculator",
abstract="Background: Mobile health apps have emerged as useful tools for patients and clinicians alike, sharing health information or assisting in clinical decision-making. Prostate cancer (PCa) risk calculator mobile apps have been introduced to assess risks of PCa and high-grade PCa (Gleason score ?7). The Rotterdam Prostate Cancer Risk Calculator and Coral--Prostate Cancer Nomogram Calculator apps were developed from the 2 most-studied PCa risk calculators, the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the North American Prostate Cancer Prevention Trial (PCPT) risk calculators, respectively. A systematic review has indicated that the Rotterdam and Coral apps perform best during the prebiopsy stage. However, the epidemiology of PCa varies among different populations, and therefore, the applicability of these apps in a Taiwanese population needs to be evaluated. This study is the first to validate the PCa risk calculator apps with both biopsy and prostatectomy cohorts in Taiwan. Objective: The study's objective is to validate the PCa risk calculator apps using a Taiwanese cohort of patients. Additionally, we aim to utilize postprostatectomy pathology outcomes to assess the accuracy of both apps with regard to high-grade PCa. Methods: All male patients who had undergone transrectal ultrasound prostate biopsies in a single Taiwanese tertiary medical center from 2012 to 2018 were identified retrospectively. The probabilities of PCa and high-grade PCa were calculated utilizing the Rotterdam and Coral apps, and compared with biopsy and prostatectomy results. Calibration was graphically evaluated with the Hosmer-Lemeshow goodness-of-fit test. Discrimination was analyzed utilizing the area under the receiver operating characteristic curve (AUC). Decision curve analysis was performed for clinical utility. Results: Of 1134 patients, 246 (21.7\%) were diagnosed with PCa; of these 246 patients, 155 (63\%) had high-grade PCa, according to the biopsy results. After confirmation with prostatectomy pathological outcomes, 47.2\% (25/53) of patients were upgraded to high-grade PCa, and 1.2\% (1/84) of patients were downgraded to low-grade PCa. Only the Rotterdam app demonstrated good calibration for detecting high-grade PCa in the biopsy cohort. The discriminative ability for both PCa (AUC: 0.779 vs 0.687; DeLong's method: P<.001) and high-grade PCa (AUC: 0.862 vs 0.758; P<.001) was significantly better for the Rotterdam app. In the prostatectomy cohort, there was no significant difference between both apps (AUC: 0.857 vs 0.777; P=.128). Conclusions: The Rotterdam and Coral apps can be applied to the Taiwanese cohort with accuracy. The Rotterdam app outperformed the Coral app in the prediction of PCa and high-grade PCa. Despite the small size of the prostatectomy cohort, both apps, to some extent, demonstrated the predictive capacity for true high-grade PCa, confirmed by the whole prostate specimen. Following our external validation, the Rotterdam app might be a good alternative to help detect PCa and high-grade PCa for Taiwanese men. ",
doi="10.2196/16322",
url="http://www.jmir.org/2020/12/e16322/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33337340"
}


@Article{info:doi/10.2196/21693,
author="Sprave, Tanja
and Z{\"o}ller, Daniela
and Stoian, Raluca
and R{\"u}hle, Alexander
and Kalckreuth, Tobias
and Haehl, Erik
and Fahrner, Harald
and Binder, Harald
and Grosu, Anca-Ligia
and Heinemann, Felix
and Nicolay, Henrik Nils",
title="App-Controlled Treatment Monitoring and Support for Head and Neck Cancer Patients (APCOT): Protocol for a Prospective Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="9",
volume="9",
number="12",
pages="e21693",
keywords="mHealth",
keywords="head and neck cancer",
keywords="HNSCC",
keywords="radiotherapy",
keywords="mobile app",
keywords="quality of life",
keywords="patient-reported outcome measures",
abstract="Background: Head and neck cancers (HNCs) are among the most common malignancies, which often require multimodal treatment that includes radiation therapy and chemotherapy. Patients with HNC have a high burden of symptoms due to both the damaging effects of the tumor and the aggressive multimodal treatment. Close symptom monitoring over the course of the disease may help to identify patients in need of medical interventions. Objective: This APCOT (App-Controlled Treatment Monitoring and Support for Head and Neck Cancer Patients) trial is designed to assess the feasibility of monitoring HNC patients during the course of (chemo)radiation therapy daily using a mobile app. Additionally, symptom patterns, patient satisfaction, and quality of life will be measured in app-monitored patients in comparison to a patient cohort receiving standard-of-care physician appointments, and health economy aspects of app monitoring will be analyzed. Methods: This prospective randomized single-center trial will evaluate the feasibility of integrating electronic patient-reported outcome measures (ePROMs) into the treatment workflow of HNC patients. Patients undergoing definitive or adjuvant (chemo)radiation therapy as part of their HNC treatment at the Department of Radiation Oncology, University Medical Center Freiburg (Freiburg, Germany) will receive weekly physician appointments and additional appointments as requested to monitor and potentially treat symptoms during the course of treatment. Patients in the experimental arm will additionally be monitored daily using a dedicated app regarding their disease- and treatment-related symptoms, quality of life, and need for personal physician appointments. The feasibility of ePROM monitoring will be tested as the primary endpoint and will be defined if ?80\% of enrolled patients have answered ?80\% of their daily app-based questions. Quality of life will be assessed using the validated European Organisation for Research and Treatment of Cancer questionnaires, and patient satisfaction will be measured by the validated Patient Satisfaction Questionnaire Short Form at the initiation, in the middle, and at completion of radiation therapy, as well as at follow-up examinations. Additionally, the number and duration of physician appointments during the course of radiation therapy will be quantified for both ePROM-monitored and standard-of-care patients. Results: This trial will enroll 100 patients who will be randomized (1:1) between the experimental arm with ePROM monitoring and the control arm with standard patient care. Recruitment will take 18 months, and trial completion is planned at 24 months after enrollment of the last patient. Conclusions: This trial will establish the feasibility of close ePROM monitoring of HNC patients undergoing (chemo)radiation therapy. The results can form the basis for further trials investigating potential clinical benefits of detailed symptom monitoring and patient-centered care in HNC patients regarding oncologic outcomes and quality of life. Trial Registration: German Clinical Trials Register DRKS00020491; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00020491 International Registered Report Identifier (IRRID): PRR1-10.2196/21693 ",
doi="10.2196/21693",
url="https://www.researchprotocols.org/2020/12/e21693",
url="http://www.ncbi.nlm.nih.gov/pubmed/33295291"
}


@Article{info:doi/10.2196/18982,
author="Biran, Noa
and Anthony Kouyat{\'e}, Robin
and Yucel, Emre
and McGovern, E. Gillian
and Schoenthaler, M. Antoinette
and Durling, G. Olivia
and Unawane, Rashmi
and Schutt, Andrew
and Panjabi, Sumeet",
title="Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="17",
volume="4",
number="11",
pages="e18982",
keywords="mHealth",
keywords="digital health",
keywords="electronic patient-reported outcome",
keywords="ePRO",
keywords="patient-reported outcome",
keywords="PRO",
keywords="mobile",
keywords="app",
keywords="implementation science",
keywords="multiple myeloma",
keywords="relapsed refractory multiple myeloma",
abstract="Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83\% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. ",
doi="10.2196/18982",
url="http://formative.jmir.org/2020/11/e18982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200997"
}


@Article{info:doi/10.2196/19180,
author="Maguire, Roma
and Connaghan, John
and Arber, Anne
and Klepacz, Naomi
and Blyth, G. Kevin
and McPhelim, John
and Murray, Paul
and Rupani, Hitasha
and Chauhan, Anoop
and Williams, Peter
and McNaughton, Laura
and Woods, Kirstie
and Moylan, Anne",
title="Advanced Symptom Management System for Patients with Malignant Pleural Mesothelioma (ASyMSmeso): Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="12",
volume="22",
number="11",
pages="e19180",
keywords="malignant pleural mesothelioma",
keywords="patient reported outcome measures",
keywords="cancer",
keywords="mobile health",
keywords="telemedicine, symptom monitoring",
abstract="Background: Patients with malignant pleural mesothelioma (MPM) have a life-limiting illness and short prognosis and experience many debilitating symptoms from early in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer. Objective: This study aimed to determine the feasibility and acceptability of using an ASyMS adapted for use by patients with MPM, called ASyMSmeso, enabling the remote monitoring of symptoms using a smartphone. Methods: This was a convergent mixed methods study using patient-reported outcome measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC), Technology Acceptance Model (TAM) measure for eHealth, and Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study, semistructured interviews with 11 health professionals, 8 patients, and 3 carers were conducted to collect their experience with using ASyMSmeso. Results: Eighteen patients with MPM agreed to participate in the study (33.3\% response rate). The completion rates of study PROMs were high (97.2\%-100\%), and completion rates of the daily symptom questionnaire were also high, at 88.5\%. There were no significant changes in quality of life, as measured by LCSS-Meso. There were statistically significant improvements in the SPARC psychological need domain (P=.049) and in the ``Usefulness'' domain of the TAM (P=.022). End-of-study interviews identified that both patients and clinicians found the system quick and easy to use. For patients, in particular, the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable, and areas that were mentioned included the early management of symptoms and connectivity between patients and clinicians, leading to enhanced communication. Conclusions: This study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone are feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home. ",
doi="10.2196/19180",
url="https://www.jmir.org/2020/11/e19180",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180025"
}


@Article{info:doi/10.2196/21697,
author="Cancino, S. Ramon
and Su, Zhaohui
and Mesa, Ruben
and Tomlinson, E. Gail
and Wang, Jing",
title="The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities",
journal="JMIR Cancer",
year="2020",
month="Oct",
day="29",
volume="6",
number="2",
pages="e21697",
keywords="cancer",
keywords="screening",
keywords="COVID-19",
keywords="coronavirus",
keywords="telemedicine",
keywords="social determinants",
keywords="health",
keywords="education",
keywords="training",
keywords="social media",
keywords="campaign",
keywords="branding",
keywords="cobranding",
doi="10.2196/21697",
url="http://cancer.jmir.org/2020/2/e21697/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33027039"
}


@Article{info:doi/10.2196/20480,
author="Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Ribed, Almudena
and Gonzalez-Anleo, Cristina
and Martin-Conde, Maite
and Romero-Jimenez, Rosa
and Iglesias-Peinado, Irene
and Herranz-Alonso, Ana
and Sanjurjo-Saez, Maria",
title="Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="16",
volume="8",
number="10",
pages="e20480",
keywords="e-OncoSalud",
keywords="app",
keywords="smartphone",
keywords="oral antineoplastic agent",
keywords="oncology",
abstract="Background: Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. Objective: The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. Methods: We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. Results: With regard to drug safety, 73\% (37/51) of the patients in the control group and 70\% (35/50) of the patients in the intervention group (P=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (P=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (P>.99). In the control group, 49\% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36\% (18/50) of the patients in the intervention group (P=.76). Adherence to treatment was 97.6\% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9\% [SD 10.0]; P=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; P<.001). Approximately 60\% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2\%), doubts about contraindications and interactions with OAAs (70/283, 24.7\%), and consultations for adverse reactions to treatment (39/283, 13.8\%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. Conclusions: Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group. ",
doi="10.2196/20480",
url="http://mhealth.jmir.org/2020/10/e20480/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064100"
}


@Article{info:doi/10.2196/18230,
author="Heynsbergh, Natalie
and O, (Eric) Seung Chul
and Livingston, M. Patricia",
title="Assessment of Data Usage of Cancer e-Interventions (ADUCI) Framework for Health App Use of Cancer Patients and Their Caregivers: Framework Development Study",
journal="JMIR Cancer",
year="2020",
month="Sep",
day="15",
volume="6",
number="2",
pages="e18230",
keywords="multimedia",
keywords="user engagement",
keywords="cancer",
keywords="smartphone",
keywords="framework",
keywords="usage data",
keywords="eHealth technology",
keywords="e-intervention",
keywords="data analysis",
keywords="efficiency",
keywords="e-research",
keywords="apps",
abstract="Background: Multimedia interventions can provide a cost-effective solution to public health needs; however, user engagement is low. Multimedia use within specific populations such as those affected by cancer differs from that of the general population. To our knowledge, there are no frameworks on how to accurately assess usage within this population to ensure that interventions are appropriate for the end users. Therefore, a framework was developed to improve the accuracy of determining data usage. Formative work included creating a data usage framework during target audience testing for smartphone app development and analysis in a pilot study. Objective: The purpose of this study was to develop a framework for assessing smartphone app usage among people living with cancer and their caregivers. Methods: The frequency and duration of use were compared based on manual data extraction from two previous studies and the newly developed Assessment of Data Usage of Cancer e-Interventions (ADUCI) Framework. Results: Manual extraction demonstrated that 279 logins occurred compared with 241 when the ADUCI Framework was applied. The frequency of use in each section of the app also decreased when the ADUCI Framework was used. The total duration of use was 91,256 seconds (25.3 hours) compared with 53,074 seconds (14.7 hours) when using the ADUCI Framework. The ADUCI Framework identified 38 logins with no navigation, and there were 15 discrepancies in the data where time on a specific page of the app exceeded the login time. Practice recommendations to improve user engagement and capturing usage data include tracking data use in external websites, having a login function on apps, creating a five-star page rating functionality, using the ADUCI Framework to thoroughly clean usage data, and validating the Framework between expected and observed use. Conclusions: Applying the ADUCI Framework may eliminate errors and allow for more accurate analysis of usage data in e-research projects. The Framework can also improve the process of capturing usage data by providing a guide for usage data analysis to facilitate evidence-based assessment of user engagement with apps. ",
doi="10.2196/18230",
url="http://cancer.jmir.org/2020/2/e18230/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32930666"
}


@Article{info:doi/10.2196/18946,
author="Cheng, Chao
and Ho, Hung Rainbow Tin
and Guo, Yan
and Zhu, Mengting
and Yang, Weixiong
and Li, Yiran
and Liu, Zhenguo
and Zhuo, Shuyu
and Liang, Qi
and Chen, Zhenghong
and Zeng, Yu
and Yang, Jiali
and Zhang, Zhanfei
and Zhang, Xu
and Monroe-Wise, Aliza
and Yeung, Sai-Ching",
title="Development and Feasibility of a Mobile Health--Supported Comprehensive Intervention Model (CIMmH) for Improving the Quality of Life of Patients With Esophageal Cancer After Esophagectomy: Prospective, Single-Arm, Nonrandomized Pilot Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="18",
volume="22",
number="8",
pages="e18946",
keywords="esophageal cancer",
keywords="quality of life",
keywords="nutrition",
keywords="physical exercise",
keywords="psychological support",
keywords="mobile health",
keywords="mHealth",
abstract="Background: Patients with esophageal cancer often experience clinically relevant deterioration of quality of life (QOL) after esophagectomy owing to malnutrition, lack of physical exercise, and psychological symptoms. Objective: This study aimed to evaluate the feasibility, safety, and efficacy of a comprehensive intervention model using a mobile health system (CIMmH) in patients with esophageal cancer after esophagectomy. Methods: Twenty patients with esophageal cancer undergoing the modified McKeown surgical procedure were invited to join the CIMmH program with both online and offline components for 12 weeks. The participants were assessed before surgery and again at 1 and 3 months after esophagectomy. QOL, depressive symptoms, anxiety, stress, nutrition, and physical fitness were measured. Results: Of the 20 patients, 16 (80\%) completed the program. One month after esophagectomy, patients showed significant deterioration in overall QOL (P=.02), eating (P=.005), reflux (P=.04), and trouble with talking (P<.001). At the 3-month follow-up, except for pain (P=.02), difficulty with eating (P=.03), dry mouth (P=.04), and trouble with talking (P=.003), all other QOL dimensions returned to the preoperative level. There were significant reductions in weight (P<.001) and BMI (P=.02) throughout the study, and no significant changes were observed for physical fitness measured by change in the 6-minute walk distance between baseline and the 1-month follow-up (P=.22) or between baseline and the 3-month follow-up (P=.52). Depressive symptoms significantly increased 1 month after surgery (P<.001), while other psychological measures did not show relevant changes. Although there were declines in many measures 1 month after surgery, these were much improved at the 3-month follow-up, and the recovery was more profound and faster than with traditional rehabilitation programs. Conclusions: The CIMmH was feasible and safe and demonstrated encouraging efficacy testing with a control group for enhancing recovery after surgery among patients with esophageal cancer in China. Trial Registration: Chinese Clinical Trial Registry (ChiCTR-IPR-1800019900); http://www.chictr.org.cn/showprojen.aspx?proj=32811. ",
doi="10.2196/18946",
url="http://www.jmir.org/2020/8/e18946/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32808933"
}


@Article{info:doi/10.2196/17058,
author="Crafoord, Marie-Ther{\'e}se
and Fjell, Maria
and Sundberg, Kay
and Nilsson, Marie
and Langius-Ekl{\"o}f, Ann",
title="Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e17058",
keywords="engagement",
keywords="adherence",
keywords="mHealth",
keywords="mobile app",
keywords="cancer supportive care",
keywords="symptom management",
keywords="usage metrics",
keywords="breast cancer",
keywords="prostate cancer",
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 lower 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 usage of specific app functions for both patient groups. Patients' experience of relevance and interactivity influenced their engagement positively. ",
doi="10.2196/17058",
url="https://www.jmir.org/2020/8/e17058",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663140"
}


@Article{info:doi/10.2196/17408,
author="Gra{\vs}i{\v c} Kuhar, Cvetka
and Gortnar Cepeda, Tja{\vs}a
and Kova{\v c}, Timotej
and Kukar, Matja?
and Ru?i{\'c} Gorenjec, Nina",
title="Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="4",
volume="8",
number="8",
pages="e17408",
keywords="breast cancer",
keywords="systemic therapy",
keywords="mobile application",
keywords="patient-reported outcome",
keywords="quality of life",
abstract="Background: Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. Objective: The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. Methods: Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. Results: The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95\% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95\% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95\% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)---social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. Conclusions: Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated. ",
doi="10.2196/17408",
url="https://mhealth.jmir.org/2020/8/e17408",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427567"
}


@Article{info:doi/10.2196/17134,
author="Benjumea, Jaime
and Ropero, Jorge
and Rivera-Romero, Octavio
and Dorronzoro-Zubiete, Enrique
and Carrasco, Alejandro",
title="Assessment of the Fairness of Privacy Policies of Mobile Health Apps: Scale Development and Evaluation in Cancer Apps",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="28",
volume="8",
number="7",
pages="e17134",
keywords="privacy",
keywords="mhealth apps",
keywords="fairness assessment scale",
keywords="cancer apps",
keywords="GDPR",
abstract="Background: Cancer patients are increasingly using mobile health (mHealth) apps to take control of their health. Many studies have explored their efficiency, content, usability, and adherence; however, these apps have created a new set of privacy challenges, as they store personal and sensitive data. Objective: The purpose of this study was to refine and evaluate a scale based on the General Data Protection Regulation and assess the fairness of privacy policies of mHealth apps. Methods: Based on the experience gained from our previous work, we redefined some of the items and scores of our privacy scale. Using the new version of our scale, we conducted a case study in which we analyzed the privacy policies of cancer Android apps. A systematic search of cancer mobile apps was performed in the Spanish version of the Google Play website. Results: The redefinition of certain items reduced discrepancies between reviewers. Thus, use of the scale was made easier, not only for the reviewers but also for any other potential users of our scale. Assessment of the privacy policies revealed that 29\% (9/31) of the apps included in the study did not have a privacy policy, 32\% (10/31) had a score over 50 out of a maximum of 100 points, and 39\% (12/31) scored fewer than 50 points. Conclusions: In this paper, we present a scale for the assessment of mHealth apps that is an improved version of our previous scale with adjusted scores. The results showed a lack of fairness in the mHealth app privacy policies that we examined, and the scale provides developers with a tool to evaluate their privacy policies. ",
doi="10.2196/17134",
url="http://mhealth.jmir.org/2020/7/e17134/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720913"
}


@Article{info:doi/10.2196/18132,
author="Wang, Tze-Fang
and Huang, Rou-Chen
and Yang, Su-Chen
and Chou, Chyuan
and Chen, Lee-Chen",
title="Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="27",
volume="8",
number="7",
pages="e18132",
keywords="care needs",
keywords="health information",
keywords="mobile health app",
keywords="oral cancer",
keywords="technology acceptance",
keywords="quality of life",
abstract="Background: Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. Objective: This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. Methods: After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients' quality of life, nursing care needs, and acceptance of the mHealth app. Results: The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (--7.24 vs --4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). Conclusions: Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients' need for physiological care and improving their quality of life. Trial Registration: ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968 ",
doi="10.2196/18132",
url="http://mhealth.jmir.org/2020/7/e18132/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716303"
}


@Article{info:doi/10.2196/17609,
author="Amor-Garc{\'i}a, {\'A}ngel Miguel
and Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Melgarejo-Ortu{\~n}o, Alejandra
and Herranz-Alonso, Ana
and Arranz Arija, {\'A}ngel Jos{\'e}
and Sanjurjo-S{\'a}ez, Mar{\'i}a",
title="Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="23",
volume="8",
number="7",
pages="e17609",
keywords="genitourinary cancer",
keywords="mobile apps",
keywords="eHealth",
keywords="mHealth",
keywords="rating tool",
abstract="Background: The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer. Objective: The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps. Methods: We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5. Results: In total, 46 apps were analyzed. Of these, 31 (67\%) were available on Android, 6 (13\%) on iOS, and 9 (20\%) on both platforms. The apps were free in 89\% of cases (41/46), and 61\% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30\% of cases (14/46) and cervical cancer in 17\% (8/46). The apps were mainly informative (63\%, 29/46), preventive (24\%, 11/46), and diagnostic (13\%, 6/46). Only 7/46 apps (15\%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: ``Bladder cancer manager,'' ``Kidney cancer manager,'' ``My prostate cancer manager,'' ``Target Ovarian Cancer Symptoms Diary,'' and ``My Cancer Coach.'' We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62). Conclusions: MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality. ",
doi="10.2196/17609",
url="http://mhealth.jmir.org/2020/7/e17609/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706737"
}


@Article{info:doi/10.2196/15591,
author="Ooi, Yau Chor
and Ng, Jenn Chirk
and Sales, E. Anne
and Lim, Min Hooi",
title="Implementation Strategies for Web-Based Apps for Screening: Scoping Review",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="20",
volume="22",
number="7",
pages="e15591",
keywords="internet",
keywords="mHealth",
keywords="eHealth",
keywords="mass screening",
keywords="implementation strategies",
abstract="Background: Screening is an effective primary prevention strategy in health care, as it enables the early detection of diseases. However, the uptake of such screening remains low. Different delivery methods for screening have been developed and found to be effective in increasing the uptake of screening, including the use of web-based apps. Studies have shown that web-based apps for screening are effective in increasing the uptake of health screening among the general population. However, not much is known about the effective implementation of such web-based apps in the real-world setting. Implementation strategies are theory-based methods or techniques used to enhance the adoption, implementation, and sustainability of evidence-based interventions. Implementation strategies are important, as they allow us to understand how to implement an evidence-based intervention. Therefore, a scoping review to identify the various implementation strategies for web-based apps for screening is warranted. Objective: This scoping review aims to identify (1) strategies used to implement web-based apps for health screening, (2) frameworks used for implementing web-based apps for health screening, (3) outcome measures of implementation strategies, and (4) effective implementation strategies. Methods: This scoping review was conducted based on Arksey and O'Malley's framework. After identifying the review question, two researchers independently screened and selected relevant literature from PubMed, Embase, Cochrane, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, International Standard Randomised Controlled Trial Number Registry, OpenGrey, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Web of Science. This was followed by charting the data using a standardized form. Finally, we collated, summarized, and reported the results quantitatively and qualitatively based on the review objectives. Results: A total of 16,476 studies were retrieved, of which 5669 were duplicates. From a total of 10,807 studies, 10,784 studies were excluded based on their titles and abstracts. There were 23 full-text articles reviewed, and 4 articles were included in the final analysis. Many studies were excluded because they focused on the effectiveness and not on the implementation of web-based apps. Facilitation was the most cited implementation strategy used, followed by reminders, clinical champions, and educational meetings and materials. Only 2 studies used implementation frameworks to guide the evaluation of their studies. Common outcome measures for implementation strategies were feasibility, fidelity, and penetration. Implementation strategies reported to be effective were quality improvement meetings, facilitation, educational meetings, and clinical champions. Conclusions: There is a dearth of literature on the implementation of web-based apps for health screening. Implementation strategies were developed without any reported use of implementation theories or frameworks in most studies. More research on the development and evaluation of web-based screening app implementations is needed. ",
doi="10.2196/15591",
url="http://www.jmir.org/2020/7/e15591/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706655"
}


@Article{info:doi/10.2196/17372,
author="Tian, Xu
and Xu, Ling-Li
and Liu, Xiao-Ling
and Chen, Wei-Qing",
title="Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="1",
volume="8",
number="6",
pages="e17372",
keywords="colonoscopy",
keywords="bowel preparation",
keywords="patient education",
keywords="polyp detection rate",
keywords="adenoma detection rate",
keywords="meta-analysis",
abstract="Background:  To improve patients' comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. Objective: This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. Methods: We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. Results: We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95\% CI 1.05-1.35; P<.05; I2=42\%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95\% CI 1.15-1.64; P<.001; I2=0\%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95\% CI 1.22-2.53; P<.05; I2=0\%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95\% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. Conclusions: The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data. ",
doi="10.2196/17372",
url="https://mhealth.jmir.org/2020/6/e17372",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347798"
}


@Article{info:doi/10.2196/16527,
author="Ngo, Victoria
and Matsumoto, G. Cynthia
and Joseph, G. Jill
and Bell, F. Janice
and Bold, J. Richard
and Davis, Andra
and Reed, C. Sarah
and Kim, K. Katherine",
title="The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="26",
volume="8",
number="5",
pages="e16527",
keywords="care coordination, continuity of patient care",
keywords="oncology",
keywords="chemotherapy",
keywords="patient-centered care",
keywords="mobile health",
keywords="technology adoption",
abstract="Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)---a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. Objective: This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. Methods: A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. Results: A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. Conclusions: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness. ",
doi="10.2196/16527",
url="http://mhealth.jmir.org/2020/5/e16527/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452814"
}


@Article{info:doi/10.2196/15895,
author="Ector, ICG Genevi{\`e}ve
and Westerweel, E. Peter
and Hermens, PMG Rosella
and Braspenning, AE Karin
and Heeren, CM Barend
and Vinck, MF Oscar
and de Jong, JM Jan
and Janssen, JWM Jeroen
and Blijlevens, MA Nicole",
title="The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach",
journal="J Med Internet Res",
year="2020",
month="May",
day="15",
volume="22",
number="5",
pages="e15895",
keywords="eHealth",
keywords="chronic myeloid leukemia",
keywords="patient participation",
keywords="mobile apps",
abstract="Background: With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective: The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods: The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results: The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients' symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions: The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves. ",
doi="10.2196/15895",
url="https://www.jmir.org/2020/5/e15895",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412424"
}


@Article{info:doi/10.2196/17320,
author="Jung, Miyeon
and Lee, SaeByul
and Kim, Jisun
and Kim, HeeJeong
and Ko, BeomSeok
and Son, Ho Byung
and Ahn, Sei-Hyun
and Park, Rang Yu
and Cho, Daegon
and Chung, Haekwon
and Park, Jin Hye
and Lee, Minsun
and Lee, Won Jong
and Chung, Seockhoon
and Chung, Yong Il",
title="A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="4",
volume="8",
number="5",
pages="e17320",
keywords="telemedicine",
keywords="breast neoplasms",
keywords="mobile apps",
keywords="quality of life",
keywords="validation",
keywords="patient-reported outcome measures (PROMs)",
keywords="questionnaire",
abstract="Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient's health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire--9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire--9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 ",
doi="10.2196/17320",
url="https://mhealth.jmir.org/2020/5/e17320",
url="http://www.ncbi.nlm.nih.gov/pubmed/32364508"
}


@Article{info:doi/10.2196/15780,
author="Hou, I-Ching
and Lan, Min-Fang
and Shen, Shan-Hsiang
and Tsai, Yu Pei
and Chang, Jen King
and Tai, Hao-Chih
and Tsai, Ay-Jen
and Chang, Polun
and Wang, Tze-Fang
and Sheu, Shuh-Jen
and Dykes, C. Patricia",
title="The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e15780",
keywords="breast cancer",
keywords="mobile health application",
keywords="self-management",
keywords="design thinking",
abstract="Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. ",
doi="10.2196/15780",
url="http://mhealth.jmir.org/2020/4/e15780/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352390"
}


@Article{info:doi/10.2196/16476,
author="Chow, I. Philip
and Showalter, L. Shayna
and Gerber, Matthew
and Kennedy, M. Erin
and Brenin, David
and Mohr, C. David
and Lattie, G. Emily
and Gupta, Alisha
and Ocker, Gabrielle
and Cohn, F. Wendy",
title="Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study",
journal="JMIR Cancer",
year="2020",
month="Apr",
day="15",
volume="6",
number="1",
pages="e16476",
keywords="breast cancer",
keywords="mental health",
keywords="mHealth",
abstract="Background: Nearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer. Objective: The aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer. Methods: This pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute--designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention. Results: The minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement. Conclusions: There is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone--delivered programs with additional phone support can be used to support patients with breast cancer. International Registered Report Identifier (IRRID): RR2-10.2196/11452 ",
doi="10.2196/16476",
url="http://cancer.jmir.org/2020/1/e16476/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32293570"
}


@Article{info:doi/10.2196/17292,
author="Low, A. Carissa
and Danko, Michaela
and Durica, C. Krina
and Kunta, Reddy Abhineeth
and Mulukutla, Raghu
and Ren, Yiyi
and Bartlett, L. David
and Bovbjerg, H. Dana
and Dey, K. Anind
and Jakicic, M. John",
title="A Real-Time Mobile Intervention to Reduce Sedentary Behavior Before and After Cancer Surgery: Usability and Feasibility Study",
journal="JMIR Perioper Med",
year="2020",
month="Mar",
day="23",
volume="3",
number="1",
pages="e17292",
keywords="sedentary behavior",
keywords="mobile health",
keywords="smartphone",
keywords="mobile phone",
keywords="wearable device",
keywords="surgical oncology",
keywords="physical activity",
abstract="Background: Sedentary behavior (SB) is common after cancer surgery and may negatively affect recovery and quality of life, but postoperative symptoms such as pain can be a significant barrier to patients achieving recommended physical activity levels. We conducted a single-arm pilot trial evaluating the usability and acceptability of a real-time mobile intervention that detects prolonged SB in the perioperative period and delivers prompts to walk that are tailored to daily self-reported symptom burden. Objective: The aim of this study is to develop and test a mobile technology-supported intervention to reduce SB before and after cancer surgery, and to evaluate the usability and feasibility of the intervention. Methods: A total of 15 patients scheduled for abdominal cancer surgery consented to the study, which involved using a Fitbit smartwatch with a companion smartphone app across the perioperative period (from a minimum of 2 weeks before surgery to 30 days postdischarge). Participants received prompts to walk after any SB that exceeded a prespecified threshold, which varied from day to day based on patient-reported symptom severity. Participants also completed weekly semistructured interviews to collect information on usability, acceptability, and experience using the app and smartphone; in addition, smartwatch logs were examined to assess participant study compliance. Results: Of eligible patients approached, 79\% (15/19) agreed to participate. Attrition was low (1/15, 7\%) and due to poor health and prolonged hospitalization. Participants rated (0-100) the smartphone and smartwatch apps as very easy (mean 92.3 and 93.2, respectively) and pleasant to use (mean 93.0 and 93.2, respectively). Overall satisfaction with the whole system was 89.9, and the mean System Usability Scale score was 83.8 out of 100. Overall compliance with symptom reporting was 51\% (469/927 days), decreasing significantly from before surgery (264/364, 73\%) to inpatient recovery (32/143, 22\%) and postdischarge (173/420, 41\%). Overall Fitbit compliance was 70\% (653/927 days) but also declined from before surgery (330/364, 91\%) to inpatient (51/143, 36\%) and postdischarge (272/420, 65\%). Conclusions: Perioperative patients with cancer were willing to use a smartwatch- and smartphone-based real-time intervention to reduce SB, and they rated the apps as very easy and pleasant to use. Compliance with the intervention declined significantly after surgery. The effects of the intervention on postoperative activity patterns, recovery, and quality of life will be evaluated in an ongoing randomized trial. ",
doi="10.2196/17292",
url="http://periop.jmir.org/2020/1/e17292/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393915"
}


@Article{info:doi/10.2196/14435,
author="Kim, Yoon
and Seo, Jinserk
and An, So-Yeon
and Sinn, Hyun Dong
and Hwang, Hye Ji",
title="Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="11",
volume="8",
number="3",
pages="e14435",
keywords="mHealth",
keywords="hepatocellular carcinoma",
keywords="rehabilitation",
keywords="exercise",
keywords="physical fitness",
keywords="physical activity",
abstract="Background: Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. Objective: The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. Methods: A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants' physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the  European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. Results: Of the 37 patients, 31 (84\%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. Conclusions: Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy. ",
doi="10.2196/14435",
url="http://mhealth.jmir.org/2020/3/e14435/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32159517"
}


@Article{info:doi/10.2196/17084,
author="Hou, I-Ching
and Lin, Hsin-Yi
and Shen, Shan-Hsiang
and Chang, King-Jen
and Tai, Hao-Chih
and Tsai, Ay-Jen
and Dykes, C. Patricia",
title="Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="4",
volume="8",
number="3",
pages="e17084",
keywords="breast cancer",
keywords="mHealth app",
keywords="self-management",
keywords="quality of life",
abstract="Background: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires---the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)---were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3\% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248 ",
doi="10.2196/17084",
url="http://mhealth.jmir.org/2020/3/e17084/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130181"
}


@Article{info:doi/10.2196/15487,
author="Yaacob, Azwany Nor
and Mohamad Marzuki, Fadhil Muhamad
and Yaacob, Majdi Najib
and Ahmad, Bariyah Shahrul
and Abu Hassan, Radzi Muhammad",
title="Effectiveness of the ColorApp Mobile App for Health Education and Promotion for Colorectal Cancer: Quasi-Experimental Study",
journal="JMIR Hum Factors",
year="2020",
month="Feb",
day="25",
volume="7",
number="1",
pages="e15487",
keywords="colorectal cancer",
keywords="mobile app",
keywords="effectiveness",
keywords="knowledge",
keywords="attitude",
abstract="Background: Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods: A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results: There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F1,95=0.36, P=.55). Conclusions: The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer. ",
doi="10.2196/15487",
url="https://humanfactors.jmir.org/2020/1/e15487",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130119"
}


@Article{info:doi/10.2196/15969,
author="Spahrk{\"a}s, S. Simon
and Looijmans, Anne
and Sanderman, Robbert
and Hagedoorn, Mari{\"e}t",
title="Beating Cancer-Related Fatigue With the Untire Mobile App: Protocol for a Waiting List Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="14",
volume="9",
number="2",
pages="e15969",
keywords="RCT",
keywords="mHealth",
keywords="app",
keywords="intervention",
keywords="fatigue",
keywords="quality of life",
keywords="cancer patients",
keywords="cancer survivors",
keywords="psycho-oncology",
abstract="Background: Many cancer patients and survivors worldwide experience disabling fatigue as the main side effect of their illness and the treatments involved. Face-to-face therapy is effective in treating cancer-related fatigue (CRF), but it is also resource-intensive. Offering a self-management program via a mobile phone app (ie, the Untire app), based on elements of effective face-to-face treatments, might increase the number of patients receiving adequate support for fatigue and decrease care costs. Objective: The aim of this protocol is to describe a randomized controlled trial (RCT) to assess the effectiveness of the Untire app in reducing fatigue in cancer patients and survivors after 12 weeks of app use as compared with a waiting list control group. Substudies nested within this trial include questions concerning the reach and costs of online recruitment and uptake and usage of the Untire app. Methods: The Untire app study is a waiting list RCT targeting cancer patients and survivors who experience moderate to severe fatigue via social media (Facebook and Instagram) across 4 English-speaking countries (Australia, Canada, the United Kingdom, and the United States). The Untire app includes psychoeducation and exercises concerning energy conservation, activity management, optimizing restful sleep, mindfulness-based stress reduction, psychosocial support, cognitive behavioral therapy, and physical activity. After randomization, participants in the intervention group could access the Untire app immediately, whereas control participants had no access to the Untire app until the primary follow-up assessment at 12 weeks. Participants completed questionnaires at baseline before randomization and after 4, 8, 12, and 24 weeks. The study outcomes are fatigue (primary) and quality of life (QoL; secondary). Potential moderators and mediators of the hypothesized treatment effect on levels of fatigue and QoL were also assessed. Link clicks and app activation are used to assess reach and uptake, respectively. Log data are used to explore the characteristics of app use. Sample size calculations for the primary outcome showed that we needed to include 164 participants with complete 12-week measures both in the intervention and the control groups. The intention-to-treat approach is used in the primary analyses, which refers to analyzing all participants regardless of their app use. Results: Participants were recruited from March to October 2018. The last participant completed the 24-week assessment in March 2019. Conclusions: This mobile health (mHealth) RCT recruited participants online in multiple countries to examine the uptake and effectiveness of the Untire self-management app to reduce CRF. Many advantages of mHealth apps are assumed, such as the immediate access to the app, the low thresholds to seek support, and the absence of contact with care professionals that will reduce costs. If found effective, this app can easily be offered worldwide to patients experiencing CRF. Trial Registration: Netherlands Trial Register NL6642; https://www.trialregister.nl/trial/6642. International Registered Report Identifier (IRRID): DERR1-10.2196/15969 ",
doi="10.2196/15969",
url="http://www.researchprotocols.org/2020/2/e15969/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130185"
}


@Article{info:doi/10.2196/16926,
author="Huberty, Jennifer
and Puzia, Megan
and Eckert, Ryan
and Larkey, Linda",
title="Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study",
journal="JMIR Cancer",
year="2020",
month="Feb",
day="10",
volume="6",
number="1",
pages="e16926",
keywords="cancer",
keywords="cancer survivors",
keywords="mindfulness",
keywords="meditation",
keywords="consumer behavior",
keywords="mobile apps",
keywords="health",
keywords="mental health",
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 (between 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 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 apps and provide a framework for evaluating their effects. ",
doi="10.2196/16926",
url="http://cancer.jmir.org/2020/1/e16926/"
}


@Article{info:doi/10.2196/16652,
author="Bricker, B. Jonathan
and Watson, L. Noreen
and Heffner, L. Jaimee
and Sullivan, Brianna
and Mull, Kristin
and Kwon, Diana
and Westmaas, Lee Johann
and Ostroff, Jamie",
title="A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="17",
volume="4",
number="1",
pages="e16652",
keywords="smartphone app",
keywords="mHealth",
keywords="tobacco",
keywords="smoking",
keywords="cancer patient",
abstract="Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute's QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36\%) and breast (10/59, 17\%) cancers. The 2-month follow-up survey retention rate was 92\% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90\% [19/21] for Quit2Heal vs 65\% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86\% [18/21] for Quit2Heal vs 62\% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20\% (5/25) for Quit2Heal versus 7\% (2/29) for QuitGuide (odds ratio 5.16, 95\% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 ",
doi="10.2196/16652",
url="http://formative.jmir.org/2020/1/e16652/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31951215"
}


@Article{info:doi/10.2196/15008,
author="Hangh{\o}j, Signe
and Boisen, A. Kirsten
and Hjerming, Maiken
and Elsbernd, Abbey
and Pappot, Helle",
title="Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study",
journal="JMIR Cancer",
year="2020",
month="Jan",
day="2",
volume="6",
number="1",
pages="e15008",
keywords="AYA",
keywords="adolescent and young adult",
keywords="app",
keywords="cancer",
keywords="co-creation",
keywords="mHealth",
keywords="mobile phone",
keywords="think-aloud test",
keywords="usability",
abstract="Background: Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kr{\ae}ftv{\ae}rket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience. Objective: The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kr{\ae}ftv{\ae}rket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app. Methods: A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kr{\ae}ftv{\ae}rket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results: The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization---female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app. Conclusions: Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kr{\ae}ftv{\ae}rket app with the input of more AYAs. ",
doi="10.2196/15008",
url="https://cancer.jmir.org/2020/1/e15008",
url="http://www.ncbi.nlm.nih.gov/pubmed/31895046"
}


@Article{info:doi/10.2196/13829,
author="Pappot, Helle
and Assam Taarnh{\o}j, Gry
and Elsbernd, Abbey
and Hjerming, Maiken
and Hangh{\o}j, Signe
and Jensen, Marc
and Boisen, Arntz Kirsten",
title="Health-Related Quality of Life Before and After Use of a Smartphone App for Adolescents and Young Adults With Cancer: Pre-Post Interventional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="3",
volume="7",
number="10",
pages="e13829",
keywords="adolescent",
keywords="young adult",
keywords="cancer",
keywords="mHealth",
keywords="smartphone",
keywords="survivorship",
keywords="quality of life",
abstract="Background: Adolescent and young adult (AYA) patients with cancer are a group with underexplored needs throughout treatment and in survivorship. This missing knowledge can influence their quality of life (QoL). Given this fact, we have developed a smartphone app based on a cocreation process and have an investigation of QoL among users planned as part of pilot testing this app. Future research is warranted to determine the effect of mobile health (mHealth) tools such as smartphone apps among the AYA cancer population. Objective: The aim of this study was to investigate the feasibility of a smartphone app among AYA patients with cancer in active treatment and posttreatment, in a pilot test by measuring health-related QoL before and after the use of the app. Methods: Participants were recruited via the youth support initiative and social organization for AYAs with cancer, Kr{\ae}ftv{\ae}rket, based at Rigshospitalet, University Hospital of Copenhagen, Denmark. Participants were evenly distributed in active treatment and posttreatment groups. After written informed consent, all participants were asked to use the app Kr{\ae}ftv{\ae}rket as they deemed appropriate over a 6-week period. The participants were asked to complete the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before and after the 6-week period. The collected QoL data were analyzed with t tests to determine differences between groups and from baseline. Results: In total, we enrolled 20 participants, 10 in active treatment and 10 posttreatment (median time after treatment was 4 months) group. Median age of the participants was 25 years. No differences in QoL were seen at baseline (P=.65). The posttreatment group experienced a significant increase in overall QoL after the 6-week period (global QoL: baseline 62.5, SD 22.3; after 6 weeks 80.8, SD 9.7; P=.04). For the group in active treatment, the QoL remained stable throughout the 6 weeks. Conclusions: This study shows the feasibility and possible effect on QoL associated with the use of an mHealth tool in AYA patients. mHealth support tools are warranted for this population. ",
doi="10.2196/13829",
url="https://mhealth.jmir.org/2019/10/e13829",
url="http://www.ncbi.nlm.nih.gov/pubmed/31584008"
}


@Article{info:doi/10.2196/13584,
author="Tarricone, Rosanna
and Cucciniello, Maria
and Armeni, Patrizio
and Petracca, Francesco
and Desouza, C. Kevin
and Hall, Kelly Leslie
and Keefe, Dorothy",
title="Mobile Health Divide Between Clinicians and Patients in Cancer Care: Results From a Cross-Sectional International Survey",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="06",
volume="7",
number="9",
pages="e13584",
keywords="mHealth",
keywords="cancer",
keywords="mobile phone",
keywords="survey",
keywords="mobile app",
keywords="digital health",
abstract="Background: Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients' and clinicians' expectations of mHealth apps are. Objective: This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods: Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results: A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46\%) was far lower than that of clinicians (859/1116, 76.97\%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8\% for clinicians and 38.7\% for patients using the propensity score--based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions: mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients' chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians' workload, be tested for validity and effectiveness, and fit the criteria for reimbursement. ",
doi="10.2196/13584",
url="https://mhealth.jmir.org/2019/9/e13584/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31493318"
}


@Article{info:doi/10.2196/13245,
author="Cruz, Marques Fl{\'a}via Oliveira Almeida
and Vilela, Alencar Ricardo
and Ferreira, Barros Elaine
and Melo, Santos Nilce
and Reis, Dos Paula Elaine Diniz",
title="Evidence on the Use of Mobile Apps During the Treatment of Breast Cancer: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Aug",
day="27",
volume="7",
number="8",
pages="e13245",
keywords="mobile applications",
keywords="health education",
keywords="nursing care",
keywords="review",
keywords="educational technology",
keywords="breast neoplasms",
abstract="Background: Cancer is a major cause of morbidity, disability, and mortality worldwide, and breast cancer is the most common cause of death in women. Different modalities of cancer treatment can have adverse effects that reduce the quality of life of patients and lead to treatment interruptions, if not managed properly. The use of mobile technologies has brought innovative possibilities for improving health care. Mobile apps can help individuals manage their own health and well-being and may also promote healthy lifestyles and information access. Objective: The aim of this study was to identify available evidence on the use of mobile apps to provide information and facilitate communication regarding self-care management related to the adverse effects of toxicities owing to breast cancer therapy. Methods: This systematic review includes studies which were identified using a search strategy adapted for each electronic database: CINAHL, Cochrane Library, LILACS, LIVIVO, PubMed, SCOPUS, and Web of Science. In addition, a gray literature search was performed using Google Scholar. All the electronic database searches were conducted on April 17, 2019. Two investigators independently reviewed the titles and abstracts of the studies identified and then read the full text of all selected papers. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. Results: A total of 9 studies which met the eligibility criteria---3 randomized clinical trials and 6 nonrandomized studies published in English from 2010 to 2018---were considered for this systematic review; 396 patients with breast cancer, as well as 40 experts in the medical and nursing fields, and 3 software engineers were included. Conclusions: The evidence from the studies included in this systematic review is currently limited but suggests that mobile apps for women with breast cancer might be an acceptable information source that can improve patient well-being; they can also be used to report symptoms and adverse treatment-related effects and promote self-care. There is a need to test more evidence-based apps in future randomized clinical trials. ",
doi="10.2196/13245",
url="http://mhealth.jmir.org/2019/8/e13245/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31456578"
}


@Article{info:doi/10.2196/14187,
author="Richards, Rebecca
and Kinnersley, Paul
and Brain, Kate
and Staffurth, John
and Wood, Fiona",
title="The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="31",
volume="7",
number="7",
pages="e14187",
keywords="education, medical",
keywords="medical information exchange",
keywords="smartphone",
keywords="mobile apps",
abstract="Background: The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. Objective: We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. Methods: Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. Results: Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients' unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. Conclusions: This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted. ",
doi="10.2196/14187",
url="http://mhealth.jmir.org/2019/7/e14187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31368446"
}


@Article{info:doi/10.2196/14292,
author="Huberty, Jennifer
and Eckert, Ryan
and Larkey, Linda
and Joeman, Lynda
and Mesa, Ruben",
title="Experiences of Using a Consumer-Based Mobile Meditation App to Improve Fatigue in Myeloproliferative Patients: Qualitative Study",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="22",
volume="5",
number="2",
pages="e14292",
keywords="mindfulness",
keywords="meditation",
keywords="mobile phone",
keywords="mHealth",
keywords="digital health",
keywords="cancer",
abstract="Background: Myeloproliferative neoplasm (MPN) patients suffer from long-term symptoms and reduced quality of life. Mindfulness meditation is a complementary therapy shown to be beneficial for alleviating a range of cancer-related symptoms; however, in-person meditation interventions are difficult for cancer patients to attend. Meditation via a mobile phone app represents a novel approach in MPN patients for delivering meditation. Objective: The study aimed to report MPN patients' (ie, na{\"i}ve or nearly na{\"i}ve meditators) perceptions of meditation and explore their experiences in the context of using a mobile phone for meditation after participation in an 8-week consumer-based meditation app feasibility study. Methods: MPN patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 that received varying orders of 2 consumer-based apps (10\% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min per day of mobile phone-based meditation, irrespective of the app and order in which they received the apps. At the conclusion of the study, participants were asked whether they would like to participate in a 20-min phone interview comprising 9 to 10 questions to discuss their perceptions and experiences while using the mobile phone meditation apps. The interviews were transcribed verbatim and imported into NVivo 12 (QSR International) for coding and analysis, using a combination of deductive and inductive methods to organize the data, generate categories, and develop themes and subthemes. Results: A total of 48 MPN patients completed postintervention interviews, of which 29\% (14/48) of the patients only used the 10\% Happier app, 21\% (10/48) of the patients only used the Calm app, and 46\% (22/48) of the patients used both apps during the 8-week intervention. Themes identified in the analysis of interview data related to (1) perceptions of meditation before, during, and after the study, (2) perceptions of the Calm app, (3) perceptions of the 10\% Happier app, (4) perceived impacts of using the meditation apps, (5) overall experiences of participating in the study, (6) recommendations surrounding meditation for other MPN patients, and (7) plans to continue meditation. Conclusions: The qualitative findings of this study suggest that MPN patients who are na{\"i}ve or nearly na{\"i}ve meditators perceived mobile phone meditation as enjoyable, preferred the Calm app over the 10\% Happier app, perceived the Calm app as more appealing (eg, narrator's voice and different meditations or background sounds offered), and perceived beneficial effects of meditation on mental health, sleep, fatigue, and pain. Future research is needed to better understand the efficacy of mobile phone meditation on MPN patient outcomes and meditation app design features that enhance uptake among its users. ",
doi="10.2196/14292",
url="http://cancer.jmir.org/2019/2/e14292/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31333197"
}


@Article{info:doi/10.2196/13543,
author="N{\'a}poles, Mar{\'i}a Anna
and Santoyo-Olsson, Jasmine
and Chac{\'o}n, Liliana
and Stewart, L. Anita
and Dixit, Niharika
and Ortiz, Carmen",
title="Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="09",
volume="5",
number="2",
pages="e13543",
keywords="Hispanic Americans",
keywords="cancer survivors",
keywords="mobile apps",
keywords="feasibility studies",
abstract="Background: Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. Methods: The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. Results: All women (n=23) were foreign-born with limited English proficiency; 13 (57\%) had an elementary school education or less, 16 (70\%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83\%) completed all 5 coaching calls. The majority (n=17; 81\%) rated the overall quality of the app as ``very good'' or ``excellent'' (all rated it as at least ``good''). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=--.26; P=.02; Cohen d=0.4) and health distress levels (B=--.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). Conclusions: We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. ",
doi="10.2196/13543",
url="http://cancer.jmir.org/2019/2/e13543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31290395"
}


@Article{info:doi/10.2196/12242,
author="Sewitch, J. Maida
and Fallone, A. Carlo
and Ghali, Peter
and Lee, Eun Ga",
title="What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="02",
volume="7",
number="7",
pages="e12242",
keywords="colonoscopy",
keywords="early detection of cancer",
keywords="mobile health technology",
keywords="qualitative research",
keywords="smartphone",
keywords="user-centered",
abstract="Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11\% of patients do not keep their colonoscopy appointments and up to 33\% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app. ",
doi="10.2196/12242",
url="https://mhealth.jmir.org/2019/7/e12242/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31125310"
}


@Article{info:doi/10.2196/12542,
author="Yang, Jing
and Weng, Lizhu
and Chen, Zhikui
and Cai, Hongfu
and Lin, Xiaoyan
and Hu, Zhijian
and Li, Na
and Lin, Bijuan
and Zheng, Bin
and Zhuang, Qian
and Du, Bin
and Zheng, Zhiyuan
and Liu, Maobai",
title="Development and Testing of a Mobile App for Pain Management Among  Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="29",
volume="7",
number="5",
pages="e12542",
keywords="cancer",
keywords="pain management",
keywords="quality of life",
keywords="adherence",
abstract="Background: The incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain. Objective: The aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app. Methods: This randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system's usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients. Results: All participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74\%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16\%) indicated that they were somewhat satisfied, 2 (6\%) indicated neutral feelings, and 1 (3\%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied. Conclusions: Pain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients. Trial Registration: Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153 ",
doi="10.2196/12542",
url="http://mhealth.jmir.org/2019/5/e12542/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31144672"
}


@Article{info:doi/10.2196/12317,
author="Hamel, M. Lauren
and Thompson, S. Hayley
and Albrecht, L. Terrance
and Harper, WK Felicity",
title="Designing and Testing Apps to Support Patients With Cancer: Looking to Behavioral Science to Lead the Way",
journal="JMIR Cancer",
year="2019",
month="Apr",
day="22",
volume="5",
number="1",
pages="e12317",
keywords="behavioral science",
keywords="cancer",
keywords="mobile apps",
keywords="evidence-based practice",
keywords="smartphone",
keywords="mHealth",
abstract="Background: Behavioral science has a long and strong tradition of rigorous experimental and applied methodologies, which have produced several influential and far-reaching theoretical frameworks and have guided countless inquiries of human behavior in various contexts. In cancer care, behavioral scientists have established a firm foundation of research focused on understanding the experience of cancer and using that understanding to design and implement theory- and evidenced-based interventions to help patients cope with the cancer experience. Given the rich behavioral research base in oncology, behavioral scientists are ideally positioned to lead the integration of evidence-based science on behavior and behavior change into the development of smartphone apps supporting patients with cancer. Smartphone apps are being disseminated to patients with cancer with claims of being able to help them negotiate areas of vulnerability in their cancer experience. However, the vast majority of these apps are developed without the rigor and expertise of behavioral scientists. Objective: In this article, we have illustrated the importance of behavioral science leading the development and evaluation of apps to support patients with cancer by providing an illustrative scientific process that our team of behavioral scientists, patient stakeholders, medical oncologists, and software developers used to empirically design and evaluate 2 patient-focused apps: the Discussion of Cost App (DISCO App) and MyPatientPal. Methods: Using a focused literature review and a descriptive roadmap of our team's process for designing and evaluating patient-focused behavioral apps for patients with cancer, we have demonstrated how behavioral scientists are integral to the development of empirically sound apps to help support patients with cancer. Specifically, we have illustrated the process by which our multidisciplinary team combined the established user-centered design principles and behavioral science theory and scientific rigor to design and evaluate 2 patient-focused apps. Results: On the basis of initial acceptability and feasibility testing among patients and providers, our team has demonstrated how critical behavioral science is for designing and evaluating app-based interventions for patients with cancer. Conclusions: Behavioral science can and should be coupled with user-centered design principles to provide theoretical guidance and the rigor of the scientific method, thereby adding the much-needed and critical evidence for these types of app-based interventions for patients with cancer. ",
doi="10.2196/12317",
url="http://cancer.jmir.org/2019/1/e12317/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066691"
}


@Article{info:doi/10.2196/13555,
author="Jacob, Christine
and Sanchez-Vazquez, Antonio
and Ivory, Chris",
title="Clinicians' Role in the Adoption of an Oncology Decision Support App in Europe and Its Implications for Organizational Practices: Qualitative Case Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="03",
volume="7",
number="5",
pages="e13555",
keywords="telemedicine",
keywords="smartphone",
keywords="cell phone",
keywords="oncologists",
keywords="electronic health record",
keywords="workflow",
keywords="workload",
keywords="workplace",
keywords="public health practice",
keywords="technology",
keywords="perception",
keywords="health education",
keywords="mHealth",
keywords="mobile health",
keywords="telehealth",
keywords="eHealth",
abstract="Background: Despite the existence of adequate technological infrastructure and clearer policies, there are situations where users, mainly physicians, resist mobile health (mHealth) solutions. This is of particular concern, bearing in mind that several studies, both in developed and developing countries, showed that clinicians' adoption is the most influential factor in such solutions' success. Objective: The aim of this study was to focus on understanding clinicians' roles in the adoption of an oncology decision support app, the factors impacting this adoption, and its implications for organizational and social practices. Methods: A qualitative case study of a decision support app in oncology, called ONCOassist, was conducted. The data were collected through 17 in-depth interviews with clinicians and nurses in the United Kingdom, Ireland, France, Italy, Spain, and Portugal. Results: This case demonstrates the affordances and constraints of mHealth technology at the workplace, its implications for the organization of work, and clinicians' role in its constant development and adoption. The research findings confirmed that factors such as app operation and stability, ease of use, usefulness, cost, and portability play a major role in the adoption decision; however, other social factors such as endorsement, neutrality of the content, attitude toward technology, existing workload, and internal organizational politics are also reported as key determinants of clinicians' adoption. Interoperability and cultural views of mobile usage at work are the key workflow disadvantages, whereas higher efficiency and performance, sharpened practice, and location flexibility are the main workflow advantages. Conclusions: Several organizational implications emerged, suggesting the need for some actions such as fostering a work culture that embraces new technologies and the creation of new digital roles for clinicians both on the hospitals or clinics and on the development sides but also more collaboration between health care organizations and digital health providers to enable electronic medical record integration and solving of any interoperability issues. From a theoretical perspective, we also suggest the addition of a fourth step to Leonardi's methodological guidance that accounts for user engagement; embedding the users in the continuous design and development processes ensures the understanding of user-specific affordances that can then be made more obvious to other users and increase the potential of such tools to go beyond their technological features and have a higher impact on workflow and the organizing process. ",
doi="10.2196/13555",
url="https://mhealth.jmir.org/2019/5/e13555/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066710"
}


@Article{info:doi/10.2196/12662,
author="Huberty, Jennifer
and Eckert, Ryan
and Larkey, Linda
and Kurka, Jonathan
and Rodr{\'i}guez De Jes{\'u}s, A. Sue
and Yoo, Wonsuk
and Mesa, Ruben",
title="Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="29",
volume="3",
number="2",
pages="e12662",
keywords="mindfulness",
keywords="meditation",
keywords="smartphone",
keywords="mHealth",
keywords="cancer",
keywords="quality of life",
abstract="Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10\% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4\% (94/128) patients completing the intervention. Of the participants who completed the 10\% Happier app, 61\% (46/76) enjoyed it, 66\% (50/76) were satisfied with the content, and 77\% (59/76) would recommend to others. Of those who completed the Calm app, 83\% (56/68) enjoyed it, 84\% (57/68) were satisfied with the content, and 97\% (66/68) would recommend to others. Of those who completed the educational control, 91\% (56/61) read it, 87\% (53/61) enjoyed it, and 71\% (43/61) learned something. Participants who completed the 10\% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10\% Happier app participants saw small effects on anxiety (P<.001 d=?0.43), depression (P=.02; d=?0.38), sleep disturbance (P=.01; d=?0.40), total symptom burden (P=.13; d=?0.27), and fatigue (P=.06; d=?0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=?0.22), depression (P=.09; d=?0.29), sleep disturbance (P=.002; d=?0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=?0.27), and fatigue (P=.13; d=?0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10\% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM) ",
doi="10.2196/12662",
url="http://formative.jmir.org/2019/2/e12662/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31033443"
}


@Article{info:doi/10.2196/11989,
author="Wu, Jin-Ming
and Ho, Te-Wei
and Chang, Yao-Ting
and Hsu, ChungChieh
and Tsai, Jui Chia
and Lai, Feipei
and Lin, Ming-Tsan",
title="Wearable-Based Mobile Health App in Gastric Cancer Patients for Postoperative Physical Activity Monitoring: Focus Group Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="23",
volume="7",
number="4",
pages="e11989",
keywords="telemedicine",
keywords="exercise",
keywords="perioperative care",
keywords="gastrectomy",
keywords="stomach neoplasms",
abstract="Background: Surgical cancer patients often have deteriorated physical activity (PA), which in turn, contributes to poor outcomes and early recurrence of cancer. Mobile health (mHealth) platforms are progressively used for monitoring clinical conditions in medical subjects. Despite prevalent enthusiasm for the use of mHealth, limited studies have applied these platforms to surgical patients who are in much need of care because of acutely significant loss of physical function during the postoperative period. Objective: The aim of our study was to determine the feasibility and clinical value of using 1 wearable device connected with the mHealth platform to record PA among patients with gastric cancer (GC) who had undergone gastrectomy. Methods: We enrolled surgical GC patients during their inpatient stay and trained them to use the app and wearable device, enabling them to automatically monitor their walking steps. The patients continued to transmit data until postoperative day 28. The primary aim of this study was to validate the feasibility of this system, which was defined as the proportion of participants using each element of the system (wearing the device and uploading step counts) for at least 70\% of the 28-day study. ``Definitely feasible,'' ``possibly feasible,'' and ``not feasible'' were defined as ?70\%, 50\%-69\%, and <50\% of participants meeting the criteria, respectively. Moreover, the secondary aim was to evaluate the clinical value of measuring walking steps by examining whether they were associated with early discharge (length of hospital stay <9 days). Results: We enrolled 43 GC inpatients for the analysis. The weekly submission rate at the first, second, third, and fourth week was 100\%, 93\%, 91\%, and 86\%, respectively. The overall daily submission rate was 95.5\% (1150 days, with 43 subjects submitting data for 28 days). These data showed that this system met the definition of ``definitely feasible.'' Of the 54 missed transmission days, 6 occurred in week 2, 12 occurred in week 3, and 36 occurred in week 4. The primary reason for not sending data was that patients or caregivers forgot to charge the wearable devices (>90\%). Furthermore, we used a multivariable-adjusted model to predict early discharge, which demonstrated that every 1000-step increment of walking on postoperative day 5 was associated with early discharge (odds ratio 2.72, 95\% CI 1.17-6.32; P=.02). Conclusions: Incorporating the use of mobile phone apps with wearable devices to record PA in patients of postoperative GC was feasible in patients undergoing gastrectomy in this study. With the support of the mHealth platform, this app offers seamless tracing of patients' recovery with a little extra burden and turns subjective PA into an objective, measurable parameter. ",
doi="10.2196/11989",
url="http://mhealth.jmir.org/2019/4/e11989/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31012858"
}


@Article{info:doi/10.2196/10187,
author="Boceta, Jaime
and Samper, Daniel
and de la Torre, Alejandro
and S{\'a}nchez-de la Rosa, Rainel
and Gonz{\'a}lez, Gloria",
title="Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain",
journal="JMIR Cancer",
year="2019",
month="Apr",
day="01",
volume="5",
number="1",
pages="e10187",
keywords="breakthrough cancer pain",
keywords="mHealth",
keywords="mobile app",
keywords="App INES{\textperiodcentered}DIO",
abstract="Background: Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). Objective: This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES{\textperiodcentered}DIO developed for the management of patients with BTcP. Methods: This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. Results: Of the 175 physicians, 96\% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43\%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80\% (140/175) of physicians. The majority (157/175, 90\%) answered that App INES{\textperiodcentered}DIO was well designed and 94\% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients' clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES{\textperiodcentered}DIO. Conclusions: Our study showed that App INES{\textperiodcentered}DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP. ",
doi="10.2196/10187",
url="https://cancer.jmir.org/2019/1/e10187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30932862"
}


@Article{info:doi/10.2196/10930,
author="Jongerius, Chiara
and Russo, Selena
and Mazzocco, Ketti
and Pravettoni, Gabriella",
title="Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="11",
volume="7",
number="2",
pages="e10930",
keywords="breast cancer care",
keywords="breast cancer management",
keywords="breast cancer prevention",
keywords="breast cancer survivorship",
keywords="mobile applications",
keywords="mHealth applications",
abstract="Background: The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. Objective: The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. Methods: A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions' features, outcome measures, and results. Results: We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. Conclusions: Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations. ",
doi="10.2196/10930",
url="http://mhealth.jmir.org/2019/2/e10930/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30741644"
}


@Article{info:doi/10.2196/11114,
author="Azulay, Revital
and Valinsky, Liora
and Hershkowitz, Fabienne
and Magnezi, Racheli",
title="Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="05",
volume="7",
number="2",
pages="e11114",
keywords="adherence",
keywords="cancer screening",
keywords="colonoscopy",
keywords="fetal occult blood test",
keywords="patient-physician relationship",
keywords="positive colorectal cancer screening",
keywords="SMS",
keywords="text reminder",
abstract="Background: Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation. Objective: The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result. Methods: This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95\% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians' attitude. Results: Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3\% vs 47.1\%; OR 2.17, 95\% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001). Conclusions: A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests. Trial Registration: ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl) ",
doi="10.2196/11114",
url="http://mhealth.jmir.org/2019/2/e11114/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30720439"
}


@Article{info:doi/10.2196/11779,
author="Heynsbergh, Natalie
and Heckel, Leila
and Botti, Mari
and Livingston, M. Patricia",
title="A Smartphone App to Support Carers of People Living With Cancer: A Feasibility and Usability Study",
journal="JMIR Cancer",
year="2019",
month="Jan",
day="31",
volume="5",
number="1",
pages="e11779",
keywords="cancer",
keywords="carer",
keywords="mobile app",
keywords="smartphone",
keywords="technology",
keywords="mobile phone",
abstract="Background: Carers experience unique needs while caring for someone with cancer. Interventions that address carers' needs and well-being have been developed and tested; however, the use of smartphone apps to support adult carers looking after another adult with cancer has not been assessed. Objective: The objective of this study was to test the feasibility, usability, and acceptability of a smartphone app, called the Carer Guide App, for carers of people with colorectal cancer. Methods: We recruited carers of people with colorectal cancer from outpatient day oncology units and provided them with access to the smartphone app for 30 days. Carers had access to video instructions and email contact details for technical support. Carers received 2 email messages per week that directed them to resources available within the app. Carers completed demographic questions at baseline and questions related to feasibility and usability at 30 days post app download. We used recruitment and attrition rates to determine feasibility and relevance of content to carers' needs as self-reported by carers. We assessed usability through the ease of navigation and design and use of technical support or instructional videos. Acceptability was measured through self-reported usage, usage statistics provided by Google Analytics, and comments for improvement. Results: We recruited 31\% (26/85) eligible carers into the trial. Of the 26 carers, the majority were female (19, 73\%), on average 57 years of age, were caring for a spouse with cancer (19, 73\%), and held a university degree (19, 73\%). Regarding feasibility, carers perceived the content of the Carer Guide App as relevant to the information they were seeking. Regarding usability, carers perceived the navigation and design of the app as easy to use. Of the 26 carers, 4 (15\%) viewed the downloading and navigation video and 7 (27\%) used the contact email address for queries and comments. Acceptability: On average, carers used the smartphone app for 22 minutes (SD 21 minutes) over the 30-day trial. Of 26 participants, 19 completed a follow-up questionnaire. Of 19 carers, 7 (37\%) logged on 3 to 4 times during the 30 days and 5 (26\%) logged on more than 5 times. The majority (16/19, 84\%) of carers stated that they would recommend the app be available for all carers. Comments for improvement included individualized requests for specific content. Conclusions: The Carer Guide App was feasible and usable among carers of people with colorectal cancer. Acceptability can be improved through the inclusion of a variety of information and resources. A randomized controlled trial is required to assess the impact of the Carer Guide App on carers' health and well-being. ",
doi="10.2196/11779",
url="http://cancer.jmir.org/2019/1/e11779/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30702432"
}


@Article{info:doi/10.2196/mhealth.9351,
author="Hagoel, Lea
and Stein, Nili
and Rennert, Gad
and Neter, Efrat",
title="Better Ask Than Tell: Responses to mHealth Interrogative Reminders and Associations With Colorectal Cancer Screening Subsequent Uptake in a Prospective Cohort Intervention",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="21",
volume="7",
number="1",
pages="e9351",
keywords="adherence",
keywords="colorectal cancer",
keywords="cancer screening",
keywords="health behaviors",
keywords="interrogative reminders",
keywords="short message service text messages",
abstract="Background: Text message (short message service, SMS) interrogative reminders were adopted in population screening for the early detection of colorectal cancer (CRC). Objective: This study aims to examine responses to text message (SMS) reminders and associate responses with senders' characteristics, message type (interrogative/declarative), and subsequent screening uptake. Methods: We conducted a prospective cohort intervention. Text message (SMS) reminders to undergo CRC screening, randomized into interrogative and declarative phrasing, were sent to nonadherent 40,000 women and men (age 50-74 years) at CRC average risk. We analyzed recipient responses by message phrasing, recipient characteristics, and for content, the latter predicting subsequent CRC screening per program database. Results: While interrogative text message (SMS) reminders elicited 7.67\% (1475/19,227) responses, declarative ones elicited 0.76\% (146/19,262) responses. Text message (SMS) responses were content analyzed and grouped into attitudes toward CRC screening (1237/1512, 81.8\% positive) and intention to screen (1004/1512, 62.6\%). Text message (SMS) respondents screened significantly more than nonrespondents after 6 months (415/1621, 25.6\% vs 3322/36,868, 9.0\%; $\chi$12=487.5, P<.001); 1 year (340/1621, 21.0\% vs 4711/36,868; $\chi$12=91.5, P<.001); and 2 years (225/1621, 13.9\% vs 3924/36,868; $\chi$12=16.9, P<.001) following the reminders. In a multivariable logistic regression among text message (SMS) respondents, screening after 6 months was significantly predicted by older age, past sporadic screening, attitudes, and intentions. Conclusions: Interrogative text message (SMS) reminders reached previously uninvolved sectors in the CRC target population---men, sporadic-screenees, and the ``never-tested'' before. This novel application resulted in a population-level, incrementally enhanced screening. Asking patients about their future health behavior may be relevant for enhancing other health behaviors in preventive medicine and clinical settings. ",
doi="10.2196/mhealth.9351",
url="https://mhealth.jmir.org/2019/1/e9351/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30664486"
}


@Article{info:doi/10.2196/11724,
author="Skrabal Ross, Xiomara
and Gunn, M. Kate
and Patterson, Pandora
and Olver, Ian",
title="Mobile-Based Oral Chemotherapy Adherence--Enhancing Interventions: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="21",
volume="6",
number="12",
pages="e11724",
keywords="medication adherence",
keywords="antineoplastic agents",
keywords="neoplasms",
keywords="cell phone",
keywords="text messaging",
keywords="mobile apps",
keywords="review",
keywords="mHealth",
abstract="Background: Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone--based interventions improve adherence to oral chemotherapy is unknown. Objective: This scoping review aims to explore what is known about mobile phone--delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions. Methods: This study followed Arksey and O'Malley's scoping review methodological framework. Results: The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence--enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders' engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone--delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy. Conclusions: Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence--enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone--delivered interventions that can be translated into oncology settings. ",
doi="10.2196/11724",
url="http://mhealth.jmir.org/2018/12/e11724/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578182"
}


@Article{info:doi/10.2196/10932,
author="Moradian, Saeed
and Krzyzanowska, K. Monika
and Maguire, Roma
and Morita, P. Plinio
and Kukreti, Vishal
and Avery, Jonathan
and Liu, Geoffrey
and Cafazzo, Joseph
and Howell, Doris",
title="Usability Evaluation of a Mobile Phone--Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study",
journal="JMIR Cancer",
year="2018",
month="Dec",
day="21",
volume="4",
number="2",
pages="e10932",
keywords="mobile apps",
keywords="mobile health",
keywords="mobile phone",
keywords="patient-centered care",
keywords="patient remote monitoring",
keywords="self-care",
keywords="symptom management",
keywords="usability testing",
abstract="Background: As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system. Objective: This study aims to evaluate the usability of the ASyMS, a mobile phone--based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS. Methods: We used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence. Results: The thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80\% (8/10) of participants had great motivation to use the ASyMS, 70\% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100\%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation. Conclusions: The ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed. ",
doi="10.2196/10932",
url="http://cancer.jmir.org/2018/2/e10932/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578238"
}


@Article{info:doi/10.2196/10280,
author="Tutelman, R. Perri
and Chambers, T. Christine
and Stinson, N. Jennifer
and Parker, A. Jennifer
and Barwick, Melanie
and Witteman, O. Holly
and Jibb, Lindsay
and Stinson, C. Hayley
and Fernandez, V. Conrad
and Nathan, C. Paul
and Campbell, Fiona
and Irwin, Karen",
title="The Implementation Effectiveness of a Freely Available Pediatric Cancer Pain Assessment App: A Pilot Implementation Study",
journal="JMIR Cancer",
year="2018",
month="Dec",
day="21",
volume="4",
number="2",
pages="e10280",
keywords="cancer pain",
keywords="pain assessment",
keywords="pediatric cancer",
keywords="mHealth",
keywords="eHealth",
keywords="implementation",
abstract="Background: Pain Squad is an evidence-based, freely available iOS app designed to assess pain in children with cancer. Once research-based technologies such as Pain Squad are validated, it is important to evaluate their performance in natural settings to optimize their real-world clinical use. Objective: The objective of this study was to evaluate the implementation effectiveness of Pain Squad in a natural setting. Methods: Parents of 149 children with cancer (aged 8-18 years) were contacted to invite their child to participate. Participating children downloaded Pain Squad on their own iOS devices from the Apple App Store and reported their pain using the app twice daily for 1 week. Participants then emailed their pain reports from the app to the research team and completed an online survey on their experiences. Key implementation outcomes included acceptability, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Results: Of the 149 parents contacted, 16 of their children agreed to participate. More than a third (6/16, 37.5\%) of participating children returned their pain reports to the research team. Adherence to the pain assessments was 62.1\% (mean 8.7/14 assessments). The 6 children who returned reports rated the app as highly feasible to download and use and rated their overall experience as acceptable. They also reported that they would be willing to sustain their Pain Squad use over several weeks and that they would recommend it to other children with cancer, which suggests that it may have potential for penetration. Conclusions: While Pain Squad was well received by the small number of children who completed the study, user uptake, engagement, and adherence were significant barriers to the implementation of Pain Squad in a natural setting. Implementation studies such as this highlight important challenges and opportunities for promoting the use and uptake of evidence-based technologies by the intended end-users. ",
doi="10.2196/10280",
url="http://cancer.jmir.org/2018/2/e10280/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578200"
}


@Article{info:doi/10.2196/10026,
author="Richards, Rebecca
and Kinnersley, Paul
and Brain, Kate
and McCutchan, Grace
and Staffurth, John
and Wood, Fiona",
title="Use of Mobile Devices to Help Cancer Patients Meet Their Information Needs in Non-Inpatient Settings: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="14",
volume="6",
number="12",
pages="e10026",
keywords="cell phone",
keywords="smartphone",
keywords="computers, handheld",
keywords="cancer",
keywords="neoplasms",
keywords="patients",
keywords="information dissemination",
keywords="consumer health information",
abstract="Background: The shift from inpatient to outpatient cancer care means that patients are now required to manage their condition at home, away from regular supervision by clinicians. Subsequently, research has consistently reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. To date, no systematic reviews have evaluated how mobile devices have been used specifically to help patients meet to their information needs. Objective: A systematic review was conducted to identify studies that describe the use of mobile interventions to enable patients with cancer meet their cancer-related information needs in non-inpatient settings, and to describe the effects and feasibility of these interventions. Methods: MEDLINE, Embase, and PsycINFO databases were searched up until January 2017. Search terms related to ``mobile devices,'' ``information needs,'' and ``cancer'' were used. There were no restrictions on study type in order to be as inclusive as possible. Study participants were patients with cancer undergoing treatment. Interventions had to be delivered by a mobile or handheld device, attempt to meet patients' cancer-related information needs, and be for use in non-inpatient settings. Critical Appraisal Skills Programme checklists were used to assess the methodological quality of included studies. A narrative synthesis was performed and findings were organized by common themes found across studies. Results: The initial search yielded 1020 results. We included 23 articles describing 20 studies. Interventions aimed to improve the monitoring and management of treatment-related symptoms (17/20, 85\%), directly increase patients' knowledge related to their condition (2/20, 10\%), and improve communication of symptoms to clinicians in consultations (1/20, 5\%). Studies focused on adult (17/20; age range 24-87 years) and adolescent (3/20; age range 8-18 years) patients. Sample sizes ranged from 4-125, with 13 studies having 25 participants or fewer. Most studies were conducted in the United Kingdom (12/20, 52\%) or United States (7/20, 30\%). Of the 23 articles included, 12 were of medium quality, 9 of poor quality, and 2 of good quality. Overall, interventions were reported to be acceptable and perceived as useful and easy to use. Few technical problems were encountered. Adherence was generally consistent and high (periods ranged from 5 days to 6 months). However, there was considerable variation in use of intervention components within and between studies. Reported benefits of the interventions included improved symptom management, patient empowerment, and improved clinician-patient communication, although mixed findings were reported for patients' health-related quality of life and anxiety. Conclusions: The current review highlighted that mobile interventions for patients with cancer are only meeting treatment or symptom-related information needs. There were no interventions designed to meet patients' full range of cancer-related information needs, from information on psychological support to how to manage finances during cancer, and the long-term effects of treatment. More comprehensive interventions are required for patients to meet their information needs when managing their condition in non-inpatient settings. Controlled evaluations are needed to further determine the effectiveness of these types of intervention. ",
doi="10.2196/10026",
url="https://mhealth.jmir.org/2018/12/e10026/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30552082"
}


@Article{info:doi/10.2196/10703,
author="Orlemann, Till
and Reljic, Dejan
and Zenker, Bj{\"o}rn
and Meyer, Julia
and Eskofier, Bjoern
and Thiemt, Jana
and Herrmann, Joachim Hans
and Neurath, Friedrich Markus
and Zopf, Yurdag{\"u}l",
title="A Novel Mobile Phone App (OncoFood) to Record and Optimize the Dietary Behavior of Oncologic Patients: Pilot Study",
journal="JMIR Cancer",
year="2018",
month="Nov",
day="20",
volume="4",
number="2",
pages="e10703",
keywords="cancer",
keywords="mobile apps",
keywords="diet",
keywords="nutrition",
keywords="protein intake",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Catabolism and tumor-specific therapy lead to reduced nutrient intake and weight loss in cancer patients. Maintaining a specific individualized diet can be challenging for the patient as the nutritional counseling options are limited. Monitoring of nutrient intake and frequent feedback are, however, vital for successful nutritional therapy because they support the patient's compliance and realization of dietary therapeutic goals. Objective: This study aimed at investigating the feasibility and applicability of a novel mobile phone app to assess and evaluate dietary behaviors in oncologic patients. Methods: To determine dietary habits and food preferences in oncologic patients, initially 1400 nutritional records were evaluated and analyzed. The results provided the basis for creating a nutritional mobile phone app. Key requirements for the app included simple handling, recording the daily intake, and a comparison of nutrient targets and current status. In total, 39 cancer patients were recruited for the study; 15 patients dropped out prior to the study. All patients received a nutritional anamnesis, nutritional analysis, and nutritional counseling. Individual energy and nutrient aims were defined. The intervention group (n=12) additionally used the app. Weight and body composition of each group were evaluated after 4 weeks. Results: The app group gained significantly more weight (P=.045; mean weight 1.03 kg vs --1.46 kg). Also, skeletal muscle mass showed a significant increase in the app group (P=.009; mean skeletal muscle mass 0.58 kg vs --0.61 kg) compared with the control group. There was no significant difference between groups relating to the daily protein intake (P=.06). Additionally, there was a decrease in macronutrient intake during the study period in the control group. Conclusions: Our study indicates that patients who track their daily dietary habits using a mobile phone app are more likely to reach their nutritional goals than the control patients. Further large-scale studies are needed to confirm these initial findings and test the applicability on a broader basis. ",
doi="10.2196/10703",
url="http://cancer.jmir.org/2018/2/e10703/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30459139"
}


@Article{info:doi/10.2196/mhealth.9494,
author="Soto, Mauricio
and Martinez-Gutierrez, Javiera
and Momany, McKenzie
and Capurro, Daniel
and Ciampi Spode, Francis
and Cea, Emilia
and Mergudich, Tania
and Puschel, Klaus",
title="Preferences of Underserved Chilean Women on a Mobile Technology Intervention for Cervical Cancer Screening: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="20",
volume="6",
number="11",
pages="e196",
keywords="mHealth",
keywords="cancer screening",
keywords="Latina women",
abstract="Background: In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mobile health, mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations. Objective: The objective of this study was to investigate the use of cell phones and text messaging (short message service, SMS) in Latina women from disadvantaged communities to design an mHealth intervention for improving cervical cancer screening rates. Methods: We conducted 9 focus groups among women aged 25-64 years to better understand the implementation barriers and perceptions of a text message (SMS)--based intervention designed to improve cervical cancer screening rates. We used the PRECEDE-PROCEED model to categorize identified themes using template analysis. Results: Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. Furthermore, they prefer personal contact with their health care providers regarding Papanicolaou (Pap) testing. Younger women, on the other hand, find text messaging easy to use and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests. Factors that facilitate the uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy. Overall, these results support the implementation of an mHealth intervention to increase cervical cancer screening rates. Conclusions: This study describes the opinions of women nonadherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although the overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations. ",
doi="10.2196/mhealth.9494",
url="http://mhealth.jmir.org/2018/11/e196/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30459141"
}


@Article{info:doi/10.2196/10296,
author="Loh, Poh Kah
and Ramsdale, Erika
and Culakova, Eva
and Mendler, H. Jason
and Liesveld, L. Jane
and O'Dwyer, M. Kristen
and McHugh, Colin
and Gilles, Maxence
and Lloyd, Terri
and Goodman, Molly
and Klepin, D. Heidi
and Mustian, M. Karen
and Schnall, Rebecca
and Mohile, G. Supriya",
title="Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study",
journal="JMIR Cancer",
year="2018",
month="Oct",
day="29",
volume="4",
number="2",
pages="e10296",
keywords="Mobile health application",
keywords="geriatric assessment",
keywords="older adults",
keywords="cancer",
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. ",
doi="10.2196/10296",
url="http://cancer.jmir.org/2018/2/e10296/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30373733"
}


@Article{info:doi/10.2196/11826,
author="Backonja, Uba
and Haynes, C. Sarah
and Kim, K. Katherine",
title="Data Visualizations to Support Health Practitioners' Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study",
journal="JMIR Hum Factors",
year="2018",
month="Oct",
day="16",
volume="5",
number="4",
pages="e11826",
keywords="cancer care facilities",
keywords="informatics",
keywords="patient-centered care",
keywords="patient-generated health data",
keywords="precision medicine",
keywords="visualization",
abstract="Background: There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. Objective: The aim of the study was to assess the health care practitioners' perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care. Methods: Medical doctors (n=4) and registered nurses (n=4) providing cancer care at an academic medical center in the western United States provided feedback on visualization mock-ups. Mock-up designs were guided by current health informatics and visualization literature and the Munzner Nested Model for Visualization Design. User-centered design methods, a mock patient persona, and a scenario were used to elicit insights from participants. Directed content analysis was used to identify themes from session transcripts. Means and SDs were calculated for health care practitioners' rankings of overview visualizations. Results: Themes identified were data elements, supportive elements, confusing elements, interpretation, and use of visualization. Overall, participants found the visualizations useful and with the potential to provide personalized care. Use of color, reference lines, and familiar visual presentations (calendars, line graphs) were noted as helpful in interpreting data. Conclusions: Visualizations guided by a framework and literature can support health care practitioners' understanding of data for individuals with multiple chronic conditions engaged in cancer care. This understanding has the potential to support the provision of personalized care. ",
doi="10.2196/11826",
url="http://humanfactors.jmir.org/2018/4/e11826/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30327290"
}


@Article{info:doi/10.2196/10916,
author="El Shafie, A. Rami
and Weber, Dorothea
and Bougatf, Nina
and Sprave, Tanja
and Oetzel, Dieter
and Huber, E. Peter
and Debus, J{\"u}rgen
and Nicolay, H. Nils",
title="Supportive Care in Radiotherapy Based on a Mobile App: Prospective Multicenter Survey",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Aug",
day="30",
volume="6",
number="8",
pages="e10916",
keywords="mHealth",
keywords="radiotherapy",
keywords="mobile app",
keywords="quality of life",
keywords="surveillance",
keywords="patient-reported outcome",
keywords="acceptance",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Consumer electronics and Web-enabled mobile devices are playing an increasing role in patient care, and their use in the oncologic sector opens up promising possibilities in the fields of supportive cancer care and systematic patient follow-up. Objective: The objective of our study was to assess the acceptance and possible benefits of a mobile app--based concept for supportive care of cancer patients undergoing radiotherapy. Methods: In total, 975 patients presenting for radiotherapy due to breast or prostate cancer were screened; of them, 200 owned a smartphone and consented to participate in the survey. Patients were requested to complete a questionnaire at 2 time points: prior to the initiation (T0) and after the completion (T1) of radiotherapy. The questionnaire included questions about the habits of smartphone usage, technical knowledge and abilities of the participants, readiness to use a mobile app within the context of radiotherapy, possible features of the mobile app, and general attitude toward the different aspects of oncologic treatments. For quantitative analysis, sum scores were calculated for all areas of interest, and results were correlated with patient characteristics. Additionally, answers were quantitatively compared between time points T0 and T1. Results: Median patient age was 57 (range 27-78) years. Of the 200 participants, 131 (66.2\%) reported having the ability to use their smartphones with minimal to no help and 75.8\% (150/200) had not used their smartphones in a medical context before. However, 73.3\% (146/200) and 83.4\% (166/200) of patients showed a strong interest in using a mobile app for supportive care during radiotherapy and as part of the clinical follow-up, respectively. Patients most commonly requested functionalities regarding appointment scheduling in the clinic (176/200, 88.0\%) and the collection of patient-reported outcome data regarding their illness, therapy, and general well-being (130/200, 65.0\%). Age was identified as the most influential factor regarding patient attitude, with patients aged <55 years being significantly more inclined toward and versed in smartphone use (P<.001). The acceptance of mobile apps was significantly higher in patients exhibiting a Karnofsky performance index <80\% (P=.01). Support in the context of therapy-related side effects was judged most important by patients with poor clinical performance (P=.006). The overall acceptance of mobile apps in the context of radiotherapy surveillance was high at a median item sum score of 71.4/100 and was not significantly influenced by tumor stage, age, gender, treatment setting, or previous radiotherapies. Conclusions: The acceptance of mobile apps for the surveillance and follow-up of cancer patients undergoing radiotherapy is high; this high acceptance level will serve as a basis for future clinical trials investigating the clinical benefits of mobile app--based treatment support. Introduction of mobile apps into the clinical routine should be considered as an opportunity to improve and intensify supportive treatment for cancer patients. ",
doi="10.2196/10916",
url="http://mhealth.jmir.org/2018/8/e10916/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30166275"
}


@Article{info:doi/10.2196/10487,
author="Delrieu, Lidia
and P{\'e}rol, Olivia
and Fervers, B{\'e}atrice
and Friedenreich, Christine
and Vallance, Jeff
and Febvey-Combes, Olivia
and P{\'e}rol, David
and Canada, Brice
and Roitmann, Eva
and Dufresne, Armelle
and Bachelot, Thomas
and Heudel, Pierre-Etienne
and Tr{\'e}dan, Olivier
and Touillaud, Marina
and Pialoux, Vincent",
title="A Personalized Physical Activity Program With Activity Trackers and a Mobile Phone App for Patients With Metastatic Breast Cancer: Protocol for a Single-Arm Feasibility Trial",
journal="JMIR Res Protoc",
year="2018",
month="Aug",
day="30",
volume="7",
number="8",
pages="e10487",
keywords="metastatic breast cancer",
keywords="physical activity",
keywords="oxidative stress",
keywords="activity trackers",
keywords="feasibility",
abstract="Background: About 5\% of breast cancer cases are metastatic at diagnosis, and 20\%-30\% of localized breast cancer cases become secondarily metastatic. Patients frequently report many detrimental symptoms related to metastasis and treatments. The physical, biological, psychological, and clinical benefits of physical activity during treatment in patients with localized breast cancer have been demonstrated; however, limited literature exists regarding physical activity and physical activity behavior change in patients with metastatic breast cancer. Objective: The primary objective of this study is to assess the feasibility of a 6-month physical activity intervention with activity trackers in patients with metastatic breast cancer (the Advanced stage Breast cancer and Lifestyle Exercise, ABLE Trial). Secondary objectives are to examine the effects of physical activity on physical, psychological, anthropometrics, clinical, and biological parameters. Methods: We plan to conduct a single-center, single-arm trial with 60 patients who are newly diagnosed with metastatic breast cancer. Patients will receive an unsupervised and personalized 6-month physical activity program that includes an activity tracker Nokia Go and is based on the physical activity recommendation. Patients will be encouraged to accumulate at least 150 minutes per week of moderate-to-vigorous intensity physical activity. Baseline and 6-month assessments will include anthropometric measures, functional tests (eg, 6-minute walk test and upper and lower limb strength), blood draws, patient-reported surveys (eg, quality of life and fatigue), and clinical markers of tumor progression (eg, Response Evaluation Criteria In Solid Tumors criteria). Results: Data collection occurred between October 2016 and January 2018, and the results are expected in August 2018. Conclusions: The ABLE Trial will be the first study to assess the feasibility and effectiveness of an unsupervised and personalized physical activity intervention performed under real-life conditions with activity trackers in patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 (Accessed by WebCite at http://www.webcitation.org/71yabi0la) Registered Report Identifier: RR1-10.2196/10487 ",
doi="10.2196/10487",
url="http://www.researchprotocols.org/2018/8/e10487/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30166274"
}


@Article{info:doi/10.2196/10976,
author="Brinker, Josef Titus
and Brieske, Martin Christian
and Esser, Stefan
and Klode, Joachim
and Mons, Ute
and Batra, Anil
and R{\"u}ther, Tobias
and Seeger, Werner
and Enk, H. Alexander
and von Kalle, Christof
and Berking, Carola
and Heppt, V. Markus
and Gatzka, V. Martina
and Bernardes-Souza, Breno
and Schlenk, F. Richard
and Schadendorf, Dirk",
title="A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="15",
volume="20",
number="8",
pages="e10976",
keywords="face aging",
keywords="smoking cessation",
keywords="HIV",
keywords="mobile apps",
keywords="HIV patients",
keywords="HIV seropositivity",
keywords="smoking",
keywords="cessation",
keywords="tobacco smoking",
keywords="morphing",
abstract="Background: There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. Objective: The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. Methods: We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. Results: During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3\%) tried the app and 179 (38.6\%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0\%) were men and 84 of 179 (46.9\%) were smokers. Of the smokers, 55 of 81 (68\%) said the intervention motivated them to quit (men: 45, 68\%; women: 10, 67\%); 41 (51\%) said that it motivated them to discuss quitting with their doctor (men: 32, 49\%; women: 9, 60\%); and 72 (91\%) perceived the intervention as fun (men: 57, 90\%; women: 15, 94\%). Of the nonsmokers, 92 (98\%) said that it motivated them never to take up smoking (men: 72, 99\%; women: 20, 95\%). Among all patients, 102 (22.0\%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3\%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). Conclusions: A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking. ",
doi="10.2196/10976",
url="http://www.jmir.org/2018/8/e10976/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30111525"
}


@Article{info:doi/10.2196/jmir.9812,
author="Marzorati, Chiara
and Renzi, Chiara
and Russell-Edu, William Samuel
and Pravettoni, Gabriella",
title="Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e223",
keywords="telemedicine",
keywords="family",
keywords="caregivers",
keywords="neoplasms",
keywords="systematic review",
abstract="Background: The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. Objective: We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. Methods: We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. Results: We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. Conclusions: Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results. ",
doi="10.2196/jmir.9812",
url="http://www.jmir.org/2018/6/e223/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914858"
}


@Article{info:doi/10.2196/cancer.8951,
author="Ainsworth, Cole Matthew
and Pekmezi, Dori
and Bowles, Heather
and Ehlers, Diane
and McAuley, Edward
and Courneya, S. Kerry
and Rogers, Q. Laura",
title="Acceptability of a Mobile Phone App for Measuring Time Use in Breast Cancer Survivors (Life in a Day): Mixed-Methods Study",
journal="JMIR Cancer",
year="2018",
month="May",
day="14",
volume="4",
number="1",
pages="e9",
keywords="cancer",
keywords="technology",
keywords="time management",
keywords="mHealth",
keywords="physical activity",
abstract="Background: Advancements in mobile technology allow innovative data collection techniques such as measuring time use (ie, how individuals structure their time) for the purpose of improving health behavior change interventions. Objective: The aim of this study was to examine the acceptability of a 5-day trial of the Life in a Day mobile phone app measuring time use in breast cancer survivors to advance technology-based measurement of time use. Methods: Acceptability data were collected from participants (N=40; 100\% response rate) using a self-administered survey after 5 days of Life in a Day use. Results: Overall, participants had a mean age of 55 years (SD 8) and completed 16 years of school (SD 2). Participants generally agreed that learning to use Life in a Day was easy (83\%, 33/40) and would prefer to log activities using Life in a Day over paper-and-pencil diary (73\%, 29/40). A slight majority felt that completing Life in a Day for 5 consecutive days was not too much (60\%, 24/40) or overly time-consuming (68\%, 27/40). Life in a Day was rated as easy to read (88\%, 35/40) and navigate (70\%, 32/40). Participants also agreed that it was easy to log activities using the activity timer at the start and end of an activity (90\%, 35/39). Only 13\% (5/40) downloaded the app on their personal phone, whereas 63\% (19/30) of the remaining participants would have preferred to use their personal phone. Overall, 77\% (30/39) of participants felt that the Life in a Day app was good or very good. Those who agreed that it was easy to edit activities were significantly more likely to be younger when compared with those who disagreed (mean 53 vs 58 years, P=.04). Similarly, those who agreed that it was easy to remember to log activities were more likely to be younger (mean 52 vs 60 years, P<.001). Qualitative coding of 2 open-ended survey items yielded 3 common themes for Life in a Day improvement (ie, convenience, user interface, and reminders). Conclusions: A mobile phone app is an acceptable time-use measurement modality. Improving convenience, user interface, and memory prompts while addressing the needs of older participants is needed to enhance app utility. Trial Registration: ClinicalTrials.gov NCT00929617; https://clinicaltrials.gov/ct2/show/NCT00929617 (Archived by WebCite at http://www.webcitation.org/6z2bZ4P7X) ",
doi="10.2196/cancer.8951",
url="http://cancer.jmir.org/2018/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29759953"
}


@Article{info:doi/10.2196/mhealth.9363,
author="Soh, Yeong Ji
and Cha, Chul Won
and Chang, Kyung Dong
and Hwang, Hye Ji
and Kim, Kihyung
and Rha, Miyong
and Kwon, Hee",
title="Development and Validation of a Multidisciplinary Mobile Care System for Patients With Advanced Gastrointestinal Cancer: Interventional Observation Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="07",
volume="6",
number="5",
pages="e115",
keywords="mobile health",
keywords="health apps",
keywords="mobile phone",
keywords="mobile care system",
abstract="Background: Mobile health apps have emerged as supportive tools in the management of advanced cancers. However, only a few apps have self-monitoring features, and they are not standardized and validated. Objective: This study aimed to develop and validate a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer. Methods: The development of the multidisciplinary mobile health management system was divided into 3 steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. The app was developed to achieve 3 major clinical goals: support for quality of life, nutrition, and rehabilitation. Three main functional themes were developed to achieve clinical goals: a to-do list, health education, and in-app chat. Thirteen clinically oriented measures were included: the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire, Scored Patient-Generated Subjective Global Assessment (PG-SGA), distress, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, International Physical Activity Questionnaire--Short Form, Low anterior resection syndrome score, satisfaction rate, etc. To validate the system, a prospective observational study was conducted. Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited. We followed the subjects for 12 weeks, and selected clinical measures were taken online and offline. Results: After the development process, a multidisciplinary app, the Life Manager, was launched. For evaluation, 203 patients were recruited for the study, of whom 101 (49.8\%) had gastric cancer, and 102 (50.2\%) were receiving palliative care. Most patients were in their fifties (35.5\%), and 128 (63.1\%) were male. Overall, 176 subjects (86.7\%) completed the study. Among subjects who dropped out, the most common reason was the change of patient's clinical condition (51.9\%). During the study period, subjects received multiple health education sessions. For the gastric cancer group, the ``general gastric cancer education'' was most frequently viewed (322 times), and for the colon cancer group, the ``warming-up exercise'' was most viewed (340 times). Of 13 measurements taken from subjects, 9 were taken offline (response rate: 52.0\% to 90.1\%), and 3 were taken online (response rate: 17.6\% to 57.4\%). The overall satisfaction rate among subjects was favorable and ranged from 3.93 (SD 0.88) to 4.01 (SD 0.87) on the 5-point Likert scale. Conclusions: A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinically oriented measures. A prospective study was performed for its evaluation, which showed favorable satisfaction. ",
doi="10.2196/mhealth.9363",
url="http://mhealth.jmir.org/2018/5/e115/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29735478"
}


@Article{info:doi/10.2196/mhealth.9311,
author="Zhu, Jiemin
and Ebert, Lyn
and Guo, Dongmei
and Yang, Sumei
and Han, Qiuying
and Chan, Wai-Chi Sally",
title="Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women's Perceptions",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="11",
volume="6",
number="4",
pages="e85",
keywords="mobile app",
keywords="breast cancer",
keywords="chemotherapy",
abstract="Background: Women with breast cancer undergoing chemotherapy experience difficulty in accessing adequate cancer care in China. Mobile apps have the potential to provide easily accessible support for these women. However, there remains a paucity of randomized controlled trials to evaluate the effectiveness of app-based programs targeting specifically women with breast cancer undergoing chemotherapy. Moreover, women's perceptions and experiences related to using and interacting within the app-based program have rarely been reported. Therefore, an app-based Breast Cancer e-Support program was developed and evaluated using a randomized controlled trial. Based on the incorporation of Bandura's self-efficacy and social exchange theory, Breast Cancer e-Support program lasted for 12 weeks covering 4 cycles of chemotherapy and had 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Objective: As a part of the randomized controlled trial, the aim of this study was to explore the participants' perception of Breast Cancer e-Support program, its strengths and weaknesses, and suggestions to improve the program. Methods: A descriptive qualitative study was employed. Thirteen women with breast cancer from 2 university-affiliated hospitals in China, who were randomly allocated to the Breast Cancer e-Support program in the randomized controlled trial, were interviewed from November 2016 to February 2017. Purposive sampling was used based on women's scores of self-efficacy after the completion of the intervention. Inductive content analysis was used to analyze the transcripts, allowing the categories and subcategories to flow from the data. Results: The qualitative interviews revealed that participants perceived the Breast Cancer e-Support program to be helpful in enhancing knowledge, improving confidence level, and promoting emotional well-being. Women also identified access to tailored advice from experts and convenience as the benefits of this program. Physical or psychological health status, stigma related with breast cancer, and app instability were mentioned as the challenges to engagement. Suggestions for improvement included adding message reminders to prompt instant communication and search engine to locate information quickly, supplementing more interesting and practical knowledge, updating the information more often, and quickening the responses to women's questions. The participants recommended the Breast Cancer e-Support program to be incorporated as routine care to support women during chemotherapy. Conclusions: This study demonstrates the potential of the Breast Cancer e-Support program to support women during chemotherapy. Future app-based programs should apply a family-centered approach and provide more support on stigma associated with the disease to encourage engagement with the app. Suggestions of improvement regarding the design, content, and operation of the app-based intervention should be addressed in future studies. It is promising to incorporate the Breast Cancer e-Support program into routine care to generalize the benefits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ ACTRN12616000639426.aspx (Archived by WebCite at http://www.webcitation.org/6v1n9hGZq) ",
doi="10.2196/mhealth.9311",
url="http://mhealth.jmir.org/2018/4/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29643056"
}


@Article{info:doi/10.2196/mhealth.9319,
author="Jibb, A. Lindsay
and Stevens, J. Bonnie
and Nathan, C. Paul
and Seto, Emily
and Cafazzo, A. Joseph
and Johnston, L. Donna
and Hum, Vanessa
and Stinson, N. Jennifer",
title="Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="06",
volume="6",
number="4",
pages="e80",
keywords="pain",
keywords="adolescent",
keywords="cancer",
keywords="supportive care",
keywords="mHealth",
keywords="qualitative",
abstract="Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. Objective: The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. Methods: Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. Results: Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents' lives, and recommendations for intervention improvement. Conclusions: Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes. ",
doi="10.2196/mhealth.9319",
url="http://mhealth.jmir.org/2018/4/e80/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29625951"
}


@Article{info:doi/10.2196/resprot.8915,
author="El Shafie, A. Rami
and Bougatf, Nina
and Sprave, Tanja
and Weber, Dorothea
and Oetzel, Dieter
and Machmer, Timo
and Huber, E. Peter
and Debus, J{\"u}rgen
and Nicolay, H. Nils",
title="Oncologic Therapy Support Via Means of a Dedicated Mobile App (OPTIMISE-1): Protocol for a Prospective Pilot Trial",
journal="JMIR Res Protoc",
year="2018",
month="Mar",
day="06",
volume="7",
number="3",
pages="e70",
keywords="mHealth",
keywords="radiotherapy",
keywords="mobile application",
keywords="quality of life",
keywords="cancer",
keywords="Patient-Reported Outcome Measures (PROMs)",
abstract="Background: The increasing role of consumer electronics and Web-enabled mobile devices in the medical sector opens up promising possibilities for integrating novel technical solutions into therapy and patient support for oncologic illnesses. A recent survey carried out at Heidelberg University Hospital suggested a high acceptance among patients for an additional approach to patient care during radiotherapy based on patient-reported outcomes by a dedicated mobile app. Objective: The aim of this trial (OPTIMISE-1: Oncologic Therapy Support Via Means of a Dedicated Mobile App -- A Prospective Feasibility Evaluation) is to prospectively evaluate the feasibility of employing a mobile app for the systematic support of radiooncological patients throughout the course of their radiotherapy by monitoring symptoms and patient performance, and facilitating the background-exchange of relevant information between patient and physician. Methods: The present single-center, prospective, exploratory trial, conducted at Heidelberg University Hospital, assesses the feasibility of integrating an app-based approach into patient-care during radiotherapy. Patients undergoing curative radiotherapy for thoracic or pelvic tumors will be surveyed regarding general performance, treatment-related quality of life (QoL) and symptoms, and their need to personally consult a physician by means of a mobile app during treatment. The primary endpoint of feasibility will be reached when 80\% of the patients have successfully answered 80\% of their respective questions scheduled for each treatment day. Furthermore, treatment-related patient satisfaction and health-related QoL is assessed by the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires at the beginning (baseline) and end of radiotherapy, and at the first follow-up. Results: This trial will recruit 50 patients over a period of 12 months. Follow-up will be completed after 18 months, and publication of results is planned at 24 months after trial initiation. Conclusions: This study will serve as a basis for future studies aiming to exploit the constant innovation in mobile medical appliances and integrate novel patient-centered concepts into patient care in the context of radiotherapy. Trial Registration: ClinicalTrials.gov NCT03168048; https://clinicaltrials.gov/ct2/show/NCT03168048 (Archived at WebCite http://www.webcitation.org/6wtWGgi0X) ",
doi="10.2196/resprot.8915",
url="https://www.researchprotocols.org/2018/3/e70/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29510971"
}


@Article{info:doi/10.2196/jmir.9046,
author="Low, A. Carissa
and Dey, K. Anind
and Ferreira, Denzil
and Kamarck, Thomas
and Sun, Weijing
and Bae, Sangwon
and Doryab, Afsaneh",
title="Estimation of Symptom Severity During Chemotherapy From Passively Sensed Data: Exploratory Study",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="19",
volume="19",
number="12",
pages="e420",
keywords="patient reported outcome measures",
keywords="cancer",
keywords="mobile health",
abstract="Background: Physical and psychological symptoms are common during chemotherapy in cancer patients, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in mobile phones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. Objective: The aim of this study was to explore whether passively sensed mobile phone and Fitbit data could be used to estimate daily symptom burden during chemotherapy. Methods: A total of 14 patients undergoing chemotherapy for gastrointestinal cancer participated in the 4-week study. Participants carried an Android phone and wore a Fitbit device for the duration of the study and also completed daily severity ratings of 12 common symptoms. Symptom severity ratings were summed to create a total symptom burden score for each day, and ratings were centered on individual patient means and categorized into low, average, and high symptom burden days. Day-level features were extracted from raw mobile phone sensor and Fitbit data and included features reflecting mobility and activity, sleep, phone usage (eg, duration of interaction with phone and apps), and communication (eg, number of incoming and outgoing calls and messages). We used a rotation random forests classifier with cross-validation and resampling with replacement to evaluate population and individual model performance and correlation-based feature subset selection to select nonredundant features with the best predictive ability. Results: Across 295 days of data with both symptom and sensor data, a number of mobile phone and Fitbit features were correlated with patient-reported symptom burden scores. We achieved an accuracy of 88.1\% for our population model. The subset of features with the best accuracy included sedentary behavior as the most frequent activity, fewer minutes in light physical activity, less variable and average acceleration of the phone, and longer screen-on time and interactions with apps on the phone. Mobile phone features had better predictive ability than Fitbit features. Accuracy of individual models ranged from 78.1\% to 100\% (mean 88.4\%), and subsets of relevant features varied across participants. Conclusions: Passive sensor data, including mobile phone accelerometer and usage and Fitbit-assessed activity and sleep, were related to daily symptom burden during chemotherapy. These findings highlight opportunities for long-term monitoring of cancer patients during chemotherapy with minimal patient burden as well as real-time adaptive interventions aimed at early management of worsening or severe symptoms. ",
doi="10.2196/jmir.9046",
url="http://www.jmir.org/2017/12/e420/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258977"
}


@Article{info:doi/10.2196/mhealth.8349,
author="Pereira-Salgado, Amanda
and Westwood, A. Jennifer
and Russell, Lahiru
and Ugalde, Anna
and Ortlepp, Bronwen
and Seymour, F. John
and Butow, Phyllis
and Cavedon, Lawrence
and Ong, Kevin
and Aranda, Sanchia
and Breen, Sibilah
and Kirsa, Suzanne
and Dunlevie, Andrew
and Schofield, Penelope",
title="Mobile Health Intervention to Increase Oral Cancer Therapy Adherence in Patients With Chronic Myeloid Leukemia (The REMIND System): Clinical Feasibility and Acceptability Assessment",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="06",
volume="5",
number="12",
pages="e184",
keywords="mobile phone",
keywords="neoplasms",
keywords="Internet",
keywords="medication adherence",
abstract="Background: Optimal dosing of oral tyrosine kinase inhibitor therapy is critical to treatment success and survival of patients with chronic myeloid leukemia (CML). Drug intolerance secondary to toxicities and nonadherence are significant factors in treatment failure. Objective: The objective of this study was to develop and pilot-test the clinical feasibility and acceptability of a mobile health system (REMIND) to increase oral drug adherence and patient symptom self-management among people with CML (chronic phase). Methods: A multifaceted intervention was iteratively developed using the intervention development framework by Schofield and Chambers, consisting of defining the patient problem and iteratively refining the intervention. The clinical feasibility and acceptability were examined via patient and intervention nurse interviews, which were audiotaped, transcribed, and deductively content analyzed. Results: The intervention comprised 2 synergistically operating elements: (1) daily medication reminders and routine assessment of side effects with evidence-based self-care advice delivered in real time and (2) question prompt list (QPL) questions and routinely collected individual patient adherence and side effect profile data used to shape nurses' consultations, which employed motivational interviewing to support adoption of self-management behaviors. A total of 4 consultations and daily alerts and advice were delivered over 10 weeks. In total, 58\% (10/17) of patients and 2 nurses participated in the pilot study. Patients reported several benefits of the intervention: help in establishing medication routines, resolution of symptom uncertainty, increased awareness of self-care, and informed decision making. Nurses also endorsed the intervention: it assisted in establishing pill-taking routines and patients developing effective solutions to adherence challenges. Conclusions: The REMIND system with nurse support was usable and acceptable to both patients and nurses. It has the potential to improve adherence and side-effect management and should be further evaluated. ",
doi="10.2196/mhealth.8349",
url="http://mhealth.jmir.org/2017/12/e184/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29212628"
}


@Article{info:doi/10.2196/mhealth.8741,
author="Rincon, Esther
and Monteiro-Guerra, Francisco
and Rivera-Romero, Octavio
and Dorronzoro-Zubiete, Enrique
and Sanchez-Bocanegra, Luis Carlos
and Gabarron, Elia",
title="Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="04",
volume="5",
number="12",
pages="e187",
keywords="cancer",
keywords="mHealth",
keywords="app",
keywords="mobile phone",
keywords="quality of life",
keywords="well-being",
abstract="Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients' quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients' user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients' disease management. Trial Registration: PROSPERO CRD42017073069; https://www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID= CRD42017073069 (Archived by WebCite at http://www.webcitation.org/6v38Clb9T) ",
doi="10.2196/mhealth.8741",
url="http://mhealth.jmir.org/2017/12/e187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29203459"
}


@Article{info:doi/10.2196/mhealth.7091,
author="Lee, Hee
and Ghebre, Rahel
and Le, Chap
and Jang, Jeong Yoo
and Sharratt, Monica
and Yee, Douglas",
title="Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="07",
volume="5",
number="11",
pages="e154",
keywords="breast cancer",
keywords="mammogram",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app intervention",
keywords="multimedia text message",
keywords="tailored message",
keywords="Korean immigrant women",
keywords="breast cancer disparity",
abstract="Background: Despite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes. Objective: This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community. Methods: Using a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed. Results: The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75\%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30\%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group. Conclusions: A mobile phone app--based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens. Trial Registration: Clinicaltrials.gov NCT01972048;?https://clinicaltrials.gov/show/NCT01972048?(Archived by WebCite at?https://clinicaltrials.gov/archive/NCT01972048/2013\_10\_29) ",
doi="10.2196/mhealth.7091",
url="http://mhealth.jmir.org/2017/11/e154/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29113961"
}


@Article{info:doi/10.2196/cancer.7599,
author="Langius-Ekl{\"o}f, Ann
and Christiansen, Mats
and Lindstr{\"o}m, Veronica
and Blomberg, Karin
and H{\"a}lleberg Nyman, Maria
and Wengstr{\"o}m, Yvonne
and Sundberg, Kay",
title="Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data",
journal="JMIR Cancer",
year="2017",
month="Oct",
day="31",
volume="3",
number="2",
pages="e18",
keywords="mobile apps",
keywords="mHealth",
keywords="prostate cancer",
keywords="symptom assessment",
abstract="Background: Patients undergoing radiotherapy for prostate cancer experience symptoms related to both the cancer itself and its treatment, and it is evident that patients with prostate cancer have unmet supportive care needs related to their disease. Over the past decade, there has been an increase in the amount of research within the field of mobile health and the use of apps as tools for managing illness. The main challenge is to develop a mobile technology to its full potential of being interactive in real time. The interactive app Interaktor, which aims to identify and manage symptoms in real time includes (1) a function for patients' assessment of the occurrence, frequency, and distress of symptoms; (2) a connection to a monitoring Web interface; (3) a risk assessment model that sends alerts via text message to health care providers; (4) continuous access to evidence-based self-care advice and links to relevant websites for more information; and (5) graphs for the patients and health care providers to view the history of symptom reporting. Objective: The aim of the study was to investigate user behavior, adherence to reporting, and the patients' experiences of using Interaktor during radiotherapy for localized advanced prostate cancer. Methods: The patients were instructed to report daily during the time of treatment and then for an additional 3 weeks. Logged data from patients' use of the app were analyzed with descriptive statistics. Interview data about experiences of using the app were analyzed with content analysis. Results: A total of 66 patients participated in the study. Logged data showed that adherence to daily reporting of symptoms was high (87\%). The patients used all the symptoms included in the app. Of the reports, 15.6\% generated alerts to the health care providers. Overall, the patients found that it was easy and not particularly time-consuming to send a daily report, and many described it as becoming a routine. Reporting symptoms facilitated reflection on their symptoms and gave them a sense of security. Few technological problems were reported. Conclusions: The use of Interaktor increased patients' sense of security and their reflections on their own well-being and thereby served as a supportive tool for the self-management of symptoms during treatment of prostate cancer. Some further development of the app's content might be beneficial for future use. ",
doi="10.2196/cancer.7599",
url="http://cancer.jmir.org/2017/2/e18/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29089290"
}


@Article{info:doi/10.2196/cancer.8192,
author="Baseman, Janet
and Revere, Debra
and Baldwin, Laura-Mae",
title="A Mobile Breast Cancer Survivorship Care App: Pilot Study",
journal="JMIR Cancer",
year="2017",
month="Sep",
day="26",
volume="3",
number="2",
pages="e14",
keywords="breast neoplasms",
keywords="data collection",
keywords="feasibility studies",
keywords="mobile apps",
keywords="survivors",
keywords="telemedicine",
abstract="Background: Cancer survivors living in rural areas experience unique challenges due to additional burdens, such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, poorer mental health and physical functioning, and lower-than-average quality of life compared to urban survivors. Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care app to facilitate care coordination; support medical, psychosocial, and practical needs; and improve survivors' long-term health outcomes. Methods: An interactive prototype app, SmartSurvivor, was developed that included recommended survivorship care plan components. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6), primary care providers (n=4), and an oncologist (n=1). Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Our pilot study indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research. ",
doi="10.2196/cancer.8192",
url="http://cancer.jmir.org/2017/2/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28951383"
}


@Article{info:doi/10.2196/jmir.8661,
author="Brinker, Josef Titus
and Brieske, Martin Christian
and Schaefer, Matthias Christoph
and Buslaff, Fabian
and Gatzka, Martina
and Petri, Philip Maximilian
and Sondermann, Wiebke
and Schadendorf, Dirk
and Stoffels, Ingo
and Klode, Joachim",
title="Photoaging Mobile Apps in School-Based Melanoma Prevention: Pilot Study",
journal="J Med Internet Res",
year="2017",
month="Sep",
day="08",
volume="19",
number="9",
pages="e319",
keywords="melanoma",
keywords="skin cancer",
keywords="prevention",
keywords="mobile apps",
keywords="smartphones",
keywords="photoaging",
keywords="schools",
keywords="secondary schools",
keywords="adolescents",
abstract="Background: Around 90\% of melanomas are caused by exposure to ultraviolet (UV) radiation and are therefore eminently preventable. Tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to malignant melanoma and other skin cancers are too far in the future to fathom. Given the substantial amount of time children and adolescents spend in schools, as well as with their mobile phones, addressing melanoma prevention via both of these ways is crucial. However, no school-based intervention using mobile apps has been evaluated to date. We recently released a photoaging mobile app, in which a selfie is altered to predict future appearance dependent on UV protection behavior and skin type. Objective: In this pilot study, we aimed to use mobile phone technology to improve school-based melanoma prevention and measure its preliminary success in different subgroups of students with regard to their UV protection behavior, Fitzpatrick skin type and age. Methods: We implemented a free photoaging mobile phone app (Sunface) in 2 German secondary schools via a method called mirroring. We ``mirrored'' the students' altered 3-dimensional (3D) selfies reacting to touch on mobile phones or tablets via a projector in front of their whole grade. Using an anonymous questionnaire capturing sociodemographic data as well as risk factors for melanoma we then measured their perceptions of the intervention on a 5-point Likert scale among 205 students of both sexes aged 13-19 years (median 15 years). Results: We measured more than 60\% agreement in both items that measured motivation to reduce UV exposure and only 12.5\% disagreement: 126 (63.0\%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 124 (61.7\%) to increase use of sun protection. However, only 25 (12.5\%) disagreed with both items. The perceived effect on motivation was increased in participants with Fitzpatrick skin types 1-2 in both tanning bed avoidance (n=74, 71.8\% agreement in skin types 1-2 vs n=50, 53.8\% agreement in skin types 3-6) and increased use of sun protection (n=70, 68.0\% agreement in skin types 1-2 vs n=52, 55.3\% agreement in skin types 3-6), and also positively correlated with higher age. Conclusions: We present a novel way of integrating photoaging in school-based melanoma prevention that affects the students' peer group, considers the predictors of UV exposure in accordance with the theory of planned behavior, and is particularly effective in changing behavioral predictors in fair-skinned adolescents (Fitzpatrick skin types 1-2). Further research is required to evaluate the intervention's prospective effects on adolescents of various cultural backgrounds. ",
doi="10.2196/jmir.8661",
url="http://www.jmir.org/2017/9/e319/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28887295"
}


@Article{info:doi/10.2196/jmir.7893,
author="Uy, Catherine
and Lopez, Jennifer
and Trinh-Shevrin, Chau
and Kwon, C. Simona
and Sherman, E. Scott
and Liang, S. Peter",
title="Text Messaging Interventions on Cancer Screening Rates: A Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="24",
volume="19",
number="8",
pages="e296",
keywords="text messaging",
keywords="early detection of cancer",
keywords="breast neoplasms",
keywords="colorectal neoplasms",
keywords="lung neoplasms",
keywords="mHealth",
keywords="uterine cervical neoplasms",
abstract="Background: Despite high-quality evidence demonstrating that screening reduces mortality from breast, cervical, colorectal, and lung cancers, a substantial portion of the population remains inadequately screened. There is a critical need to identify interventions that increase the uptake and adoption of evidence-based screening guidelines for preventable cancers at the community practice level. Text messaging (short message service, SMS) has been effective in promoting behavioral change in various clinical settings, but the overall impact and reach of text messaging interventions on cancer screening are unknown. Objective: The objective of this systematic review was to assess the effect of text messaging interventions on screening for breast, cervical, colorectal, and lung cancers. Methods: We searched multiple databases for studies published between the years 2000 and 2017, including PubMed, EMBASE, and the Cochrane Library, to identify controlled trials that measured the effect of text messaging on screening for breast, cervical, colorectal, or lung cancers. Study quality was evaluated using the Cochrane risk of bias tool. Results: Our search yielded 2238 citations, of which 31 underwent full review and 9 met inclusion criteria. Five studies examined screening for breast cancer, one for cervical cancer, and three for colorectal cancer. No studies were found for lung cancer screening. Absolute screening rates for individuals who received text message interventions were 0.6\% to 15.0\% higher than for controls. Unadjusted relative screening rates for text message recipients were 4\% to 63\% higher compared with controls. Conclusions: Text messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer screening. Benefit was observed in various countries, including resource-poor and non-English-speaking populations. Given the paucity of data, additional research is needed to better quantify the effectiveness of this promising intervention. ",
doi="10.2196/jmir.7893",
url="http://www.jmir.org/2017/8/e296/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28838885"
}


@Article{info:doi/10.2196/mhealth.7178,
author="Sun, Yunheng
and Jiang, Feng
and Gu, J. Juan
and Wang, Ken Y.
and Hua, Hongwei
and Li, Jing
and Cheng, Zhijun
and Liao, Zhijun
and Huang, Qian
and Hu, Weiwei
and Ding, Gang",
title="Development and Testing of an Intelligent Pain Management System (IPMS) on Mobile Phones Through a Randomized Trial Among Chinese Cancer Patients: A New Approach in Cancer Pain Management",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e108",
keywords="cancer pain",
keywords="intelligent pain management system",
keywords="smart phone",
keywords="intervention",
abstract="Background: Cancer has become increasingly prevalent in China over the past few decades. Among the factors that determine the quality of life of cancer patients, pain has commonly been recognized as a most critical one; it could also lead to the ineffective treatment of the cancer. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS). Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system's usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as ``the Oncology Center''). In a pretest, participants completed a pain management knowledge questionnaire and were evaluated using the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14-day trial period, another round of cancer pain assessment, KPS evaluation and pain management knowledge assessment were repeated. In the trial group, the data were fully automatically collected by the IPMS. In the control group, the data were collected using conventional methods, such as phone interviews or door-to-door visits by physicians. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants successfully completed the trial. First, the feasibility of IPMS by observing the number of daily pain assessments recorded among patients was assessed. Second, the users' satisfaction, effectiveness of pain management, and changes in the quality of their lives were evaluated. All the participants gave high satisfaction score after they used IMPS. Both groups reported similar pain scores and KPS scores at the baseline. At the end of the trial, the mean pain score of the trial group was significantly lower than of the control group (P<.001). The ending KPS score of the trial group was significantly higher than of the control group (P<.001). The improvement of pain management knowledge score in the trial group was more pronounced than that in the control group (P<.001). Conclusions: This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors and to provide real-time supportive intervention on a convenient basis at a low cost. Overall, the IPMS can serve as a reliable and effective approach to control cancer pain and improve quality of life for patients with cancer pain. Trial Registration: Clinicaltrials.gov NCT02765269; http://clinicaltrials.gov/ct2/show/NCT02765269 (Archived by WebCite at?http://www.webcitation.org/6rnwsgDgv) ",
doi="10.2196/mhealth.7178",
url="http://mhealth.jmir.org/2017/7/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743681"
}


@Article{info:doi/10.2196/jmir.7421,
author="Voruganti, Teja
and Grunfeld, Eva
and Jamieson, Trevor
and Kurahashi, M. Allison
and Lokuge, Bhadra
and Krzyzanowska, K. Monika
and Mamdani, Muhammad
and Moineddin, Rahim
and Husain, Amna",
title="My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="18",
volume="19",
number="7",
pages="e219",
keywords="MeSH: Internet",
keywords="professional-patient relations",
keywords="interdisciplinary communication",
keywords="neoplasms",
keywords="adult",
keywords="chronic disease",
keywords="continuity of patient care",
keywords="patient care team",
keywords="communication",
keywords="outcome assessment (health care)",
abstract="Background: The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. Objective: The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. Methods: We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ?3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. Results: Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3\%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. Conclusions: The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. Trial Registration: ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb). ",
doi="10.2196/jmir.7421",
url="http://www.jmir.org/2017/7/e219/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28720558"
}


@Article{info:doi/10.2196/mhealth.7689,
author="Kessel, Anne Kerstin
and Vogel, ME Marco
and Kessel, Carmen
and Bier, Henning
and Biedermann, Tilo
and Friess, Helmut
and Herschbach, Peter
and von Eisenhart-Rothe, R{\"u}diger
and Meyer, Bernhard
and Kiechle, Marion
and Keller, Ulrich
and Peschel, Christian
and Schmid, M. Roland
and Combs, E. Stephanie",
title="Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="14",
volume="5",
number="6",
pages="e81",
keywords="clinical oncology",
keywords="surveys and questionnaires",
keywords="mobile apps",
keywords="mHealth",
keywords="eHealth",
abstract="Background: In the last decade, the health care sector has been enriched by numerous innovations such as apps and connected devices that assist users in weight reduction and diabetes management. However, only a few native apps in the oncological context exist, which support patients during treatment and aftercare. Objective: The objective of this study was to analyze patients' acceptance regarding app use and to investigate the functions of an oncological app that are most required, and the primary reasons for patients to refuse app-assisted cancer care. Methods: We designed and conducted a survey with 23 questions, inquiring patients about their technical knowledge and equipment, as well as the possible advantages and disadvantages, data transfer, and general functionality of an app. Results: A total of 375 patients participated; the participation rate was 60.7\% (375/618). Gender distribution was about 3:4 (female:male) with a median age of 59 years (range 18-92 years). Whereas 69.6\% (261/375) of patients used mobile devices, 16.3\% (61/375) did not own one, and 9.1\% (34/375) only used a personal computer (PC). About half of the patients rated their usability skills as very good and good (18.9\% 71/375; 35.2\% 132/375), 23.5\% (88/375) described their skills as intermediate, and 14.4\% (54/375) as bad. Of all patients, 182 (48.5\%, 182/375) were willing to send data to their treating clinic via an app, that is, to a server (61.0\% 111/182) or as email (33.5\%, 61/182). About two-thirds (68.7\%, 125/182) believed that additional and regularly sent data would be an ideal complement to the standard follow-up procedure. Additionally, 86.8\% (158/182) wished to be contacted by a physician when entered data showed irregularities. Because of lack of skills (34.4\%, 56/163), concerns about the use of data (35.0\%, 57/163), lack of capable devices (25.8\%, 42/163), and the wish for personal contact with the treating physician (47.2\%, 77/163), a total of 163 (43.5\%, 163/375) patients refused to use an app. Pearson correlation showed a significant but mild relationship between age and app use (P=.03, r=?.12), favoring younger age; male gender correlated as well (P=.04; r=?.11). Conclusions: The results show that the introduction of mobile apps needs to follow different strategies depending on the patients' attitude. Age and gender seem to be the strongest predictive factors. For oncology patients, our survey showed that about half of the patients were willing to send data via an app supporting their treatment. In the future, clinical data such as quality of life and treatment satisfaction recorded by mobile health (mHealth) devices could be used to evaluate and improve therapy workflow. Furthermore, apps could support classical visits, document adverse effects, and remind patients of treatment dates or drug intake. ",
doi="10.2196/mhealth.7689",
url="http://mhealth.jmir.org/2017/6/e81/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28615159"
}


@Article{info:doi/10.2196/mhealth.6697,
author="Urner, Esther
and Delavy, Martine
and Catarino, Rosa
and Viviano, Manuela
and Meyer-Hamme, Ulrike
and Benski, Anne-Caroline
and Jinoro, Jeromine
and Heriniainasolo, Lea Josea
and Undurraga, Manuela
and De Vuyst, Hugo
and Combescure, Christophe
and Vassilakos, Pierre
and Petignat, Patrick",
title="A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="29",
volume="5",
number="5",
pages="e72",
keywords="cervical cancer",
keywords="squamous intraepithelial lesions of the cervix",
keywords="HPV",
keywords="acetic acid",
keywords="lugol's iodine",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Sub-Saharan African countries are marked by a high incidence of cervical cancer. Madagascar ranks 11th among the countries with the highest cervical cancer incidence worldwide. Objective: The aim of the study was to evaluate the performances of digital smartphone-based visual inspection with acetic acid (D-VIA) and Lugol's iodine (D-VILI) for diagnosing cervical precancer and cancer. Methods: Human papillomavirus (HPV)-positive women recruited through a cervical screening campaign had D-VIA and D-VILI examinations with endocervical curettage (ECC) and cervical biopsy. Three images were captured for each woman (native, D-VIA, D-VILI) using a smartphone camera. The images were randomly coded and distributed on 2 online databases?(Google Forms). The D-VIA form included native and D-VIA images, and the D-VILI form included native and D-VILI images. Pathological cases were defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Physicians rated the images as non-pathological or pathological. Using the ECC and cervical biopsy results as references, the sensitivity and specificity of D-VIA and D-VILI examinations for each and all physicians were calculated. Results: Altogether, 15 clinicians assessed 240 images. Sensitivity was higher for the D-VIA interpretations (94.1\%; 95\% CI 81.6-98.3) than for the D-VILI interpretations (78.8\%; 95\% CI 54.1-92.1; P=.009). In contrast, the specificity was higher for the D-VILI interpretations (56.4\%; 95\% CI 38.3-72.9) than for the D-VIA interpretations?(50.4\%; 95\% CI 35.9-64.8; P=.005). Conclusion: Smartphone-based image for triage of HPV-positive women is more accurate for detecting CIN2+ lesions with D-VIA than D-VILI, although with a small loss of specificity. ",
doi="10.2196/mhealth.6697",
url="http://mhealth.jmir.org/2017/5/e72/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28554879"
}


@Article{info:doi/10.2196/rehab.6319,
author="Constantinescu, Gabriela
and Loewen, Irene
and King, Ben
and Brodt, Chris
and Hodgetts, William
and Rieger, Jana",
title="Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Mar",
day="24",
volume="4",
number="1",
pages="e3",
keywords="app design",
keywords="dysphagia",
keywords="games for health",
keywords="gamification",
keywords="head and neck cancer",
keywords="mHealth",
keywords="mobile health",
keywords="patient adherence",
keywords="patient engagement",
abstract="Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development. ",
doi="10.2196/rehab.6319",
url="http://rehab.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582245"
}


@Article{info:doi/10.2196/mhealth.7073,
author="Ginossar, Tamar
and Shah, Ali Sayyed Fawad
and West, J. Andrew
and Bentley, M. Joshua
and Caburnay, A. Charlene
and Kreuter, W. Matthew
and Kinney, Y. Anita",
title="Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Mar",
day="13",
volume="5",
number="3",
pages="e20",
keywords="mobile phones",
keywords="mobile apps",
keywords="breast cancer",
keywords="cancer-related content",
abstract="Background: Breast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps. Objective: This study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price. Methods: Following identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM). Results: The most common aim of apps was educational (73/101, 72.3\%), followed by behavior change (24/101, 23.9\%), fundraising (20/101, 19.8\%), and advocacy (14/101, 13.9\%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7\%). Less than half of the apps (46/101, 45.5\%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5\%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5\%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5\%). Information about breast cancer diagnosis was included in 42 apps (41.58\%) and 43 (42.6\%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8\%) apps. Only one (1.0\%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6\%) and few (24/101, 23.8\%) defined key terms. Conclusions: Current breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities. ",
doi="10.2196/mhealth.7073",
url="http://mhealth.jmir.org/2017/3/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28288954"
}


@Article{info:doi/10.2196/mhealth.6970,
author="Robertson, C. Michael
and Tsai, Edward
and Lyons, J. Elizabeth
and Srinivasan, Sanjana
and Swartz, C. Maria
and Baum, L. Miranda
and Basen-Engquist, M. Karen",
title="Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jan",
day="24",
volume="5",
number="1",
pages="e3",
keywords="mHealth",
keywords="physical activity",
keywords="survivors",
keywords="technology",
keywords="focus groups",
keywords="smartphone",
abstract="Background: Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective: The aim of this study was to take a qualitative approach to provide practical insight regarding this population's preferences for the features and messages of an app to increase PA. Methods: A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results: Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69\%) and mostly white (25/35, 71\%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions: Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors' preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors. ",
doi="10.2196/mhealth.6970",
url="http://mhealth.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28119278"
}


@Article{info:doi/10.2196/resprot.6597,
author="Pugh, Gemma
and McCann, Lisa",
title="Assessing the Quality, Feasibility, and Efficacy of Electronic Patient Platforms Designed to Support Adolescents and Young Adults With Cancer: A Systematic Review Protocol",
journal="JMIR Res Protoc",
year="2017",
month="Jan",
day="17",
volume="6",
number="1",
pages="e4",
keywords="adolescent",
keywords="neoplasms",
keywords="telemedicine",
keywords="review",
abstract="Background: A range of innovative websites, mobile technologies, eHealth and mHealth platforms have emerged to support adolescents and young adults (AYAs) with cancer. Previous reviews have identified these various applications and solutions, but no review has summarized the quality, feasibility, and efficacy of existing patient platforms (inclusive of websites, mobile technologies, mHealth and eHealth platforms) developed specifically for young people with cancer. Objective: This paper describes the design of a protocol to conduct a review of published studies or reports which describe or report on an existing platform designed specifically for AYAs who have had a cancer diagnosis. Methods: A search string was developed using a variety of key words and Medical Subject Heading and applied to bibliographic databases. General data (sample characteristics, patient platform development, design and, if applicable, pilot testing outcomes) will be extracted from reports and studies. Drawing on a previously developed coding schematic, the identified patient platforms will be coded for mode of delivery into (1) automated functions, (2) communicative functions, and (3) use of supplementary modes. An adapted version of the Mobile App Rating Scale (MARS) will be used to assess the of quality of each identified patient platform. The methodological quality of included studies will be assessed using the Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst). Both authors will independently screen eligible studies for final inclusion and will both be responsible for data extraction and appraisal. Data will be synthesized narratively to provide an overview of identified patient platforms. Results: The review began in October 2016 and is currently in progress. The review paper will be submitted for peer-review and publication in the summer of 2017. Conclusions: This review will be unique in its focus on assessing, where possible, the quality and efficacy of patient platforms for adolescents and young adults diagnosed with cancer. Results generated from this review will provide an invaluable insight into the utility of modern technology in supporting young people with cancer. ",
doi="10.2196/resprot.6597",
url="http://www.researchprotocols.org/2017/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28096067"
}


@Article{info:doi/10.2196/cancer.6750,
author="Pereira-Azevedo, Nuno
and Os{\'o}rio, Lu{\'i}s
and Fraga, Avelino
and Roobol, J. Monique",
title="Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App",
journal="JMIR Cancer",
year="2017",
month="Jan",
day="06",
volume="3",
number="1",
pages="e1",
keywords="mHealth",
keywords="prostate cancer",
keywords="nomogram",
abstract="Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ?7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high---92\% (27.7/30), 87\% (26.2/30), and 89\% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app's interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. ",
doi="10.2196/cancer.6750",
url="http://cancer.jmir.org/2017/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410180"
}


@Article{info:doi/10.2196/jmir.2350,
author="Stinson, N. Jennifer
and Jibb, A. Lindsay
and Nguyen, Cynthia
and Nathan, C. Paul
and Maloney, Marie Anne
and Dupuis, Lee L.
and Gerstle, Ted J.
and Alman, Benjamin
and Hopyan, Sevan
and Strahlendorf, Caron
and Portwine, Carol
and Johnston, L. Donna
and Orr, Mike",
title="Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer",
journal="J Med Internet Res",
year="2013",
month="Mar",
day="08",
volume="15",
number="3",
pages="e51",
keywords="neoplasms",
keywords="pain",
keywords="child",
keywords="adolescent",
keywords="youth",
keywords="cellular phone",
keywords="game",
abstract="Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent's life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective: Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods: We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results: Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81\%, SD 22\%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. Conclusions: A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing. ",
doi="10.2196/jmir.2350",
url="http://www.jmir.org/2013/3/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23475457"
}