%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23483 %T Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer: Systematic Review %A Jones,Owain T %A Calanzani,Natalia %A Saji,Smiji %A Duffy,Stephen W %A Emery,Jon %A Hamilton,Willie %A Singh,Hardeep %A de Wit,Niek J %A Walter,Fiona M %+ Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, 2 Wort's Causeway, Cambridge, CB1 8RN, United Kingdom, 44 1223762554, otj24@medschl.cam.ac.uk %K artificial intelligence %K machine learning %K electronic health records %K primary health care %K early detection of cancer %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: More than 17 million people worldwide, including 360,000 people in the United Kingdom, were diagnosed with cancer in 2018. Cancer prognosis and disease burden are highly dependent on the disease stage at diagnosis. Most people diagnosed with cancer first present in primary care settings, where improved assessment of the (often vague) presenting symptoms of cancer could lead to earlier detection and improved outcomes for patients. There is accumulating evidence that artificial intelligence (AI) can assist clinicians in making better clinical decisions in some areas of health care. Objective: This study aimed to systematically review AI techniques that may facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. The quality of the evidence, the phase of development the AI techniques have reached, the gaps that exist in the evidence, and the potential for use in primary care were evaluated. Methods: We searched MEDLINE, Embase, SCOPUS, and Web of Science databases from January 01, 2000, to June 11, 2019, and included all studies providing evidence for the accuracy or effectiveness of applying AI techniques for the early detection of cancer, which may be applicable to primary care EHRs. We included all study designs in all settings and languages. These searches were extended through a scoping review of AI-based commercial technologies. The main outcomes assessed were measures of diagnostic accuracy for cancer. Results: We identified 10,456 studies; 16 studies met the inclusion criteria, representing the data of 3,862,910 patients. A total of 13 studies described the initial development and testing of AI algorithms, and 3 studies described the validation of an AI algorithm in independent data sets. One study was based on prospectively collected data; only 3 studies were based on primary care data. We found no data on implementation barriers or cost-effectiveness. Risk of bias assessment highlighted a wide range of study quality. The additional scoping review of commercial AI technologies identified 21 technologies, only 1 meeting our inclusion criteria. Meta-analysis was not undertaken because of the heterogeneity of AI modalities, data set characteristics, and outcome measures. Conclusions: AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended. %M 33656443 %R 10.2196/23483 %U https://www.jmir.org/2021/3/e23483 %U https://doi.org/10.2196/23483 %U http://www.ncbi.nlm.nih.gov/pubmed/33656443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26799 %T Minimizing the Impact of the COVID-19 Epidemic on Oncology Clinical Trials: Retrospective Study of Beijing Cancer Hospital %A Fu,Zhiying %A Jiang,Min %A Wang,Kun %A Li,Jian %+ Beijing Institute for Cancer Research, Beijing Cancer Hospital, No 52 Fucheng Road, Haidian District, Beijing, China, 86 1088196949, LIJIAN8409@126.com %K COVID-19 %K clinical trials %K management strategy %K information technology %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In view of repeated COVID-19 outbreaks in most countries, clinical trials will continue to be conducted under outbreak prevention and control measures for the next few years. It is very significant to explore an optimal clinical trial management model during the outbreak period to provide reference and insight for other clinical trial centers worldwide. Objective: The aim of this study was to explore the management strategies used to minimize the impact of the COVID-19 epidemic on oncology clinical trials. Methods: We implemented a remote management model to maintain clinical trials conducted at Beijing Cancer Hospital, which realized remote project approval, remote initiation, remote visits, remote administration and remote monitoring to get through two COVID-19 outbreaks in the capital city from February to April and June to July 2020. The effectiveness of measures was evaluated as differences in rates of protocol compliance, participants lost to follow-up, participant withdrawal, disease progression, participant mortality, and detection of monitoring problems. Results: During the late of the first outbreak, modifications were made in trial processing, participant management and quality control, which allowed the hospital to ensure the smooth conduct of 572 trials, with a protocol compliance rate of 85.24% for 3718 participants across both outbreaks. No COVID-19 infections were recorded among participants or trial staff, and no major procedural errors occurred between February and July 2020. These measures led to significantly higher rates of protocol compliance and significantly lower rates of loss to follow-up or withdrawal after the second outbreak than after the first, without affecting rates of disease progression or mortality. The hospital provided trial sponsors with a remote monitoring system in a timely manner, and 3820 trial issues were identified. Conclusions: When public health emergencies occur, an optimal clinical trial model combining on-site and remote management could guarantee the health care and treatment needs of clinical trial participants, in which remote management plays a key role. %M 33591924 %R 10.2196/26799 %U https://www.jmir.org/2021/3/e26799 %U https://doi.org/10.2196/26799 %U http://www.ncbi.nlm.nih.gov/pubmed/33591924 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18269 %T Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study %A Ma,Jinfei %A Zou,Zihao %A Pazo,Emmanuel Eric %A Moutari,Salissou %A Liu,Ye %A Jin,Feng %+ Department of Breast Surgery, The First Affiliated Hospital of China Medical University, No 155 Nanjing Road, Heping District, Shenyang, 110001, China, 86 18040031101, jinfeng@cmu.edu.cn %K breast cancer %K NFBSI-16 %K patient-reported outcome %K reproducibility %K test-retest reliability %K web-based questionnaire %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy–Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall τ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ρ) were documented for all 4 subscales—Disease-Related Symptoms Subscale–Physical (ρ=0.93), Disease-Related Symptoms Subscale–Emotional (ρ=0.85), Treatment Side Effects Subscale (ρ=0.95), and Function and Well-Being Subscale (ρ=0.91)—and total NFBSI-16 score (ρ=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. %M 33650978 %R 10.2196/18269 %U https://medinform.jmir.org/2021/3/e18269 %U https://doi.org/10.2196/18269 %U http://www.ncbi.nlm.nih.gov/pubmed/33650978 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e25635 %T Machine Learning Approach to Predict the Probability of Recurrence of Renal Cell Carcinoma After Surgery: Prediction Model Development Study %A Kim,HyungMin %A Lee,Sun Jung %A Park,So Jin %A Choi,In Young %A Hong,Sung-Hoo %+ Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea, 82 2 2258 6228, toomey@catholic.ac.kr %K renal cell carcinoma %K recurrence %K machine learning %K naïve Bayes %K algorithm %K cancer %K surgery %K web-based %K database %K prediction %K probability %K carcinoma %K kidney %K model %K development %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Renal cell carcinoma (RCC) has a high recurrence rate of 20% to 30% after nephrectomy for clinically localized disease, and more than 40% of patients eventually die of the disease, making regular monitoring and constant management of utmost importance. Objective: The objective of this study was to develop an algorithm that predicts the probability of recurrence of RCC within 5 and 10 years of surgery. Methods: Data from 6849 Korean patients with RCC were collected from eight tertiary care hospitals listed in the KOrean Renal Cell Carcinoma (KORCC) web-based database. To predict RCC recurrence, analytical data from 2814 patients were extracted from the database. Eight machine learning algorithms were used to predict the probability of RCC recurrence, and the results were compared. Results: Within 5 years of surgery, the highest area under the receiver operating characteristic curve (AUROC) was obtained from the naïve Bayes (NB) model, with a value of 0.836. Within 10 years of surgery, the highest AUROC was obtained from the NB model, with a value of 0.784. Conclusions: An algorithm was developed that predicts the probability of RCC recurrence within 5 and 10 years using the KORCC database, a large-scale RCC cohort in Korea. It is expected that the developed algorithm will help clinicians manage prognosis and establish customized treatment strategies for patients with RCC after surgery. %M 33646127 %R 10.2196/25635 %U https://medinform.jmir.org/2021/3/e25635 %U https://doi.org/10.2196/25635 %U http://www.ncbi.nlm.nih.gov/pubmed/33646127 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23147 %T Prediction of Prolonged Length of Hospital Stay After Cancer Surgery Using Machine Learning on Electronic Health Records: Retrospective Cross-sectional Study %A Jo,Yong-Yeon %A Han,JaiHong %A Park,Hyun Woo %A Jung,Hyojung %A Lee,Jae Dong %A Jung,Jipmin %A Cha,Hyo Soung %A Sohn,Dae Kyung %A Hwangbo,Yul %+ Healthcare AI Team, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 10 8885 2812, yulhwangbo@ncc.re.kr %K postoperative length of stay %K cancer surgery %K machine learning %K electronic health records %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Postoperative length of stay is a key indicator in the management of medical resources and an indirect predictor of the incidence of surgical complications and the degree of recovery of the patient after cancer surgery. Recently, machine learning has been used to predict complex medical outcomes, such as prolonged length of hospital stay, using extensive medical information. Objective: The objective of this study was to develop a prediction model for prolonged length of stay after cancer surgery using a machine learning approach. Methods: In our retrospective study, electronic health records (EHRs) from 42,751 patients who underwent primary surgery for 17 types of cancer between January 1, 2000, and December 31, 2017, were sourced from a single cancer center. The EHRs included numerous variables such as surgical factors, cancer factors, underlying diseases, functional laboratory assessments, general assessments, medications, and social factors. To predict prolonged length of stay after cancer surgery, we employed extreme gradient boosting classifier, multilayer perceptron, and logistic regression models. Prolonged postoperative length of stay for cancer was defined as bed-days of the group of patients who accounted for the top 50% of the distribution of bed-days by cancer type. Results: In the prediction of prolonged length of stay after cancer surgery, extreme gradient boosting classifier models demonstrated excellent performance for kidney and bladder cancer surgeries (area under the receiver operating characteristic curve [AUC] >0.85). A moderate performance (AUC 0.70-0.85) was observed for stomach, breast, colon, thyroid, prostate, cervix uteri, corpus uteri, and oral cancers. For stomach, breast, colon, thyroid, and lung cancers, with more than 4000 cases each, the extreme gradient boosting classifier model showed slightly better performance than the logistic regression model, although the logistic regression model also performed adequately. We identified risk variables for the prediction of prolonged postoperative length of stay for each type of cancer, and the importance of the variables differed depending on the cancer type. After we added operative time to the models trained on preoperative factors, the models generally outperformed the corresponding models using only preoperative variables. Conclusions: A machine learning approach using EHRs may improve the prediction of prolonged length of hospital stay after primary cancer surgery. This algorithm may help to provide a more effective allocation of medical resources in cancer surgery. %M 33616544 %R 10.2196/23147 %U https://medinform.jmir.org/2021/2/e23147 %U https://doi.org/10.2196/23147 %U http://www.ncbi.nlm.nih.gov/pubmed/33616544 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e21401 %T Development of a Web-Based System for Exploring Cancer Risk With Long-term Use of Drugs: Logistic Regression Approach %A Yang,Hsuan-Chia %A Islam,Md Mohaimenul %A Nguyen,Phung Anh Alex %A Wang,Ching-Huan %A Poly,Tahmina Nasrin %A Huang,Chih-Wei %A Li,Yu-Chuan Jack %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 15 F, No. 172-1, Sec 2, Kellung Rd, Da'an District, Taipei, 110, Taiwan, 886 2 27361661 ext 7600, jaak88@gmail.com %K cancer %K risk %K prevention %K chemoprevention %K long-term–use drugs %K drug %K epidemiology %K temporal model %K modeling %K web-based system %D 2021 %7 15.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Existing epidemiological evidence regarding the association between the long-term use of drugs and cancer risk remains controversial. Objective: We aimed to have a comprehensive view of the cancer risk of the long-term use of drugs. Methods: A nationwide population-based, nested, case-control study was conducted within the National Health Insurance Research Database sample cohort of 1999 to 2013 in Taiwan. We identified cases in adults aged 20 years and older who were receiving treatment for at least two months before the index date. We randomly selected control patients from the patients without a cancer diagnosis during the 15 years (1999-2013) of the study period. Case and control patients were matched 1:4 based on age, sex, and visit date. Conditional logistic regression was used to estimate the association between drug exposure and cancer risk by adjusting potential confounders such as drugs and comorbidities. Results: There were 79,245 cancer cases and 316,980 matched controls included in this study. Of the 45,368 associations, there were 2419, 1302, 662, and 366 associations found statistically significant at a level of P<.05, P<.01, P<.001, and P<.0001, respectively. Benzodiazepine derivatives were associated with an increased risk of brain cancer (adjusted odds ratio [AOR] 1.379, 95% CI 1.138-1.670; P=.001). Statins were associated with a reduced risk of liver cancer (AOR 0.470, 95% CI 0.426-0.517; P<.0001) and gastric cancer (AOR 0.781, 95% CI 0.678-0.900; P<.001). Our web-based system, which collected comprehensive data of associations, contained 2 domains: (1) the drug and cancer association page and (2) the overview page. Conclusions: Our web-based system provides an overview of comprehensive quantified data of drug-cancer associations. With all the quantified data visualized, the system is expected to facilitate further research on cancer risk and prevention, potentially serving as a stepping-stone to consulting and exploring associations between the long-term use of drugs and cancer risk. %M 33587043 %R 10.2196/21401 %U http://publichealth.jmir.org/2021/2/e21401/ %U https://doi.org/10.2196/21401 %U http://www.ncbi.nlm.nih.gov/pubmed/33587043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e15598 %T Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study %A O'Cathail,Micheal %A Aznar-Garcia,Luis %A Sivanandan,Ananth %A Diver,Claire %A Patel,Poulam %A Tang,Pui-Shan %A Christian,Judith %+ Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Hucknall Road, Nottingham, NG5 1PB, United Kingdom, 44 07460617317, mocathail@gmail.com %K telemedicine %K teleconsultations %K brain metastases %K stereotactic radiosurgery %K mobile phone %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. %M 33544082 %R 10.2196/15598 %U http://formative.jmir.org/2021/2/e15598/ %U https://doi.org/10.2196/15598 %U http://www.ncbi.nlm.nih.gov/pubmed/33544082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24619 %T Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation %A Chen,Zhuo-Jia %A Liang,Wei-Ting %A Liu,Qing %A He,Rong %A Chen,Qian-Chao %A Li,Qiu-Feng %A Zhang,Yao %A Du,Xiao-Dong %A Pan,Ying %A Liu,Shu %A Li,Xiao-Yan %A Wei,Xue %A Huang,He %A Huang,Hong-Bing %A Liu,Tao %+ Department of Pharmacy, Sun Yat-sen University Cancer Center, Guangzhou, China, huanghb@sysucc.org.cn %K COVID-19 %K cancer patients %K remote pharmacy %K service platform %K implementation %K oncology %K pharmacy %K online platform %K cancer %K health management %K app %K online hospital %K acceptance %K impact %D 2021 %7 21.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC. Objective: The aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China. Methods: The total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients’ gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients’ satisfaction in using the remote prescription service. Results: A total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39%), and 90.18% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42%), liver cancer (249/1212, 20.54%), and thyroid cancer (125/1212, 10.31%). Of the 1718 prescriptions delivered, 1435 (83.5%) were sent to Guangdong Province and 283 (16.5%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88% (88/100) of the patients were very satisfied, and 12% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform. Conclusions: The remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service. %M 33395398 %R 10.2196/24619 %U http://www.jmir.org/2021/1/e24619/ %U https://doi.org/10.2196/24619 %U http://www.ncbi.nlm.nih.gov/pubmed/33395398 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21752 %T A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study %A Sandell,Tiffany %A Schütze,Heike %A Miller,Andrew %+ Wollongong Hospital, Loftus Street, Wollongong, 2500, Australia, 61 24222500, tiffany.sandell@health.nsw.gov.au %K radiation oncology %K general practice %K health technology %K communication %K cancer %K shared care %K follow-up %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective: The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods: This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results: Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions: Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients’ preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID): PRR1-10.2196/21752 %M 33464209 %R 10.2196/21752 %U http://www.researchprotocols.org/2021/1/e21752/ %U https://doi.org/10.2196/21752 %U http://www.ncbi.nlm.nih.gov/pubmed/33464209 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e19689 %T Use of BERT (Bidirectional Encoder Representations from Transformers)-Based Deep Learning Method for Extracting Evidences in Chinese Radiology Reports: Development of a Computer-Aided Liver Cancer Diagnosis Framework %A Liu,Honglei %A Zhang,Zhiqiang %A Xu,Yan %A Wang,Ni %A Huang,Yanqun %A Yang,Zhenghan %A Jiang,Rui %A Chen,Hui %+ School of Biomedical Engineering, Capital Medical University, No 10, Xitoutiao, Youanmen, Fengtai District, Beijing, China, 86 010 83911545, chenhui@ccmu.edu.cn %K BiLSTM-CRF %K natural language processing %K radiology reports %K information extraction %K computer-aided diagnosis %K BERT %D 2021 %7 12.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Liver cancer is a substantial disease burden in China. As one of the primary diagnostic tools for detecting liver cancer, dynamic contrast-enhanced computed tomography provides detailed evidences for diagnosis that are recorded in free-text radiology reports. Objective: The aim of our study was to apply a deep learning model and rule-based natural language processing (NLP) method to identify evidences for liver cancer diagnosis automatically. Methods: We proposed a pretrained, fine-tuned BERT (Bidirectional Encoder Representations from Transformers)-based BiLSTM-CRF (Bidirectional Long Short-Term Memory-Conditional Random Field) model to recognize the phrases of APHE (hyperintense enhancement in the arterial phase) and PDPH (hypointense in the portal and delayed phases). To identify more essential diagnostic evidences, we used the traditional rule-based NLP methods for the extraction of radiological features. APHE, PDPH, and other extracted radiological features were used to design a computer-aided liver cancer diagnosis framework by random forest. Results: The BERT-BiLSTM-CRF predicted the phrases of APHE and PDPH with an F1 score of 98.40% and 90.67%, respectively. The prediction model using combined features had a higher performance (F1 score, 88.55%) than those using APHE and PDPH (84.88%) or other extracted radiological features (83.52%). APHE and PDPH were the top 2 essential features for liver cancer diagnosis. Conclusions: This work was a comprehensive NLP study, wherein we identified evidences for the diagnosis of liver cancer from Chinese radiology reports, considering both clinical knowledge and radiology findings. The BERT-based deep learning method for the extraction of diagnostic evidence achieved state-of-the-art performance. The high performance proves the feasibility of the BERT-BiLSTM-CRF model in information extraction from Chinese radiology reports. The findings of our study suggest that the deep learning–based method for automatically identifying evidences for diagnosis can be extended to other types of Chinese clinical texts. %M 33433395 %R 10.2196/19689 %U http://www.jmir.org/2021/1/e19689/ %U https://doi.org/10.2196/19689 %U http://www.ncbi.nlm.nih.gov/pubmed/33433395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24733 %T Perceived Needs Versus Predisposing/Enabling Characteristics in Relation to Internet Cancer Information Seeking Among the US and Chinese Public: Comparative Survey Research %A Zhang,Di %A Hu,Hongchao %A Shi,Zhen %A Li,Biao %+ School of Journalism and Communication, Renmin University of China, RM713 Mingde Journalism Buliding, Renmin University of China, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 18810286586, libiao@ruc.edu.cn %K HINTS %K health information seeking behavior (HISB) %K China %K United States %K comparative research %K cultural sensitivity %D 2021 %7 11.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the rise of the internet, online health information seeking has become a worldwide phenomenon. However, health and health communication are inherently culture bound. A data-driven cross-country comparison enables us to better understand how cultural factors moderate the association between individual-level determinants and online health information seeking. Objective: The objective of the study was to examine similarities and differences in determinants of internet cancer information seeking between the US and Chinese general public (excluding cancer patients and survivors) under the framework of a behavioral model of health services use. Methods: This study used Health Information National Trends Survey (HINTS) 2017 (US data) and HINTS-China 2017 data to answer the research question. It focused on people with no cancer history and with internet access. For the HINTS 2017, the sample size was 2153; for the HINTS-China 2017, the sample size was 2358. To compare China and the United States, the researchers selected the same set of study variables for each dataset. Under the framework of the behavioral model of health services use, these predictors were predisposing factors, enabling factors, and need factors. Results: In terms of the predisposing factors, a higher age, college degree or above, being currently unemployed, and having a family history of cancer were associated with internet cancer information seeking for the Chinese respondents; none of these factors were related to information seeking for the US respondents, although a lower age was associated with information seeking. Regarding the enabling conditions, lower trust in family members and friends as reliable information sources was the only factor associated with information seeking for the Chinese respondents, while no enabling factor was related to information seeking for the US respondents. Regarding the need factors, perceived health status was not related to information seeking for the Chinese respondents, while perception of poorer health condition was related to information seeking for the US respondents. Higher cancer fear was related to information seeking for both groups, but the magnitude of association was smaller for the Chinese respondents than for the US respondents. Conclusions: Overall, under the framework of the behavioral model of health services use, the results based on multivariate logistic regression reveal clear patterns of cross-country/cultural differences in the factors associated with internet cancer information seeking behaviors: predisposing characteristics and enabling conditions are more important in China, while perceived needs are more significant in the US. Such differences might reflect possible US-China differences in job environment (eg, job pressure) and culture (individualism vs collectivism and family structure). %M 33427668 %R 10.2196/24733 %U http://www.jmir.org/2021/1/e24733/ %U https://doi.org/10.2196/24733 %U http://www.ncbi.nlm.nih.gov/pubmed/33427668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18655 %T Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients %A Schmalz,Oliver %A Jacob,Christine %A Ammann,Johannes %A Liss,Blasius %A Iivanainen,Sanna %A Kammermann,Manuel %A Koivunen,Jussi %A Klein,Alexander %A Popescu,Razvan Andrei %+ Medical Affairs (Personalised Healthcare and Patient Access), F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070 Basel, Switzerland, 41 792 921 758, johannes.ammann@roche.com %K advanced or metastatic non-small cell lung cancer %K cancer immunotherapy %K digital patient monitoring %K drug- and indication-specific cancer immunotherapy module %K eHealth %K mHealth %K quality of patient care %K patient-reported outcomes %K real-time symptom reporting %K user experience %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer immunotherapy (CIT), as a monotherapy or in combination with chemotherapy, has been shown to extend overall survival in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). However, patients experience treatment-related symptoms that they are required to recall between hospital visits. Digital patient monitoring and management (DPMM) tools may improve clinical practice by allowing real-time symptom reporting. Objective: This proof-of-concept pilot study assessed patient and health care professional (HCP) adoption of our DPMM tool, which was designed specifically for patients with advanced or metastatic NSCLC treated with CIT, and the tool’s impact on clinical care. Methods: Four advisory boards were assembled in order to co-develop a drug- and indication-specific CIT (CIT+) module, based on a generic CIT DPMM tool from Kaiku Health, Helsinki, Finland. A total of 45 patients treated with second-line single-agent CIT (ie, atezolizumab or otherwise) for advanced or metastatic NSCLC, as well as HCPs, whose exact number was decided by the clinics, were recruited from 10 clinics in Germany, Finland, and Switzerland between February and May 2019. All clinics were provided with the Kaiku Health generic CIT DPMM tool, including our CIT+ module. Data on user experience, overall satisfaction, and impact of the tool on clinical practice were collected using anonymized surveys—answers ranged from 1 (low agreement) to 5 (high agreement)—and HCP interviews; surveys and interviews consisted of closed-ended Likert scales and open-ended questions, respectively. The first survey was conducted after 2 months of DPMM use, and a second survey and HCP interviews were conducted at study end (ie, after ≥3 months of DPMM use); only a subgroup of HCPs from each clinic responded to the surveys and interviews. Survey data were analyzed quantitatively; interviews were recorded, transcribed verbatim, and translated into English, where applicable, for coding and qualitative thematic analysis. Results: Among interim survey respondents (N=51: 13 [25%] nurses, 11 [22%] physicians, and 27 [53%] patients), mean rankings of the tool’s seven usability attributes ranged from 3.2 to 4.4 (nurses), 3.7 to 4.5 (physicians), and 3.7 to 4.2 (patients). At the end-of-study survey (N=48: 19 [40%] nurses, 8 [17%] physicians, and 21 [44%] patients), most respondents agreed that the tool facilitated more efficient and focused discussions between patients and HCPs (nurses and patients: mean rating 4.2, SD 0.8; physicians: mean rating 4.4, SD 0.8) and allowed HCPs to tailor discussions with patients (mean rating 4.35, SD 0.65). The standalone tool was well integrated into HCP daily clinical workflow (mean rating 3.80, SD 0.75), enabled workflow optimization between physicians and nurses (mean rating 3.75, SD 0.80), and saved time by decreasing phone consultations (mean rating 3.75, SD 1.00) and patient visits (mean rating 3.45, SD 1.20). Workload was the most common challenge of tool use among respondents (12/19, 63%). Conclusions: Our results demonstrate high user satisfaction and acceptance of DPMM tools by HCPs and patients, and highlight the improvements to clinical care in patients with advanced or metastatic NSCLC treated with CIT monotherapy. However, further integration of the tool into the clinical information technology data flow is required. Future studies or registries using our DPMM tool may provide insights into significant effects on patient quality of life or health-economic benefits. %M 33346738 %R 10.2196/18655 %U http://www.jmir.org/2020/12/e18655/ %U https://doi.org/10.2196/18655 %U http://www.ncbi.nlm.nih.gov/pubmed/33346738 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e25501 %T Impact of Telemedicine Use by Oncology Physicians on the Patient and Informal Caregiver Experience of Receiving Care: Protocol for a Scoping Review in the Context of COVID-19 %A Thiessen,Maclean %A Soriano,Andrea Michelle %A Loewen,Hal John %A Decker,Kathleen Margaret %+ Research Institute of Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada, 1 204 787 4249, macthiessen@gmail.com %K cancer %K experience %K information needs %K telemedicine %K telehealth %K COVID-19 %K patient satisfaction %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 pandemic, the use of telemedicine by oncology physicians in Manitoba, Canada, has increased to limit the risk of exposure to the virus for both patients and health care providers. It is not clear how telemedicine impacts the information needs of patients or the experience of receiving cancer care. Objective: The objective of this study is to describe how the use of telemedicine impacts the information needs and experience of patients with cancer and their informal caregivers (ie, family and friends) and identify directions for future research. Methods: This review will include all studies addressing telemedicine in the cancer context including those using quantitative, qualitative, and mixed methods approaches. This scoping review will be conducted using the methodology described by the Joanna Briggs Institute. In collaboration with a librarian scientist specializing in health sciences, a comprehensive search will be undertaken to identify and retrieve relevant reports published in English from 1990 to the present. Databases searched will include MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, and PsycINFO. Data will be extracted by two independent reviewers, synthesized, and reported in a summary table and in a narrative format describing what has been reported regarding the impact of telemedicine by physicians in oncology on the experience of patients and their informal caregivers and their receipt of information. Results: The results from this scoping review are expected to be available by late spring 2021. Conclusions: The results from this scoping review will be useful for informing practice as well as directing future research, both in the context of COVID-19 and beyond. International Registered Report Identifier (IRRID): PRR1-10.2196/25501 %M 33290243 %R 10.2196/25501 %U http://www.researchprotocols.org/2020/12/e25501/ %U https://doi.org/10.2196/25501 %U http://www.ncbi.nlm.nih.gov/pubmed/33290243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22034 %T Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study %A Kondylakis,Haridimos %A Axenie,Cristian %A (Kiran) Bastola,Dhundy %A Katehakis,Dimitrios G %A Kouroubali,Angelina %A Kurz,Daria %A Larburu,Nekane %A Macía,Iván %A Maguire,Roma %A Maramis,Christos %A Marias,Kostas %A Morrow,Philip %A Muro,Naiara %A Núñez-Benjumea,Francisco José %A Rampun,Andrik %A Rivera-Romero,Octavio %A Scotney,Bryan %A Signorelli,Gabriel %A Wang,Hui %A Tsiknakis,Manolis %A Zwiggelaar,Reyer %+ FORTH-ICS, N Plastira 100, Vassilika Vouton, Heraklion, 70013, Greece, 30 2810391449, kondylak@gmail.com %K neoplasms %K inventions %K data-driven science %D 2020 %7 15.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)–funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. Objective: This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020–funded projects. Methods: Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. Results: Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. Conclusions: Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations. %M 33320099 %R 10.2196/22034 %U https://www.jmir.org/2020/12/e22034 %U https://doi.org/10.2196/22034 %U http://www.ncbi.nlm.nih.gov/pubmed/33320099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e17485 %T Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version %A Verot,Elise %A Bouleftour,Wafa %A Macron,Corinne %A Rivoirard,Romain %A Chauvin,Franck %+ Centre Hygée, University of Saint-Etienne, University of Lyon, Hesper EA 7425, Rue de la Marandière, Saint-Priest-en-Jarez, 42023, France, 33 682309796, elise.verot@univ-st-etienne.fr %K oncology %K nursing %K implementation science %K PAM-13 %K patient activation %K REALM-R %K health literacy %K mixed method %D 2020 %7 8.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient’s needs, with nursing care adapting accordingly. Objective: The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. Methods: This study will follow the “Reach, Effectiveness, Adoption, Implementation, and Maintenance” framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the “Capability, Opportunity, Motivation, and Behavior” model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient’s anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient’s enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. Results: This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. Conclusions: This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Trial Registration: ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 International Registered Report Identifier (IRRID): DERR1-10.2196/17485 %M 33289495 %R 10.2196/17485 %U https://www.researchprotocols.org/2020/12/e17485 %U https://doi.org/10.2196/17485 %U http://www.ncbi.nlm.nih.gov/pubmed/33289495 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e20137 %T The Tablet-Based, Engagement, Assessment, Support, and Sign-Posting (EASSi) Tool for Facilitating and Structuring Sexual Well-Being Conversations in Routine Prostate Cancer Care: Mixed-Methods Study %A McCaughan,Eilís %A Flannagan,Carrie %A Parahoo,Kader %A Connaghan,John %A Maguire,Roma %A Steele,Mary %A Thompson,Samantha %A Jain,Suneil %A Kirby,Michael %A Brady,Nuala %A O'Connor,Seán R %+ Institute of Nursing & Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 2870124091, em.mccaughan@ulster.ac.uk %K prostate cancer %K sexual well-being %K quality of life %K communication %D 2020 %7 4.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Long-term side-effects associated with different prostate cancer treatment approaches are common. Sexual challenges are the most frequently occurring issues and can result in increased psychological morbidity. It is recognized that barriers to communication can make initiating discussions around sexual concerns in routine practice difficult. Health care professionals need to routinely initiate conversations, effectively engage with patients, and assess needs in order to provide essential support. One proposed method that could support health care professionals to do this involves the use of prompts or structured frameworks to guide conversations. Objective: This study aimed to assess feasibility, acceptability, and satisfaction with the tablet-based Engagement, Assessment, Support, and Sign-posting (EASSi) tool designed to facilitate and structure sexual well-being discussions in routine prostate cancer care. Methods: Health care professionals (n=8) used the EASSi tool during 89 posttreatment appointments. Quantitative data were recorded based on program usage and surveys completed by health care professionals and patients. Qualitative data exploring perceptions on use of the tool were gathered using semistructured interviews with all health care professionals (n=8) and a sample of patients (n=10). Results: Surveys were completed by health care professionals immediately following each appointment (n=89, 100%). Postal surveys were returned by 59 patients (66%). Health care professionals and patients reported that the tool helped facilitate discussions (81/89, 91% and 50/59, 85%, respectively) and that information provided was relevant (82/89, 92% and 50/59, 85%, respectively). The mean conversation duration was 6.01 minutes (SD 2.91). Qualitative synthesis identified the tool’s ability to initiate and structure discussions, improve the “depth” of conversations, and normalize sexual concerns. Conclusions: The EASSi tool was appropriate and acceptable for use in practice and provided a flexible approach to facilitate routine brief conversations and deliver essential sexual well-being support. Further work will be conducted to evaluate the effectiveness of using the tablet-based tool in prostate cancer care settings. %M 33275109 %R 10.2196/20137 %U http://cancer.jmir.org/2020/2/e20137/ %U https://doi.org/10.2196/20137 %U http://www.ncbi.nlm.nih.gov/pubmed/33275109 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e24222 %T Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation %A Levine,Oren Hannun %A McGillion,Michael %A Levine,Mark %+ Department of Oncology, McMaster University, Room 104, G Wing, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada, 1 905 527 2299 ext 42176, mlevine@mcmaster.ca %K care %K patient-physician relationship %K patient-centered care %K oncology care delivery %K virtual visits %K telehealth %K virtual care %K cancer %K oncology %K evaluation %K COVID-19 %D 2020 %7 24.11.2020 %9 Viewpoint %J JMIR Cancer %G English %X The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19–free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon. %M 33180741 %R 10.2196/24222 %U http://cancer.jmir.org/2020/2/e24222/ %U https://doi.org/10.2196/24222 %U http://www.ncbi.nlm.nih.gov/pubmed/33180741 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e20288 %T Telehealth and Palliative Care for Patients With Cancer: Implications of the COVID-19 Pandemic %A Grewal,Udhayvir Singh %A Terauchi,Stephanie %A Beg,Muhammad Shaalan %+ Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, , United States, 1 5136416314, muhammad.beg@utsouthwestern.edu %K COVID-19 %K telehealth %K palliative care %K telepalliative care %K patients with cancer %K telemedicine %D 2020 %7 24.11.2020 %9 Viewpoint %J JMIR Cancer %G English %X It has been reported that the incidence of SARS-CoV-2 infection is higher in patients with cancer than in the general population and that patients with cancer are at an increased risk of developing severe life-threatening complications from COVID-19. Increased transmission and poor outcomes noted in emerging data on patients with cancer and COVID-19 call for aggressive isolation and minimization of nosocomial exposure. Palliative care and oncology providers are posed with unique challenges due to the ongoing COVID-19 pandemic. Telepalliative care is the use of telehealth services for remotely delivering palliative care to patients through videoconferencing, telephonic communication, or remote symptom monitoring. It offers great promise in addressing the palliative and supportive care needs of patients with advanced cancer during the ongoing pandemic. We discuss the case of a 75-year-old woman who was initiated on second-line chemotherapy, to highlight how innovations in technology and telehealth-based interventions can be used to address patients’ palliative and supportive care needs in the ongoing epidemic. %M 33049695 %R 10.2196/20288 %U http://cancer.jmir.org/2020/2/e20288/ %U https://doi.org/10.2196/20288 %U http://www.ncbi.nlm.nih.gov/pubmed/33049695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18982 %T Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study %A Biran,Noa %A Anthony Kouyaté,Robin %A Yucel,Emre %A McGovern,Gillian E %A Schoenthaler,Antoinette M %A Durling,Olivia G %A Unawane,Rashmi %A Schutt,Andrew %A Panjabi,Sumeet %+ Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, United States, 1 551 996 8704, Noa.Biran@hackensackmeridian.org %K mHealth %K digital health %K electronic patient-reported outcome %K ePRO %K patient-reported outcome %K PRO %K mobile %K app %K implementation science %K multiple myeloma %K relapsed refractory multiple myeloma %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33200997 %R 10.2196/18982 %U http://formative.jmir.org/2020/11/e18982/ %U https://doi.org/10.2196/18982 %U http://www.ncbi.nlm.nih.gov/pubmed/33200997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20709 %T Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research %A Matis,Juraj %A Svetlak,Miroslav %A Slezackova,Alena %A Svoboda,Marek %A Šumec,Rastislav %+ Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno, +42062500, Czech Republic, 420 773111330, msvetlak@med.muni.cz %K eHealth %K mHealth %K mindfulness %K cancer %K systematic review %K mobile phone %D 2020 %7 16.11.2020 %9 Review %J J Med Internet Res %G English %X Background: eHealth mindfulness-based programs (eMBPs) are on the rise in complex oncology and palliative care. However, we are still at the beginning of answering the questions of how effective eMBPs are and for whom, and what kinds of delivery modes are the most efficient. Objective: This systematic review aims to examine the feasibility and efficacy of eMBPs in improving the mental health and well-being of patients with cancer, to describe intervention characteristics and delivery modes of these programs, and to summarize the results of the included studies in terms of moderators, mediators, and predictors of efficacy, adherence, and attrition. Methods: In total, 4 databases (PubMed, PsycINFO, Scopus, and Web of Knowledge) were searched using relevant search terms (eg, mindfulness, program, eHealth, neoplasm) and their variations. No restrictions were imposed on language or publication type. The results of the efficacy of eMBPs were synthesized through the summarizing effect estimates method. Results: A total of 29 published papers describing 24 original studies were included in this review. In general, the results indicate that eMBPs have the potential to reduce the levels of stress, anxiety, depression, fatigue, sleep problems, and pain, and improve the levels of mindfulness, posttraumatic growth, and some parameters of general health. The largest median of Cohen d effect sizes were observed in reducing anxiety and depression (within-subject: median −0.38, IQR −0.62 to −0.27; between-group: median −0.42, IQR −0.58 to −0.22) and facilitating posttraumatic growth (within-subject: median 0.42, IQR 0.35 to 0.48; between-group: median 0.32, IQR 0.22 to 0.39). The efficacy of eMBP may be comparable with that of parallel, face-to-face MBPs in some cases. All studies that evaluated the feasibility of eMBPs reported that they are feasible for patients with cancer. Potential moderators, mediators, and predictors of the efficacy, attrition, and adherence of eMBPs are discussed. Conclusions: Although the effects of the reviewed studies were highly heterogeneous, the review provides evidence that eMBPs are an appropriate way for mindfulness practice to be delivered to patients with cancer. Thus far, existing eMBPs have mostly attempted to convert proven face-to-face mindfulness programs to the eHealth mode. They have not yet fully exploited the potential of eHealth technology. %M 33196452 %R 10.2196/20709 %U http://www.jmir.org/2020/11/e20709/ %U https://doi.org/10.2196/20709 %U http://www.ncbi.nlm.nih.gov/pubmed/33196452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19180 %T Advanced Symptom Management System for Patients with Malignant Pleural Mesothelioma (ASyMSmeso): Mixed Methods Study %A Maguire,Roma %A Connaghan,John %A Arber,Anne %A Klepacz,Naomi %A Blyth,Kevin G %A McPhelim,John %A Murray,Paul %A Rupani,Hitasha %A Chauhan,Anoop %A Williams,Peter %A McNaughton,Laura %A Woods,Kirstie %A Moylan,Anne %+ Department of Computing and Information Sciences, University of Strathclyde, LT14 14a, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 (0)141 548 3589, Roma.maguire@strath.ac.uk %K malignant pleural mesothelioma %K patient reported outcome measures %K cancer %K mobile health %K telemedicine, symptom monitoring %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33180025 %R 10.2196/19180 %U https://www.jmir.org/2020/11/e19180 %U https://doi.org/10.2196/19180 %U http://www.ncbi.nlm.nih.gov/pubmed/33180025 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e20224 %T Mobile Health App for Prostate Cancer Patients on Androgen Deprivation Therapy: Qualitative Usability Study %A Nabi,Junaid %A Cone,Eugene B %A Vasavada,Anjali %A Sun,Maxine %A Kilbridge,Kerry L %A Kibel,Adam S %A Berry,Donna L %A Trinh,Quoc-Dien %+ Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis St, ASB II-3, Boston, MA, 02115, United States, 1 617 525 7350, trinh.qd@gmail.com %K mobile health application %K prostate cancer %K androgen deprivation therapy %K thematic analysis %K qualitative methods %D 2020 %7 3.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Androgen deprivation therapy (ADT) increases the risk of metabolic adverse effects among patients with prostate cancer. The transformative impact of mobile health (mHealth) apps may benefit men managing activity and nutrition at home. Objective: This study aimed to evaluate the usability and patient experience of a newly developed mHealth app among prostate cancer patients on ADT and physicians’ beliefs about the potential benefits of using this app. Methods: This study took place over 2 months, beginning in March 2019. A sample of 5 patients (age 45-75 years) initiating ADT participated in a semistructured focus group discussion with a facilitator. The study participants also included 5 specialist physicians who provided in-depth interviews. An institutional review board–approved script was used to guide both the focus group and physician interviews. Usability was tested through specific scenarios presented to the patients, including downloading the mHealth app, entering information on physical activity and meals, and navigating the app. The focus group and interviews were audio recorded and transcribed. Content analysis was used to analyze the transcripts iteratively and exhaustively. Thematic discrepancies between reviewers were resolved through consensus. Results: The mean age of the patients was 62 years. This group included 4 White and 1 Latin American patients. The physician specialists included 2 urologists, 2 medical oncologists, and 1 radiation oncologist. Analyses revealed that the patients appreciated the holistic care enabled by the app. Difficulties were observed with registration of the app among 60% (3/5) of the patients; however, all the patients were able to input information about their physical activity and navigate the options within the app. Most patients (4/5, 80%) were able to input data on their recent meal. Among the health care physicians, the dominant themes reflected in the interviews included undermining of patients ability to use technology, patients’ fear of technology, and concern for the ability of older patients to access technology. Conclusions: The patients reported an overall positive experience of using an mHealth app to record and track diet and exercise. Usability was observed to be an important factor for adoption and was determined by ease of registration and use, intuitive appearance of the app, and focus on holistic cancer care. The physicians believed that the app was easy to use but raised concerns about usability among older men who may not typically use smartphone apps. %M 33141104 %R 10.2196/20224 %U https://mhealth.jmir.org/2020/11/e20224 %U https://doi.org/10.2196/20224 %U http://www.ncbi.nlm.nih.gov/pubmed/33141104 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20510 %T Information Access and Use by Patients With Cancer and Their Friends and Family: Development of a Grounded Theory %A Thiessen,Maclean %A Sinclair,Shane %A Tang,Patricia A %A Raffin Bouchal,Shelley %+ Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada, 1 2047878776, macthiessen@gmail.com %K persons %K personal autonomy %K patient-centered care %K health education %K health information–seeking behavior %K grounded theory %K empowerment %K cancer %K qualitative research %K adaptation, psychological %K mobile phone %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information has been identified as a commonly unmet supportive care need for those living with cancer (ie, patients and their friends and family). The information needed to help individuals plan their lives around the consequences of cancer, such as the receipt of health care, is an example of an important informational need. A suitable theory to guide the development of interventions designed to meet this informational need has not been identified by the authors. Objective: The aim of this study is to generate a grounded theory capable of guiding the development of interventions designed to assist those living with cancer in meeting their informational needs. Methods: Classic grounded theory was used to analyze data collected through digitally recorded one-on-one audio interviews with 31 patients with cancer and 29 friends and family members. These interviews focused on how the participants had accessed and used information to plan their lives and what barriers they faced in obtaining and using this information. Results: The theory that emerged consisted of 4 variables: personal projects, cancer as a source of disruption to personal projects, information as the process of accessing and interpreting cancer-related data (CRD) to inform action, and CRD quality as defined by accessibility, credibility, applicability, and framing. CRD quality as a moderator of personal project disruption by cancer is the core concept of this theory. Conclusions: Informational resources providing accessible, credible, applicable, and positively framed CRD are likely key to meeting the information needs of those affected by cancer. Web-based informational resources delivering high-quality CRD focused on assisting individuals living with cancer in maintaining and planning their personal projects are predicted to improve quality of life. Research is needed to develop and integrate resources informed by this theoretical framework into clinical practice. %M 33118940 %R 10.2196/20510 %U http://www.jmir.org/2020/10/e20510/ %U https://doi.org/10.2196/20510 %U http://www.ncbi.nlm.nih.gov/pubmed/33118940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19685 %T Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial %A Girgis,Afaf %A Durcinoska,Ivana %A Arnold,Anthony %A Descallar,Joseph %A Kaadan,Nasreen %A Koh,Eng-Siew %A Miller,Andrew %A Ng,Weng %A Carolan,Martin %A Della-Fiorentina,Stephen A %A Avery,Sandra %A Delaney,Geoff P %+ Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, Sydney, 2170, Australia, 61 0412142841, afaf.girgis@unsw.edu.au %K patient-reported outcomes (PROs) %K eHealth %K patient-centered care %K electronic health record %K nonrandomized controlled trial %K emergency department presentations %K pragmatic trial %K symptom screening %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective: This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods: Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results: From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions: Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4729-3 %M 33118954 %R 10.2196/19685 %U http://www.jmir.org/2020/10/e19685/ %U https://doi.org/10.2196/19685 %U http://www.ncbi.nlm.nih.gov/pubmed/33118954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21238 %T Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach %A Sungur,Hande %A Yılmaz,Nida Gizem %A Chan,Brittany Ming Chu %A van den Muijsenbergh,Maria E T C %A van Weert,Julia C M %A Schouten,Barbara C %+ Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Postbus 15791, Amsterdam, 1001 NG, Netherlands, 31 20 525 3680, h.sungur@uva.nl %K cancer %K patient participation %K health services needs and demand %K eHealth %K migrants %K physician-patient relations %K culture %K mobile phone %D 2020 %7 26.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective: This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods: The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results: The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions: Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group. %M 33104008 %R 10.2196/21238 %U http://www.jmir.org/2020/10/e21238/ %U https://doi.org/10.2196/21238 %U http://www.ncbi.nlm.nih.gov/pubmed/33104008 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20480 %T Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study %A Collado-Borrell,Roberto %A Escudero-Vilaplana,Vicente %A Ribed,Almudena %A Gonzalez-Anleo,Cristina %A Martin-Conde,Maite %A Romero-Jimenez,Rosa %A Iglesias-Peinado,Irene %A Herranz-Alonso,Ana %A Sanjurjo-Saez,Maria %+ Hospital General Universitario Gregorio Marañon, Dr. Esquerdo 46, Madrid, Spain, 34 915867714, vicente.escudero@salud.madrid.org %K e-OncoSalud %K app %K smartphone %K oral antineoplastic agent %K oncology %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 33064100 %R 10.2196/20480 %U http://mhealth.jmir.org/2020/10/e20480/ %U https://doi.org/10.2196/20480 %U http://www.ncbi.nlm.nih.gov/pubmed/33064100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19694 %T Exploring the Health-Related Quality of Life of Patients Treated With Immune Checkpoint Inhibitors: Social Media Study %A Cotté,François-Emery %A Voillot,Paméla %A Bennett,Bryan %A Falissard,Bruno %A Tzourio,Christophe %A Foulquié,Pierre %A Gaudin,Anne-Françoise %A Lemasson,Hervé %A Grumberg,Valentine %A McDonald,Laura %A Faviez,Carole %A Schück,Stéphane %+ Kap Code, 28 rue d'Enghien, Paris, 75010, France, 33 624058742, pamela.voillot@kapcode.fr %K health-related quality of life %K immunotherapy %K patients with cancer %K social media use %K measures %K real world %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat several types of tumors. Impact of this emerging therapy on patients’ health-related quality of life (HRQoL) is usually collected in clinical trials through standard questionnaires. However, this might not fully reflect HRQoL of patients under real-world conditions. In parallel, users’ narratives from social media represent a potential new source of research concerning HRQoL. Objective: The aim of this study is to assess and compare coverage of ICI-treated patients’ HRQoL domains and subdomains in standard questionnaires from clinical trials and in real-world setting from social media posts. Methods: A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experiences with ICIs between January 2011 and August 2018. Automatic and manual extractions were implemented to create a corpus where domains and subdomains of HRQoL were classified. These annotations were compared with domains covered by 2 standard HRQoL questionnaires, the EORTC QLQ-C30 and the FACT-G. Results: We identified 150 users who described their own experience with ICI (89/150, 59.3%) or that of their relative (61/150, 40.7%), with 137 users (91.3%) reporting at least one HRQoL domain in their social media posts. A total of 8 domains and 42 subdomains of HRQoL were identified: Global health (1 subdomain; 115 patients), Symptoms (13; 76), Emotional state (10; 49), Role (7; 22), Physical activity (4; 13), Professional situation (3; 9), Cognitive state (2; 2), and Social state (2; 2). The QLQ-C30 showed a wider global coverage of social media HRQoL subdomains than the FACT-G, 45% (19/42) and 29% (12/42), respectively. For both QLQ-C30 and FACT-G questionnaires, coverage rates were particularly suboptimal for Symptoms (68/123, 55.3% and 72/123, 58.5%, respectively), Emotional state (7/49, 14% and 24/49, 49%, respectively), and Role (17/22, 77% and 15/22, 68%, respectively). Conclusions: Many patients with cancer are using social media to share their experiences with immunotherapy. Collecting and analyzing their spontaneous narratives are helpful to capture and understand their HRQoL in real-world setting. New measures of HRQoL are needed to provide more in-depth evaluation of Symptoms, Emotional state, and Role among patients with cancer treated with immunotherapy. %M 32915159 %R 10.2196/19694 %U http://www.jmir.org/2020/9/e19694/ %U https://doi.org/10.2196/19694 %U http://www.ncbi.nlm.nih.gov/pubmed/32915159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18228 %T Artificial Intelligence in Health Care: Bibliometric Analysis %A Guo,Yuqi %A Hao,Zhichao %A Zhao,Shichong %A Gong,Jiaqi %A Yang,Fan %+ Social Welfare Program, School of Public Administration, Dongbei University of Finance and Economics, 217 Jianshan Street, Shahekou District, Dalian, China, 86 411 84710562, fyang10@dufe.edu.cn %K health care %K artificial intelligence %K bibliometric analysis %K telehealth %K neural networks %K machine learning %D 2020 %7 29.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As a critical driving power to promote health care, the health care–related artificial intelligence (AI) literature is growing rapidly. Objective: The purpose of this analysis is to provide a dynamic and longitudinal bibliometric analysis of health care–related AI publications. Methods: The Web of Science (Clarivate PLC) was searched to retrieve all existing and highly cited AI-related health care research papers published in English up to December 2019. Based on bibliometric indicators, a search strategy was developed to screen the title for eligibility, using the abstract and full text where needed. The growth rate of publications, characteristics of research activities, publication patterns, and research hotspot tendencies were computed using the HistCite software. Results: The search identified 5235 hits, of which 1473 publications were included in the analyses. Publication output increased an average of 17.02% per year since 1995, but the growth rate of research papers significantly increased to 45.15% from 2014 to 2019. The major health problems studied in AI research are cancer, depression, Alzheimer disease, heart failure, and diabetes. Artificial neural networks, support vector machines, and convolutional neural networks have the highest impact on health care. Nucleosides, convolutional neural networks, and tumor markers have remained research hotspots through 2019. Conclusions: This analysis provides a comprehensive overview of the AI-related research conducted in the field of health care, which helps researchers, policy makers, and practitioners better understand the development of health care–related AI research and possible practice implications. Future AI research should be dedicated to filling in the gaps between AI health care research and clinical applications. %M 32723713 %R 10.2196/18228 %U http://www.jmir.org/2020/7/e18228/ %U https://doi.org/10.2196/18228 %U http://www.ncbi.nlm.nih.gov/pubmed/32723713 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e15911 %T Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study %A Abdulaal,Ahmed %A Arhi,Chanpreet %A Ziprin,Paul %+ Imperial College London, Department of Surgery and Cancer, St Mary's Hospital Campus, Praed Street, London, W2 1NY, United Kingdom, 44 0754513315, ahmed.abdulaal@nhs.net %K surgery %K cancer %K colorectal %K delay %D 2020 %7 17.7.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results: A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect. %M 32706666 %R 10.2196/15911 %U https://www.i-jmr.org/2020/3/e15911 %U https://doi.org/10.2196/15911 %U http://www.ncbi.nlm.nih.gov/pubmed/32706666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19322 %T Rapid Utilization of Telehealth in a Comprehensive Cancer Center as a Response to COVID-19: Cross-Sectional Analysis %A Lonergan,Peter E %A Washington III,Samuel L %A Branagan,Linda %A Gleason,Nathaniel %A Pruthi,Raj S %A Carroll,Peter R %A Odisho,Anobel Y %+ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, United States, 1 (415) 353 2200, anobel.odisho@ucsf.edu %K health informatics %K telehealth %K video visits %K COVID-19 %K video consultation %K pandemic %K electronic health record %K EHR %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of the coronavirus disease (COVID-19) pandemic in March 2020 created unprecedented challenges in the provision of scheduled ambulatory cancer care. As a result, there has been a renewed focus on video-based telehealth consultations as a means to continue ambulatory care. Objective: The aim of this study is to analyze the change in video visit volume at the University of California, San Francisco (UCSF) Comprehensive Cancer Center in response to COVID-19 and compare patient demographics and appointment data from January 1, 2020, and in the 11 weeks after the transition to video visits. Methods: Patient demographics and appointment data (dates, visit types, and departments) were extracted from the electronic health record reporting database. Video visits were performed using a HIPAA (Health Insurance Portability and Accountability Act)-compliant video conferencing platform with a pre-existing workflow. Results: In 17 departments and divisions at the UCSF Cancer Center, 2284 video visits were performed in the 11 weeks before COVID-19 changes were implemented (mean 208, SD 75 per week) and 12,946 video visits were performed in the 11-week post–COVID-19 period (mean 1177, SD 120 per week). The proportion of video visits increased from 7%-18% to 54%-72%, between the pre– and post–COVID-19 periods without any disparity based on race/ethnicity, primary language, or payor. Conclusions: In a remarkably brief period of time, we rapidly scaled the utilization of telehealth in response to COVID-19 and maintained access to complex oncologic care at a time of social distancing. %M 32568721 %R 10.2196/19322 %U https://www.jmir.org/2020/7/e19322 %U https://doi.org/10.2196/19322 %U http://www.ncbi.nlm.nih.gov/pubmed/32568721 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19691 %T Virtual Management of Patients With Cancer During the COVID-19 Pandemic: Web-Based Questionnaire Study %A Tashkandi,Emad %A Zeeneldin,Ahmed %A AlAbdulwahab,Amal %A Elemam,Omima %A Elsamany,Shereef %A Jastaniah,Wasil %A Abdullah,Shaker %A Alfayez,Mohammad %A Jazieh,Abdul Rahman %A Al-Shamsi,Humaid O %+ Department of Medical Oncology, Oncology Center, King Abdullah Medical City, PO box 715, Makkah, 21955, Saudi Arabia, 966 555290061, Tashkandi.e@kamc.med.sa %K teleoncology %K telemedicine %K eHealth %K cancer %K COVID-19 %K public health %D 2020 %7 24.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the coronavirus disease (COVID-19) pandemic, patients with cancer in rural settings and distant geographical areas will be affected the most by curfews. Virtual management (telemedicine) has been shown to reduce health costs and improve access to care. Objective: The aim of this survey is to understand oncologists’ awareness of and views on virtual management, challenges, and preferences, as well as their priorities regarding the prescribing of anticancer treatments during the COVID-19 pandemic. Methods: We created a self-administrated electronic survey about the virtual management of patients with cancer during the COVID-19 pandemic. We evaluated its clinical sensibility and pilot tested the instrument. We surveyed practicing oncologists in Gulf and Arab countries using snowball sampling via emails and social media networks. Reminders were sent 1 and 2 weeks later using SurveyMonkey. Results: We received 222 responses from validated oncologists from April 2-22, 2020. An awareness of virtual clinics, virtual multidisciplinary teams, and virtual prescriptions was reported by 182 (82%), 175 (79%), and 166 (75%) respondents, respectively. Reported challenges associated with virtual management were the lack of physical exam (n=134, 60%), patients’ awareness and access (n=131, 59%), the lack of physical attendance of patients (n=93, 42%), information technology (IT) support (n=82, 37%), and the safety of virtual management (n=78, 35%). Overall, 111 (50%) and 107 (48%) oncologists did not prefer the virtual prescription of chemotherapy and novel immunotherapy, respectively. However, 188 (85%), 165 (74%), and 127 (57%) oncologists preferred the virtual prescription of hormonal therapy, bone modifying agents, and targeted therapy, respectively. In total, 184 (83%), 183 (83%), and 176 (80%) oncologists preferred to continue neoadjuvant, adjuvant, and perioperative treatments, respectively. Overall, 118 (53%) respondents preferred to continue first-line palliative treatment, in contrast to 68 (30%) and 47 (21%) respondents indicating a preference to interrupt second- and third-line palliative treatment, respectively. For administration of virtual prescriptions, all respondents preferred the oral route and 118 (53%) preferred the subcutaneous route. In contrast, 193 (87%) did not prefer the intravenous route for virtual prescriptions. Overall, 102 (46%) oncologists responded that they would “definitely” prefer to manage patients with cancer virtually. Conclusions: Oncologists have a high level of awareness of virtual management. Although their survey responses indicated that second- and third-line palliative treatments should be interrupted, they stated that neoadjuvant, adjuvant, perioperative, and first-line palliative treatments should continue. Our results confirm that oncologists’ views on the priority of anticancer treatments are consistent with the evolving literature during the COVID-19 pandemic. Challenges to virtual management should be addressed to improve the care of patients with cancer. %M 32501807 %R 10.2196/19691 %U http://www.jmir.org/2020/6/e19691/ %U https://doi.org/10.2196/19691 %U http://www.ncbi.nlm.nih.gov/pubmed/32501807 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e17821 %T End-to-End Models to Imitate Traditional Chinese Medicine Syndrome Differentiation in Lung Cancer Diagnosis: Model Development and Validation %A Liu,Ziqing %A He,Haiyang %A Yan,Shixing %A Wang,Yong %A Yang,Tao %A Li,Guo-Zheng %+ School of Artifical Intelligence and Information Techology, Nanjing University of Chinese Medicine, Nanjing, China, 86 13405803341, taoyang1111@126.com %K traditional Chinese medicine %K syndrome differentiation %K lung cancer %K medical record %K deep learning %K model fusion %D 2020 %7 16.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Traditional Chinese medicine (TCM) has been shown to be an efficient mode to manage advanced lung cancer, and accurate syndrome differentiation is crucial to treatment. Documented evidence of TCM treatment cases and the progress of artificial intelligence technology are enabling the development of intelligent TCM syndrome differentiation models. This is expected to expand the benefits of TCM to lung cancer patients. Objective: The objective of this work was to establish end-to-end TCM diagnostic models to imitate lung cancer syndrome differentiation. The proposed models used unstructured medical records as inputs to capitalize on data collected for practical TCM treatment cases by lung cancer experts. The resulting models were expected to be more efficient than approaches that leverage structured TCM datasets. Methods: We approached lung cancer TCM syndrome differentiation as a multilabel text classification problem. First, entity representation was conducted with Bidirectional Encoder Representations from Transformers and conditional random fields models. Then, five deep learning–based text classification models were applied to the construction of a medical record multilabel classifier, during which two data augmentation strategies were adopted to address overfitting issues. Finally, a fusion model approach was used to elevate the performance of the models. Results: The F1 score of the recurrent convolutional neural network (RCNN) model with augmentation was 0.8650, a 2.41% improvement over the unaugmented model. The Hamming loss for RCNN with augmentation was 0.0987, which is 1.8% lower than that of the same model without augmentation. Among the models, the text-hierarchical attention network (Text-HAN) model achieved the highest F1 scores of 0.8676 and 0.8751. The mean average precision for the word encoding–based RCNN was 10% higher than that of the character encoding–based representation. A fusion model of the text-convolutional neural network, text-recurrent neural network, and Text-HAN models achieved an F1 score of 0.8884, which showed the best performance among the models. Conclusions: Medical records could be used more productively by constructing end-to-end models to facilitate TCM diagnosis. With the aid of entity-level representation, data augmentation, and model fusion, deep learning–based multilabel classification approaches can better imitate TCM syndrome differentiation in complex cases such as advanced lung cancer. %M 32543445 %R 10.2196/17821 %U https://medinform.jmir.org/2020/6/e17821 %U https://doi.org/10.2196/17821 %U http://www.ncbi.nlm.nih.gov/pubmed/32543445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16527 %T The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial %A Ngo,Victoria %A Matsumoto,Cynthia G %A Joseph,Jill G %A Bell,Janice F %A Bold,Richard J %A Davis,Andra %A Reed,Sarah C %A Kim,Katherine K %+ Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th Street, Suite 2600, Sacramento, CA, United States, 1 5107615461, kathykim@ucdavis.edu %K care coordination, continuity of patient care %K oncology %K chemotherapy %K patient-centered care %K mobile health %K technology adoption %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32452814 %R 10.2196/16527 %U http://mhealth.jmir.org/2020/5/e16527/ %U https://doi.org/10.2196/16527 %U http://www.ncbi.nlm.nih.gov/pubmed/32452814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16604 %T User Experiences of an Internet-Based Stepped-Care Intervention for Individuals With Cancer and Concurrent Symptoms of Anxiety or Depression (the U-CARE AdultCan Trial): Qualitative Study %A Igelström,Helena %A Hauffman,Anna %A Alfonsson,Sven %A Sjöström,Jonas %A Cajander,Åsa %A Johansson,Birgitta %+ Department of Neuroscience, Uppsala University, BMC, Box 593, Uppsala, 75124, Sweden, 46 184714761, helena.igelstrom@neuro.uu.se %K interactive web portal %K stepped care %K user experience %K cancer %K interviews %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet-based stepped-care intervention iCAN-DO, used in the multicenter randomized controlled trial AdultCan, was developed for adult patients undergoing treatment for cancer and concurrently experiencing anxiety or depressive symptoms. iCAN-DO aimed to decrease symptoms of anxiety or depression. Step 1 comprises access to a library with psychoeducational material and a peer-support section, as well as the possibility to pose questions to a nurse. Step 2 of the intervention offers treatment consisting of internet-based cognitive behavioral therapy (iCBT) to participants still experiencing anxiety or depression at 1, 4, or 7 months after inclusion. Objective: The study aimed to explore user experiences of delivery, design, and structure of iCAN-DO from the perspective of people with cancer. Methods: We studied user experiences by interviewing 15 informants individually: 10 women with breast cancer (67%), 4 men with prostate cancer (27%), and 1 man with colorectal cancer (7%) with a mean age 58.9 years (SD 8.9). The interviews focused on informants' perceptions of ease of use and of system design and structure. Informants had been included in iCAN-DO for at least 7 months. They were purposefully selected based on activity in Step 1, participation in iCBT (ie, Step 2), gender, and diagnosis. Results: Of the 15 informants, 6 had been offered iCBT (40%). All informants used the internet on a daily basis, but 2 (13%) described themselves as very inexperienced computer users. The analysis revealed three subthemes, concerning how user experiences were affected by disease-specific factors and side effects (User experience in the context of cancer), technical problems (Technical struggles require patience and troubleshooting), and the structure and design of iCAN-DO (Appealing and usable, but rather simple). Conclusions: The results indicate that user experiences were affected by informants’ life situations, the technical aspects and the design of iCAN-DO, and informants’ preferences. The results have generated some developments feasible to launch during the ongoing study, but if iCAN-DO is to be used beyond research interest, a greater level of tailoring of information, features, and design may be needed to improve user experiences. The use of recurrent questionnaires during the treatment period may highlight an individual’s health, but also function as a motivator showing improvements over time. %M 32427108 %R 10.2196/16604 %U http://www.jmir.org/2020/5/e16604/ %U https://doi.org/10.2196/16604 %U http://www.ncbi.nlm.nih.gov/pubmed/32427108 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e16493 %T Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health %A Berbyuk Lindström,Nataliya %A Woldemariam,Aynalem Abraha %A Bekele,Abebe %A Munthe,Christian %A Andersson,Rune %A Girma Kebede,Bethlehem %A Linderholm,Barbro %A Tigeneh,Wondemagegnhu %+ Department of Applied Information Technology, University of Gothenburg, Box 100, Gothenburg, 40530, Sweden, 46 733268716, nataliya.berbyuk.lindstrom@ait.gu.se %K communication %K culture %K cancer %K ethics %K person-centered care %K Ethiopia %D 2020 %7 19.5.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations. Objective: The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area. Methods: This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions. Results: The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021. Conclusions: The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication. International Registered Report Identifier (IRRID): DERR1-10.2196/16493 %M 32427112 %R 10.2196/16493 %U https://www.researchprotocols.org/2020/5/e16493 %U https://doi.org/10.2196/16493 %U http://www.ncbi.nlm.nih.gov/pubmed/32427112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15895 %T The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach %A Ector,Geneviève ICG %A Westerweel,Peter E %A Hermens,Rosella PMG %A Braspenning,Karin AE %A Heeren,Barend CM %A Vinck,Oscar MF %A de Jong,Jan JM %A Janssen,Jeroen JWM %A Blijlevens,Nicole MA %+ Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, 6500 Hb, Netherlands, 31 243618810, genevieve.ector@radboudumc.nl %K eHealth %K chronic myeloid leukemia %K patient participation %K mobile apps %D 2020 %7 15.5.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32412424 %R 10.2196/15895 %U https://www.jmir.org/2020/5/e15895 %U https://doi.org/10.2196/15895 %U http://www.ncbi.nlm.nih.gov/pubmed/32412424 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18378 %T Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction %A Shaw,Sara E %A Seuren,Lucas Martinus %A Wherton,Joseph %A Cameron,Deborah %A A'Court,Christine %A Vijayaraghavan,Shanti %A Morris,Joanne %A Bhattacharya,Satyajit %A Greenhalgh,Trisha %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865617830, sara.shaw@phc.ox.ac.uk %K delivery of health care %K physical examination %K remote consultation %K telemedicine %K health communication %K language %K nonverbal communication %K mobile phone %D 2020 %7 11.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. Objective: Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. Methods: We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). Results: Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. Conclusions: A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. International Registered Report Identifier (IRRID): RR2-10.2196/10913 %M 32391799 %R 10.2196/18378 %U http://www.jmir.org/2020/5/e18378/ %U https://doi.org/10.2196/18378 %U http://www.ncbi.nlm.nih.gov/pubmed/32391799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16084 %T A User-Friendly, Web-Based Integrative Tool (ESurv) for Survival Analysis: Development and Validation Study %A Pak,Kyoungjune %A Oh,Sae-Ock %A Goh,Tae Sik %A Heo,Hye Jin %A Han,Myoung-Eun %A Jeong,Dae Cheon %A Lee,Chi-Seung %A Sun,Hokeun %A Kang,Junho %A Choi,Suji %A Lee,Soohwan %A Kwon,Eun Jung %A Kang,Ji Wan %A Kim,Yun Hak %+ Department of Anatomy, School of Medicine, Pusan National University, 49 Busandaehak-ro, Yangsan, 50612, Republic of Korea, 82 515108091, yunhak10510@pusan.ac.kr %K survival analysis %K grouped variable selection %K The Cancer Genome Atlas %K web-based tool %K user service %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prognostic genes or gene signatures have been widely used to predict patient survival and aid in making decisions pertaining to therapeutic actions. Although some web-based survival analysis tools have been developed, they have several limitations. Objective: Taking these limitations into account, we developed ESurv (Easy, Effective, and Excellent Survival analysis tool), a web-based tool that can perform advanced survival analyses using user-derived data or data from The Cancer Genome Atlas (TCGA). Users can conduct univariate analyses and grouped variable selections using multiomics data from TCGA. Methods: We used R to code survival analyses based on multiomics data from TCGA. To perform these analyses, we excluded patients and genes that had insufficient information. Clinical variables were classified as 0 and 1 when there were two categories (for example, chemotherapy: no or yes), and dummy variables were used where features had 3 or more outcomes (for example, with respect to laterality: right, left, or bilateral). Results: Through univariate analyses, ESurv can identify the prognostic significance for single genes using the survival curve (median or optimal cutoff), area under the curve (AUC) with C statistics, and receiver operating characteristics (ROC). Users can obtain prognostic variable signatures based on multiomics data from clinical variables or grouped variable selections (lasso, elastic net regularization, and network-regularized high-dimensional Cox-regression) and select the same outputs as above. In addition, users can create custom gene signatures for specific cancers using various genes of interest. One of the most important functions of ESurv is that users can perform all survival analyses using their own data. Conclusions: Using advanced statistical techniques suitable for high-dimensional data, including genetic data, and integrated survival analysis, ESurv overcomes the limitations of previous web-based tools and will help biomedical researchers easily perform complex survival analyses. %M 32369034 %R 10.2196/16084 %U https://www.jmir.org/2020/5/e16084 %U https://doi.org/10.2196/16084 %U http://www.ncbi.nlm.nih.gov/pubmed/32369034 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 4 %P e14710 %T Next-Generation Sequencing–Based Cancer Panel Data Conversion Using International Standards to Implement a Clinical Next-Generation Sequencing Research System: Single-Institution Study %A Park,Phillip %A Shin,Soo-Yong %A Park,Seog Yun %A Yun,Jeonghee %A Shin,Chulmin %A Jung,Jipmin %A Choi,Kui Son %A Cha,Hyo Soung %+ Cancer Data Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Goyang, 10408, Republic of Korea, 82 1073502088, kkido@ncc.re.kr %K data standardization %K clinical sequencing data %K next-generation sequencing %K translational research information system %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The analytical capacity and speed of next-generation sequencing (NGS) technology have been improved. Many genetic variants associated with various diseases have been discovered using NGS. Therefore, applying NGS to clinical practice results in precision or personalized medicine. However, as clinical sequencing reports in electronic health records (EHRs) are not structured according to recommended standards, clinical decision support systems have not been fully utilized. In addition, integrating genomic data with clinical data for translational research remains a great challenge. Objective: To apply international standards to clinical sequencing reports and to develop a clinical research information system to integrate standardized genomic data with clinical data. Methods: We applied the recently published ISO/TS 20428 standard to 367 clinical sequencing reports generated by panel (91 genes) sequencing in EHRs and implemented a clinical NGS research system by extending the clinical data warehouse to integrate the necessary clinical data for each patient. We also developed a user interface with a clinical research portal and an NGS result viewer. Results: A single clinical sequencing report with 28 items was restructured into four database tables and 49 entities. As a result, 367 patients’ clinical sequencing data were connected with clinical data in EHRs, such as diagnosis, surgery, and death information. This system can support the development of cohort or case-control datasets as well. Conclusions: The standardized clinical sequencing data are not only for clinical practice and could be further applied to translational research. %M 32329738 %R 10.2196/14710 %U http://medinform.jmir.org/2020/4/e14710/ %U https://doi.org/10.2196/14710 %U http://www.ncbi.nlm.nih.gov/pubmed/32329738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13188 %T Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study %A Janssen,Anna %A Donnelly,Candice %A Kay,Judy %A Thiem,Peter %A Saavedra,Aldo %A Pathmanathan,Nirmala %A Elder,Elisabeth %A Dinh,Phuong %A Kabir,Masrura %A Jackson,Kirsten %A Harnett,Paul %A Shaw,Tim %+ Research in Implementation Science and eHealth Group, Faculty of Health Sciences, The University of Sydney, Charles Perkins Centre (D17), Sydney, 2006, Australia, 61 9036 9406, anna.janssen@sydney.edu.au %K eHealth %K clinical informatics %K human-centered design %K data visualization %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge. %M 32314968 %R 10.2196/13188 %U https://www.jmir.org/2020/4/e13188 %U https://doi.org/10.2196/13188 %U http://www.ncbi.nlm.nih.gov/pubmed/32314968 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16533 %T Optimizing the Analytical Value of Oncology-Related Data Based on an In-Memory Analysis Layer: Development and Assessment of the Munich Online Comprehensive Cancer Analysis Platform %A Nasseh,Daniel %A Schneiderbauer,Sophie %A Lange,Michael %A Schweizer,Diana %A Heinemann,Volker %A Belka,Claus %A Cadenovic,Ranko %A Buysse,Laurence %A Erickson,Nicole %A Mueller,Michael %A Kortuem,Karsten %A Niyazi,Maximilian %A Marschner,Sebastian %A Fey,Theres %+ Comprehensive Cancer Center Munich, Pettenkoferstraße 8a, Munich, 80336, Germany, 49 (0)89 440077754, Daniel.Nasseh@med.uni-muenchen.de %K oncology %K database management systems %K data visualization %K usability %D 2020 %7 17.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Many comprehensive cancer centers incorporate tumor documentation software supplying structured information from the associated centers’ oncology patients for internal and external audit purposes. However, much of the documentation data included in these systems often remain unused and unknown by most of the clinicians at the sites. Objective: To improve access to such data for analytical purposes, a prerollout of an analysis layer based on the business intelligence software QlikView was implemented. This software allows for the real-time analysis and inspection of oncology-related data. The system is meant to increase access to the data while simultaneously providing tools for user-friendly real-time analytics. Methods: The system combines in-memory capabilities (based on QlikView software) with innovative techniques that compress the complexity of the data, consequently improving its readability as well as its accessibility for designated end users. Aside from the technical and conceptual components, the software’s implementation necessitated a complex system of permission and governance. Results: A continuously running system including daily updates with a user-friendly Web interface and real-time usage was established. This paper introduces its main components and major design ideas. A commented video summarizing and presenting the work can be found within the Multimedia Appendix. Conclusions: The system has been well-received by a focus group of physicians within an initial prerollout. Aside from improving data transparency, the system’s main benefits are its quality and process control capabilities, knowledge discovery, and hypothesis generation. Limitations such as run time, governance, or misinterpretation of data are considered. %M 32077858 %R 10.2196/16533 %U https://www.jmir.org/2020/4/e16533 %U https://doi.org/10.2196/16533 %U http://www.ncbi.nlm.nih.gov/pubmed/32077858 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16680 %T Use of Telephone and Digital Channels to Engage Socioeconomically Disadvantaged Adults in Health Disparities Research Within a Social Service Setting: Cross-Sectional Study %A Alcaraz,Kassandra I %A Vereen,Rhyan N %A Burnham,Donna %+ Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, United States, 1 4044178019, kassandra.alcaraz@cancer.org %K cross-sectional studies %K electronic mail %K health status disparities %K health care disparities %K internet %K mobile phone %K telephone %K text messaging %K social services %D 2020 %7 1.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels. Objective: This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type. Methods: The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service–focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics. Results: A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23%) and the highest survey completion rate (91.24%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14%) yet the lowest survey completion rate (74.0%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95% CI 1.23-1.88), married (aOR 1.52, 95% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95% CI 1.67-2.82), have a household income ≥US $25,000 a year (aOR 2.02, 95% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95% CI 1.27-1.83 for good-to-excellent health). Conclusions: Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service–based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health. %M 32234699 %R 10.2196/16680 %U https://www.jmir.org/2020/4/e16680 %U https://doi.org/10.2196/16680 %U http://www.ncbi.nlm.nih.gov/pubmed/32234699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16547 %T Experiences of Internet-Based Stepped Care in Individuals With Cancer and Concurrent Symptoms of Anxiety and Depression: Qualitative Exploration Conducted Alongside the U-CARE AdultCan Randomized Controlled Trial %A Hauffman,Anna %A Alfonsson,Sven %A Igelström,Helena %A Johansson,Birgitta %+ Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, Uppsala University, Akademiska University Hospital ing 100 D, Uppsala, SE-751 85, Sweden, 46 18 611 00 00, anna.hauffman@igp.uu.se %K internet-based stepped care %K internet-based interactive health communication application %K internet-based intervention %K telemedicine %K patient portals %K oncology nursing %K self care %K psychoeducation %D 2020 %7 30.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with newly diagnosed cancer may experience impaired health in several aspects and often have a large need for information and support. About 30% will experience symptoms of anxiety and depression, with varying needs of knowledge and support. Despite this, many of these patients lack appropriate support. Internet-based support programs may offer a supplement to standard care services, but must be carefully explored from a user perspective. Objective: The purpose of this study was to explore the participants’ perceptions of the relevance and benefits of an internet-based stepped care program (iCAN-DO) targeting individuals with cancer and concurrent symptoms of anxiety and depression. Methods: We performed a qualitative study with an inductive approach, in which we used semistructured questions to interview 15 individuals using iCAN-DO. We analyzed the interviews using content analysis. Results: The analysis found 17 subcategories regarding the stepped care intervention, resulting in 4 categories. Participants described the need for information as large and looked upon finding information almost as a survival strategy when receiving the cancer diagnosis. iCAN-DO was seen as a useful, reliable source of information and support. It was used as a complement to standard care and as a means to inform next of kin. Increased knowledge was a foundation for continued processing of participants’ own feelings. The optimal time to gain access to iCAN-DO would have been when being informed of the diagnosis. The most common denominator was feeling acknowledged and supported, but with a desire for further adaptation of the system to each individual’s own situation and needs. Conclusions: Users saw the internet-based stepped care program as safe and reliable and used it as a complement to standard care. Similar interventions may gain from more personalized contents, being integrated into standard care, or using symptom tracking to adjust the contents. Offering this type of program close to diagnosis may provide benefits to users. Trial Registration: ClincalTrials.gov NCT-01630681; https://clinicaltrials.gov/ct2/show/NCT01630681 %M 32224483 %R 10.2196/16547 %U http://www.jmir.org/2020/3/e16547/ %U https://doi.org/10.2196/16547 %U http://www.ncbi.nlm.nih.gov/pubmed/32224483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16013 %T The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology %A Alonso Puig,Mario %A Alonso-Prieto,Mercedes %A Miró,Jordi %A Torres-Luna,Raquel %A Plaza López de Sabando,Diego %A Reinoso-Barbero,Francisco %+ Pediatric Pain Unit, Anesthesiology-Critical Care Service, University La Paz Hospital, Paseo de la Castellana, 261, Madrid, 28046, Spain, 34 676687569 ext 676687569, meme27@hotmail.es %K hematology oncology %K pediatric patient %K acute pain %K patient-controlled analgesia %K video pupilometer %K analgesia nociception index %D 2020 %7 30.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings. Objective: The main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients. Methods: Clinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters. Results: Twenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 µg/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs. Conclusions: The use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine. %M 32224482 %R 10.2196/16013 %U http://www.jmir.org/2020/3/e16013/ %U https://doi.org/10.2196/16013 %U http://www.ncbi.nlm.nih.gov/pubmed/32224482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16810 %T Blockchain-Authenticated Sharing of Genomic and Clinical Outcomes Data of Patients With Cancer: A Prospective Cohort Study %A Glicksberg,Benjamin Scott %A Burns,Shohei %A Currie,Rob %A Griffin,Ann %A Wang,Zhen Jane %A Haussler,David %A Goldstein,Theodore %A Collisson,Eric %+ Division of Hematology and Oncology, Department of Medicine, University of California, 1450 3rd Street, San Francisco, CA, 94158, United States, 1 4153539888, collissonlab@gmail.com %K data sharing %K electronic health records %K genomics %K medicine %K blockchain %K neoplasms %D 2020 %7 20.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Efficiently sharing health data produced during standard care could dramatically accelerate progress in cancer treatments, but various barriers make this difficult. Not sharing these data to ensure patient privacy is at the cost of little to no learning from real-world data produced during cancer care. Furthermore, recent research has demonstrated a willingness of patients with cancer to share their treatment experiences to fuel research, despite potential risks to privacy. Objective: The objective of this study was to design, pilot, and release a decentralized, scalable, efficient, economical, and secure strategy for the dissemination of deidentified clinical and genomic data with a focus on late-stage cancer. Methods: We created and piloted a blockchain-authenticated system to enable secure sharing of deidentified patient data derived from standard of care imaging, genomic testing, and electronic health records (EHRs), called the Cancer Gene Trust (CGT). We prospectively consented and collected data for a pilot cohort (N=18), which we uploaded to the CGT. EHR data were extracted from both a hospital cancer registry and a common data model (CDM) format to identify optimal data extraction and dissemination practices. Specifically, we scored and compared the level of completeness between two EHR data extraction formats against the gold standard source documentation for patients with available data (n=17). Results: Although the total completeness scores were greater for the registry reports than those for the CDM, this difference was not statistically significant. We did find that some specific data fields, such as histology site, were better captured using the registry reports, which can be used to improve the continually adapting CDM. In terms of the overall pilot study, we found that CGT enables rapid integration of real-world data of patients with cancer in a more clinically useful time frame. We also developed an open-source Web application to allow users to seamlessly search, browse, explore, and download CGT data. Conclusions: Our pilot demonstrates the willingness of patients with cancer to participate in data sharing and how blockchain-enabled structures can maintain relationships between individual data elements while preserving patient privacy, empowering findings by third-party researchers and clinicians. We demonstrate the feasibility of CGT as a framework to share health data trapped in silos to further cancer research. Further studies to optimize data representation, stream, and integrity are required. %M 32196460 %R 10.2196/16810 %U http://www.jmir.org/2020/3/e16810/ %U https://doi.org/10.2196/16810 %U http://www.ncbi.nlm.nih.gov/pubmed/32196460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15002 %T Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort Study %A Fernández-Méndez,Rocío %A Wong,Mei Yin %A Rastall,Rebecca J %A Rebollo-Díaz,Samuel %A Oberg,Ingela %A Price,Stephen J %A Joannides,Alexis J %+ Department of Clinical Neurosciences, University of Cambridge, Box 165, A Block, Level 3, B Spur, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 1223746466, rociofmendez.inv@gmail.com %K quality improvement %K electronic health records %K hospital referral %K hospital oncology services %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. Objective: This study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology center, using a service-developed proforma, in terms of waiting times and information completeness. Methods: We carried out a retrospective cohort study based on the review of medical records of referred adult patients, excluding follow-ups. Primary outcome measures were durations of three key phases within the referral pathway and completion rates of six referral fields. Results: A total of 248 patients were referred to the specialist center during the study period. Median (IQR) diagnostic imaging to referral intervals were 3 (1-5) days with eReferrals, and 9 (4-19), 19 (14-49), and 8 (4-23) days with paper proforma, paper letter, and internal referrals, respectively (P<.001). Median (IQR) referral to multidisciplinary team decision intervals were 3 (2-7), 2 (1-3), 8 (2-24), and 3 (2-6) days respectively (P=.01). For patients having surgery, median (IQR) diagnostic imaging to surgery intervals were 28 (21-41), 34 (27-51), 104 (69-143), and 32 (15-89) days, respectively (P<.001). Proportions of complete fields differed significantly by referral type in all study fields (all with Ps <.001) except for details of presentation, which were present in all referrals. All study fields were always present in eReferrals, as these are compulsory for referral submission. Depending on the data field, level of completeness in the remaining referral types ranged within 69% (65/94) to 87% (82/94), 15% (3/20) to 65% (13/20), and 22% (8/41) to 63% (26/41) in paper proforma, paper letter, and internal referrals, respectively. Conclusions: An electronic, Web-based, service-developed specific proforma for neuro-oncology referrals performs significantly better, with shorter waiting times and greater completeness of information than other referral types. A wider application of eReferrals is an important first step to streamlining specialist care pathways and providing excellent care. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/15002 %M 32134389 %R 10.2196/15002 %U https://www.jmir.org/2020/3/e15002 %U https://doi.org/10.2196/15002 %U http://www.ncbi.nlm.nih.gov/pubmed/32134389 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e16334 %T Performance of Computer-Aided Diagnosis in Ultrasonography for Detection of Breast Lesions Less and More Than 2 cm: Prospective Comparative Study %A Yongping,Liang %A Zhou,Ping %A Juan,Zhang %A Yongfeng,Zhao %A Liu,Wengang %A Shi,Yifan %+ The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Hexiyuelu District, Changsha, Hunan, 410013, China, 86 13974809881, zhouping1000@hotmail.com %K ultrasonography %K breast neoplasm %K breast imaging reporting and data system (BI-RADS) %K breast neoplasms diagnosis %K cancer screening %K computer diagnostic aid %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Computer-aided diagnosis (CAD) is used as an aid tool by radiologists on breast lesion diagnosis in ultrasonography. Previous studies demonstrated that CAD can improve the diagnosis performance of radiologists. However, the optimal use of CAD on breast lesions according to size (below or above 2 cm) has not been assessed. Objective: The aim of this study was to compare the performance of different radiologists using CAD to detect breast tumors less and more than 2 cm in size. Methods: We prospectively enrolled 261 consecutive patients (mean age 43 years; age range 17-70 years), including 398 lesions (148 lesions>2 cm, 79 malignant and 69 benign; 250 lesions≤2 cm, 71 malignant and 179 benign) with breast mass as the prominent symptom. One novice radiologist with 1 year of ultrasonography experience and one experienced radiologist with 5 years of ultrasonography experience were each assigned to read the ultrasonography images without CAD, and then again at a second reading while applying the CAD S-Detect. We then compared the diagnostic performance of the readers in the two readings (without and combined with CAD) with breast imaging. The McNemar test for paired data was used for statistical analysis. Results: For the novice reader, the area under the receiver operating characteristic curve (AUC) improved from 0.74 (95% CI 0.67-0.82) from the without-CAD mode to 0.88 (95% CI 0.83-0.93; P<.001) at the combined-CAD mode in lesions≤2 cm. For the experienced reader, the AUC improved from 0.84 (95% CI 0.77-0.90) to 0.90 (95% CI 0.86-0.94; P=.002). In lesions>2 cm, the AUC moderately decreased from 0.81 to 0.80 (novice reader) and from 0.90 to 0.82 (experienced reader). The sensitivity of the novice and experienced reader in lesions≤2 cm improved from 61.97% and 73.23% at the without-CAD mode to 90.14% and 97.18% (both P<.001) at the combined-CAD mode, respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity for both novice and experienced readers, while also improving the negative predictive value and AUC for lesions≤2 cm, demonstrating important application value in the clinical diagnosis of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800019649; http://www.chictr.org.cn/showprojen.aspx?proj=33094 %M 32130149 %R 10.2196/16334 %U https://medinform.jmir.org/2020/3/e16334 %U https://doi.org/10.2196/16334 %U http://www.ncbi.nlm.nih.gov/pubmed/32130149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e14122 %T Concordance Between Watson for Oncology and a Multidisciplinary Clinical Decision-Making Team for Gastric Cancer and the Prognostic Implications: Retrospective Study %A Tian,Yulong %A Liu,Xiaodong %A Wang,Zixuan %A Cao,Shougen %A Liu,Zimin %A Ji,Qinglian %A Li,Zequn %A Sun,Yuqi %A Zhou,Xin %A Wang,Daosheng %A Zhou,Yanbing %+ Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, No 16 Jiangsu Road, Shinan District, Qingdao, China, 86 13708971773, zhouyanbing999@aliyun.com %K Watson for Oncology %K artificial intelligence %K gastric cancer %K concordance %K multidisciplinary team %D 2020 %7 20.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With the increasing number of cancer treatments, the emergence of multidisciplinary teams (MDTs) provides patients with personalized treatment options. In recent years, artificial intelligence (AI) has developed rapidly in the medical field. There has been a gradual tendency to replace traditional diagnosis and treatment with AI. IBM Watson for Oncology (WFO) has been proven to be useful for decision-making in breast cancer and lung cancer, but to date, research on gastric cancer is limited. Objective: This study compared the concordance of WFO with MDT and investigated the impact on patient prognosis. Methods: This study retrospectively analyzed eligible patients (N=235) with gastric cancer who were evaluated by an MDT, received corresponding recommended treatment, and underwent follow-up. Thereafter, physicians inputted the information of all patients into WFO manually, and the results were compared with the treatment programs recommended by the MDT. If the MDT treatment program was classified as “recommended” or “considered” by WFO, we considered the results concordant. All patients were divided into a concordant group and a nonconcordant group according to whether the WFO and MDT treatment programs were concordant. The prognoses of the two groups were analyzed. Results: The overall concordance of WFO and the MDT was 54.5% (128/235) in this study. The subgroup analysis found that concordance was less likely in patients with human epidermal growth factor receptor 2 (HER2)-positive tumors than in patients with HER2-negative tumors (P=.02). Age, Eastern Cooperative Oncology Group performance status, differentiation type, and clinical stage were not found to affect concordance. Among all patients, the survival time was significantly better in concordant patients than in nonconcordant patients (P<.001). Multivariate analysis revealed that concordance was an independent prognostic factor of overall survival in patients with gastric cancer (hazard ratio 0.312 [95% CI 0.187-0.521]). Conclusions: The treatment recommendations made by WFO and the MDT were mostly concordant in gastric cancer patients. If the WFO options are updated to include local treatment programs, the concordance will greatly improve. The HER2 status of patients with gastric cancer had a strong effect on the likelihood of concordance. Generally, survival was better in concordant patients than in nonconcordant patients. %M 32130123 %R 10.2196/14122 %U http://www.jmir.org/2020/2/e14122/ %U https://doi.org/10.2196/14122 %U http://www.ncbi.nlm.nih.gov/pubmed/32130123 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e15969 %T Beating Cancer-Related Fatigue With the Untire Mobile App: Protocol for a Waiting List Randomized Controlled Trial %A Spahrkäs,Simon S %A Looijmans,Anne %A Sanderman,Robbert %A Hagedoorn,Mariët %+ Department of Health Psychology, University Medical Center Groningen, University of Groningen, FA12, POB 30 001, Groningen, 9700 RB, Netherlands, 31 503616810, s.s.spahrkas@umcg.nl %K RCT %K mHealth %K app %K intervention %K fatigue %K quality of life %K cancer patients %K cancer survivors %K psycho-oncology %D 2020 %7 14.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32130185 %R 10.2196/15969 %U http://www.researchprotocols.org/2020/2/e15969/ %U https://doi.org/10.2196/15969 %U http://www.ncbi.nlm.nih.gov/pubmed/32130185 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e15535 %T The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care %A Pooni,Amandeep %A Schmocker,Selina %A Brown,Carl %A MacLean,Anthony %A Williams,Lara %A Baxter,Nancy N %A Simunovic,Marko %A Liberman,Alexander Sender %A Drolet,Sebastien %A Neumann,Katerina %A Jhaveri,Kartik %A Kirsch,Richard %A Kennedy,Erin Diane %+ Department of Surgery, Mount Sinai Hospital, 600 University Ave Room 449, Toronto, ON, Canada, 1 5864800 ext 6872, erin.kennedy@sinaihealthsystem.ca %K rectal cancer %K quality improvement %K knowledge translation %D 2020 %7 29.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Over the last 2 decades, the use of multimodal strategies, including total mesorectal excision (TME) surgery, preoperative chemotherapy, multidisciplinary case conference, pelvic magnetic resonance imaging, and pathologic assessment using Quirke method, has led to significant improvements in oncologic outcomes for patients with rectal cancer. Although the literature supports claims on the effectiveness of these multimodal strategies, the uptake of these multimodal strategies varies considerably among centers, suggesting that the best evidence is not always implemented into clinical practice. Objective: This study aims to perform a quality improvement initiative to (1) identify existing gaps in care for these multimodal strategies and (2) implement knowledge translation (KT) interventions to close these gaps to optimize quality of care for patients with rectal cancer across high-volume centers in Canada. Methods: Process indicators for the selected multimodal strategies to optimize rectal cancer care will be selected and prospectively collected for all patients with stages 1 to 3 rectal cancer undergoing TME surgery. KT interventions, including audit and feedback, opinion leaders, and community of practice, will be implemented to increase the uptake of these clinical strategies. Results: The uptake of the process indicators over time and the effect of the uptake of the process indicators on short- and long-term oncologic outcomes will be evaluated for each multimodal strategy. Conclusions: This quality improvement initiative will identify existing gaps in care for the selected multimodal strategies and implement KT interventions to close these gaps. The results of this study will inform further efforts to optimize rectal cancer care. International Registered Report Identifier (IRRID): DERR1-10.2196/15535 %M 32012108 %R 10.2196/15535 %U https://www.researchprotocols.org/2020/1/e15535 %U https://doi.org/10.2196/15535 %U http://www.ncbi.nlm.nih.gov/pubmed/32012108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e17055 %T Benefits of Mobile Apps for Cancer Pain Management: Systematic Review %A Zheng,Caiyun %A Chen,Xu %A Weng,Lizhu %A Guo,Ling %A Xu,Haiting %A Lin,Meimei %A Xue,Yan %A Lin,Xiuqin %A Yang,Aiqin %A Yu,Lili %A Xue,Zenggui %A Yang,Jing %+ Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 350001, China, 86 0591 86218372, wlz0965@fjmu.edu.cn %K mobile apps %K cancer pain %K meta-analysis %K instant messaging %D 2020 %7 23.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pain ratings reported by patients with cancer continue to increase, and numerous computer and phone apps for managing cancer-related pain have been developed recently; however, whether these apps effectively alleviate patients’ pain remains unknown. Objective: This study aimed to comprehensively evaluate the role of mobile apps in the management of cancer pain. Methods: Literature on the use of apps for cancer pain management and interventions, published before August 2019, was retrieved from the following databases: MEDLINE, Embase, Cochrane, CINAHL, Scopus, and PsycINFO. The effects of apps on cancer pain were evaluated using RevMan5.3 software, and the rates of adverse drug reactions were analyzed using the R Statistical Software Package 3.5.3. Results: A total of 13 studies were selected for the analysis: 5 randomized controlled trials (RCTs), 4 before-after studies, 2 single-arm trials, 1 prospective cohort study, and 1 prospective descriptive study. The 5 RCTs reported data for 487 patients (240 patients in the intervention group and 247 patients in the control group), and the remaining studies reported data for 428 patients. We conducted a meta-analysis of the RCTs. According to the meta-analysis, apps can significantly reduce pain scores (mean difference [MD]=–0.50, 95% CI –0.94 to –0.07, I2=62%, P=.02). We then used apps that have an instant messaging module for subgroup analysis; these apps significantly reduced patients’ pain scores (MD=–0.67, 95% CI –1.06 to –0.28, I2=57%, P<.01). Patients using apps without an instant messaging module did not see a reduction in the pain score (MD=0.30, 95% CI –1.31 to 1.92, I2=70%, P=.71). Overall, patients were highly satisfied with using apps. Other outcomes, such as pain catastrophizing or quality of life, demonstrated greater improvement in patients using apps with instant messaging modules compared with patients not using an app. Conclusions: The use of apps with instant messaging modules is associated with reduced pain scores in patients with cancer-related pain, and patient acceptance of these apps is high. Apps without instant messaging modules are associated with relatively higher pain scores. The presence of an instant messaging module may be a key factor affecting the effect of an app on cancer pain. %M 32012088 %R 10.2196/17055 %U http://mhealth.jmir.org/2020/1/e17055/ %U https://doi.org/10.2196/17055 %U http://www.ncbi.nlm.nih.gov/pubmed/32012088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16652 %T A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness %A Bricker,Jonathan B %A Watson,Noreen L %A Heffner,Jaimee L %A Sullivan,Brianna %A Mull,Kristin %A Kwon,Diana %A Westmaas,Johann Lee %A Ostroff,Jamie %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K smartphone app %K mHealth %K tobacco %K smoking %K cancer patient %D 2020 %7 17.1.2020 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 31951215 %R 10.2196/16652 %U http://formative.jmir.org/2020/1/e16652/ %U https://doi.org/10.2196/16652 %U http://www.ncbi.nlm.nih.gov/pubmed/31951215 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14985 %T Understanding Drivers of Resistance Toward Implementation of Web-Based Self-Management Tools in Routine Cancer Care Among Oncology Nurses: Cross-Sectional Survey Study %A de Wit,Matthijs %A Kleijnen,Mirella %A Lissenberg-Witte,Birgit %A van Uden-Kraan,Cornelia %A Millet,Kobe %A Frambach,Ruud %A Verdonck-de Leeuw,Irma %+ Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Van der Boechorstraat 7, Amsterdam, 1081 BT, Netherlands, 31 204440988, im.verdonck@vumc.nl %K psycho-oncology %K health-related quality of life %K self-management %K eHealth %K implementation science %K resistance to innovations %D 2019 %7 17.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting patients to engage in (Web-based) self-management tools is increasingly gaining importance, but the engagement of health care professionals is lagging behind. This can partly be explained by resistance among health care professionals. Objective: The aim of this study was to investigate drivers of resistance among oncology nurses toward Web-based self-management tools in cancer care. Methods: Drawing from previous research, combining clinical and marketing perspectives, and several variables and instruments, we developed the Resistance to Innovation model (RTI-model). The RTI-model distinguishes between passive and active resistance, which can be enhanced or reduced by functional drivers (incompatibility, complexity, lack of value, and risk) and psychological drivers (role ambiguity, social pressure from the institute, peers, and patients). Both types of drivers can be moderated by staff-, organization-, patient-, and environment-related factors. We executed a survey covering all components of the RTI-model on a cross-sectional sample of nurses working in oncology in the Netherlands. Structural equation modeling was used to test the full model, using a hierarchical approach. In total, 2500 nurses were approached, out of which 285 (11.40%) nurses responded. Results: The goodness of fit statistic of the uncorrected base model of the RTI-model (n=239) was acceptable (χ21=9.2; Comparative Fit Index=0.95; Tucker Lewis index=0.21; Root Mean Square Error of Approximation=0.19; Standardized Root Mean Square=0.016). In line with the RTI-model, we found that both passive and active resistance among oncology nurses toward (Web-based) self-management tools were driven by both functional and psychological drivers. Passive resistance toward Web-based self-management tools was enhanced by complexity, lack of value, and role ambiguity, and it was reduced by institutional social pressure. Active resistance was enhanced by complexity, lack of value, and social pressure from peers, and it was reduced by social pressure from the institute and patients. In contrast to what we expected, incompatibility with current routines was not a significant driver of either passive or active resistance. This study further showed that these drivers of resistance were moderated by expertise (P=.03), managerial support (P=.004), and influence from external stakeholders (government; P=.04). Conclusions: Both passive and active resistance in oncology nurses toward Web-based self-management tools for patients with cancer are driven by functional and psychological drivers, which may be more or less strong, depending on expertise, managerial support, and governmental influence. %M 31845900 %R 10.2196/14985 %U http://www.jmir.org/2019/12/e14985/ %U https://doi.org/10.2196/14985 %U http://www.ncbi.nlm.nih.gov/pubmed/31845900 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 12 %P e14361 %T Defining the Supportive Care Needs and Psychological Morbidity of Patients With Functioning Versus Nonfunctioning Neuroendocrine Tumors: Protocol for a Phase 1 Trial of a Nurse-Led Online and Phone-Based Intervention %A Guccione,Lisa %A Gough,Karla %A Drosdowsky,Allison %A Fisher,Krista %A Price,Timothy %A Pavlakis,Nick %A Khasraw,Mustafa %A Wyld,David %A Ransom,David %A Kong,Grace %A Rogers,Megan %A Leyden,Simone %A Leyden,John %A Michael,Michael %A Schofield,Penelope %+ Department of Cancer Experiences Research, Peter MacCallum Cancer Center, 305 Grattan Street, Melbourne, 3000, Australia, 61 38559 5908, Lisa.Guccione@petermac.org %K cancer %K neuroendocrine tumors %K NETs %K supportive care interventions %K telehealth %K eHealth %D 2019 %7 3.12.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Online information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population. Objective: This study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning). Methods: This is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention’s acceptability, appropriateness, and feasibility. Results: Currently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed. Conclusions: Limited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population. International Registered Report Identifier (IRRID): DERR1-10.2196/14361 %M 31793892 %R 10.2196/14361 %U https://www.researchprotocols.org/2019/12/e14361 %U https://doi.org/10.2196/14361 %U http://www.ncbi.nlm.nih.gov/pubmed/31793892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14360 %T A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support %A Signorelli,Gabriel Ruiz %A Lehocki,Fedor %A Mora Fernández,Matilde %A O'Neill,Gillian %A O'Connor,Dominic %A Brennan,Louise %A Monteiro-Guerra,Francisco %A Rivero-Rodriguez,Alejandro %A Hors-Fraile,Santiago %A Munoz-Penas,Juan %A Bonjorn Dalmau,Mercè %A Mota,Jorge %A Oliveira,Ricardo B %A Mrinakova,Bela %A Putekova,Silvia %A Muro,Naiara %A Zambrana,Francisco %A Garcia-Gomez,Juan M %+ Oncoavanze, Calle Presidente Cardenas, 8 Local Oncoavanze, Seville, 41013, Spain, 34 954 231 459, gasignorelli@gmail.com %K cancer %K Connected Health %K mHealth %K eHealth %K mental health %K physical activity %K rehabilitation %K wearable %K Internet of Things %K quality of life %D 2019 %7 29.10.2019 %9 Viewpoint %J J Med Internet Res %G English %X The evidence that quality of life is a positive variable for the survival of cancer patients has prompted the interest of the health and pharmaceutical industry in considering that variable as a final clinical outcome. Sustained improvements in cancer care in recent years have resulted in increased numbers of people living with and beyond cancer, with increased attention being placed on improving quality of life for those individuals. Connected Health provides the foundations for the transformation of cancer care into a patient-centric model, focused on providing fully connected, personalized support and therapy for the unique needs of each patient. Connected Health creates an opportunity to overcome barriers to health care support among patients diagnosed with chronic conditions. This paper provides an overview of important areas for the foundations of the creation of a new Connected Health paradigm in cancer care. Here we discuss the capabilities of mobile and wearable technologies; we also discuss pervasive and persuasive strategies and device systems to provide multidisciplinary and inclusive approaches for cancer patients for mental well-being, physical activity promotion, and rehabilitation. Several examples already show that there is enthusiasm in strengthening the possibilities offered by Connected Health in persuasive and pervasive technology in cancer care. Developments harnessing the Internet of Things, personalization, patient-centered design, and artificial intelligence help to monitor and assess the health status of cancer patients. Furthermore, this paper analyses the data infrastructure ecosystem for Connected Health and its semantic interoperability with the Connected Health economy ecosystem and its associated barriers. Interoperability is essential when developing Connected Health solutions that integrate with health systems and electronic health records. Given the exponential business growth of the Connected Health economy, there is an urgent need to develop mHealth (mobile health) exponentially, making it both an attractive and challenging market. In conclusion, there is a need for user-centered and multidisciplinary standards of practice to the design, development, evaluation, and implementation of Connected Health interventions in cancer care to ensure their acceptability, practicality, feasibility, effectiveness, affordability, safety, and equity. %M 31663861 %R 10.2196/14360 %U http://www.jmir.org/2019/10/e14360/ %U https://doi.org/10.2196/14360 %U http://www.ncbi.nlm.nih.gov/pubmed/31663861 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e12163 %T Developing Machine Learning Algorithms for the Prediction of Early Death in Elderly Cancer Patients: Usability Study %A Sena,Gabrielle Ribeiro %A Lima,Tiago Pessoa Ferreira %A Mello,Maria Julia Gonçalves %A Thuler,Luiz Claudio Santos %A Lima,Jurema Telles Oliveira %+ Department of Geriatric Oncology, Instituto de Medicina Integral Prof Fernando Figueira, Rua dos Coelhos 300, Recife, 50070-902, Brazil, 55 81 21224100, gabriellesena8@gmail.com %K geriatric assessment %K aged %K machine learning %K medical oncology %K death %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: The importance of classifying cancer patients into high- or low-risk groups has led many research teams, from the biomedical and bioinformatics fields, to study the application of machine learning (ML) algorithms. The International Society of Geriatric Oncology recommends the use of the comprehensive geriatric assessment (CGA), a multidisciplinary tool to evaluate health domains, for the follow-up of elderly cancer patients. However, no applications of ML have been proposed using CGA to classify elderly cancer patients. Objective: The aim of this study was to propose and develop predictive models, using ML and CGA, to estimate the risk of early death in elderly cancer patients. Methods: The ability of ML algorithms to predict early mortality in a cohort involving 608 elderly cancer patients was evaluated. The CGA was conducted during admission by a multidisciplinary team and included the following questionnaires: mini-mental state examination (MMSE), geriatric depression scale-short form, international physical activity questionnaire-short form, timed up and go, Katz index of independence in activities of daily living, Charlson comorbidity index, Karnofsky performance scale (KPS), polypharmacy, and mini nutritional assessment-short form (MNA-SF). The 10-fold cross-validation algorithm was used to evaluate all possible combinations of these questionnaires to estimate the risk of early death, considered when occurring within 6 months of diagnosis, in a variety of ML classifiers, including Naive Bayes (NB), decision tree algorithm J48 (J48), and multilayer perceptron (MLP). On each fold of evaluation, tiebreaking is handled by choosing the smallest set of questionnaires. Results: It was possible to select CGA questionnaire subsets with high predictive capacity for early death, which were either statistically similar (NB) or higher (J48 and MLP) when compared with the use of all questionnaires investigated. These results show that CGA questionnaire selection can improve accuracy rates and decrease the time spent to evaluate elderly cancer patients. Conclusions: A simplified predictive model aiming to estimate the risk of early death in elderly cancer patients is proposed herein, minimally composed by the MNA-SF and KPS. We strongly recommend that these questionnaires be incorporated into regular geriatric assessment of older patients with cancer. %M 31573896 %R 10.2196/12163 %U https://cancer.jmir.org/2019/2/e12163 %U https://doi.org/10.2196/12163 %U http://www.ncbi.nlm.nih.gov/pubmed/31573896 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e12071 %T Digital Interventions to Support Adolescents and Young Adults With Cancer: Systematic Review %A McCann,Lisa %A McMillan,Kathryn Anne %A Pugh,Gemma %+ Digital Health and Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 16 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 (0)141 548 3857, lisa.mccann@strath.ac.uk %K adolescent %K neoplasms %K telemedicine %K systematic review %K eHealth %D 2019 %7 31.07.2019 %9 Review %J JMIR Cancer %G English %X Background: The last decade has seen an increase in the number of digital health interventions designed to support adolescents and young adults (AYAs) with cancer. Objective: The objective of this review was to identify, characterize, and fully assess the quality, feasibility, and efficacy of existing digital health interventions developed specifically for AYAs, aged between 13 and 39 years, living with or beyond a cancer diagnosis. Methods: Searches were performed in PubMed, EMBASE, and Web of Science to identify digital health interventions designed specifically for AYA living with or beyond a cancer diagnosis. Data on the characteristics and outcomes of each intervention were synthesized. Results: A total of 4731 intervention studies were identified through the searches; 38 interventions (43 research papers) met the inclusion criteria. Most (20/38, 53%) were website-based interventions. Most studies focused on symptom management and medication adherence (15, 39%), behavior change (15, 39%), self-care (8, 21%), and emotional health (7, 18%). Most digital health interventions included multiple automated and communicative functions such as enriched information environments, automated follow-up messages, and access to peer support. Where reported (20, 53% of studies), AYAs’ subjective experience of using the digital platform was typically positive. The overall quality of the studies was found to be good (mean Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields scores >68%). Some studies reported feasibility outcomes (uptake, acceptability, and attrition) but were not sufficiently powered to comment on intervention effects. Conclusions: Numerous digital interventions have been developed and designed to support young people living with and beyond a diagnosis of cancer. However, many of these interventions have yet to be deployed, implemented, and evaluated at scale. %M 31368438 %R 10.2196/12071 %U http://cancer.jmir.org/2019/2/e12071/ %U https://doi.org/10.2196/12071 %U http://www.ncbi.nlm.nih.gov/pubmed/31368438 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e14292 %T Experiences of Using a Consumer-Based Mobile Meditation App to Improve Fatigue in Myeloproliferative Patients: Qualitative Study %A Huberty,Jennifer %A Eckert,Ryan %A Larkey,Linda %A Joeman,Lynda %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85281, United States, 1 402 301 1304, jhuberty@asu.edu %K mindfulness %K meditation %K mobile phone %K mHealth %K digital health %K cancer %D 2019 %7 22.07.2019 %9 Original Paper %J JMIR Cancer %G English %X 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, naïve or nearly naïve 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 naïve or nearly naïve 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. %M 31333197 %R 10.2196/14292 %U http://cancer.jmir.org/2019/2/e14292/ %U https://doi.org/10.2196/14292 %U http://www.ncbi.nlm.nih.gov/pubmed/31333197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12542 %T Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial %A Yang,Jing %A Weng,Lizhu %A Chen,Zhikui %A Cai,Hongfu %A Lin,Xiaoyan %A Hu,Zhijian %A Li,Na %A Lin,Bijuan %A Zheng,Bin %A Zhuang,Qian %A Du,Bin %A Zheng,Zhiyuan %A Liu,Maobai %+ Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 350001, China, 86 0591 86218372, liumb0591@sina.com %K cancer %K pain management %K quality of life %K adherence %D 2019 %7 29.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 31144672 %R 10.2196/12542 %U http://mhealth.jmir.org/2019/5/e12542/ %U https://doi.org/10.2196/12542 %U http://www.ncbi.nlm.nih.gov/pubmed/31144672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e10256 %T The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review %A Tarver,Will L %A Haggstrom,David A %+ VA Health Services Research and Development, Center for Health Information & Communication, Richard L Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN, 46202, United States, 1 317 988 2616, wltarver@iu.edu %K underserved populations %K medical informatics %K cancer %D 2019 %7 23.04.2019 %9 Review %J J Med Internet Res %G English %X Background: In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective: The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods: Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results: This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions: There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability. %M 31012855 %R 10.2196/10256 %U http://www.jmir.org/2019/4/e10256/ %U https://doi.org/10.2196/10256 %U http://www.ncbi.nlm.nih.gov/pubmed/31012855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11387 %T Identification of Anxiety and Depression Symptoms in Patients With Cancer: Comparison Between Short and Long Web-Based Questionnaires %A Mattsson,Susanne %A Olsson,Erik Martin Gustaf %A Carlsson,Maria %A Johansson,Birgitta Beda Kristina %+ Lifestyle and Rehabilitation in long term illness, Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 75122, Sweden, 46 184710000 ext 6637, susanne.mattsson@pubcare.uu.se %K screening %K cancer %K depression %K anxiety %K internet %K eHealth %D 2019 %7 05.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Physicians and nurses in cancer care easily fail to detect symptoms of psychological distress because of barriers such as lack of time, training on screening methods, and knowledge about how to diagnose anxiety and depression. National guidelines in several countries recommend routine screening for emotional distress in patients with cancer, but in many clinics, this is not implemented. By inventing screening methods that are time-efficient, such as digitalized and automatized screenings with short instruments, we can alleviate the burden on patients and staff. Objective: The aim of this study was to compare Web-based versions of the ultrashort electronic Visual Analogue Scale (eVAS) anxiety and eVAS depression and the short Hospital Anxiety and Depression Scale (HADS) with Web-based versions of the longer Montgomery Åsberg Depression Rating Scale-Self-report (MADRS-S) and the State Trait Anxiety Inventory- State (STAI-S) with regard to their ability to identify symptoms of anxiety and depression in patients with cancer. Methods: Data were obtained from a consecutive sample of patients with newly diagnosed (<6 months) breast, prostate, or colorectal cancer or with recurrence of colorectal cancer (N=558). The patients were recruited at 4 hospitals in Sweden between April 2013 and September 2015, as part of an intervention study administered via the internet. All questionnaires were completed on the Web at the baseline assessment in the intervention study. Results: The ultrashort and short Web-based-delivered eVAS anxiety, eVAS depression and HADS were found to have an excellent ability to discriminate between persons with and without clinical levels of symptoms of anxiety and depression compared with recommended cutoffs of the longer instruments MADRS-S and STAI-S (area under the curve: 0.88-0.94). Cutoffs of >6 on HADS anxiety and >7 hundredths (hs) on eVAS anxiety identified patients with anxiety symptoms with high accuracy. For HADS depression, at a cutoff of >5 and eVAS depression at a cutoff of >7 hs, the accuracy was very high likewise. Conclusions: The use of the short and ultrashort tools, eVAS and HADS, may be a suitable initial method of Web-based screening in busy clinical settings. However, there are still a proportion of patients who lack access to the internet or the ability to use it. There is a need to find solutions for this group to find all the patients with psychological distress. %M 30950804 %R 10.2196/11387 %U https://www.jmir.org/2019/4/e11387/ %U https://doi.org/10.2196/11387 %U http://www.ncbi.nlm.nih.gov/pubmed/30950804 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e10530 %T Investigation of Radiation Oncologists’ Awareness of Online Reputation Management %A Waxer,Jonathan Fredric %A Srivastav,Sudesh %A DiBiase,Christian Steven %A DiBiase,Steven Joseph %+ Department of Radiation Oncology, New York-Presbyterian Queens, Weill Cornell Medicine, 56-45 Main Street, Flushing, NY, 11355, United States, 1 718 670 1501, sdibiase@tulane.edu %K reputation %K management %K internet %K patient satisfaction %K surveys and questionnaires %K radiation oncology %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Online reputation management (ORM) is an emerging practice strategy that emphasizes the systematic and proactive monitoring of online reviews relating to one’s professional reputation. Objective: We developed this survey project to assess whether radiation oncologists are aware of ORM and how it is utilized in their practices. We hypothesized that ORM is largely unknown by most practicing radiation oncologists and that little time is spent actively managing their reputations. Methods: An online survey was submitted to 1222 radiation oncologists using the Qualtrics research platform. Physician emails were gathered from the American Society for Radiation Oncology member directory. A total of 85 physicians initiated the survey, whereas 76 physicians completed more than or equal to 94% (15/16) of the survey questions and were subsequently used in our analyses. The survey consisted of 15 questions querying practice demographics, patient satisfaction determination, ORM understanding, and activities to address ORM and 1 question for physicians to opt-in to a US $50 Amazon gift card raffle. The survey data were summarized using a frequency table, and data were analyzed using the Chi-square test, Fisher exact test, and Spearman correlation coefficients. Results: We calculated a 7% (85/1222) response rate for our survey, with a completion rate of 89% (76/85). A majority of respondents (97%, 74/76) endorsed being somewhat or strongly concerned about patient satisfaction (P<.001). However, 58% (44/76) of respondents reported spending 0 hours per week reviewing or managing their online reputation and 39% (30/76) reported spending less than 1 hour per week (P<.001). A majority of physicians (58%, 44/76) endorsed no familiarity with ORM (P<.001) and 70% (53/76) did not actively manage their online reputation (P<.001). Although 83% (63/76) of respondents strongly or somewhat believed that patients read online reviews (P<.001), 57% (43/76) of respondents did not check their online reviews (P=.25) and 80% (61/76) endorsed never responding to online reviews (P<.001). Moreover, 58% (44/76) of the respondents strongly or somewhat supported the idea of managing their online reputation going forward (P=.001). In addition, 11 out of the 28 pairs of questions asked in our correlation studies reached statistical significance. Degree of concern for patient satisfaction and the notion of managing one’s ORM going forward were the 2 most frequently correlated topics of statistical significance in our analyses. Conclusions: ORM is presently under-recognized in radiation oncology. Although most practitioners are concerned about patient satisfaction, little effort is directed toward the internet on this matter. ORM offers an area of practice improvement for many practicing radiation oncologists. %M 30932863 %R 10.2196/10530 %U https://cancer.jmir.org/2019/1/e10530/ %U https://doi.org/10.2196/10530 %U http://www.ncbi.nlm.nih.gov/pubmed/30932863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e9958 %T User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients %A Prince,Rebecca M %A Soung Yee,Anthony %A Parente,Laura %A Enright,Katherine A %A Grunfeld,Eva %A Powis,Melanie %A Husain,Amna %A Gandhi,Sonal %A Krzyzanowska,Monika K %+ University Health Network, 610 University Ave., Toronto, ON,, Canada, 1 416 946 6542, monika.krzyzanowska@uhn.ca %K prototype %K Web-based tool %K toxicity management %K chemotherapy %K self-management %D 2019 %7 28.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population. Objective: This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities. Methods: User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users. Results: Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information. Conclusions: Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption. %M 30920373 %R 10.2196/jmir.9958 %U http://www.jmir.org/2019/3/e9958/ %U https://doi.org/10.2196/jmir.9958 %U http://www.ncbi.nlm.nih.gov/pubmed/30920373 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e10813 %T Adaptation and Implementation of a Mobile Phone–Based Remote Symptom Monitoring System for People With Cancer in Europe %A Furlong,Eileen %A Darley,Andrew %A Fox,Patricia %A Buick,Alison %A Kotronoulas,Grigorios %A Miller,Morven %A Flowerday,Adrian %A Miaskowski,Christine %A Patiraki,Elisabeth %A Katsaragakis,Stylianos %A Ream,Emma %A Armes,Jo %A Gaiger,Alexander %A Berg,Geir %A McCrone,Paul %A Donnan,Peter %A McCann,Lisa %A Maguire,Roma %+ School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, D04 V1W8, Ireland, 353 7166478, eileen.furlong@ucd.ie %K telemedicine %K methods %K patient care %K cancer %K symptom management %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective: This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. Methods: There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. Results: The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. Conclusions: Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries. %M 30869641 %R 10.2196/10813 %U http://cancer.jmir.org/2019/1/e10813/ %U https://doi.org/10.2196/10813 %U http://www.ncbi.nlm.nih.gov/pubmed/30869641 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11111 %T Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App %A Lipson-Smith,Ruby %A White,Fiona %A White,Alan %A Serong,Lesley %A Cooper,Guy %A Price-Bell,Georgia %A Hyatt,Amelia %+ Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia, 61 3 8559 7837, amelia.hyatt@petermac.org %K referral and consultation %K adult %K humans %K cancer %K audiovisual aids %K mobile apps %K community-based participatory research %K health behavior %K psychological theory %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients’ recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient’s medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. %M 30860487 %R 10.2196/11111 %U http://formative.jmir.org/2019/1/e11111/ %U https://doi.org/10.2196/11111 %U http://www.ncbi.nlm.nih.gov/pubmed/30860487 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11094 %T Mobile Phone App–Based Pulmonary Rehabilitation for Chemotherapy-Treated Patients With Advanced Lung Cancer: Pilot Study %A Park,Sojung %A Kim,Ji Youn %A Lee,Jae Cheol %A Kim,Hyeong Ryul %A Song,Seungjae %A Kwon,Hee %A Ji,Wonjun %A Choi,Chang Min %+ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa–gu, 88 Olympic-ro 43-gil, Seoul, 05505, Republic of Korea, 82 2 3010 5902, ccm9607@gmail.com %K chemotherapy %K physical fitness %K lung cancer %K rehabilitation %K quality of life %D 2019 %7 04.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advanced lung cancer patients often have chronic lung disease with reduced exercise capacities and various symptoms leading to altered quality of life (QoL). No studies have assessed pulmonary rehabilitation (PR) employing a mobile app and an Internet of Things device in advanced lung cancer patients undergoing chemotherapy. Objective: This study aimed to determine the feasibility and efficacy of smartphone app–based PR on exercise capacity, symptom management, and QoL in patients with advanced lung cancer undergoing chemotherapy. Methods: A total of 100 patients were recruited in a prospective, single-arm intervention study using a smartphone app–based PR program for 12 weeks. Exercise capacity (6-min walking distance, 6MWD), QoL, symptom scale scores, and distress indexes were investigated. Results: A total of 90 patients completed the PR program. The most common cause of drop out was hospitalization because of cancer progression. After PR, there was significant improvement in the 6MWD; 380.1 m (SD 74.1) at baseline, 429.1 m (SD 58.6) at 6 weeks (P<.001), and 448.1 m (SD 50.0) at 12 weeks (P<.001). However, the dyspnea scale score showed no significant improvement in the patients overall, but there was a trend for improvement in those with a stable tumor response (P=.07). Role (P=.02), emotional (P<.001), and social functioning (P=.002) scale scores showed significant improvement after PR. Symptom scale scores for fatigue (P<.001), anorexia (P=.047), and diarrhea (P=.01) also showed significant improvement. There was significant improvement in depression (P=.048) and anxiety (P=.01), whereas there was no significant change in QoL (P=.06) and severity of pain (P=.24). Conclusions: Smartphone app–based PR represents an effective and feasible program to improve exercise capacity and to manage symptoms and distress in patients with advanced lung cancer who are undergoing chemotherapy. %M 30714943 %R 10.2196/11094 %U http://mhealth.jmir.org/2019/2/e11094/ %U https://doi.org/10.2196/11094 %U http://www.ncbi.nlm.nih.gov/pubmed/30714943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10875 %T Electronic Systems for Patients to Report and Manage Side Effects of Cancer Treatment: Systematic Review %A Warrington,Lorraine %A Absolom,Kate %A Conner,Mark %A Kellar,Ian %A Clayton,Beverly %A Ayres,Michael %A Velikova,Galina %+ Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Beckett Street, Leeds, LS9 7TF, United Kingdom, 44 1132068504, l.warrington@leeds.ac.uk %K oncology %K chemotherapy %K patient reported outcomes %K patient centered %K medical informatics %D 2019 %7 24.01.2019 %9 Review %J J Med Internet Res %G English %X Background: There has been a dramatic increase in the development of electronic systems to support cancer patients to report and manage side effects of treatment from home. Systems vary in the features they offer to patients, which may affect how patients engage with them and how they improve patient-centered outcomes. Objective: This review aimed to (1) describe the features and functions of existing electronic symptom reporting systems (eg, symptom monitoring, tailored self-management advice), and (2) explore which features may be associated with patient engagement and patient-centered outcomes. Methods: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed guidelines from the Centre for Reviews and Dissemination (University of York, United Kingdom). Primary searches were undertaken of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and the Health Technology Assessment databases. Secondary searches were undertaken by screening reference lists and citations. Two researchers applied broad inclusion criteria to identify and select relevant records. Data were extracted and summarized using Microsoft Excel. In order to meet the aims, the study selection, data extraction, and data synthesis comprised two stages: (1) identifying and characterizing available systems and (2) summarizing data on patient engagement and patient-centered outcomes. Results: We identified 77 publications relating to 41 distinct systems. In Stage 1, all publications were included (N=77). The features identified that supported clinicians and care were facility for health professionals to remotely access and monitor patient-reported data (24/41, 58%) and function to send alerts to health professionals for severe symptoms (17/41, 41%). Features that supported patients were facility for patients to monitor/review their symptom reports over time (eg, graphs) (19/41, 46%), general patient information about cancer treatment and side effects (17/41, 41%), tailored automated patient advice on symptom management (12/41, 29%), feature for patients to communicate with the health care team (6/41, 15%), and a forum for patients to communicate with one another (4/41, 10%). In Stage 2, only publications that included some data on patient engagement or patient-centered outcomes were included (N=29). A lack of consistency between studies in how engagement was defined, measured, or reported, and a wide range of methods chosen to evaluate systems meant that it was not possible to compare across studies or make conclusions on relationships with system features. Conclusions: Electronic systems have the potential to help patients manage side effects of cancer treatment, with some evidence to suggest a positive effect on patient-centered outcomes. However, comparison across studies is difficult due to the wide range of assessment tools used. There is a need to develop guidelines for assessing and reporting engagement with systems, and a set of core outcomes for evaluation. We hope that this review will contribute to the field by introducing a taxonomy for characterizing system features. Trial Registration: PROSPERO CRD42016035915; www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016035915 %M 30679145 %R 10.2196/10875 %U http://www.jmir.org/2019/1/e10875/ %U https://doi.org/10.2196/10875 %U http://www.ncbi.nlm.nih.gov/pubmed/30679145 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e11373 %T Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study %A Karsten,Maria M %A Speiser,Dorothee %A Hartmann,Claudia %A Zeuschner,Nele %A Lippold,Kai %A Kiver,Verena %A Gocke,Peter %A Kirchberger,Valerie %A Blohmer,Jens-Uwe %+ Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450664279, maria-margarete.karsten@charite.de %K breast cancer %K International Council Health Outcome Measurement %K mobile phone %K patient-reported outcomes %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries. Objective: This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charité Breast Center This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments. Methods: In November 2016, we implemented a Web-based system to collect PRO data at Charité Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charité, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires. Results: By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4% (51/541) of the patients were under the age of 40 years, 49.7% (269/541) between 40 and 60 years, 39.6% (214/541) between 60 and 80 years, and 1.3% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0% (8/134) of the patients between 50 and 60 years, 6.0% (9/150) between 60 and 70 years, and 12.7% (9/71) over the age of 70 years preferred paper versions. Conclusions: Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate. %M 30573450 %R 10.2196/11373 %U http://cancer.jmir.org/2018/2/e11373/ %U https://doi.org/10.2196/11373 %U http://www.ncbi.nlm.nih.gov/pubmed/30573450 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e12 %T Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study %A Asfaw,Alemseged Ayele %A Yan,Connie H %A Sweiss,Karen %A Wirth,Scott %A Ramirez,Victor H %A Patel,Pritesh R %A Sharp,Lisa K %+ Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, MC871, 833 South Wood Street, Chicago, IL, 60612, United States, 1 312 355 3569, sharpl@uic.edu %K antineoplastic therapy %K challenges %K race/ethnicity %K medication adherence %K multiple myeloma %D 2018 %7 12.11.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Many recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested. Objective: This study aimed to explore patients’ (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs. Methods: An in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology—Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance. Results: A total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80% (16/20) were African American. In addition, 18 (90%, 18/20) owned a smartphone and 85% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60% (12/20) of the patients expressed interest in trying a bottle in the future. Conclusions: Results identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned. %M 30425032 %R 10.2196/cancer.9918 %U http://cancer.jmir.org/2018/2/e12/ %U https://doi.org/10.2196/cancer.9918 %U http://www.ncbi.nlm.nih.gov/pubmed/30425032 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e46 %T Development of an eHealth System to Capture and Analyze Patient Sensor and Self-Report Data: Mixed-Methods Assessment of Potential Applications to Improve Cancer Care Delivery %A Lucas,Alexander R %A Bass,Michael B %A Rothrock,Nan E %A O'Connor,Mary L %A Sorkin,Mia R %A Nawyn,Jason %A Albinali,Fahd %A Wagner,Lynne I %+ Comprehensive Cancer Center, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 336 713 1478, lywagner@wakehealth.edu %K cancer %K care delivery %K decision support %K eHealth %K mobile phone %K survivorship %K symptom monitoring %D 2018 %7 22.10.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Capturing and Analyzing Sensor and Self-Report Data for Clinicians and Researchers (COMPASS) is an electronic health (eHealth) platform designed to improve cancer care delivery through passive monitoring of patients’ health status and delivering customizable reports to clinicians. Based on data from sensors and context-driven administration of patient-reported outcome (PRO) measures, key indices of patients’ functional status can be collected between regular clinic visits, supporting clinicians in the delivery of patient care. Objective: The first phase of this project aimed to systematically collect input from oncology providers and patients on potential clinical applications for COMPASS to refine the system. Methods: Ten clinicians representing various oncology specialties and disciplines completed semi-structured interviews designed to solicit clinician input on how COMPASS can best support clinical care delivery. Three cancer patients tested a prototype of COMPASS for 7 days and provided feedback. Interview data were tabulated using thematic content analysis to identify the most clinically relevant objective and PRO domains. Results: Thematic content analysis revealed that clinicians were most interested in monitoring vital statistics, symptoms, and functional status, including the physical activity level (n=9), weight (n=5), fatigue (n=9), sleep quality (n=8), and anxiety (n=7). Patients (2 in active treatment and 1 in remission) reported that they would use such a device, were enthusiastic about their clinicians monitoring their health status, especially the tracking of symptoms, and felt knowing their clinicians were monitoring and reviewing their health status provided valuable reassurance. Patients would, however, like to provide some context to their data. Conclusions: Clinicians and patients both articulated potential benefits of the COMPASS system in improving cancer care. From a clinician standpoint, data need to be easily interpretable and actionable. The fact that patients and clinicians both see potential value in eHealth systems suggests wider adoption and utilization could prove to be a useful tool for improving care delivery. %M 30348634 %R 10.2196/medinform.9525 %U http://medinform.jmir.org/2018/4/e46/ %U https://doi.org/10.2196/medinform.9525 %U http://www.ncbi.nlm.nih.gov/pubmed/30348634 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e11826 %T Data Visualizations to Support Health Practitioners’ Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study %A Backonja,Uba %A Haynes,Sarah C %A Kim,Katherine K %+ Betty Irene Moore School of Nursing, University of California Davis, 2450 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 510 761 5461, kathykim@ucdavis.edu %K cancer care facilities %K informatics %K patient-centered care %K patient-generated health data %K precision medicine %K visualization %D 2018 %7 16.10.2018 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 30327290 %R 10.2196/11826 %U http://humanfactors.jmir.org/2018/4/e11826/ %U https://doi.org/10.2196/11826 %U http://www.ncbi.nlm.nih.gov/pubmed/30327290 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e11087 %T Using Artificial Intelligence (Watson for Oncology) for Treatment Recommendations Amongst Chinese Patients with Lung Cancer: Feasibility Study %A Liu,Chaoyuan %A Liu,Xianling %A Wu,Fang %A Xie,Mingxuan %A Feng,Yeqian %A Hu,Chunhong %+ Department of Oncology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China, 86 13508486908, huchunhong@csu.edu.cn %K Watson for Oncology %K artificial intelligence %K lung neoplasms %K comparative study %K interdisciplinary communication %D 2018 %7 25.9.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) is developing quickly in the medical field and can benefit both medical staff and patients. The clinical decision support system Watson for Oncology (WFO) is an outstanding representative AI in the medical field, and it can provide to cancer patients prompt treatment recommendations comparable with ones made by expert oncologists. WFO is increasingly being used in China, but limited reports on whether WFO is suitable for Chinese patients, especially patients with lung cancer, exist. Here, we report a retrospective study based on the consistency between the lung cancer treatment recommendations made for the same patient by WFO and by the multidisciplinary team at our center. Objective: The aim of this study was to explore the feasibility of using WFO for lung cancer cases in China and to ascertain ways to make WFO more suitable for Chinese patients with lung cancer. Methods: We selected all lung cancer patients who were hospitalized and received antitumor treatment for the first time at the Second Xiangya Hospital Cancer Center from September to December 2017 (N=182). WFO made treatment recommendations for all supported cases (n=149). If the actual therapeutic regimen (administered by our multidisciplinary team) was recommended or for consideration according to WFO, we defined the recommendations as consistent; if the actual therapeutic regimen was not recommended by WFO or if WFO did not provide the same treatment option, we defined the recommendations as inconsistent. Blinded second round reviews were performed by our multidisciplinary team to reassess the incongruent cases. Results: WFO did not support 18.1% (33/182) of recommendations among all cases. Of the 149 supported cases, 65.8% (98/149) received recommendations that were consistent with the recommendations of our team. Logistic regression analysis showed that pathological type and staging had significant effects on consistency (P=.004, odds ratio [OR] 0.09, 95% CI 0.02-0.45 and P<.001, OR 9.5, 95% CI 3.4-26.1, respectively). Age, gender, and presence of epidermal growth factor receptor gene mutations had no effect on consistency. In 82% (42/51) of the inconsistent cases, our team administered two China-specific treatments, which were different from the recommendations made by WFO but led to excellent outcomes. Conclusions: In China, most of the treatment recommendations of WFO are consistent with the recommendations of the expert group, although a relatively high proportion of cases are still not supported by WFO. Therefore, WFO cannot currently replace oncologists. WFO can improve the efficiency of clinical work by providing assistance to doctors, but it needs to learn the regional characteristics of patients to improve its assistive ability. %M 30257820 %R 10.2196/11087 %U http://www.jmir.org/2018/9/e11087/ %U https://doi.org/10.2196/11087 %U http://www.ncbi.nlm.nih.gov/pubmed/30257820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e11547 %T Digital Health in Melanoma Posttreatment Care in Rural and Remote Australia: Systematic Review %A Rollin,Audrey %A Ridout,Brad %A Campbell,Andrew %+ Faculty of Health Sciences, The University of Sydney, City Road, Sydney, 2006, Australia, 61 466110171, audrey.rollin@sydney.edu.au %K digital health %K eHealth %K technology %K melanoma %K posttreatment care %K support care services %K rural areas %K remote communities %K patient-centric %K oncology %D 2018 %7 24.9.2018 %9 Review %J J Med Internet Res %G English %X Background: The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services. Objective: The aim of this review was to understand how digital health is currently used for melanoma posttreatment care and determine the benefits for Australian rural and remote areas. Methods: A systematic search of PubMed, Medline, PsycINFO, and Scopus was conducted in March 2018. Findings were clustered per type of intervention and related direct outcomes. Results: Five studies met the inclusion criteria, but none investigated the benefits of digital health for melanoma posttreatment care in rural and remote areas of Australia. Some empirical studies demonstrated consumers’ acceptance of digital intervention for posttreatment care. The findings did not take into consideration individual, psychological, and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare. Conclusions: Digital interventions may be used as an adjunct service by clinicians during melanoma posttreatment care, especially in regions that are less-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates, and accessibility to posttreatment care management between urban and rural/remote populations. %M 30249578 %R 10.2196/11547 %U http://www.jmir.org/2018/9/e11547/ %U https://doi.org/10.2196/11547 %U http://www.ncbi.nlm.nih.gov/pubmed/30249578 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 9 %P e10287 %T An e-Prehabilitation System of Care for Teenagers and Young Adults Diagnosed With Cancer: Protocol for a Qualitative Co-Design Study %A McCann,Lisa %A McMillan,Kathryn A %A Hewitt,Christopher %+ Digital Health & Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 5483587, lisa.mccann@strath.ac.uk %K digital health %K human factors %K co-design %K prehabilitation %K teenagers and young adults %K cancer %K mobile phone %D 2018 %7 12.09.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: A diagnosis of cancer in young adulthood can pose many different and unique challenges for individuals. The provision of adequate and appropriate information as well as care and support for teenagers and young adults at the time of diagnosis is central to their health care experience going forward. Moreover, appropriate and accessible information provision is critical to ensure that young individuals with cancer feel equipped and empowered to make decisions about, and be involved in, their treatment and recovery throughout their experience; this is a concept known as prehabilitation. As digital interventions and resources that support teenagers and young adults with cancer are an increasingly desirable part of health care provision, this study will focus on the development of an age- and population-appropriate electronic prehabilitation (e-Prehabilitation) system of care. Objective: We will conduct an exploratory, co-design research project that will inform the development of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. A collaborative approach to data collection and prototype design will ensure that a patient-centered approach is embedded throughout. Methods: A qualitative, co-design study utilizing surveys, interviews, and focus group discussions is being conducted with teenagers and young adults, health care professionals, and technologists. Results: This research study is in progress; recruitment and data collection activities have commenced and findings are expected in early 2019. Conclusions: The findings of this study will have important implications for informing the future development and evaluation of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. Registered Report Identifier: RR1-10.2196/10287 %M 30209030 %R 10.2196/10287 %U http://www.researchprotocols.org/2018/9/e10287/ %U https://doi.org/10.2196/10287 %U http://www.ncbi.nlm.nih.gov/pubmed/30209030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e223 %T Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review %A Marzorati,Chiara %A Renzi,Chiara %A Russell-Edu,Samuel William %A Pravettoni,Gabriella %+ Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, via Ripamonti 435, Milan,, Italy, 39 0257489207, chiara.marzorati@ieo.it %K telemedicine %K family %K caregivers %K neoplasms %K systematic review %D 2018 %7 18.06.2018 %9 Review %J J Med Internet Res %G English %X 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. %M 29914858 %R 10.2196/jmir.9812 %U http://www.jmir.org/2018/6/e223/ %U https://doi.org/10.2196/jmir.9812 %U http://www.ncbi.nlm.nih.gov/pubmed/29914858 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e10160 %T Patient-Centered Mobile Health Data Management Solution for the German Health Care System (The DataBox Project) %A Brinker,Titus Josef %A Rudolph,Stefanie %A Richter,Daniela %A von Kalle,Christof %+ Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany, 49 15175084347, titus.brinker@gmail.com %K medical informatics %K health data management %D 2018 %7 11.05.2018 %9 Viewpoint %J JMIR Cancer %G English %X This article describes the DataBox project which offers a perspective of a new health data management solution in Germany. DataBox was initially conceptualized as a repository of individual lung cancer patient data (structured and unstructured). The patient is the owner of the data and is able to share his or her data with different stakeholders. Data is transferred, displayed, and stored online, but not archived. In the long run, the project aims at replacing the conventional method of paper- and storage-device-based handling of data for all patients in Germany, leading to better organization and availability of data which reduces duplicate diagnostic procedures, treatment errors, and enables the training as well as usage of artificial intelligence algorithms on large datasets. %M 29752255 %R 10.2196/10160 %U http://cancer.jmir.org/2018/1/e10160/ %U https://doi.org/10.2196/10160 %U http://www.ncbi.nlm.nih.gov/pubmed/29752255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e150 %T Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study %A Greenhalgh,Trisha %A Shaw,Sara %A Wherton,Joseph %A Vijayaraghavan,Shanti %A Morris,Joanne %A Bhattacharya,Satya %A Hanson,Philippa %A Campbell-Richards,Desirée %A Ramoutar,Seendy %A Collard,Anna %A Hodkinson,Isabel %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 1865289293, trish.greenhalgh@phc.ox.ac.uk %K remote consultations %K diabetes mellitus %K ethnography %K interviews %K organizational case studies %K health systems %D 2018 %7 17.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. Objective: The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. Methods: A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). Results: When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2% and 22% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Conclusions: Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. %M 29625956 %R 10.2196/jmir.9897 %U http://www.jmir.org/2018/4/e150/ %U https://doi.org/10.2196/jmir.9897 %U http://www.ncbi.nlm.nih.gov/pubmed/29625956 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e64 %T Input of Psychosocial Information During Multidisciplinary Team Meetings at Medical Oncology Departments: Protocol for an Observational Study %A Horlait,Melissa %A Van Belle,Simon %A Leys,Mark %+ Organisation, Policy and Social Inequalities in Health Care, Department of Health Sciences, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 24774901, mhorlait@vub.be %K multidisciplinary collaboration %K oncology %K multidisciplinary communication %K health services %K qualitative research %K multidisciplinary oncology consultations %D 2018 %7 26.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multidisciplinary team meetings (MDTMs) have become standard practice in oncology and gained the status of the key decision-making forum for cancer patient management. The current literature provides evidence that MDTMs are achieving their intended objectives but there are also indications to question the positive impact of MDTMs in oncology settings. For cancer management to be patient-centered, it is crucial that medical information as well as psychosocial aspects—such as the patients’ living situation, possible family problems, patients' mental state, and patients’ perceptions and values or preferences towards treatment or care—are considered and discussed during MDTMs. Previous studies demonstrate that failure to account for patients’ psychosocial information has a negative impact on the implementation of the treatment recommendations formulated during MDTMs. Few empirical studies have demonstrated the predominant role of physicians during MDTMs, leading to the phenomenon that medical information is shared almost exclusively at the expense of psychosocial information. However, more in-depth insight on the underlying reasons why MDTMs fail to take into account psychosocial information of cancer patients is needed. Objective: This paper presents a research protocol for a cross-sectional observational study that will focus on exploring the barriers to considering psychosocial information during MDTMs at medical oncology departments. Methods: This protocol encompasses a cross-sectional comparative case study of MDTMs at medical oncology departments in Flanders, Belgium. MDTMs from various oncology subspecialties at inpatient medical oncology departments in multiple hospitals (academic as well as general hospitals) are compared. The observations focus on the “multidisciplinary oncology consultation” (MOC), a formally regulated and financed type of MDTM in Belgian oncology since 2003. Data are collected through nonparticipant observations of MOC–meetings. Observational data are supplemented with semi-structured individual interviews with members of the MOC–meetings. Results: The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology departments. Results of this study will particularly focus on the input of psychosocial information during MDTMs. Conclusions: The concept of an MDTM should not merely be a group of care professionals who mostly work independently and occasionally liaise with one another. Interventions aiming to enhance the input of psychosocial information are crucial to ensure that MDTMs can benefit from their diverse membership to achieve their full potential. The findings from this study can be used to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. %M 29483068 %R 10.2196/resprot.9239 %U http://www.researchprotocols.org/2018/2/e64/ %U https://doi.org/10.2196/resprot.9239 %U http://www.ncbi.nlm.nih.gov/pubmed/29483068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e50 %T Ecuadorian Cancer Patients’ Preference for Information and Communication Technologies: Cross-Sectional Study %A Cherrez Ojeda,Ivan %A Vanegas,Emanuel %A Torres,Michell %A Calderón,Juan Carlos %A Calero,Erick %A Cherrez,Annia %A Felix,Miguel %A Mata,Valeria %A Cherrez,Sofia %A Simancas,Daniel %+ Universidad Especialidades Espíritu Santo, Av Samborondón, Km 2.5, Samborondón, 091650, Ecuador, 593 5114555, ivancherrez@gmail.com %K social media %K telemedicine %K cancer %K Web 2.0 %K mHealth %D 2018 %7 20.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. Objective: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. Methods: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. Results: Of the total, 43.2% (216/500) of participants reported that they had access to the Internet, and 25.4% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5%, 145/218) and short message service (SMS) text messaging (61.0%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0%, 157/218) followed by SMS (63.8%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. Conclusions: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries. %M 29463492 %R 10.2196/jmir.8485 %U http://www.jmir.org/2018/2/e50/ %U https://doi.org/10.2196/jmir.8485 %U http://www.ncbi.nlm.nih.gov/pubmed/29463492 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e2 %T The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System %A Kurahashi,Allison M %A Stinson,Jennifer N %A van Wyk,Margaret %A Luca,Stephanie %A Jamieson,Trevor %A Weinstein,Peter %A Cafazzo,Joseph A %A Lokuge,Bhadra %A Cohen,Eyal %A Rapoport,Adam %A Husain,Amna %+ The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada, 1 416 586 4800 ext 7886, amna.husain@sinaihealthsystem.ca %K patient-centered care %K patient participation %K chronic disease %K communication %K internet communication tools %K usability testing %K interdisciplinary communication %K health communication %K continuity of patient care %K patient care team %K inventions %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system’s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users’ perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions—composing, posting, and reading messages—with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. %M 29317386 %R 10.2196/humanfactors.7882 %U http://humanfactors.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/humanfactors.7882 %U http://www.ncbi.nlm.nih.gov/pubmed/29317386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e407 %T Mindfulness-Based Cognitive Therapy for Cancer Patients Delivered via Internet: Qualitative Study of Patient and Therapist Barriers and Facilitators %A Compen,Félix R %A Bisseling,Else M %A Schellekens,Melanie PJ %A Jansen,Ellen TM %A van der Lee,Marije L %A Speckens,Anne EM %+ Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Centre, Reinier Postlaan, Postbus 9101, Nijmegen, 6500HB, Netherlands, 31 243610405, felix.compen@radboudumc.nl %K mindfulness %K psycho-oncology %K cancer survivors %K telemedicine %K qualitative research %D 2017 %7 18.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of patients living with cancer is growing, and a substantial number of patients suffer from psychological distress. Mindfulness-based interventions (MBIs) seem effective in alleviating psychological distress. Unfortunately, several cancer patients find it difficult, if not impossible, to attend a group-based course. Internet-based MBIs (eMBIs) such as Internet-based mindfulness-based cognitive therapy (eMBCT) may offer solutions. However, it is yet to be studied what facilitators and barriers cancer patients experience during eMBCT. Objective: This study aimed to explore facilitators and barriers of individual asynchronous therapist-assisted eMBCT as experienced by both patients and therapists. Methods: Patients with heterogeneous cancer diagnoses suffering from psychological distress were offered eMBCT. This 9-week intervention mirrored the group-based MBCT protocol and included weekly asynchronous written therapist feedback. Patients were granted access to a website that contained the eMBCT protocol and a secured inbox, and they were asked to practice and fill out diaries on which the therapist provided feedback. In total, 31 patients participated in an individual posttreatment interview on experienced facilitators and barriers during eMBCT. Moreover, eight therapists were interviewed. The data were analyzed with qualitative content analysis to identify barriers and facilitators in eMBCT. Results: Both patients and therapists mentioned four overarching themes as facilitators and barriers: treatment setting (the individual and Internet-based nature of the treatment), treatment format (how the treatment and its guidance were organized and delivered), role of the therapist, and individual patient characteristics. Conclusions: The eMBCT provided flexibility in when, where, and how patients and therapists engage in MBCT. Future studies should assess how different eMBCT designs could further improve barriers that were found. %M 29254912 %R 10.2196/jmir.7783 %U http://www.jmir.org/2017/12/e407/ %U https://doi.org/10.2196/jmir.7783 %U http://www.ncbi.nlm.nih.gov/pubmed/29254912 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e354 %T Reducing Symptom Distress in Patients With Advanced Cancer Using an e-Alert System for Caregivers: Pooled Analysis of Two Randomized Clinical Trials %A Gustafson,David H %A DuBenske,Lori L %A Atwood,Amy K %A Chih,Ming-Yuan %A Johnson,Roberta A %A McTavish,Fiona %A Quanbeck,Andrew %A Brown,Roger L %A Cleary,James F %A Shah,Dhavan %+ Center for Health Enhancement Systems Studies, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Mechanical Engineering Building, 4th Floor, 1513 University Ave., Madison, WI, 53706, United States, 1 6082395535, dhgustaf@wisc.edu %K Internet %K health communication %K palliative care %K communication barriers %K signs and symptoms %K eHealth %D 2017 %7 14.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Symptom distress in patients toward the end of life can change rapidly. Family caregivers have the potential to help patients manage those symptoms, as well as their own stress, if they are equipped with the proper resources. Electronic health (eHealth) systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could. Objective: The aim of this paper was to assess the effects on cancer patient symptom distress of an eHealth system that alerts clinicians to significant changes in the patient’s symptoms, as reported by a family caregiver. Methods: A pooled analysis from two randomized clinical trials (NCT00214162 and NCT00365963) compared outcomes at 12 months for two unblinded groups: a control group (Comprehensive Health Enhancement Support System [CHESS]-Only) that gave caregivers access to CHESS, an online support system, and an experimental group (CHESS+CR [Clinician Report]), which also had CHESS but with a CR that automatically alerted clinicians if symptoms exceeded a predetermined threshold of severity. Participants were dyads (n=235) of patients with advanced lung, breast, or prostate cancer and their respective family caregivers from 5 oncology clinics in the United States of America. The proportion of improved patient threshold symptoms was compared between groups using area-under-the-curve analysis and binomial proportion tests. The proportion of threshold symptoms out of all reported symptoms was also examined. Results: When severe caregiver-reported symptoms were shared with clinicians, the symptoms were more likely to be subsequently reported as improved than when the symptoms were not shared with clinicians (P<.001). Fewer symptom reports were completed in the group of caregivers whose reports went to clinicians than in the CHESS-Only group (P<.001), perhaps because caregivers, knowing their reports might be sent to a doctor, feared they might be bothering the clinician. Conclusions: This study suggests that an eHealth system designed for caregivers that alerts clinicians to worrisome changes in patient health status may lead to reduced patient distress. Trial Registration: Clinicaltrials.gov NCT00214162; https://clinicaltrials.gov/ct2/show/NCT00214162 (Archived by WebCite at http://www.webcitation.org/6nmgdGfuD) and Clinicaltrials.gov NCT00365963; https://clinicaltrials.gov/ct2/show/NCT00365963 (Archived by WebCite at http://www.webcitation.org/6nmh0U8VP) %M 29138131 %R 10.2196/jmir.7466 %U http://www.jmir.org/2017/11/e354/ %U https://doi.org/10.2196/jmir.7466 %U http://www.ncbi.nlm.nih.gov/pubmed/29138131 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e18 %T 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 %A Langius-Eklöf,Ann %A Christiansen,Mats %A Lindström,Veronica %A Blomberg,Karin %A Hälleberg Nyman,Maria %A Wengström,Yvonne %A Sundberg,Kay %+ Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, C3, Alfred Nobels allé 23, Huddinge, 141 83, Sweden, 46 722535878, ann.langius-eklof@ki.se %K mobile apps %K mHealth %K prostate cancer %K symptom assessment %D 2017 %7 31.10.2017 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 29089290 %R 10.2196/cancer.7599 %U http://cancer.jmir.org/2017/2/e18/ %U https://doi.org/10.2196/cancer.7599 %U http://www.ncbi.nlm.nih.gov/pubmed/29089290 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e336 %T Effectiveness of Two Web-Based Interventions for Chronic Cancer-Related Fatigue Compared to an Active Control Condition: Results of the “Fitter na kanker” Randomized Controlled Trial %A Bruggeman-Everts,Fieke Z %A Wolvers,Marije D J %A van de Schoot,Rens %A Vollenbroek-Hutten,Miriam M R %A Van der Lee,Marije L %+ Helen Dowling Instituut, Scientific Research Department, Professor Bronkhorstlaan 20, Bilthoven, 3723 MB, Netherlands, 31 30 252 40 20, bruggeman.everts@gmail.com %K fatigue %K cancer survivors %K Internet interventions %K mindfulness-based cognitive therapy %K physiotherapy %K accelerometry %K latent growth analysis %K implementation %K RCT %D 2017 %7 19.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. Objective: The current paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. Methods: Severely fatigued cancer survivors were recruited via online and offline channels, and self-registered on an open-access website. After eligibility checks, 167 participants were randomized via an embedded automated randomization function into: (1) physiotherapist-guided Ambulant Activity Feedback (AAF) therapy encompassing the use of an accelerometer (n=62); (2) psychologist-guided Web-based mindfulness-based cognitive therapy (eMBCT; n=55); or (3) an unguided active control condition receiving psycho-educational emails (n=50). All interventions lasted nine weeks. Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale (primary outcome) six times from baseline (T0b) to six months (T2). Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule (secondary outcome). Treatment dropout was investigated. Results: Multiple group latent growth curve analysis, corrected for individual time between assessments, showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group. The analyses were checked by a researcher who was blind to allocation. Clinically relevant changes in fatigue severity were observed in 66% (41/62) of patients in AAF, 49% (27/55) of patients in eMBCT, and 12% (6/50) of patients in psycho-education. Dropout was 18% (11/62) in AAF, mainly due to technical problems and poor usability of the accelerometer, and 38% (21/55) in eMBCT, mainly due to the perceived high intensity of the program. Conclusions: Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails. Trial Registration: Trialregister.nl NTR3483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3483 (Archived by WebCite at http://www.webcitation.org/6NWZqon3o) %M 29051138 %R 10.2196/jmir.7180 %U http://www.jmir.org/2017/10/e336/ %U https://doi.org/10.2196/jmir.7180 %U http://www.ncbi.nlm.nih.gov/pubmed/29051138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e334 %T Effect of a Website That Presents Patients’ Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial %A Giesler,Jürgen M %A Keller,Bettina %A Repke,Tim %A Leonhart,Rainer %A Weis,Joachim %A Muckelbauer,Rebecca %A Rieckmann,Nina %A Müller-Nordhorn,Jacqueline %A Lucius-Hoene,Gabriele %A Holmberg,Christine %+ Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Seestr 73 - Haus 10, Berlin, 13347, Germany, 49 30450529192, christine.holmberg@charite.de %K self-efficacy %K colorectal cancer %K patient competence %K narrative information %K Web-based experiential information %D 2017 %7 13.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients often seek other patients’ experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people’s health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients’ Experiences) aims to provide scientifically based online information on people’s experiences with health and illness to fulfill patients’ needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. Objective: The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. Methods: In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks Results: The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline. Conclusions: The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users’ motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients’ perceived effects of using such a website. Trial Registration: Clinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi) %M 29030329 %R 10.2196/jmir.7639 %U http://www.jmir.org/2017/10/e334/ %U https://doi.org/10.2196/jmir.7639 %U http://www.ncbi.nlm.nih.gov/pubmed/29030329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e330 %T eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability %A Girgis,Afaf %A Durcinoska,Ivana %A Levesque,Janelle V %A Gerges,Martha %A Sandell,Tiffany %A Arnold,Anthony %A Delaney,Geoff P %A , %+ South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Level 2, Education Building, Liverpool Hospital, Cnr Elizabeth/Goulburn Streets, Liverpool, 2170, Australia, 61 412142841, afaf.girgis@unsw.edu.au %K patient reported outcome measures %K eHealth %K self-management %K medical oncology %K patient-centered care %K electronic health records %D 2017 %7 02.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite accumulating evidence indicating that collecting patient-reported outcomes (PROs) and transferring results to the treating health professional in real time has the potential to improve patient well-being and cancer outcomes, this practice is not widespread. Objective: The aim of this study was to test the feasibility and acceptability of PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care), a newly developed electronic health (eHealth) system that facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. Methods: We developed an eHealth system in consultation with content-specific expert advisory groups and tested it with patients receiving treatment or follow-up care in two hospitals in New South Wales, Australia, over a 3-month period. Participants were recruited in clinic and completed self-report Web-based assessments either just before their upcoming clinical consultation or every 4 weeks if in follow-up care. A mixed methods approach was used to evaluate feasibility and acceptability of PROMPT-Care; data collected throughout the study informed the accuracy and completeness of data transfer procedures, and extent of missing data was determined from participants’ assessments. Patients participated in cognitive interviews while completing their first assessment and completed evaluation surveys and interviews at study-end to assess system acceptability and usefulness of patient self-management resources, and oncology staff were interviewed at study-end to determine the acceptability and perceived usefulness of real-time PRO reporting. Results: A total of 42 patients consented to the study; 7 patients were withdrawn before starting the intervention primarily because of changes in eligibility. Overall, 35 patients (13 on treatment and 22 in follow-up) completed 67 assessments during the study period. Mean completeness of patient-reported data was 93%, with 100% accuracy of data transfer. Ten patients completed cognitive interviews, 28 completed evaluation surveys, and 14 completed evaluation interviews at study-end. PROMPT-Care patient acceptability was high—100% (28/28) reported the time to complete the Web-based assessments (average 15 min) as about right, most willing to answer more questions (79%, 22/28 yes), 96% (27/28) found the Web-based assessment easier or same as completing a paper copy, and they valued the self-management resources . Oncology staff (n=5) also reported high acceptability and potential feasibility of the system. Conclusions: Patients and oncology staff found the PROMPT-Care system to be highly acceptable, and the results suggest that it would be feasible to implement it into an oncology setting. Suggested modifications to the patient assessment survey, clinician access to the reports, and system requirements will be made as part of the next stage of large-scale testing and future implementation of the system as part of routine care. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0). %M 28970188 %R 10.2196/jmir.8360 %U https://www.jmir.org/2017/10/e330/ %U https://doi.org/10.2196/jmir.8360 %U http://www.ncbi.nlm.nih.gov/pubmed/28970188 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e23 %T Development of the Electronic Social Network Assessment Program Using the Center for eHealth and Wellbeing Research Roadmap %A Reblin,Maija %A Wu,Yelena P %A Pok,Justin %A Kane,Lauren %A Colman,Howard %A Cohen,Adam L %A Mendivil,Eduardo %A Warner,Echo L %A Meyer,Miriah %A Agutter,James %+ Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, United States, 1 813 745 8705, maija.reblin@moffitt.org %K intervention development %K user-centered design %K oncology %K caregiver %D 2017 %7 30.08.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The number of Web-based psychological and behavioral interventions is growing. Beyond their theoretical underpinnings, a key factor to the success of these interventions is how they are designed and developed to ensure usability over a new method of delivery. Our team has adapted ecomapping, a tool for visualizing family caregiver social network resources, for the Web. Here, we describe how we designed and developed the electronic Social Network Assessment Program (eSNAP) Web-based tool using a framework of the Center for eHealth and Wellbeing Research (CeHRes) Roadmap for Web-based intervention development. The CeHRes Roadmap is still new in terms of tool development and we showcase an example of its application. Objective: The aim of our study was to provide an example of the application of the Web-based intervention development process using the CeHRes Roadmap for other research teams to follow. In doing so, we are also sharing our pilot work to enhance eSNAP’s acceptance and usability for users and the feasibility of its implementation. Methods: We describe the development of the eSNAP app to support family caregivers of neuro-oncology patients. This development is based on the 5 iterative stages of the CeHRes Roadmap: contextual inquiry, value specification, design, operationalization, and summative evaluation. Research activities to support eSNAP development prior to implementation included literature review, focus groups, and iterative rounds of interviews. Results: Key lessons learned in developing the eSNAP app broadly fell under a theme of translating theoretical needs and ideas to the real world. This included how to prioritize needs to be addressed at one time, how the modality of delivery may change design requirements, and how to develop a tool to fit within the context it will be used. Conclusions: Using the CeHRes Roadmap to develop Web-based interventions such as eSNAP helps to address potential issues by outlining important intervention development milestones. In addition, by encouraging inclusion of users and other stakeholders in the process, Web-based intervention developers using the Roadmap can identify what will work in the real world and increase feasibility and effectiveness. %M 28855149 %R 10.2196/humanfactors.7845 %U http://humanfactors.jmir.org/2017/3/e23/ %U https://doi.org/10.2196/humanfactors.7845 %U http://www.ncbi.nlm.nih.gov/pubmed/28855149 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 9 %N 1 %P e15 %T The Effects of Coaching Patients to List Questions Before Visiting Cancer Specialists: Retrospective Evaluation of Visit Preparation in a Rural, Underserved Setting %A Belkora,Jeffrey K %A Naguit,Marijoyce %A Stupar,Lauren %A Wiley,James %A Volz,Shelley %A O'Donnell,Sara %+ Helen Diller Family Comprehensive Cancer Center, Department of Surgery and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, Suite 265, Box 0936, 3333 California St, San Francisco, CA, CA 94118, United States, 1 (650) 533 6965, jeff.belkora@ucsfmedctr.org %K Visit preparation %K self-efficacy %K anxiety %K question list %K patient support %K community-based participatory research %K psycho-oncology. %D 2017 %7 22.8.2017 %9 Evidence, Research %J J Participat Med %G English %X Background: A community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits. Objective: Was the question-listing intervention effective in reducing anxiety and increasing decision self-efficacy? Methods: The organization surveyed patients on decision self-efficacy (273 respondents, 99% response rate) and anxiety (190, 68%) before and after question-listing interventions delivered from 2006 – 2011. We analyzed responses using two-sided paired t-tests at 5% significance and conducted linear regression to identify significant predictors of change. We examined predictors related to the patient (location, demographics, disease status and baseline decision self-efficacy and anxiety); the intervention (including interventionist case volume); and the visit (including type of doctor seen). Results: Question-listing was associated with higher mean decision self-efficacy (2.70/3.43 pre/post, 1-4 min-max, P<.001) and lower mean anxiety (7.26/5.87, 1-10 min-max, P<.001). Significant predictors of change in decision self-efficacy included: patient location; interventionist case volume; baseline decision self-efficacy and anxiety. Higher baseline anxiety was also associated with reductions in anxiety. Conclusions: In a sustained community-based implementation, the intervention helped patients prepare for oncology visits. Patients reported higher self-efficacy and lower anxiety. %R 10.2196/jopm.8949 %U http://jopm.jmir.org/2017/1/e15/ %U https://doi.org/10.2196/jopm.8949 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e288 %T “Am I normal?” The Wishes of Patients With Lymphoma to Compare Their Patient-Reported Outcomes With Those of Their Peers %A Oerlemans,Simone %A Arts,Lindy P %A Horevoorts,Nicole J %A van de Poll-Franse,Lonneke V %+ Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, PO Box 19079, 3501 DB, Utrecht, 3501 DB, Netherlands, 31 (0) 88 234 6195, s.oerlemans@iknl.nl %K lymphoma %K health-related quality of life %K personalized feedback %K self-care %K access to information %K population-based research %D 2017 %7 15.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing feedback to patients on their patient-reported outcomes (PROs) can help patients in monitoring their functioning and symptoms and may help empower them. Objective: The objective of this study was to investigate whether patients with lymphoma wished to receive PRO feedback, including the option to compare their scores with those of their peers, and how this feedback was evaluated. Methods: We invited 64 patients participating in a lymphoma cohort who were eligible for a follow-up questionnaire and gave them the option to receive PRO feedback. Patients completed questions about health-related quality of life (HRQoL) and symptoms. PRO feedback was provided via bar charts. Results: Of the 64 invited patients, 45 participated (response rate 70%) and 36 of those (80%) wished to receive PRO feedback. The vast majority (34/36, 94%) compared their scores with those of a lymphoma reference cohort, and 64% (23/36) compared their score with those of a normative population without cancer. All patients wished to receive feedback on their HRQoL, and 29 (81%) to 33 (92%) wanted feedback on their functioning, fatigue, neuropathy, anxiety, and depressive symptoms. Of the 36 participants wishing to receive PRO feedback, 35 (97%) viewed it as being useful, with reassurance and knowledge about their own functioning in relation to what is “normal” being the most frequently mentioned reasons. Conclusions: A high number of patients with lymphoma wished to receive PRO feedback. Patients reported the comparison of their scores versus a lymphoma reference cohort as most valuable. Further research should investigate whether PRO feedback could increase empowerment and possibly improve HRQoL. %M 28811271 %R 10.2196/jmir.7079 %U http://www.jmir.org/2017/8/e288/ %U https://doi.org/10.2196/jmir.7079 %U http://www.ncbi.nlm.nih.gov/pubmed/28811271 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e10 %T Supporting Lung Cancer Patients With an Interactive Patient Portal: Feasibility Study %A Groen,Wim G %A Kuijpers,Wilma %A Oldenburg,Hester SA %A Wouters,Michel WJM %A Aaronson,Neil K %A van Harten,Wim H %+ Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam,, Netherlands, 31 20 5122861, w.v.harten@nki.nl %K non-small cell lung cancer %K patient empowerment %K patient portal %K supportive care %K eHealth %K feasibility %D 2017 %7 08.08.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: MyAVL is an interactive portal for cancer patients that aims to support lung cancer patients. Objective: We aimed to evaluate the feasibility and usability of the patient portal and generate preliminary evidence on its impact. Methods: Lung cancer patients currently or recently treated with curative intent could use MyAVL noncommittally for 4 months. Feasibility, usability, and preliminary impact (ie, patient activation, quality of life, and physical activity) were studied by means of questionnaires, a focus group, and analysis of user log data. Results: We included 37 of 123 eligible patients (mean age 59.6 years). The majority of responses (82%) were positive about using MyAVL, 69% saw it as a valuable addition to care, and 56% perceived increased control over their health. No positive effects could be substantiated on the impact measures. Conclusions: MyAVL appears to be a feasible and user-friendly, multifunctional eHealth program for a selected group of lung cancer patients. However, it needs further improvements to positively impact patient outcomes. %M 28790025 %R 10.2196/cancer.7443 %U http://cancer.jmir.org/2017/2/e10/ %U https://doi.org/10.2196/cancer.7443 %U http://www.ncbi.nlm.nih.gov/pubmed/28790025 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e11 %T Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients %A Hartkopf,Andreas D %A Graf,Joachim %A Simoes,Elisabeth %A Keilmann,Lucia %A Sickenberger,Nina %A Gass,Paul %A Wallwiener,Diethelm %A Matthies,Lina %A Taran,Florin-Andrei %A Lux,Michael P %A Wallwiener,Stephanie %A Belleville,Eric %A Sohn,Christof %A Fasching,Peter A %A Schneeweiss,Andreas %A Brucker,Sara Y %A Wallwiener,Markus %+ Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 56 36956, markus.wallwiener@gmail.com %K breast cancer %K patient-reported outcome measures %K electronic patient- reported outcome %K technical skills %K willingness to use %K needs and barriers %D 2017 %7 07.08.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients’ subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited. Objective: The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients’ willingness to participate in such programs. Methods: The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes’ bias-corrected bootstrap) were performed. Results: A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ≤.001). Significant differences were found in relation to willingness to use ePRO (92.3% in the exposed group vs 59% in the nonexposed group; P=.001). Multiple barriers were identified, and most of them showed statistically significant differences in favor of the exposed patients (ie, data security [13% in the exposed patients vs 30% in the nonexposed patients; P=.003] and no prior technology usage [5% in the exposed group vs 15% in the nonexposed group; P=.02]), whereas the differences in disease burden (somatic dimension: 4% in the exposed group vs 9% in the nonexposed group; P=.13) showed no significance. In nonexposed patients, requests for support services were identified, which could increase their ePRO willingness. Conclusions: Significant barriers in relation to HRQoL, cancer-related restrictions, and especially the setting of the survey were identified in this trial. Thus, it is necessary to address and eliminate these barriers to ensure data accuracy and reliability for future ePRO assessments. Exposure seems to be a potential option to increase willingness to use ePRO and to reduce barriers. %M 28784595 %R 10.2196/cancer.6996 %U http://cancer.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/cancer.6996 %U http://www.ncbi.nlm.nih.gov/pubmed/28784595 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e108 %T 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 %A Sun,Yunheng %A Jiang,Feng %A Gu,Juan J %A Wang,Y Ken %A Hua,Hongwei %A Li,Jing %A Cheng,Zhijun %A Liao,Zhijun %A Huang,Qian %A Hu,Weiwei %A Ding,Gang %+ Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang Road, Shanghai,, China, 86 02169691540, 13817360711@163.com %K cancer pain %K intelligent pain management system %K smart phone %K intervention %D 2017 %7 25.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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) %M 28743681 %R 10.2196/mhealth.7178 %U http://mhealth.jmir.org/2017/7/e108/ %U https://doi.org/10.2196/mhealth.7178 %U http://www.ncbi.nlm.nih.gov/pubmed/28743681 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e9 %T Development, Feasibility, and Small-Scale Implementation of a Web-Based Prognostic Tool—Surveillance, Epidemiology, and End Results Cancer Survival Calculator %A Henton,Michelle %A Gaglio,Bridget %A Cynkin,Laurie %A Feuer,Eric J %A Rabin,Borsika A %+ Clinical Effectiveness and Decision Science, Patient-Centered Outcomes Research Institute, 1828 L St. NW, Ste. 900, Washington, DC, 20036, United States, 1 202 370 9410, mhenton@pcori.org %K clinical decision-making %K communication %K neoplasms %K patient care team %K Internet %D 2017 %7 20.07.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information. Objective: The aim of this study was to develop, test, and implement SEER*CSC. Methods: An iterative approach was used to develop the SEER*CSC. Based on input from cancer patient advocacy groups and physicians, an initial version of the tool was developed. Next, providers from 4 health care delivery systems were recruited to do formal usability testing of SEER*CSC. A revised version of SEER*CSC was then implemented in two health care delivery sites using a real-world clinical implementation approach, and usage data were collected. Post-implementation follow-up interviews were conducted with site champions. Finally, patients from two cancer advocacy groups participated in usability testing. Results: Overall feedback of SEER*CSC from both providers and patients was positive, with providers noting that the tool was professional and reliable, and patients finding it to be informational and helpful to use when discussing their diagnosis with their provider. However, use during the small-scale implementation was low. Reasons for low usage included time to enter data, not having treatment options in the tool, and the tool not being incorporated into the electronic health record (EHR). Patients found the language in its current version to be too complex. Conclusions: The implementation and usability results showed that participants were enthusiastic about the use and features of SEER*CSC, but sustained implementation in a real-world clinical setting faced significant challenges. As a result of these findings, SEER*CSC is being redesigned with more accessible language for a public facing release. Meta-tools, which put different tools in context of each other, are needed to assist in understanding the strengths and limitations of various tools and their place in the clinical decision-making pathway. The continued development and eventual release of prognostic tools should include feedback from multidisciplinary health care teams, various stakeholder groups, patients, and caregivers. %M 28729232 %R 10.2196/cancer.7120 %U http://cancer.jmir.org/2017/2/e9/ %U https://doi.org/10.2196/cancer.7120 %U http://www.ncbi.nlm.nih.gov/pubmed/28729232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e219 %T My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer %A Voruganti,Teja %A Grunfeld,Eva %A Jamieson,Trevor %A Kurahashi,Allison M %A Lokuge,Bhadra %A Krzyzanowska,Monika K %A Mamdani,Muhammad %A Moineddin,Rahim %A Husain,Amna %+ Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, 4th Floor, Box 13, 60 Murray Street, Toronto, ON,, Canada, 1 416 586 4800 ext 7884, amna.husain@tlcpc.org %K MeSH: Internet %K professional-patient relations %K interdisciplinary communication %K neoplasms %K adult %K chronic disease %K continuity of patient care %K patient care team %K communication %K outcome assessment (health care) %D 2017 %7 18.07.2017 %9 Original Paper %J J Med Internet Res %G English %X 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). %M 28720558 %R 10.2196/jmir.7421 %U http://www.jmir.org/2017/7/e219/ %U https://doi.org/10.2196/jmir.7421 %U http://www.ncbi.nlm.nih.gov/pubmed/28720558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e122 %T Reducing Parental Uncertainty Around Childhood Cancer: Implementation Decisions and Design Trade-Offs in Developing an Electronic Health Record-Linked Mobile App %A Marsolo,Keith %A Shuman,William %A Nix,Jeremy %A Morrison,Caroline F %A Mullins,Larry L %A Pai,Ahna LH %+ Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7024, Cincinnati, OH, 45229, United States, 1 5138030333, keith.marsolo@cchmc.org %K electronic health records %K mobile apps %K uncertainty %K ethnographic design %D 2017 %7 26.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information; however, families of newly diagnosed cancer patients are often bombarded with educational material. Technology has the potential to help families manage their informational needs and move towards normalization. Objective: The aim of this study was to create a mobile app that pulls together data from both the electronic health record (EHR) and vetted external information resources to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child’s illness. This app was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. Methods: A 2-phase qualitative study was conducted to elicit the features and content of the mobile app based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) as well as from groups like the Children’s Oncology Group (COG) and care teams within Cincinnati Children’s Hospital Medical Center (CCHMC). The use of EHR-based Web services was explored to allow data like laboratory results to be retrieved in real-time. Results: The ethnographic design process resulted in a framework that divided the content of the mobile app into the following 4 sections: (1) information about the patient’s current treatment and other data from the EHR; (2) educational background material; (3) a calendar to view upcoming appointments at their medical center; and (4) a section where participants in the RCT document the study data. Integration with the NCI databases was straightforward; however, accessing the EHR Web services posed a challenge, though the roadblocks were not technical in nature. The lack of a formal, end-to-end institutional process for requesting Web service access and a mechanism to shepherd the request through all stages of implementation proved to be the biggest barrier. Conclusions: We successfully deployed a mobile app with a custom user interface that can integrate with the EHR to retrieve laboratory results and appointment information using vendor-provided Web services. Developers should expect to face hurdles when integrating with the EHR, but many of them can be addressed with frequent communication and thorough documentation. Executive sponsorship is also a key factor for success. Trial Registration: ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT) %M 28652227 %R 10.2196/resprot.7523 %U http://www.researchprotocols.org/2017/6/e122/ %U https://doi.org/10.2196/resprot.7523 %U http://www.ncbi.nlm.nih.gov/pubmed/28652227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e172 %T Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer %A Hanlon,Peter %A Daines,Luke %A Campbell,Christine %A McKinstry,Brian %A Weller,David %A Pinnock,Hilary %+ Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 131 650 9474, hilary.pinnock@ed.ac.uk %K telehealth %K telemonitoring %K self-management %K chronic disease %K diabetes %K heart failure %K asthma %K COPD %K pulmonary disease, chronic obstructive %K cancer %D 2017 %7 17.05.2017 %9 Review %J J Med Internet Res %G English %X Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established. %M 28526671 %R 10.2196/jmir.6688 %U http://www.jmir.org/2017/5/e172/ %U https://doi.org/10.2196/jmir.6688 %U http://www.ncbi.nlm.nih.gov/pubmed/28526671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e163 %T Health-Related Internet Use in People With Cancer: Results From a Cross-Sectional Study in Two Outpatient Clinics in Sweden %A Mattsson,Susanne %A Olsson,Erik Martin Gustaf %A Johansson,Birgitta %A Carlsson,Maria %+ Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 75122, Sweden, 46 18471 6622, susanne.mattsson@pubcare.uu.se %K Oncology %K eHealth %K support %D 2017 %7 15.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The access to various forms of support during the disease trajectory is crucial for people with cancer. The provision and use of Internet health services is increasing, and it is important to further investigate the preferences and demographical characteristics of its users. Investigating the uptake and perceived value of Internet health services is a prerequisite to be able to meet the needs in the targeted group. Objective: The objective of this study was to investigate health-related Internet use among people with cancer. Methods: The health online support questionnaire (HOSQ), examining the incentives for health-related Internet support use, was administered in two Swedish outpatient hospital clinics. Of the 350 copies of the questionnaire handed out, 285 (81.4%) were returned, answered by persons with cancer who had completed treatment or were under active surveillance or another medical treatment. Results: A total of 215 (76.2%, 215/282) participants reported Internet use since being diagnosed with cancer. Internet-users were younger (P<.001), more likely to have a partner (P=.03), and had a higher level of education than nonusers (P<.001). The most common health-related activity on the Internet was searching for information (77.2%, 166/215), and users searched significantly more immediately after diagnosis compared with later on (P<.001). Use of My Healthcare Contacts was considered the most valuable Internet activity. Having a university degree (P ˂.001) and being younger in age (P=.01) were associated with a significantly higher frequency of health- related Internet use. Conclusions: People with cancer turn to the Internet for informational support that enables them to influence their care and to stay in touch with friends and relatives. Demographical differences regarding the uptake of Web-based support remains. This indicates a need for research on how to bridge this digital gap. By learning more about the use of health-related support on the Web among people with cancer, adequate support can be offered and potential strain reduced. %M 28506959 %R 10.2196/jmir.6830 %U http://www.jmir.org/2017/5/e163/ %U https://doi.org/10.2196/jmir.6830 %U http://www.ncbi.nlm.nih.gov/pubmed/28506959 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e85 %T PatientVOICE: Development of a Preparatory, Pre-Chemotherapy Online Communication Tool for Older Patients With Cancer %A van Dulmen,Sandra %A Driesenaar,Jeanine A %A van Weert,Julia CM %A van Osch,Mara %A Noordman,Janneke %+ Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, Utrecht, 3500 BN, Netherlands, 31 302729703, s.vandulmen@nivel.nl %K intervention mapping %K chemotherapy %K online intervention %K communication %K patient participation %K question prompt sheet %K elderly %D 2017 %7 10.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Good communication around cancer treatment is essential in helping patients cope with their disease and related care, especially when this information is tailored to one’s needs. Despite its importance, communication is often complex, in particular in older patients (aged 65 years or older). In addition to the age-related deterioration in information and memory processing older patients experience, communication is also complicated by their required yet often unmet role of being an active, participatory patient. Older patients rarely express their informational needs and their contributions to consultations are often limited. Therefore, older patients with cancer need to be prepared to participate more actively in their care and treatment. Objective: The objective of this paper was to report the development of PatientVOICE, an online, preparatory tool with audio facility aimed to enhance the participation of older patients during educational nursing encounters preceding chemotherapy and to improve their information recall. Methods: PatientVOICE was developed by applying the following 6 steps of the intervention mapping framework that involved both patients and nurses: (1) needs assessment, (2) specifying determinants and change objectives, (3) reviewing and selecting theoretical methods and practical strategies, (4) developing intervention components, (5) designing adoption and implementation, and (6) making an evaluation plan. Results: A careful execution of these consecutive steps resulted in the ready-to-use preparatory website. PatientVOICE provides pre-visit information about chemotherapy (ie, medical information, side effects, and recommendations of dealing with side effects), information about the educational nursing visit preceding chemotherapy (ie, aim, structure, and recommendations for preparation), techniques to improve patients’ communication skills using a question prompt sheet (QPS) and video-modeling examples showing “best practices”, and the opportunity to upload and listen back to an audio recording of a patient’s own nursing visit. Conclusions: The development process resulted in PatientVOICE, a multi-component online intervention targeted to older patients with cancer. PatientVOICE contains information about the treatment as well as information about the role of the patient during treatment. Using different methods (QPS and audio facility), we hope to support these patients during their treatment. In the future, the utility and usability of this complex intervention will be evaluated in a group of older patients who receive or have received chemotherapy. %M 28490421 %R 10.2196/resprot.6979 %U http://www.researchprotocols.org/2017/5/e85/ %U https://doi.org/10.2196/resprot.6979 %U http://www.ncbi.nlm.nih.gov/pubmed/28490421 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 1 %P e4 %T Assessing the Quality, Feasibility, and Efficacy of Electronic Patient Platforms Designed to Support Adolescents and Young Adults With Cancer: A Systematic Review Protocol %A Pugh,Gemma %A McCann,Lisa %+ Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London,, United Kingdom, 44 2076791736, gemma.pugh.14@ucl.ac.uk %K adolescent %K neoplasms %K telemedicine %K review %D 2017 %7 17.01.2017 %9 Protocol %J JMIR Res Protoc %G English %X 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. %M 28096067 %R 10.2196/resprot.6597 %U http://www.researchprotocols.org/2017/1/e4/ %U https://doi.org/10.2196/resprot.6597 %U http://www.ncbi.nlm.nih.gov/pubmed/28096067 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e11 %T Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis %A Cox,Anna %A Lucas,Grace %A Marcu,Afrodita %A Piano,Marianne %A Grosvenor,Wendy %A Mold,Freda %A Maguire,Roma %A Ream,Emma %+ School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH, United Kingdom, 44 1483684626, a.cox@surrey.ac.uk %K neoplasms %K telemedicine %K systematic review %K survival %K patient satisfaction %K patient preference %D 2017 %7 09.01.2017 %9 Review %J J Med Internet Res %G English %X Background: Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective: To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods: Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Results: Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance—a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors’ lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Conclusions: Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit. %M 28069561 %R 10.2196/jmir.6575 %U http://www.jmir.org/2017/1/e11/ %U https://doi.org/10.2196/jmir.6575 %U http://www.ncbi.nlm.nih.gov/pubmed/28069561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e305 %T Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project %A Innominato,Pasquale F %A Komarzynski,Sandra %A Mohammad-Djafari,Ali %A Arbaud,Alexandre %A Ulusakarya,Ayhan %A Bouchahda,Mohamed %A Haydar,Mazen %A Bossevot-Desmaris,Rachel %A Plessis,Virginie %A Mocquery,Magali %A Bouchoucha,Davina %A Afshar,Mehran %A Beau,Jacques %A Karaboué,Abdoulaye %A Morère,Jean-François %A Fursse,Joanna %A Rovira Simon,Jordi %A Levi,Francis %+ Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 2476575132, F.Levi@warwick.ac.uk %K domomedicine %K chronotherapy %K actigraphy %K MDASI %K telemonitoring %D 2016 %7 25.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient’s home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy. Objective: The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home. Methods: Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I