%0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64208 %T The Efficacy of Digital Interventions on Adherence to Oral Systemic Anticancer Therapy Among Patients With Cancer: Systematic Review and Meta-Analysis %A Liao,Wan-Chuen %A Angus,Fiona %A Conley,Jane %A Chen,Li-Chia %K efficacy %K digital interventions %K oral systemic anticancer therapy %K medication adherence %K cancer %K oral %K patients with cancer %K therapy %K systematic review %K meta-analysis %K care plans %K medication %K treatments %K mobile app %K mobile applications %K mHealth %K multimedia platforms %K digital technology %K self-reported %K mobile phone %D 2025 %7 16.4.2025 %9 %J JMIR Cancer %G English %X Background: Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anticancer therapy (SACT), the crucial lifesaving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions. Objectives: This systematic review and meta-analysis aimed to investigate the efficacy of digital interventions in improving adherence to oral SACTs in patients with cancer. Methods: This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. The protocol has been registered at PROSPERO (no. CRD42024550203). Fully published, randomized controlled trials (RCTs) in English on adults with cancer assessing digital interventions for improving adherence to oral SACTs were retrieved from MEDLINE, Embase, APA PsycINFO, and CINAHL Plus up to May 31, 2024. Adherence measures compared between digital intervention users and nonusers were extracted. The proportions of poor adherence were synthesized using a random-effects model. The pooled results were reported as the odds ratio and 95% CI. The heterogeneity was assessed with the I2 test (%). The mean difference and 95% CI were calculated from the mean adherence score and SD. A risk of bias assessment was conducted using version 2 of the Cochrane Risk of Bias Assessment Tool (RoB 2) for RCTs, which ensured that a quality assessment of all included studies was conducted as recommended by the Cochrane Collaboration. Results: This study included 13 RCTs on digital interventions for improving adherence to oral SACTs in patients with cancer. The 13 RCTs, published between 2016 and 2024, were conducted in the United States, South Korea, France, Egypt, Finland, Australia, Colombia, Singapore, and Turkey. The technologies used were mobile apps (n=4), reminder systems (n=4), telephone follow-ups (n=3), and interactive multimedia platforms (n=2). Adherence was measured by surveys (n=8), relative dose intensity (n=2), pill count (n=1), self-reported missed doses (n=1), a smart pill bottle (n=1), and urine aromatase inhibitor metabolite assays (n=1). Concerns regarding risk of bias primarily involved randomization, missing outcome data, and outcome measurement, including nonblinded randomization, subjective patient-reported data, and difficulties in distinguishing between missed appointments and actual medication nonadherence. Pooled results from 11 trials showed that digital technology users had significantly lower risk of poor adherence (odds ratio 0.60, 95% CI 0.47‐0.77). Two studies reported positive mean differences in adherence scores comparing digital intervention users and nonusers. However, due to considerable heterogeneity (I²=73.1%), it is difficult to make a definitive conclusion from the pooled results about the effect of digital interventions upon adherence to oral anticancer therapy. Conclusions: Digital intervention users exhibited significantly lower risk of poor oral SACTs adherence than nonusers. Acknowledging individual variation and tailoring digital technologies to prioritize patient needs is essential. Trial Registration: PROSPERO CRD42024550203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024550203 %R 10.2196/64208 %U https://cancer.jmir.org/2025/1/e64208 %U https://doi.org/10.2196/64208 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e63677 %T Assessing the Quality and Reliability of ChatGPT’s Responses to Radiotherapy-Related Patient Queries: Comparative Study With GPT-3.5 and GPT-4 %A Grilo,Ana %A Marques,Catarina %A Corte-Real,Maria %A Carolino,Elisabete %A Caetano,Marco %K artificial intelligence %K ChatGPT %K large language model %K radiotherapy %K patient information %K quality %K internet access %K health information %K cancer awareness %K accuracy %K readability %K chatbot %K patient query %K chat generative pretrained transformer %K OpenAI %K natural language processing %K patients with cancer %D 2025 %7 16.4.2025 %9 %J JMIR Cancer %G English %X Background: Patients frequently resort to the internet to access information about cancer. However, these websites often lack content accuracy and readability. Recently, ChatGPT, an artificial intelligence–powered chatbot, has signified a potential paradigm shift in how patients with cancer can access vast amounts of medical information, including insights into radiotherapy. However, the quality of the information provided by ChatGPT remains unclear. This is particularly significant given the general public’s limited knowledge of this treatment and concerns about its possible side effects. Furthermore, evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and result in delays in receiving appropriate treatment. Objective: This study aims to evaluate the quality and reliability of ChatGPT’s responses to common patient queries about radiotherapy, comparing the performance of ChatGPT’s two versions: GPT-3.5 and GPT-4. Methods: We selected 40 commonly asked radiotherapy questions and entered the queries in both versions of ChatGPT. Response quality and reliability were evaluated by 16 radiotherapy experts using the General Quality Score (GQS), a 5-point Likert scale, with the median GQS determined based on the experts’ ratings. Consistency and similarity of responses were assessed using the cosine similarity score, which ranges from 0 (complete dissimilarity) to 1 (complete similarity). Readability was analyzed using the Flesch Reading Ease Score, ranging from 0 to 100, and the Flesch-Kincaid Grade Level, reflecting the average number of years of education required for comprehension. Statistical analyses were performed using the Mann-Whitney test and effect size, with results deemed significant at a 5% level (P=.05). To assess agreement between experts, Krippendorff α and Fleiss κ were used. Results: GPT-4 demonstrated superior performance, with a higher GQS and a lower number of scores of 1 and 2, compared to GPT-3.5. The Mann-Whitney test revealed statistically significant differences in some questions, with GPT-4 generally receiving higher ratings. The median (IQR) cosine similarity score indicated substantial similarity (0.81, IQR 0.05) and consistency in the responses of both versions (GPT-3.5: 0.85, IQR 0.04; GPT-4: 0.83, IQR 0.04). Readability scores for both versions were considered college level, with GPT-4 scoring slightly better in the Flesch Reading Ease Score (34.61) and Flesch-Kincaid Grade Level (12.32) compared to GPT-3.5 (32.98 and 13.32, respectively). Responses by both versions were deemed challenging for the general public. Conclusions: Both GPT-3.5 and GPT-4 demonstrated having the capability to address radiotherapy concepts, with GPT-4 showing superior performance. However, both models present readability challenges for the general population. Although ChatGPT demonstrates potential as a valuable resource for addressing common patient queries related to radiotherapy, it is imperative to acknowledge its limitations, including the risks of misinformation and readability issues. In addition, its implementation should be supported by strategies to enhance accessibility and readability. %R 10.2196/63677 %U https://cancer.jmir.org/2025/1/e63677 %U https://doi.org/10.2196/63677 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e67108 %T Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial %A Lin,Yu Chen %A Hagen,Ryan %A Powers,Benjamin D %A Dineen,Sean P %A Milano,Jeanine %A Hume,Emma %A Sprow,Olivia %A Diaz-Carraway,Sophia %A Permuth,Jennifer B %A Deneve,Jeremiah %A Alishahi Tabriz,Amir %A Turner,Kea %K gastrointestinal cancer %K peritoneal disease %K cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy %K digital health intervention %K nutrition %K feasibility %D 2025 %7 7.4.2025 %9 %J JMIR Cancer %G English %X Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. Objective: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. Methods: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients’ reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. Results: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59% vs benchmark: 50%), study assessment completion (9/10, 90% vs benchmark: 60%), dietitian appointment attendance (7/10, 70% vs benchmark: 60%), daily food intake logging adherence (6/10, 60% vs benchmark: 60%), and participant retention (10/10, 100% vs benchmark: 60%). Most participants rated the intervention as acceptable (8/10, 80% vs benchmark: 70%) and reported a high level of usability for dietitian services (10/10, 100%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. Conclusions: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes. Trial Registration: ClinicalTrials.gov NCT05649969; https://clinicaltrials.gov/study/NCT05649969 %R 10.2196/67108 %U https://cancer.jmir.org/2025/1/e67108 %U https://doi.org/10.2196/67108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63989 %T Evaluating the Effectiveness of a Mobile App for Breast Cancer Self-Management on Self-Efficacy: Nonrandomized Intervention Trial %A Kim,Sun Mi %A Kim,Da Seul %A Jang,Yoonsung %A Kim,Min Kyoon %A Yu,Eun-Seung %A Han,Doug Hyun %A Kim,Hee Jun %+ Division of Medical Oncology, Department of Internal Medicine, College of Medicine, Chung-Ang University, 84 Heukseok-ro, Dongjack-gu, Seoul, 06974, Republic of Korea, 82 262993159, heejun.dino11@gmail.com %K breast cancer %K mobile health %K mHealth %K health education %K self-efficacy %K psychological adjustments %K mobile phone %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous mobile apps have been developed for patients with cancer. However, there is still no comprehensive app for patients with breast cancer that integrates evidence-based medical information, psychological support, and schedule management through a multidisciplinary medical approach. Objective: We aimed to investigate whether a mobile app designed to assist in the self-management of patients with breast cancer is feasible and positively affects their self-efficacy and other psychological aspects. Methods: The Cancer Manager (CAMA) app was developed to assist in the self-management of patients with breast cancer and survivors of cancer according to cancer trajectory. Its functionalities include providing evidence-based digitalized information created by experts, managing patients’ medication and medical appointment schedules, and providing a delayed question and answer system for patients to query health care professionals. In this nonrandomized intervention trial, we analyzed data from 66 patients with breast cancer, divided into experimental (CAMA: n=34, 52%) and control (treatment as usual: n=32, 48%) groups. Group allocation was determined based on the patient’s willingness to use the app and access to compatible smartphones. Outcome measures included the Korean version of the Cancer Survivor Self-Efficacy Scale, the Korean version of the Mini-Mental Adjustment to Cancer (K-Mini-MAC) Scale, the World Health Organization Quality of Life Brief Version, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Menopause Emotional Symptoms Questionnaire (MESQ). A user satisfaction survey was also conducted. Results: Throughout the intervention period, the CAMA group (vs treatment as usual group) demonstrated significant improvements in the seeking help and support subscale of the Korean version of the Cancer Survivor Self-Efficacy Scale (F1,64=5.09; P=.03), the psychological well-being subscale of the World Health Organization Quality of Life Brief Version (F1,64=5.48; P=.02), the anxious preoccupation subscale (F1,64=5.49; P=.02) and positive attitude subscale (F1,64=5.44; P=.02) of the K-Mini-MAC Scale, PHQ-9 (F1,64=4.83; P=.03), GAD-7 (F1,64=5.48; P=.02), and MESQ (F1,64=4.30; P=.04). Changes in the anxious preoccupation subscale of the K-Mini-MAC Scale scores were positively correlated with changes in the PHQ-9 (r=0.46; P=.007) and GAD-7 (r=0.41; P=.02) scores and negatively correlated with changes in the positive attitude subscale of the K-Mini-MAC Scale scores (r=–0.36; P=.04). Changes in the PHQ-9 scores were positively correlated with changes in the GAD-7 (r=0.66; P<.001) and MESQ (r=0.35; P=.04) scores. The user satisfaction survey offered insights into the CAMA app’s positive impact; trust-building outcomes; and opportunities for enhancement, such as the inclusion of communication tools and continued content enrichment. Conclusions: The mobile app for breast cancer self-management, CAMA, was deemed feasible and showed promise in improving the patients’ self-efficacy regarding seeking help and support, positive attitude toward cancer, and psychological well-being. In addition, its use might help reduce anxious preoccupation with cancer, depressive mood, anxiety, and menopausal emotional symptoms. Trial Registration: Clinical Research Information Service KCT0007917; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23348 %M 40138696 %R 10.2196/63989 %U https://mhealth.jmir.org/2025/1/e63989 %U https://doi.org/10.2196/63989 %U http://www.ncbi.nlm.nih.gov/pubmed/40138696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60588 %T Patient and Provider Perspectives of a Web-Based Intervention to Support Symptom Management After Radioactive Iodine Treatment for Differentiated Thyroid Cancer: Qualitative Study %A Carr,Alaina L %A Jenkins,Angela M %A Jonklaas,Jacqueline %A Gabriel,Kate %A Miller,Kristen E %A Graves,Kristi D %K iodine radioisotopes %K person-based approach %K self-management %K Social Cognitive Theory %K survivorship %K symptom burden %K thyroid neoplasms %K web-based intervention %K radioactive iodine treatment %K radiotherapy %K thyroid cancer %K qualitative %K quality of life %K survivorship care %K supportive care %K patient with cancer %K QoL %K cancer %K carcinoma %K malignancy %K tumor %K malignant %K oncology %K neoplasm %K benign %K neoplasia %K thyroid %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Patients diagnosed with differentiated thyroid cancer (DTC) who receive radioactive iodine (RAI) treatment experience acute, medium, and late treatment effects. The timing and severity of these effects vary by individual; common posttreatment effects include dry mouth, salivary gland swelling, dry eyes, and nose bleeds. The nature of symptoms that patients experience after RAI treatment can significantly and negatively impact health-related quality of life. Adequate information during the postprimary treatment phase remains an unmet need among the population of patients diagnosed with DTC. Objective: This qualitative study aimed to identify and understand self-management strategies for RAI-specific symptom burden from the perspectives of patients and stakeholders (cancer care providers and patient advocates). An additional aim included assessing features and functionalities desirable in the development of a web-based intervention to engage patients in their self-management and thyroid cancer survivorship care. Methods: Following the Social Cognitive Theory framework and person-based principles, we conducted six focus groups with 22 patients diagnosed with DTC who completed RAI treatment and individual interviews with 12 stakeholders in DTC care. The interviews focused on participants’ perspectives on current self-management strategies and mockups of a symptom management web-based intervention. Before focus groups and interviews, participants completed a demographics survey. Focus group discussions and interviews were transcribed and coded using content analysis. Interrater reliability was satisfactory (ɑ=.88). Results: A total of 34 individuals (patients and stakeholders) participated in the study; the mean age was 45 (SD 13.4) and 45.3 (SD 13) years, respectively. Three domains emerged from qualitative interviews: (1) difficult-to-manage RAI symptoms: short, medium, and late treatment effects; (2) key intervention structure and content feedback on mockups; and (3) intervention content to promote RAI symptom management and survivorship care. Focus group participants identified the most prevalent RAI symptoms that were difficult to manage as: dry mouth (11/22, 50%), salivary gland swelling (8/22, 36%), and changes in taste (12/22, 55%). Feedback elicited from both groups found education and symptom management mockup videos to be helpful in patient self-management of RAI symptoms, whereas patients and stakeholders provided mixed feedback on the benefits of a draft frequently asked questions page. Across focus groups and stakeholder interviews, nutrition-based symptom management strategies, communication with family members, and practical survivorship follow-up information emerged as helpful content to include in a future web-based supportive care intervention. Conclusions: Results suggest education and symptom management videos can empower patients with DTC to self-manage mild to moderate RAI symptoms on a web-based platform. Findings emphasized the need for additional information for patients related to ongoing care following RAI treatment including social support and thyroid cancer surveillance. The findings provide insights for theoretically informed interventions and recommendations for refinements in thyroid cancer survivorship from patient and provider perspectives. %R 10.2196/60588 %U https://formative.jmir.org/2025/1/e60588 %U https://doi.org/10.2196/60588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63891 %T Efficacy of a Supervised Exercise Program on Pain, Physical Function, and Quality of Life in Patients With Breast Cancer: Protocol for a Randomized Clinical Trial %A García-Molina,Jennifer %A Saiz-Vázquez,Olalla %A Santamaría-Vázquez,Montserrat %A Ortiz-Huerta,Juan Hilario %+ Paseo de los Encomendadores, Faculty of Health Sciences, University of Burgos, Paseo de los Encomendadores S/N, Burgos, 09001, Spain, 34 644592769, osaiz@ubu.es %K breast cancer %K exercise %K quality of life %K muscle strength %K pain %K efficacy %K protocol %K physical exercise %K fatigue %K loss of muscle %K physical function %K randomized clinical trial %K patients with cancer %D 2025 %7 12.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the second most common cancer in women worldwide. Treatments for this disease often result in side effects such as pain, fatigue, loss of muscle mass, and reduced quality of life. Physical exercise has been shown to effectively mitigate these side effects and improve the quality of life in patients with breast cancer. Objective: This randomized clinical trial aims to evaluate the efficacy of a 12-week supervised exercise program on pain, physical function, and quality of life in female patients with cancer. Methods: This randomized, double-blind clinical trial will recruit 325 participants, divided into an intervention group receiving the exercise program and a control group receiving standard care recommendations. Outcome measures, including pain (assessed via the Brief Pain Inventory), physical function (Disability of the Arm, Shoulder, and Hand Questionnaire), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 and European Organization for Research and Treatment of Cancer QLQ-BR23), will be evaluated at baseline, immediately post intervention, and 12 weeks post intervention. Statistical analysis will involve repeated measures of ANOVA and MANOVA to determine the significance of the intervention’s effects across time points. Results: Recruitment and data collection will commence in February of 2025, and data analysis is scheduled for completion at the end of 2025. No results are currently available Conclusions: Physical exercise is anticipated to play a significant role in alleviating pain, enhancing physical function, and improving the quality of life in female patients with cancer. This study will provide robust evidence to support the integration of supervised exercise into standard care protocols for this population. Trial Registration: ClinicalTrials.gov NCT06618690; https://clinicaltrials.gov/ct2/show/NCT06618690 International Registered Report Identifier (IRRID): PRR1-10.2196/63891 %M 40073395 %R 10.2196/63891 %U https://www.researchprotocols.org/2025/1/e63891 %U https://doi.org/10.2196/63891 %U http://www.ncbi.nlm.nih.gov/pubmed/40073395 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e63486 %T Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer %A Lyhne,Johanne Dam %A Smith,Allan ‘Ben’ %A Carstensen,Tina Birgitte Wisbech %A Beatty,Lisa %A Bamgboje-Ayodele,Adeola %A Klein,Britt %A Jensen,Lars Henrik %A Frostholm,Lisbeth %K fear of cancer recurrence %K therapist-guided %K self-guided %K online intervention %K colorectal cancer %K digital health %K psychosocial intervention %K survivorship %K eHealth %K adaptation %K survivors %K oncologists %K therapists %K acceptability %K mobile phone %D 2025 %7 5.3.2025 %9 %J JMIR Cancer %G English %X Therapist-guided eHealth interventions have been shown to engage users more effectively and achieve better outcomes than self-guided interventions when addressing psychological symptoms. Building on this evidence, this viewpoint aimed to describe the adaptation of iConquerFear, a self-guided eHealth intervention targeting fear of cancer recurrence, into a therapist-guided version (TG-iConquerFear) tailored specifically for survivors of colorectal cancer (CRC). The goal was to optimize patient outcomes while minimizing the need for extensive resources. The adaptation process followed the Information System research framework, which facilitated a systematic integration of knowledge and iterative testing. Drawing on insights from the original iConquerFear development, as well as feedback from end users, oncologists, and therapists, we began by identifying areas for improvement. These insights formed the foundation for the first design cycle. Initial internal testing revealed the need for several adjustments to enhance the intervention. While the core concept of iConquerFear remained unchanged, we made significant modifications to improve access by optimizing the platform for mobile devices, to support adherence by expanding the exercises, and to equip therapists with tools such as reflective questions and a monitoring control panel. External field testing with 5 survivors of CRC provided further validation. Participants reported a high level of acceptability, and their feedback guided additional minor points to consider incorporating in future versions. This study illustrates how a self-guided eHealth intervention can be successfully adapted into a therapist-guided format for fear of cancer recurrence, tailored to meet the needs of survivors of CRC. The described approach serves as a valuable framework for integrating therapist guidance into similar interventions, ensuring their relevance and effectiveness for targeted populations.Trial Registration: ClinicalTrials.gov NCT04287218; https://clinicaltrials.gov/study/NCT04287218 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-020-06731-6 %R 10.2196/63486 %U https://cancer.jmir.org/2025/1/e63486 %U https://doi.org/10.2196/63486 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65615 %T Remote Monitoring of Chemotherapy-Induced Peripheral Neuropathy by the NeuroDetect iOS App: Observational Cohort Study of Patients With Cancer %A Chen,Ciao-Sin %A Dorsch,Michael P %A Alsomairy,Sarah %A Griggs,Jennifer J %A Jagsi,Reshma %A Sabel,Michael %A Stino,Amro %A Callaghan,Brian %A Hertz,Daniel L %+ Department of Clinical Pharmacy, University of Michigan College of Pharmacy, University of Michigan, 428 Church St., Ann Arbor, MI, 48109, United States, 1 734 763 0015, dlhertz@med.umich.edu %K chemotherapy-induced peripheral neuropathy %K smartphone %K mobile health %K gait %K balance %K manual dexterity %K mobile phone %K chemotherapy %K peripheral neuropathy %K CIPN %K neurotoxic chemotherapy %K monitoring %K detection %K patient-reported outcomes %K mHealth %K application %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of neurotoxic chemotherapy characterized by symptoms such as numbness, tingling, and weakness. Effective monitoring and detection of CIPN are crucial for avoiding progression to irreversible symptoms. Due to the inconvenience of clinic-based objective assessment, CIPN detection relies primarily on patients’ reporting of subjective symptoms, and patient-reported outcomes are used to facilitate CIPN detection. Our previous study found evidence that objective functional assessments completed within a smartphone app may differentiate patients with and those without CIPN after treatment. Objective: This prospective, longitudinal observational cohort study aimed to determine the feasibility and accuracy of app-based remote monitoring of CIPN in patients with cancer undergoing neurotoxic chemotherapeutic treatment and to conduct exploratory comparisons of app-based functional CIPN monitoring versus patient-reported outcome–only monitoring. Methods: The NeuroDetect app (Medable Inc) includes subjective EORTC (European Organization for Research and Treatment of Cancer) Quality of Life Questionnaire (QLQ)–20-item scale (CIPN20) and 6 objective functional assessments that use smartphone sensors to mimic neurological examinations, such as walking, standing, and manual dexterity tests. The functional assessment data were collected from patients with cancer undergoing neurotoxic chemotherapy, and a neurological examination was conducted at the end of treatment to diagnose CIPN in the feet (CIPN-f) or CIPN in the hands (CIPN-h). Various classification models including NeuroDetect features only (NeuroDetect Model) CIPN20-only (CIPN20 Model) or a combination of both (Combined Model) were trained and evaluated for accuracy in predicting CIPN probability. Results: Of the 45 patients who completed functional assessments and neurological examinations, 24 had CIPN-f, and 29 had CIPN-h. The NeuroDetect Model could discriminate between patients with and those without CIPN-f (area under the curve=83.8%, comparison with no information rate P=.02) but not CIPN-h (area under the curve=67.9%, P=.18). The rolling rotation features from the eyes-closed phase of the Romberg Stance assessment showed the greatest contribution to CIPN-f (40% of total variable importance) and the Finger Tapping assessment showed the greatest contribution to CIPN-h (85% of total variable importance). The NeuroDetect Model had numerically, and at some time points statistically, superior performance to the CIPN20 Model in both CIPN-f and CIPN-h, particularly before and early in treatment. The Combined Model numerically, though not statistically, outperformed either assessment strategy individually, indicating that the combination of functional and patient-reported assessment within a smartphone may be optimal to CIPN detection. Conclusions: Our findings demonstrate the feasibility of integrating subjective and objective CIPN assessment into a smartphone app for remote, longitudinal CIPN monitoring. Studies of larger patient cohorts are needed to refine the app-based CIPN detection models and determine whether their use in practice improves CIPN detection. %M 39908091 %R 10.2196/65615 %U https://www.jmir.org/2025/1/e65615 %U https://doi.org/10.2196/65615 %U http://www.ncbi.nlm.nih.gov/pubmed/39908091 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60585 %T Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach %A Mazzella-Ebstein,Ann Marie %A Daly,Robert %A Huang,Jennie %A Bernal,Camila %A Wilhelm,Clare %A Panageas,Katherine S %A Holland,Jessie %A Salvaggio,Rori %A Ackerman,Jill %A Cracchiolo,Jennifer %A Kuperman,Gilad %A Mao,Jun %A Begue,Aaron %A Barton-Burke,Margaret %K cancer %K oncology %K clinician end users %K remote patient monitoring %K digital health %K implementation science %K patient monitoring %K patient access %K care %K communication %K usability %K functionality %K survey %K interview %K efficiency %K workflow %K user %K clinician support %D 2025 %7 24.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians’ workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program’s utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. %R 10.2196/60585 %U https://humanfactors.jmir.org/2025/1/e60585 %U https://doi.org/10.2196/60585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57659 %T Usability and Usefulness of a Symptom Management Coaching System for Patients With Cancer Treated With Immune Checkpoint Inhibitors: Comparative Mixed Methods Study %A Glaser,Savannah Lucia Caterina %A Fraterman,Itske %A van Brummelen,Noah %A Tibollo,Valentina %A Del Campo,Laura Maria %A Mallo,Henk %A Wilgenhof,Sofie %A Wilk,Szymon %A Gisko,Vitali %A Khadakou,Vadzim %A Cornet,Ronald %A Ottaviano,Manuel %A Medlock,Stephanie %+ Department of Medical Informatics, Amsterdam UMC - University of Amsterdam, Amsterdam, Netherlands, 31 205669111, s.k.medlock@amsterdamumc.nl %K oncology %K usability %K usefulness %K symptom management %K coaching system %K patients with cancer %K immune checkpoint inhibitors %K comparative qualitative study %K medication %K eHealth applications %K caregivers %K cancer treatment %K patient education %K well-being interventions %K acceptability %K melanoma %K renal cell carcinoma %K immunotherapy %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The prognosis for patients with several types of cancer has substantially improved following the introduction of immune checkpoint inhibitors, a novel type of immunotherapy. However, patients may experience symptoms both from the cancer itself and from the medication. A prototype of the eHealth tool Cancer Patients Better Life Experience (CAPABLE) was developed to facilitate symptom management, aimed at patients with melanoma and renal cell carcinoma treated with immunotherapy. Better usability of such eHealth tools can lead to improved user well-being and reduced risk of harm. It is unknown for usability evaluations whether certain usability problems would only be evident to patients whose condition closely resembles the target population, or if a broader group of patients would lead to the identification of a broader range of potential usability issues. Objective: This study aims to evaluate the CAPABLE prototype by conducting tests to assess usability, user experience, and perceived acceptability among end users, and to assess any agreements or differences in the results of our wide range of participants. Methods: This usability study was executed by interviewing participants with a melanoma or renal cell carcinoma diagnosis who have received immunotherapy and participants without direct experience with the targeted cancer types who have not received immunotherapy. Participants were asked to review the concept of the tool, perform think-aloud tasks, and complete the System Usability Scale and a Perceived Usefulness questionnaire. Usability problems were extracted from the interview data by independent coding and mapped to an eHealth Usability Problem Framework. Results: We included 21 participants in the study, aged 29 to 73 years; 13 participants who had received immunotherapy and 8 participants who had not received immunotherapy. In total, 76 usability problems were identified. A total of 22 usability problems were in the task-technology fit category of the usability framework, mostly regarding the coaching and symptom functionality of the prototype. Critical problems regarding the symptom monitoring functionality were mainly found by participants who had received immunotherapy. For 8 out of 10 statements in the Perceived Usefulness questionnaire, more than 75% of participants agreed or strongly agreed. The overall mean System Usability Scale score was 80 out of 100 (SD 11.3). Conclusions: Despite identified usability issues, participants responded positively to the Perceived Usefulness questionnaire regarding the evaluated tool. Further analysis of the usability problems indicates that it was essential to include participants who matched the target end users. Participants treated with immunotherapy, specifically with previous experience in immune-related adverse events, encountered critical problems with symptom reporting that would not have been identified if these participants were not included. For other tasks and functionalities, it seems likely that loosening the inclusion criteria would have resulted in sufficient feedback without critical missing usability issues. %M 39847771 %R 10.2196/57659 %U https://formative.jmir.org/2025/1/e57659 %U https://doi.org/10.2196/57659 %U http://www.ncbi.nlm.nih.gov/pubmed/39847771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52542 %T Factors Associated With Digital Intervention Engagement and Adherence in Patients With Cancer: Systematic Review %A Montalescot,Lucile %A Baussard,Louise %A Charbonnier,Elodie %+ Laboratoire de Psychopathologie et Processus de Santé, Université Paris-Cité, 71 avenue Edouard Vaillant, Boulogne-Billancourt, 92100, France, 33 1 76 53 29 81, lucile.montalescot@u-paris.fr %K adherence %K engagement %K eHealth %K mHealth %K cancer %K mobile health %K app %K eHealth interventions %K patient %K cancer care %K digital health %K health-related %K intervention-related %K sociodemographic %K behavior %K systematic review %D 2024 %7 11.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions offer vital support for patients with cancer through education, behavior change, and monitoring. Despite their potential, patient adherence to and engagement with these self-help interventions is challenging. Factors like user characteristics, technology, and intervention design influence adherence and engagement. Existing reviews have gaps in exploring diverse factors associated with adherence in cancer care. Objective: This systematic review aims to identify factors influencing adherence to and engagement with digital interventions with self-help components in cancer care. It examined sociodemographic, psychosocial, health-related, and intervention-related factors that affect patients’ adherence to and engagement with these digital health solutions. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted across PubMed, Embase, Cochrane Library, and PsycINFO to find studies published from January 2010 to September 2021. The studies included in this review focused on adult patients with cancer using digital interventions with self-help features. Data were extracted and synthesized using a standardized approach. Factors associated with adherence were synthesized according to their type—sociodemographic factors, psychosocial factors, health-related factors, technology-related factors, and intervention-related factors. Results: Among 9386 studies initially screened, 61 (0.6%) were eligible for analysis. These studies covered diverse eHealth intervention types, cancer types, and outcome measures. Investigating the determinants of adherence to and engagement with digital interventions was the main objective for 43% (26/61) of the included studies. Adherence and engagement were gauged using varied measures, such as dropout rates, log-ins, and self-reported measures. Results regarding factors associated with adherence and engagement were inconsistent across studies. Most sociodemographic (eg, age) and health-related factors (eg, cancer stage) yielded mixed outcomes. However, comorbidity consistently predicted lower adherence and engagement. Results regarding psychosocial factors were more stable across studies. Specifically, higher social support was associated with lower adherence and engagement. Finally, intervention-related factors like intervention type or human support showed conflicting results. Adopting an intersectional perspective revealed that specificities vary according to intervention goals and the operationalization of adherence versus engagement, with women being more adherent and engaged than men in interventions targeting distress. When focusing on adherence rather than engagement, older patients were more adherent than younger patients. Conclusions: This review highlights the complexity of adherence to and engagement with digital interventions in cancer care. While some factors, notably comorbidities and low social support, were consistently linked to adherence and engagement, others displayed mixed associations. The review underscores the need for standardizing measures, investigating specific intervention features, and enhancing study quality to optimize digital interventions for patients with cancer. Further research is crucial to better understand and improve adherence to digital health solutions in cancer care. Trial Registration: PROSPERO CRD42021281028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=281028 %R 10.2196/52542 %U https://www.jmir.org/2024/1/e52542 %U https://doi.org/10.2196/52542 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59426 %T Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach %A Nuseibeh,Betsey Zenk %A Johns,Shelley A %A Shih,Patrick C %A Lewis,Gregory F %A Gowan,Tayler M %A Jordan,Evan J %+ School of Public Health, Indiana University, 1025 East Seventh Street, Bloomington, IN, 47405, United States, 1 5132255577, bznuseib@iu.edu %K breast cancer survivors %K acceptance and commitment therapy %K mHealth app %K user-centered design %K depression %K anxiety %K therapy %K app %K breast cancer %K expert %K designer %K psychosocial %K need %K co-design %K MOSAIC %K mobile acceptance and commitment therapy stress intervention %K interviews %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the world’s most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer–specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. %R 10.2196/59426 %U https://formative.jmir.org/2024/1/e59426 %U https://doi.org/10.2196/59426 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53834 %T Patients’ and Clinicians’ Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study %A McCann,Lisa %A Lewis,Liane %A Oduntan,Olubukola %A Harris,Jenny %A Darley,Andrew %A Berg,Geir V %A Lubowitzki,Simone %A Cheevers,Katy %A Miller,Morven %A Armes,Jo %A Ream,Emma %A Fox,Patricia %A Furlong,Eileen Patricia %A Gaiger,Alexander %A Kotronoulas,Grigorios %A Patiraki,Elisabeth %A Katsaragakis,Stylianos %A McCrone,Paul %A Miaskowski,Christine %A Cardone,Antonella %A Orr,Dawn %A Flowerday,Adrian %A Skene,Simon %A Moore,Margaret %A De Souza,Nicosha %A Donnan,Peter %A Maguire,Roma %+ Digital Health and Wellness Group (DHaWG), Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 +441415483587, lisa.mccann@strath.ac.uk %K cancer %K clinician experiences %K digital interventions %K patient experiences %K remote monitoring %K qualitative methods %D 2024 %7 3.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention—Advanced Symptom Management System (ASyMS)—after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients’ and clinicians’ experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients’ experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients’ and clinicians’ experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients’ and clinicians’ experiences using ASyMS. One central orienting theme—ASyMS as a facilitator of change—was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is “normal” and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients’ and clinicians’ experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients’ and clinicians’ perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 %M 39626227 %R 10.2196/53834 %U https://www.jmir.org/2024/1/e53834 %U https://doi.org/10.2196/53834 %U http://www.ncbi.nlm.nih.gov/pubmed/39626227 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53440 %T Scope, Findability, and Quality of Information About Music-Based Interventions in Oncology: Quantitative Content Analysis of Public-Facing Websites at National Cancer Institute–Designated Cancer Centers %A Blank,Carol Ann %A Biedka,Sarah %A Montalmant,Abigail %A Saft,Katelyn %A Lape,Miranda %A Mao,Kate %A Bradt,Joke %A Liou,Kevin T %K music-based interventions %K cancer %K oncology %K symptom management %K music therapy %K music services %K National Cancer Institute %D 2024 %7 22.11.2024 %9 %J JMIR Cancer %G English %X Background: Music-based interventions (MBIs) are evidence-based, nonpharmacological treatments that include music therapy (MT) delivered by board-certified music therapists, as well as music services (MS) delivered by other health professionals and volunteers. Despite MBI’s growing evidence base in cancer symptom management, it remains unclear how MBI-related information is presented to the public. Over 80% of people with cancer use the internet to find health-related information. In the United States, the National Cancer Institute (NCI) identifies certain Cancer Centers (CCs) as NCI-designated CCs or Comprehensive Cancer Centers (CCCs) based on their excellence in research. As NCI-designated CCs and CCCs are considered the gold standard in cancer care, their websites are viewed by the public as important sources of information. Objective: We aimed to determine scope, findability, and quality of MBI-related information on public-facing websites of NCI-designated CCs/CCCs. Methods: We reviewed 64 NCI-designated CC/CCC websites (excluding basic laboratories) between November 2022 and January 2023. We extracted data on the scope of information: (1) type of MBI offered (MT or MS), (2) format (individual, group), (3) method of delivery (in person or remotely delivered), (4) setting (inpatient or outpatient), (5) target population (pediatric or adult), (6) MBI practitioner qualifications, (7) clinical indications or benefits, (8) presence of testimonials, (9) cost, and (10) scheduling or referral information. We also extracted data on findability (ie, presence of direct link or drop-down menu and the number of clicks to locate MBI-related information). Based on the scope and findability data, we rated the information quality as high, moderate, or low using an adapted scale informed by prior research. Results: Thirty-one (48%) of the 64 CC/CCCs described MBIs on their websites. Of these, 6 (19%) mentioned both MT and MS, 16 (52%) mentioned MT only, and 9 (29%) mentioned MS only. The most common format was hybrid, involving individuals and groups (n=20, 65%). The most common delivery method was in person (n=16, 52%). The most common target population was adults (n=12, 39%). The most common MBI practitioners were board-certified music therapists (n=21, 68%). The most described indications or benefits were psychological. Twenty-eight (90%) websites lacked testimonials, and 26 (84%) lacked cost information. Twenty-six (84%) websites provided scheduling or referral information. MBI-related information was found with an average of 4 (SD 1) clicks. Nine (29%) websites were of high quality, 18 (58%) were moderate, and 4 (13%) were low. Conclusions: Based on public websites, MBIs were most commonly delivered in person by board-certified music therapists to outpatient and inpatient adults, using individual and group formats to provide psychological benefits. The findability and quality of this information should be improved to promote the dissemination of MBIs for cancer symptom management. %R 10.2196/53440 %U https://cancer.jmir.org/2024/1/e53440 %U https://doi.org/10.2196/53440 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 5 %N %P e64406 %T Ethical Considerations in Human-Centered AI: Advancing Oncology Chatbots Through Large Language Models %A Chow,James C L %A Li,Kay %+ Princess Margaret Cancer Centre, University Health Network, 7/F, Rm 7-606, 700 University Ave, Toronto, ON, M5G 1X6, Canada, 1 4169464501, james.chow@uhn.ca %K artificial intelligence %K humanistic AI %K ethical AI %K human-centered AI %K machine learning %K large language models %K natural language processing %K oncology chatbot %K transformer-based model %K ChatGPT %K health care %D 2024 %7 6.11.2024 %9 Viewpoint %J JMIR Bioinform Biotech %G English %X The integration of chatbots in oncology underscores the pressing need for human-centered artificial intelligence (AI) that addresses patient and family concerns with empathy and precision. Human-centered AI emphasizes ethical principles, empathy, and user-centric approaches, ensuring technology aligns with human values and needs. This review critically examines the ethical implications of using large language models (LLMs) like GPT-3 and GPT-4 (OpenAI) in oncology chatbots. It examines how these models replicate human-like language patterns, impacting the design of ethical AI systems. The paper identifies key strategies for ethically developing oncology chatbots, focusing on potential biases arising from extensive datasets and neural networks. Specific datasets, such as those sourced from predominantly Western medical literature and patient interactions, may introduce biases by overrepresenting certain demographic groups. Moreover, the training methodologies of LLMs, including fine-tuning processes, can exacerbate these biases, leading to outputs that may disproportionately favor affluent or Western populations while neglecting marginalized communities. By providing examples of biased outputs in oncology chatbots, the review highlights the ethical challenges LLMs present and the need for mitigation strategies. The study emphasizes integrating human-centric values into AI to mitigate these biases, ultimately advocating for the development of oncology chatbots that are aligned with ethical principles and capable of serving diverse patient populations equitably. %M 39321336 %R 10.2196/64406 %U https://bioinform.jmir.org/2024/1/e64406 %U https://doi.org/10.2196/64406 %U http://www.ncbi.nlm.nih.gov/pubmed/39321336 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56475 %T Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial %A Tian,Xiaojuan %A Liu,Yan %A Zhang,Jiahua %A Yang,Lixiao %A Feng,Linyao %A Qi,Aidong %A Liu,Hanjiazi %A Liu,Pengju %A Li,Ying %K WeChat %K nutrition management %K ovarian cancer %K chemotherapy %K mobile health %D 2024 %7 4.11.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. Objective: This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Methods: Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. Results: A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). Conclusions: This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy. Trial Registration: ClinicalTrials.gov NCT06379191; https://clinicaltrials.gov/study/NCT06379191 %R 10.2196/56475 %U https://mhealth.jmir.org/2024/1/e56475 %U https://doi.org/10.2196/56475 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59061 %T Experiences of Patients With Cancer Using Electronic Symptom Management Systems: Qualitative Systematic Review and Meta-Synthesis %A Zhu,Siying %A Dong,Yan %A Li,Yumei %A Wang,Hong %A Jiang,Xue %A Guo,Mingen %A Fan,Tiantian %A Song,Yalan %A Zhou,Ying %A Han,Yuan %+ School of Nursing, Guangzhou Medical University, No. 1, Xinzao, Panyu District, Guangzhou, 511436, China, 86 020 83079032, hypyx2006@163.com %K electronic symptom management systems %K oncology care %K access to care %K symptom monitoring %K self-management %K patient-reported outcomes %K health-related outcomes %K quality of life %D 2024 %7 28.10.2024 %9 Review %J J Med Internet Res %G English %X Background: There are numerous symptoms related to cancer and its treatments that can affect the psychosomatic health and quality of life of patients with cancer. The use of electronic symptom management systems (ESMSs) can help patients with cancer monitor and manage their symptoms effectively, improving their health-related outcomes. However, patients’ adhesion to ESMSs decreases over time, and little is known about their real experiences with them. Therefore, it is necessary to gain a deep understanding of patients’ experiences with ESMSs. Objective: The purpose of this systematic review was to synthesize qualitative studies on the experiences of patients with cancer using ESMSs. Methods: A total of 12 electronic databases, including PubMed, Web of Science, Cochrane Library, EBSCOhost, Embase, PsycINFO, ProQuest, Scopus, Wanfang database, CNKI, CBM, and VIP, were searched to collect relevant studies from the earliest available record until January 2, 2024. Qualitative and mixed methods studies published in English or Chinese were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist) and the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement were used to improve transparency in reporting the synthesis of the qualitative research. The Critical Appraisal Skills Program (CASP) checklist was used to appraise the methodological quality of the included studies, and a meta-synthesis was conducted to interpret and synthesize the findings. Results: A total of 21 studies were included in the meta-synthesis. The experiences of patients with cancer using ESMSs were summarized into three major categories: (1) perceptions and attitudes toward ESMSs; (2) the value of ESMSs; and (3) barriers, requirements, and suggestions for ESMSs. Subsequently, 10 subcategories emerged from the 3 major categories. The meta-synthesis revealed that patients with cancer had both positive and negative experiences with ESMSs. In general, patients recognized the value of ESMSs in symptom assessment and management and were willing to use them, but they still encountered barriers and wanted them to be improved. Conclusions: This systematic review provides implications for developing future ESMSs that improve health-related outcomes for patients with cancer. Future research should focus on strengthening electronic equipment and technical support for ESMSs, improving their functional contents and participation forms, and developing personalized applications tailored to the specific needs and characteristics of patients with cancer. Trial Registration: PROSPERO CRD42023421730; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421730 %M 39466301 %R 10.2196/59061 %U https://www.jmir.org/2024/1/e59061 %U https://doi.org/10.2196/59061 %U http://www.ncbi.nlm.nih.gov/pubmed/39466301 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48465 %T Needs of Patients With Gynecologic Cancer and Their Caregivers for Obtaining mHealth-Supported Self-Management: Focus Group Study %A Campbell,Grace B %A Kim,Hansol %A Klinedinst,Tara C %A Klinger,Julie %A Lee,Young Ji %A Donovan,Heidi S %+ School of Nursing, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15282, United States, 1 412 417 8804, campbellg2@duq.edu %K gynecologic oncology %K gynecologic cancer %K self-management support %K user-centered design %K cancer distress %K self-management %K caregiver support %K cancer information %K women's health %K family support %K informal caregivers %K informal care %K mhealth %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Family caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. Objective: We sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. Methods: We conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified “closest support person” (caregiver). A semistructured focus group guide was used to elicit information on patients’ and caregivers’ perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. Results: A total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93%) were White and married. For caregivers (n=22), 15 (68%) identified as male and 7 (32%) as female, with ages ranging between 19 and 81 years. Overall, 59% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1—gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2—desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3—interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others’ knowledge; patients and caregivers desire having control over sharing of information with other family members. Conclusions: Designing a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers. %M 39361371 %R 10.2196/48465 %U https://cancer.jmir.org/2024/1/e48465 %U https://doi.org/10.2196/48465 %U http://www.ncbi.nlm.nih.gov/pubmed/39361371 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52018 %T Crowdfunding for Complementary and Alternative Cancer Treatments in Tijuana, Mexico: Content Analysis %A Snyder,Jeremy %A Zenone,Marco %A Grewal,Ashmita %A Caulfield,Timothy %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Blusson Hall 11300, Burnaby, BC, V5A1S6, Canada, 1 7787823258, jcs12@sfu.ca %K cancer %K crowdfunding %K Tijuana %K CAM %K patient %K patients %K insurance %K crowdfunding platforms %K GoFundMe %K GiveSendGo %K cancer clinic %K Mexico %K campaigns %K cancer treatment %K medical intervention %K CAM cancer treatments %K misinformation %K alternate care %K women's health %K internet research %K international medical tourism %K alternative cancer therapy %K financial toxicity %D 2024 %7 14.8.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. Objective: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. Methods: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary’s cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. Results: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%). Conclusions: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one’s time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment. %M 39141902 %R 10.2196/52018 %U https://cancer.jmir.org/2024/1/e52018 %U https://doi.org/10.2196/52018 %U http://www.ncbi.nlm.nih.gov/pubmed/39141902 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54819 %T Charting Health Challenges for Digital Preventive Interventions Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: National Long-Term Follow-Up Survey of Self-Rated Health Outcomes %A Nygren,Jens M %A Aili,Katarina %A Arvidsson,Susann %A Olsson,Maria %A Jarfelt,Marianne %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K digital preventive interventions %K long-term follow-up %K self-rated health outcomes %K adult survivors %K childhood acute lymphoblastic leukemia %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, but the prognosis has remarkably improved over the last 50 years in high-income countries, and thus, there is a focus on long-term health outcomes following survival and how to best provide health care support to adult long-term survivors of childhood ALL to prevent and handle potential health problems. Digital health interventions are promising to deliver feasible health promotion and prevention programs. This is particularly relevant for ensuring long-term follow-up in cases where continuous contact with oncology care may be disrupted. Moreover, these interventions are beneficial in reaching geographically dispersed target groups and overcoming the time constraints of everyday life that often hinder participation in such programs. Objective: This study aimed to fill the gaps in existing research on adult long-term survivors of childhood ALL and provide formative data that can inform the development of formalized follow-up services designed to meet the needs of these survivors in ways that align with their preferences for digital health interventions. Methods: In this cross-sectional national study, adult survivors (aged ≥18 years) of childhood ALL for over 10 years after diagnosis were compared to their siblings in terms of mental and physical health-related factors, including sleep, stress, anxiety, and depression (Depression Anxiety and Stress Scale 21 [DASS-21]); several dimensions of fatigue (Multidimensional Fatigue Inventory 20 [MFI-20]); work ability (Work Ability Index); chronic pain; and prevalences of diabetes, cardiovascular disease, headache or migraine, and rheumatic disease. Results: Overall, 426 of 855 eligible ALL survivors responded (mean age 30.9, SD 7.7 years), and they participated at an average of 24 (SD 6.9) years after ALL diagnosis. Siblings (n=135; mean age 31.5, SD 7.7 years) acted as controls. Sleep quality, sleep quantity, and mean work ability scores were significantly lower, and physical fatigue, reduced motivation, and reduced activity scores were higher in ALL survivors than in siblings. There were no significant differences between the groups in terms of BMI and prevalence of chronic pain, depression, anxiety, or stress. Physical and psychological complications were more frequent among adult ALL survivors who had received hematopoietic stem cell transplantation (HSCT) than among those who had not received HSCT. Conclusions: Our nationwide cross-sectional study addressed the scarcity of knowledge regarding the self-reported health outcomes of adult long-term survivors of childhood ALL. We highlighted significant disparities within this population and emphasized the potential of comprehensive digital interventions that target vitality, sleep quality, fatigue, and psychosocial well-being to enhance well-being and bolster the capacity for managing chronic health conditions in this target group. Such an intervention would align with the needs of this target group, which is a prerequisite for successfully incorporating technology into the daily lives of survivors of childhood ALL. %M 39133918 %R 10.2196/54819 %U https://formative.jmir.org/2024/1/e54819 %U https://doi.org/10.2196/54819 %U http://www.ncbi.nlm.nih.gov/pubmed/39133918 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53652 %T Acceptability, Effectiveness, and Roles of mHealth Applications in Supporting Cancer Pain Self-Management: Integrative Review %A Wu,Weizi %A Graziano,Teresa %A Salner,Andrew %A Chen,Ming-Hui %A Judge,Michelle P %A Cong,Xiaomei %A Xu,Wanli %+ School of Nursing, University of Connecticut, 231 Glenbrook Rd, Storrs, CT, 06269, United States, 1 8604860580, wanli.xu@uconn.edu %K cancer pain %K self-management %K mHealth applications %K integrative review %K cancer survivors %D 2024 %7 18.7.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background:  Cancer pain remains highly prevalent and persistent throughout survivorship, and it is crucial to investigate the potential of leveraging the advanced features of mobile health (mHealth) apps to empower individuals to self-manage their pain. Objective:  This review aims to comprehensively understand the acceptability, users’ experiences, and effectiveness of mHealth apps in supporting cancer pain self-management. Methods:  We conducted an integrative review following Souza and Whittemore and Knafl’s 6 review processes. Literature was searched in PubMed, Scopus, CINAHL Plus with Full Text, PsycINFO, and Embase, from 2013 to 2023. Keywords including “cancer patients,” “pain,” “self-management,” “mHealth applications,” and relevant synonyms were used in the search. The Johns Hopkins research evidence appraisal tool was used to evaluate the quality of eligible studies. A narrative synthesis was conducted to analyze the extracted data. Results:  A total of 20 studies were included, with the overall quality rated as high (n=15) to good (n=5). Using mHealth apps to monitor and manage pain was acceptable for most patients with cancer. The internal consistency of the mHealth in measuring pain was 0.96. The reported daily assessment or engagement rate ranged from 61.9% to 76.8%. All mHealth apps were designed for multimodal interventions. Participants generally had positive experiences using pain apps, rating them as enjoyable and user-friendly. In addition, 6 studies reported significant improvements in health outcomes, including enhancement in pain remission (severity and intensity), medication adherence, and a reduced frequency of breakthrough pain. The most frequently highlighted roles of mHealth apps included pain monitoring, tracking, reminders, education facilitation, and support coordination. Conclusions:  mHealth apps are effective and acceptable in supporting pain self-management. They offer a promising multi-model approach for patients to monitor, track, and manage their pain. These findings provide evidence-based insights for leveraging mHealth apps to support cancer pain self-management. More high-quality studies are needed to examine the effectiveness of digital technology–based interventions for cancer pain self-management and to identify the facilitators and barriers to their implementation in real-world practice. %M 39024567 %R 10.2196/53652 %U https://mhealth.jmir.org/2024/1/e53652 %U https://doi.org/10.2196/53652 %U http://www.ncbi.nlm.nih.gov/pubmed/39024567 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50224 %T Intensive Longitudinal Methods Among Adults With Breast or Lung Cancer: Scoping Review %A Geeraerts,Joran %A de Nooijer,Kim %A Pivodic,Lara %A De Ridder,Mark %A Van den Block,Lieve %+ End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 2 477 47 56, joran.geeraerts@vub.be %K diary %K ecological momentary assessment %K neoplasms %K quality of life %K self-report %K telemedicine %K scoping review %K longitudinal methods %K breast cancer %K lung cancer %K patients with cancer %K cancer %K intensive monitoring %K advanced disease stages %K mobile phone %D 2024 %7 12.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain. Objective: This scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors. Methods: We searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice. Results: We identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices). Conclusions: Intensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages. %M 38865186 %R 10.2196/50224 %U https://www.jmir.org/2024/1/e50224 %U https://doi.org/10.2196/50224 %U http://www.ncbi.nlm.nih.gov/pubmed/38865186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56888 %T The Experience of Cancer-Related Cognitive Impairment Across Common Cancers: Protocol for a Qualitative Systematic Review %A Ibrar,Maryam %A Rai,Harleen Kaur %A Main,Ashleigh %A McCartney,Haruno %A Maguire,Roma %A Rodriguez,Mario Alfredo Parra %+ Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 7th Fl, 26 Richmond St, Glasgow, G1 1XH, United Kingdom, 44 7769914387, maryam.ibrar@strath.ac.uk %K cancer %K neoplasms %K cancer survivors %K cancer-related cognitive impairment %K chemotherapy-related cognitive impairment %K qualitative research %K executive function %K cognition %K cognitive impairment %K quality of life %K common cancer %K qualitative synthesis %K adult %K young adult %K functional ability %K functional outcome %K qualitative %K cognitive impairments %K cancer survivor %K survival rates %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer-related cognitive impairment (CRCI) is commonly experienced by patients with cancer during treatment, and 35% of patients experience cognitive impairment after treatment completion. Impairments in memory, attention, executive functioning, and information processing speed are most reported and often negatively impact daily functioning and quality of life (QoL). Despite the large scale of reports, this adverse side effect is underinvestigated across common cancer types, and there is a lack of insight into the CRCI experience. Objective: This qualitative synthesis aims to explore the evidence in relation to the experience of CRCI across common cancers. It also aims to understand the prevalence of CRCI across various cancer types, cognitive domains, and its impact on QoL and functional ability. Methods: A comprehensive search of databases, including PubMed, American Psychological Association PsycINFO, CINAHL, and Scopus, will be conducted. A total of 2 independent reviewers will screen titles and abstracts for inclusion, followed by full-text screening. A third reviewer will resolve any arising conflicts in the process of data screening and inclusion. Subsequently, data extraction and quality assessment using the Critical Appraisal Skills Programme (CASP) tool will be conducted. The results will be analyzed using thematic analysis. Results: This review is part of a PhD program funded in January 2023. The review commenced in June 2023, and data analysis is currently in progress. The qualitative synthesis will explore the experiences of CRCI across common cancers. The included studies are expected to report on numerous cancer types such as breast cancer, prostate cancer, leukemia, and lung cancer. The included study types are most likely to be interviews, focus groups, and surveys with qualitative components. Conclusions: This protocol highlights the need for a qualitative synthesis that will explore the experience of CRCI across common cancer types. It will provide valuable insight into the lived experience of CRCI and the cognitive domains that may be disproportionately affected. There is a growing demand for further management interventions and clinically tested treatments of CRCI and the qualitative exploration of patient experience is crucial for their development. This qualitative synthesis will inform future developments and will contribute to improving QoL after cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/56888 %M 38820581 %R 10.2196/56888 %U https://www.researchprotocols.org/2024/1/e56888 %U https://doi.org/10.2196/56888 %U http://www.ncbi.nlm.nih.gov/pubmed/38820581 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53163 %T Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing %A Sien,Sang-Wha %A Kobekyaa,Francis Kyerepagr %A Puts,Martine %A Currie,Leanne %A Tompson,Margaret %A Hedges,Penelope %A McGrenere,Joanna %A Mariano,Caroline %A Haase,Kristen R %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 0979, kristenrhaase@gmail.com %K cancer %K aging %K self-management %K usability testing %K design thinking %K design %K oncology %K develop %K development %K usability %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K mHealth %K mobile health %K app %K apps %K application %K applications %K symptom %K symptoms %K comorbidity %K comorbidities %K comorbid %K multimorbidity %K multimorbidities %K co-design %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey’s self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a “home base” for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. %M 38717806 %R 10.2196/53163 %U https://aging.jmir.org/2024/1/e53163 %U https://doi.org/10.2196/53163 %U http://www.ncbi.nlm.nih.gov/pubmed/38717806 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e54178 %T Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes %A Trojan,Andreas %A Roth,Sven %A Atassi,Ziad %A Kiessling,Michael %A Zenhaeusern,Reinhard %A Kadvany,Yannick %A Schumacher,Johannes %A Kullak-Ublick,Gerd A %A Aapro,Matti %A Eniu,Alexandru %+ Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland, 41 76 34 30 200, trojan@1st.ch %K breast cancer %K biosimilar %K trastuzumab %K electronic patient-reported outcome %K ePRO %K medidux %K app %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs). Objective: The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731). Methods: Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years). Results: Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference –1.27, 95% CI –7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95% CI –3.53 to 12.44; P=.28). Conclusions: Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds. Trial Registration: ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021 %M 38573759 %R 10.2196/54178 %U https://cancer.jmir.org/2024/1/e54178 %U https://doi.org/10.2196/54178 %U http://www.ncbi.nlm.nih.gov/pubmed/38573759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47685 %T The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study %A Jiang,Yun %A Hwang,Misun %A Cho,Youmin %A Friese,Christopher R %A Hawley,Sarah T %A Manojlovich,Milisa %A Krauss,John C %A Gong,Yang %+ School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109, United States, 1 734 763 3705, jiangyu@umich.edu %K digital technology %K patient safety %K patient participation %K patient-reported outcomes %K drug-related side effects and adverse reactions %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients’ various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients’ just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients’ transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. Objective: We aim to assess oncology patients’ perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. Methods: A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants’ perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants’ technology acceptance through bivariate correlation analyses and multiple logistic regressions. Results: Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). Conclusions: In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care. %M 38457204 %R 10.2196/47685 %U https://www.jmir.org/2024/1/e47685 %U https://doi.org/10.2196/47685 %U http://www.ncbi.nlm.nih.gov/pubmed/38457204 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e39019 %T The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review %A Huang,Xiting %A Xiang,Xinyue %A Liu,Yang %A Wang,Zhiqian %A Jiang,Zhili %A Huang,Lihua %+ Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Building 17, 3rd Floor, 79 Qingchun Road, Hangzhou, 310003, China, 86 13867129329, lihuahuang818@zju.edu.cn %K gamification %K chronic diseases %K self-management %K scoping review %K mobile phone %D 2023 %7 22.12.2023 %9 Review %J JMIR Serious Games %G English %X Background: Chronic disease self-management is a public health issue of worldwide concern, and gamification is an emerging strategy to improve patients’ participation in chronic disease self-management. Some studies have summarized designs for the gamification of chronic disease self-management from the perspective of eHealth technology, but they have not mentioned differences in design methods, functions, and evaluation methods of gamified designs for self-management in different chronic diseases. Objective: This scoping review aims to synthesize the characteristics of realization forms, functions, and evaluation methods in chronic disease self-management gamification to improve self-management among the chronic disease population. Methods: We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. As of January 7, 2023, we systematically searched 9 databases for relevant studies from January 2012 to December 2022. Related data were extracted based on the research questions. We calculated the frequencies, charted the quantitative data, and coded the extracted material for qualitative content analysis. Results: We retrieved 16,221 records, of which 70 (0.43%) met the eligibility criteria. In the included research, the target populations for gamified designs for self-management of chronic diseases included patients with stroke, cancer, diabetes, chronic obstructive pulmonary disease, coronary heart disease, obesity, and hypertension. Almost all studies mentioned technical support for gamification (68/70, 97%), mainly in the form of active video games (58/70, 83%); however, less than half of the studies mentioned the theoretical basis for gamification (31/70, 44%). There were 37 concepts or theories relevant to gamification design, most of which were in the field of psychology or were cross-disciplinary (n=33, 89%). Gamification for the self-management of chronic diseases has been widely recognized, including for promoting physical exercise and rehabilitation training (48/99, 48%), increasing initiative for symptom management (18/99, 18%), providing psychological support (14/99, 14%), improving cognitive function (12/99, 12%), and improving medication adherence (7/99, 7%). A total of 39 studies mentioned the gamification effect; however, we did not find a unified evaluation standard. Conclusions: This scoping review focuses on gamification designs for chronic disease self-management and summarizes the realization forms and functions of gamification in self-management for different patient populations. With practice in a gamified internet-based environment, patients can not only master the knowledge and skills of self-management in fascinating scenarios but also benefit from gaming experience and make better health-related decisions in real life. It is worth noting that a comprehensive evaluation of the users as well as a personalized and targeted intervention should be developed before gamification. %M 38133907 %R 10.2196/39019 %U https://games.jmir.org/2023/1/e39019 %U https://doi.org/10.2196/39019 %U http://www.ncbi.nlm.nih.gov/pubmed/38133907 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e45145 %T The Impact of Digital Technology on Self-Management in Cancer: Systematic Review %A Lim,Dwight Su Chun %A Kwok,Benedict %A Williams,Patricia %A Koczwara,Bogda %+ College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, Adelaide, 5042, Australia, 61 413579765, dwight.suchun.lim@gmail.com %K self-management %K self-management support %K self-management core skills %K digital technology %K digital health %K mHealth %K mobile health %K eHealth %K cancer %K theoretical frameworks %K predictors of effect %K chronic disease %K skills %K decision-making %K cancer treatment %D 2023 %7 22.11.2023 %9 Review %J JMIR Cancer %G English %X Background: Self-management (SM) plays an important role in supporting patients’ adaptation to and management of the symptoms of chronic diseases. Cancer is a chronic disease that requires patients to have responsibility in management. Digital technology has the potential to enhance SM support, but there is little data on what SM skills are most commonly supported by digital technology. Objective: This review aimed to examine the SM core skills that were enabled and supported by digital interventions in people with cancer and identify any predictors of the effect of digital health intervention on SM core skills. Methods: Three electronic databases (MEDLINE, Scopus, and CINAHL) were searched for papers, published from January 2010 to February 2022, that reported randomized controlled trials (RCTs) involving patients with cancer or survivors of cancer where a digital technology intervention was evaluated and change in 1 or more SM core skills was a measured outcome. Results: This systematic review resulted in 12 studies that were eligible to identify which SM core skills were enabled and supported by digital intervention. The total number of participants in the 12 studies was 2627. The most common SM core skills targeted by interventions were decision-making, goal setting, and partnering with health professionals. A total of 8 (67%) out of 12 RCTs demonstrated statistically significant improvement in outcomes including self-efficacy, survivorship care knowledge and attitude, quality of life, increased knowledge of treatment, and emotional and social functioning. A total of 5 (62%) out of 8 positive RCTs used theoretical considerations in their study design; whereas in 1 (25%) out of 4 negative RCTs, theoretical considerations were used. In 3 studies, some factors were identified that were associated with the development of SM core skills, which included younger age (regression coefficient [RC]=–0.06, 95% CI –0.10 to –0.02; P=.002), computer literacy (RC=–0.20, 95% CI –0.37 to –0.03; P=.02), completing cancer treatment (Cohen d=0.31), male sex (SD 0.34 in social functioning; P=.009), higher education (SD 0.19 in social functioning; P=.04), and being a recipient of chemotherapy (SD 0.36 in depression; P=.008). In all 3 studies, there were no shared identical factors that supported the development of SM core skills, whereby each study had a unique set of factors that supported the development of SM core skills. Conclusions: Digital technology for patients with cancer appears to improve SM core skills including decision-making, goal setting, and partnering with health care partners. This effect is greater in people who are younger, male, educated, highly computer literate, completing cancer treatment, or a recipient of chemotherapy. Future research should focus on targeting multiple SM core skills and identifying predictors of the effect of digital technology intervention. Trial Registration: PROSPERO CRD42021221922; https://tinyurl.com/mrx3pfax %M 37991831 %R 10.2196/45145 %U https://cancer.jmir.org/2023/1/e45145 %U https://doi.org/10.2196/45145 %U http://www.ncbi.nlm.nih.gov/pubmed/37991831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46571 %T Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study %A Siglen,Elen %A Vetti,Hildegunn Høberg %A Augestad,Mirjam %A Steen,Vidar M %A Lunde,Åshild %A Bjorvatn,Cathrine %+ Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Jonas Lies veg 61, Bergen, 5021, Norway, 47 99569845, elen.siglen@helse-bergen.no %K chatbot %K chatbots %K genetic %K trust %K acceptability %K perception %K perceived %K genetic counseling %K hybrid health care %K digital health tool %K digital information tool %K digital health technology %K virtual assistant %K hereditary breast and ovarian cancer %K hereditary %K genetic testing %K technology %K genetic clinic %K digital tool %K ovarian cancer %K breast cancer %K information retrieval %K women’s health %K breast %K ovarian %K cancer %K oncology %K mobile phone %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective: Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods: Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results: The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: “Anytime, anywhere”; “In addition, not instead”; and “Trustworthy and true.” All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions: Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling. %M 37656502 %R 10.2196/46571 %U https://www.jmir.org/2023/1/e46571 %U https://doi.org/10.2196/46571 %U http://www.ncbi.nlm.nih.gov/pubmed/37656502 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44914 %T A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing %A Howell,Doris %A Bryant Lukosius,Denise %A Avery,Jonathan %A Santaguida,Athina %A Powis,Melanie %A Papadakos,Tina %A Addario,Vincenzo %A Lovas,Mike %A Kukreti,Vishal %A Haase,Kristen %A Mayo,Samantha J %A Papadakos,Janet %A Moradian,Saeed %A Krzyzanowska,Monika K %+ Department of Supportive Care, Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, 690 University Ave, Toronto, ON, M5G2M9, Canada, 1 6472277261, doris.howell@uhn.ca %K web-based program %K self-management %K cancer treatment %K digital technology %K co-design %K usability %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. Objective: We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). Methods: We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). Results: In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed “chapters”), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. Conclusions: The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial. %M 37477968 %R 10.2196/44914 %U https://cancer.jmir.org/2023/1/e44914 %U https://doi.org/10.2196/44914 %U http://www.ncbi.nlm.nih.gov/pubmed/37477968 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44533 %T A Mobile App to Support Self-Management in Patients with Multiple Myeloma or Chronic Lymphocytic Leukemia: Pilot Randomized Controlled Trial %A LeBlanc,Matthew R %A LeBlanc,Thomas W %A Yang,Qing %A McLaughlin,Jennifer %A Irish,Kerry %A Smith,Sophia K %+ School of Nursing, University of North Carolina at Chapel Hill, 120 N Medical Drive, CB 7460, Chapel Hill, NC, 27599, United States, 1 919 966 4260, matthew_leblanc@unc.edu %K chronic lymphocytic leukemia %K distress %K intervention %K leukemia %K mHealth %K mobile application %K multiple myeloma %K post-traumatic stress %K self-management %K symptoms %K treatment %D 2023 %7 6.7.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with blood cancer experience serious physical and emotional symptoms throughout their cancer journey. Objective: Building on previous work, we aimed to develop an app designed to help patients with multiple myeloma and chronic lymphocytic leukemia self-manage symptoms and test it for acceptability and preliminary efficacy. Methods: We developed our Blood Cancer Coach app with input from clinicians and patients. Our 2-armed randomized controlled pilot trial recruited participants from Duke Health and nationally in partnerships with the Association of Oncology Social Work, Leukemia and Lymphoma Society, and other patient groups. Participants were randomized to the attention control (Springboard Beyond Cancer website) arm or the Blood Cancer Coach app intervention arm. The fully automated Blood Cancer Coach app included symptom and distress tracking with tailored feedback, medication reminders and adherence tracking, multiple myeloma and chronic lymphocytic leukemia education resources, and mindfulness activities. Patient-reported data were collected at baseline, 4 weeks, and 8 weeks for both arms through the Blood Cancer Coach app. Outcomes of interest were global health (Patient Reported Outcomes Measurement Information System Global Health), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and cancer symptoms (Edmonton Symptom Assessment System Revised). Among participants in the intervention arm, satisfaction surveys and usage data were used to evaluate acceptability. Results: Among 180 patients who downloaded the app, 49% (89) of them consented to participate and 40% (72) of them completed baseline surveys. Of those who completed baseline surveys, 53% (38) of them completed week 4 surveys (16 intervention and 22 control) and 39% (28) of them completed week 8 surveys (13 intervention and 15 control). Most participants found the app at least moderately effective at helping manage symptoms (87%), feeling more comfortable seeking help (87%), increasing awareness of resources (73%), and reported being satisfied with the app overall (73%). Participants completed an average of 248.5 app tasks over the 8-week study period. The most used functions within the app were medication log, distress tracking, guided meditations, and symptom tracking. There were no significant differences between the control and intervention arms at week 4 or 8 on any outcomes. We also saw no significant improvement over time within the intervention arm. Conclusions: The results of our feasibility pilot were promising in which most participants found the app to be helpful in managing their symptoms, reported satisfaction with the app, and that it was helpful in several important areas. We did not, however, find significantly reduced symptoms or improved global mental and physical health over 2 months. Recruitment and retention were challenging for this app-based study, an experience echoed by others. Limitations included a predominantly White and college educated sample. Future studies would do well to include self-efficacy outcomes, target those with more symptoms, and emphasize diversity in recruitment and retention. Trial Registration: ClinicalTrials.gov NCT05928156; https://clinicaltrials.gov/study/NCT05928156 %M 37410541 %R 10.2196/44533 %U https://cancer.jmir.org/2023/1/e44533 %U https://doi.org/10.2196/44533 %U http://www.ncbi.nlm.nih.gov/pubmed/37410541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39740 %T Improving Cognitive Function Through High-Intensity Interval Training in Breast Cancer Patients Undergoing Chemotherapy: Protocol for a Randomized Controlled Trial %A Wilson,Rebekah %A Kang,Dong-Woo %A Tahbaz,Meghan %A Norris,Mary %A Uno,Hajime %A Ligibel,Jennifer %A Guenette,Jeffrey %A Christopher,Cameron %A Dieli-Conwright,Christina %+ Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, United States, 1 (617) 582 8321, christinam_dieli-conwright@dfci.harvard.edu %K cognitive function %K high-intensity interval training %K exercise %K breast cancer %K chemotherapy %K magnetic resonance imaging %K MRI %D 2023 %7 7.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than 75% of patients with breast cancer treated with chemotherapy experience cognitive impairments (eg, memory and attention problems), commonly known as chemo-brain. Exercise, especially aerobic high-intensity interval training (HIIT), is associated with better cognitive function in healthy populations. However, clinical trials testing the impact of exercise interventions on chemotherapy-induced cognitive decline in patients with cancer are lacking, and the mechanisms through which exercise could improve cognitive function are unclear. Objective: The objective of the Improving Cognitive Function Through High-Intensity Interval Training in Breast Cancer Patients Undergoing Chemotherapy trial is to examine the effects of HIIT on cognitive function in patients with breast cancer undergoing chemotherapy. Methods: This 2-arm, single-center, pilot randomized controlled trial will randomize 50 patients with breast cancer undergoing chemotherapy to HIIT or attention control. The HIIT group will perform a supervised 16-week, thrice-weekly intervention, with each session including a 5-minute warm-up at 10% maximal power output (POmax), 10 sets of alternating 1-minute high-intensity (90% POmax) and 1-minute recovery (10% POmax) intervals, and a 5-minute cooldown (10% POmax). The attention control group will receive a stretching program with no exercise components and be asked to maintain their exercise levels for 16 weeks. The primary outcomes of the study are executive function and memory measured using the National Institutes of Health toolbox and resting-state connectivity and diffusion tensor imaging microstructure evaluated using magnetic resonance imaging. The secondary and tertiary outcomes include cardiorespiratory fitness, body composition, physical fitness, and psychosocial health. The study has been approved by the institutional review board of the Dana-Farber Cancer Institute (20-222). Results: The trial was funded in January 2019, with recruitment started in June 2021. As of May 2022, a total of 4 patients have consented and been randomized (n=2, 50% to exercise; n=1, 25% to control; and n=1, 25% nonrandomized). Trial completion is expected in January 2024. Conclusions: This first-of-its-kind study incorporates a novel exercise intervention (ie, HIIT) and comprehensive cognitive measures. If positive, our findings will establish the pilot efficacy of HIIT on chemotherapy-induced cognitive function in patients with breast cancer, providing the foundation for future larger phase-II and phase-III trials to confirm the findings and potentially establish HIIT as a standard of care for women undergoing chemotherapy for breast cancer. Trial Registration: ClinicalTrials.gov NCT04724499; https://clinicaltrials.gov/ct2/show/NCT04724499 International Registered Report Identifier (IRRID): DERR1-10.2196/39740 %M 37027186 %R 10.2196/39740 %U https://www.researchprotocols.org/2023/1/e39740 %U https://doi.org/10.2196/39740 %U http://www.ncbi.nlm.nih.gov/pubmed/37027186 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43522 %T Mobile Health Apps for Breast Cancer: Content Analysis and Quality Assessment %A Yang,Seongwoo %A Bui,Cam Nhung %A Park,Kyounghoon %+ HERINGS, The Institute of Advanced Clinical & Biomedical Research, 14F, 560, Eonju-ro, Gangnam-gu, Seoul, 06144, Republic of Korea, 82 269493523, khpark@heringsglobal.com %K app %K breast cancer %K quality assessment %K mobile health %K mHealth %K digital health %K digital health intervention %K cancer management %K tablet %K prevention %K survivor %K peer-support %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required. Objective: The purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians. Methods: Based on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords “breast cancer” in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively. Results: The initial search identified 1148 apps, 69 (6%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001). Conclusions: The quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes. %M 36821352 %R 10.2196/43522 %U https://mhealth.jmir.org/2023/1/e43522 %U https://doi.org/10.2196/43522 %U http://www.ncbi.nlm.nih.gov/pubmed/36821352 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e36654 %T Nurses’ Experiences Using an Interactive System to Assess and Manage Treatment-Related Symptoms of Patients With Pancreatic Cancer: Interview Study %A Mangsbacka,Maria %A Gustavell,Tina %+ Department of Upper Abdominal Diseases, Cancer Theme, Karolinska University Hospital (Huddinge), Hälsovägen, Flemingsberg (Main entrance), C1:77, Stockholm, 14186, Sweden, 46 724682250, tina.gustavell@ki.se %K app %K health care professionals %K mobile health %K mHealth %K nurses %K pancreatic cancer %K person-centered care %K symptom-management %K qualitative interview %K nursing %K interview %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Treatment for pancreatic cancer entails symptom distress and a high burden of self-care. Patient-reported outcomes, collected with the support of mobile health (mHealth), have shown positive effects on symptom management, patient satisfaction, and quality of life for patients with cancer. For mHealth tools to become an integral part of clinical routine, experiences from health care professionals are needed. Objective: The aim of this paper is to describe nurses’ experiences of integrating an interactive system (Interaktor) for symptom assessment and management into daily practice, when caring for patients following pancreaticoduodenectomy and during chemotherapy treatment due to pancreatic cancer. Methods: Patients reported symptoms via the Interaktor app daily for 6 months. In the event of alarming symptoms, an alert was triggered to the patient’s nurse who then called the patient to offer advice and support. All nurses (n=8) who assessed patients were interviewed either individually or in a group. Transcribed interviews were analyzed using qualitative thematic analysis. Results: mHealth can facilitate person-centered care by offering nurses a way to gain knowledge about patients and to build relationships. Further, obstacles to implementation could be seen due to a lack of structural prerequisites and uncertainty about multiple ways to interact with patients. Conclusions: The Interaktor system can provide person-centered care. However, to implement mHealth tools as a clinical routine, focus needs to be placed on creating the necessary organizational conditions. %M 35576577 %R 10.2196/36654 %U https://nursing.jmir.org/2022/1/e36654 %U https://doi.org/10.2196/36654 %U http://www.ncbi.nlm.nih.gov/pubmed/35576577 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34292 %T Effect of the Nutraceutical Micodigest 2.0 on the Complication Rate of Colorectal Cancer Surgery With Curative Intent: Protocol for a Placebo-Controlled Double-blind Randomized Clinical Trial %A Regueiro,Cristina %A Codesido,Laura %A García-Nimo,Laura %A Zarraquiños,Sara %A Remedios,David %A Rodríguez-Blanco,Arturo %A Sinde,Esteban %A Fernández-de-Ana,Catalina %A Cubiella,Joaquín %+ Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Ramón Puga 52-54, Ourense, 32002, Spain, 34 988385824, cristinaregueiroexposito@gmail.com %K colorectal cancer %K surgery complications %K gut microbiota %K inflammatory pattern %K nutritional status %K nutraceutical %K postsurgery %K colorectal %K cancer %K colon %D 2022 %7 16.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Most colorectal cancer patients diagnosed are candidates for surgical resection with curative intent, although colorectal surgery is associated with some complications that could be life-threatening. Antibiotic prophylaxis is commonly used for the prevention of infectious postoperative complications. However, this intervention can change the composition of intestinal microbiota and promote adverse inflammatory outcomes in colorectal cancer patients. The combination of different fungal extracts could be beneficial because of their role in gut microbiota modulation and their anti-inflammatory activity. Objective: Based on this hypothesis, we have designed a double-bind, randomized clinical trial to evaluate the effect of the nutraceutical fungal extract Micodigest 2.0 on complications of surgery for colorectal cancer resection. Methods: Colorectal cancer candidates for surgery will be considered for inclusion in the study. After evaluation by the multidisciplinary tumor board, patients who meet selection criteria will be screened, stratified according to tumor location, and randomly allocated to be treated with Micodigest 2.0 or placebo. Treatment will be continued until admission for surgery (4-6 weeks). Participants will undergo a medical and clinical evaluation including baseline and preadmission quality of life, microbiome composition, inflammatory and nutritional status, adverse events, and adherence assessments. The main end point of the study is the surgery complication rate. We will evaluate complications using the Clavien-Dindo classification. It will be necessary to recruit 144 patients to find a relevant clinical difference. We will also evaluate the effect of the nutraceutical on microbiome composition, inflammatory response, nutritional status, and quality of life, as well as the effect of these variables on surgical complications. Results: This study was funded in 2020 by the Center for Industrial Technology Development. Recruitment began in September 2021 and is expected to be completed in September 2022. Data will be analyzed and the results will be disseminated in 2023. Conclusions: The results of this protocol study could help to reduce surgery complications in patients with colorectal cancer using the new treatment Micodigest. This study could also identify new features associated with colorectal surgery complications. In summary, this study trial could improve the management of colorectal cancer patients. Trial Registration: Clinical Trials.gov NCT04821258; https://clinicaltrials.gov/ct2/show/NCT04821258 International Registered Report Identifier (IRRID): DERR1-10.2196/34292 %M 35576566 %R 10.2196/34292 %U https://www.researchprotocols.org/2022/5/e34292 %U https://doi.org/10.2196/34292 %U http://www.ncbi.nlm.nih.gov/pubmed/35576566 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37709 %T The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial %A Keats,Melanie R %A Grandy,Scott A %A Blanchard,Christopher %A Fowles,Jonathon R %A Neyedli,Heather F %A Weeks,Adrienne C %A MacNeil,Mary V %+ Division of Kinesiology, School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada, 1 902 494 7173, melanie.keats@dal.ca %K glioblastoma %K myopathy %K resistance exercise %K functional fitness %K quality of life %K intervention %K randomized controlled trial %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Glioblastoma is the most common primary brain malignancy in adults, accounting for approximately 48% of all brain tumors. Standard treatment includes radiation and temozolomide chemotherapy. Glioblastomas are highly vascular and can cause vasogenic brain edema and mass effect, which can worsen the neurologic symptoms associated with the disease. The steroid dexamethasone (DEX) is the treatment of choice to reduce vasogenic edema and intracranial pressure associated with glioblastoma. However high-dose DEX or long-term use can result in muscle myopathy in 10%-60% of glioblastoma patients, significantly reducing functional fitness and quality of life (QOL). There is a wealth of evidence to support the use of exercise as an adjuvant therapy to improve functional ability as well as help manage treatment-related symptoms. Specifically, resistance training has been shown to increase muscle mass, strength, and functional fitness in aging adults and several cancer populations. Although studies are limited, research has shown that exercise is safe and feasible in glioblastoma populations. However, it is not clear whether resistance training can be successfully used in glioblastoma to prevent or mitigate steroid-induced muscle myopathy and associated loss of function. Objective: The primary purpose of this study is to establish whether an individualized circuit-based program will reduce steroid-induced muscle myopathy, as indicated by maintained or improved functional fitness for patients on active treatment and receiving steroids. Methods: This is a 2-armed, randomized controlled trial with repeated measures. We will recruit 38 adult (≥18 years) patients diagnosed with either primary or secondary glioblastoma who are scheduled to receive standard radiation and concurrent and adjuvant temozolomide chemotherapy postsurgical debulking and received any dose of DEX through the neurooncology clinic and the Nova Scotia Health Cancer Center. Patients will be randomly allocated to a standard of care waitlist control group or standard of care + circuit-based resistance training exercise group. The exercise group will receive a 12-week individualized, group and home-based exercise program. The control group will be advised to maintain an active lifestyle. The primary outcome, muscle myopathy (functional fitness), will be assessed using the Short Physical Performance Battery and hand grip strength. Secondary outcome measures will include body composition, cardiorespiratory fitness, physical activity, QOL, fatigue, and cognitive function. All measures will be assessed pre- and postintervention. Participant accrual, exercise adherence, and safety will be assessed throughout the study. Results: This study has been funded by the Canadian Cancer Society Atlantic Cancer Research Grant and the J.D. Irving Limited–Excellence in Cancer Research Fund (grant number 707182). The protocol was approved by the Nova Scotia Health and Acadia University’s Research Ethics Boards. Enrollment is anticipated to begin in March 2022. Conclusions: This study will inform how individualized circuit-based resistance training may improve functional independence and overall QOL of glioblastoma patients. Trial Registration: ClinicalTrails.gov NCT05116137; https://www.clinicaltrials.gov/ct2/show/NCT05116137 International Registered Report Identifier (IRRID): DERR1-10.2196/37709 %M 35507403 %R 10.2196/37709 %U https://www.researchprotocols.org/2022/5/e37709 %U https://doi.org/10.2196/37709 %U http://www.ncbi.nlm.nih.gov/pubmed/35507403 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e36788 %T Mobile-Based Self-management Application Requirements for Patients With Gastric Cancer: Quantitative Descriptive Study of Specialist and Patient Perspectives %A Yazdanian,Azade %A Mehdizadeh,Hamed %A Balaghafari,Azita %A Kahouei,Mahdi %A Masoudinezhad,Maede %+ Department of Health Information Technology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, MAZUMS Campus, Farah Abad Blvd, Sari, 4818911916, Iran, 98 1133543246, hamed13sep@gmail.com %K digital health, eHealth %K telehealth %K mHealth %K mobile app %K self-management %K patient education %K needs assessment, requirements analysis, stomach neoplasm, gastric cancer %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Gastric cancer is one of the most common gastrointestinal cancers. Patients with gastric cancer experience disabilities and complications that lead to reduced quality of life. Empowering these patients by providing them with information and self-management skills can help reduce side effects and improve their quality of life. Objective: The aim of this study was to identify the user requirements for developing a mobile-based self-management app to support patients with gastric cancer. Methods: Data were analyzed using descriptive statistics and frequency distribution reports using IBM SPSS Statistics software. Results: All of the data elements and functional requirements except “data recording times” and “weight changes in graphs” were identified as essential by clinical experts and patients. Among the functional requirements required in a gastric cancer self-management app, the capabilities related to informing, announcing warnings, and reminders are included. In the demographic data section, most patients (14/26, 53%) did not comment on the importance of recording data such as name, surname, and place of residence, and the demographic data section was met with less agreement from patients than clinicians. Conclusions: Applying the requirements mentioned in this study can improve the self-management of patients with gastric cancer. Such apps can play an important role in empowering patients and improving their quality of life. However, the apps need to be designed and implemented to see how they can meet users’ requirements. %M 35475920 %R 10.2196/36788 %U https://cancer.jmir.org/2022/2/e36788 %U https://doi.org/10.2196/36788 %U http://www.ncbi.nlm.nih.gov/pubmed/35475920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27349 %T A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training–Validation Trial %A Passardi,Alessandro %A Foca,Flavia %A Caffo,Orazio %A Tondini,Carlo Alberto %A Zambelli,Alberto %A Vespignani,Roberto %A Bartolini,Giulia %A Sullo,Francesco Giulio %A Andreis,Daniele %A Dianti,Marco %A Eccher,Claudio %A Piras,Enrico Maria %A Forti,Stefano %+ IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Via P. Maroncelli 40, Meldola, 47014, Italy, 39 0543 739992, roberto.vespignani@irst.emr.it %K adherence %K oral anticancer drug %K mHealth %K ONCO-TreC %K electronic diary %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective: The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods: Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results: A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions: ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration: ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724 %M 35080505 %R 10.2196/27349 %U https://www.jmir.org/2022/1/e27349 %U https://doi.org/10.2196/27349 %U http://www.ncbi.nlm.nih.gov/pubmed/35080505 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29485 %T A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial %A Fu,Mei Rosemary %A Axelrod,Deborah %A Guth,Amber A %A Scagliola,Joan %A Rampertaap,Kavita %A El-Shammaa,Nardin %A Qiu,Jeanna M %A McTernan,Melissa L %A Frye,Laura %A Park,Christopher S %A Yu,Gary %A Tilley,Charles %A Wang,Yao %+ School of Nursing-Camden, Rutgers University, 530 Federal Street, Camden, NJ, 08102, United States, 1 9739861758, mei.r.fu@rutgers.edu %K pain %K lymphatic exercises %K symptoms %K lymphedema %K breast cancer %K health behavior %K mHealth %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The-Optimal-Lymph-Flow (TOLF) is a patient-centered, web- and mobile-based mHealth system that delivers safe, easy, and feasible digital therapy of lymphatic exercises and limb mobility exercises. Objective: The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web- and mobile-based TOLF system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference measured by infrared perometer, BMI, and quality of life (QOL) related to pain. We hypothesized that participants in the intervention group would have improved pain and symptom experiences, limb volume difference, BMI, and QOL. Methods: A parallel RCT with a control–experimental, pre- and posttest, and repeated-measures design were used. A total of 120 patients were recruited face-to-face at the point of care during clinical visits. Patients were randomized according to pain in a 1:1 ratio into either the arm precaution (AP) control group to improve limb mobility and arm protection or The-Optimal-Lymph flow (TOLF) intervention group to promote lymph flow and limb mobility. Trial outcomes were evaluated at baseline and at week 12 after the intervention. Descriptive statistics, Fisher exact tests, Wilcoxon rank-sum tests, t test, and generalized linear mixed effects models were performed for data analysis. Results: At the study endpoint of 12 weeks, significantly fewer patients in the TOLF intervention group compared with the AP control group reported chronic pain (45% [27/60] vs 70% [42/60]; odds ratio [OR] 0.39, 95% CI 0.17-0.90; P=.02). Patients who received the TOLF intervention were significantly more likely to achieve a complete reduction in pain (50% [23/46] vs 22% [11/51]; OR 3.56, 95% CI 1.39-9.76; P=.005) and soreness (43% [21/49] vs 22% [11/51]; OR 2.60, 95% CI 1.03-6.81; P=.03). Significantly lower median severity scores were found in the TOLF group for chronic pain (MedTOLF=0, IQR 0-1 vs MedAP=1, IQR 0-2; P=.02) and general bodily pain (MedTOLF=1, IQR=0-1.5 vs MedAP=1, IQR 1-3; P=.04). Compared with the AP control group, significantly fewer patients in the TOLF group reported arm/hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited movement in shoulder (P=.02) and arm (P=.03). No significant differences between the TOLF and AP groups were found in complete reduction of aching (P=.12) and tenderness (P=.65), mean numbers of lymphedema symptom reported (P=.11), ≥5% limb volume differences (P=.48), and BMI (P=.12). Conclusions: The TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, arm/hand swelling, heaviness, and impaired limb mobility. The intervention resulted in a 13% reduction (from 40% [24/60] to 27% [16/60]) in proportions of patients who took pain medications compared with the AP control group, which had a 5% increase (from 40% [24/60] to 45% [27/60]). A 12% reduction (from 27% [16/60] to 15% [9/60]) in proportions of patients with ≥5% limb volume differences was found in the TOLF intervention, while a 5% increase in the AP control group (from 40% [24/60] to 45% [27/60]) was found. In conclusion, the TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. Trial Registration: Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5104 %M 35037883 %R 10.2196/29485 %U https://cancer.jmir.org/2022/1/e29485 %U https://doi.org/10.2196/29485 %U http://www.ncbi.nlm.nih.gov/pubmed/35037883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25792 %T Integrating Quality of Life in the Care Pathway of Cancer Patients Undergoing Immunotherapy Treatment: Descriptive, Cross-sectional Survey of an Online Patient Community's Experiences and Expectations %A Wilczynski,Ophélie %A Boisbouvier,Anthony %A Radoszycki,Lise %A Cotté,François-Emery %A Gaudin,Anne-Françoise %A Lemasson,Hervé %+ Bristol-Myers Squibb France, 3 Rue Joseph Monier, Rueil-Malmaison, 92506, France, 33 1 58 83 60 00, Herve.Lemasson@bms.com %K cancer %K quality of life %K immunotherapy %K patient community %K patient satisfaction %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: New cancer treatments, such as immune checkpoint inhibitors (ICIs), can improve survival and health-related quality of life (HRQoL) in patients with cancer. Although long-term monitoring of HRQoL has been shown to improve survival, integration of HRQoL into everyday practice remains poorly documented. Objective: This study describes experiences and expectations of patients treated with ICIs regarding a discussion of HRQoL with health care professionals (HCPs) in cancer management. Methods: This cross-sectional study was conducted in an online patient community (Carenity) in France. Patients treated with ICIs for cancer, included between September 2018 and January 2019, completed a questionnaire to assess the involvement of HCP in a discussion of HRQoL and when and what was discussed. Results: Of 82 patients included (mean age: 56.9 years, 95% CI 54.2-59.6; 46 [56%] male; 34 [41%] with lung cancer), 62 (76%) reported discussing HRQoL at least once with HCPs, mainly general practitioners (54/82, 66%), oncologists (53/82, 65%), and hospital nurses (50/82, 61%). Around half (45/82, 55%) of the patients were satisfied with these discussions. Discussions with the oncologist were at the patient’s initiative (34/53, 64%). Discussions occurred primarily during follow-up visits (40/62, 65%), when adverse events occurred (30/62, 48%), and at treatment initiation (27/62, 32%). The most discussed dimensions were symptoms (48/62, 77%) and physical well-being (43/62, 69%). With respect to expectations, 54/82 (66%) patients considered oncologists as the most important HCPs for discussing HRQoL. These discussions were desirable throughout the care pathway, particularly at diagnosis (63/82, 77%) and when treatment was initiated (75/82, 92%) or changed (68/82, 83%). All HRQoL dimensions were considered important to discuss. Conclusions: With only around half of the patients satisfied with HRQoL discussions, impactful HRQoL integration in clinical practice is critical. According to patients, this integration should involve mainly oncologists and general practitioners, should happen at every step of the care pathway, and should be extended to dimensions that are currently rarely addressed. %M 35014969 %R 10.2196/25792 %U https://www.jmir.org/2022/1/e25792 %U https://doi.org/10.2196/25792 %U http://www.ncbi.nlm.nih.gov/pubmed/35014969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31917 %T A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study %A Wan,Su Wei %A Chong,Choon Seng %A Toh,Ee-Lin %A Lim,Siew Hoon %A Loi,Carol TT %A Lew,Yuen Foong Henry %A Chua,Matthew Chin Heng %A Jee,Xin Pei %A Liu,Guangyu %A Zhu,Lixia %A Pikkarainen,Minna %A He,Hong-Gu %+ Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65167448, nurhhg@nus.edu.sg %K colorectal cancer %K digital solutions %K mobile health %K psychosocial %K mHealth %K smartphone app %K mobile phone app %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective: The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods: A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results: Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions: This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration: ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363 %M 34878991 %R 10.2196/31917 %U https://www.jmir.org/2021/12/e31917 %U https://doi.org/10.2196/31917 %U http://www.ncbi.nlm.nih.gov/pubmed/34878991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27497 %T Information Patients With Melanoma Spontaneously Report About Health-Related Quality of Life on Web-Based Forums: Case Study %A Kalf,Rachel R J %A Delnoij,Diana M J %A Ryll,Bettina %A Bouvy,Marcel L %A Goettsch,Wim G %+ Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Universiteitsweg 99, Utrecht, 3584 CG, Netherlands, 31 302537324, m.l.bouvy@uu.nl %K reimbursement decision-making %K QoL %K health care %K quality of life %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a general agreement on the importance of health-related quality of life (HRQoL). This type of information is becoming increasingly important for the value assessment of health technology assessment agencies in evaluating the benefits of new health technologies, including medicines. However, HRQoL data are often limited, and additional sources that provide this type of information may be helpful. Objective: We aim to identify the HRQoL topics important to patients with melanoma based on web-based discussions on public social media forums. Methods: We identified 3 public web-based forums from the United States and the United Kingdom, namely the Melanoma Patient Information Page, the Melanoma International Forum, and MacMillan. Their posts were randomly selected and coded using qualitative methods until saturation was reached. Results: Of the posts assessed, 36.7% (150/409) of posts on Melanoma International Forum, 45.1% (198/439) on MacMillan, and 35.4% (128/362) on Melanoma Patient Information Page focused on HRQoL. The 2 themes most frequently mentioned were mental health and (un)certainty. The themes were constructed based on underlying and more detailed codes. Codes related to fear, worry and anxiety, uncertainty, and unfavorable effects were the most-often discussed ones. Conclusions: Web-based forums are a valuable source for identifying relevant HRQoL aspects in patients with a given disease. These aspects could be cross-referenced with existing tools and they might improve the content validity of patient-reported outcome measures, including HRQoL questionnaires. In addition, web-based forums may provide health technology assessment agencies with a more holistic understanding of the external aspects affecting patient HRQoL. These aspects might support the value assessment of new health technologies and could therefore help inform topic prioritization as well as the scoping phase before any value assessment. %M 34878994 %R 10.2196/27497 %U https://www.jmir.org/2021/12/e27497 %U https://doi.org/10.2196/27497 %U http://www.ncbi.nlm.nih.gov/pubmed/34878994 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e27850 %T Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review %A Xu,Lu %A Sanders,Leslie %A Li,Kay %A Chow,James C L %+ Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 7/F, 700 University Avenue, Toronto, ON, M5G 1X6, Canada, 1 9464501 ext 5089, james.chow@rmp.uhn.ca %K chatbot %K artificial intelligence %K machine learning %K health %K medicine %K communication %K diagnosis %K cancer therapy %K ethics %K medical biophysics %K mobile phone %D 2021 %7 29.11.2021 %9 Review %J JMIR Cancer %G English %X Background: Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility. Objective: This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation. Methods: A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion. Results: Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored. Conclusions: Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine. %M 34847056 %R 10.2196/27850 %U https://cancer.jmir.org/2021/4/e27850 %U https://doi.org/10.2196/27850 %U http://www.ncbi.nlm.nih.gov/pubmed/34847056 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e22931 %T Remote Monitoring of the Performance Status and Burden of Symptoms of Patients With Gastrointestinal Cancer Via a Consumer-Based Activity Tracker: Quantitative Cohort Study %A Ghods,Alireza %A Shahrokni,Armin %A Ghasemzadeh,Hassan %A Cook,Diane %+ Geriatrics / Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, Box 205, 1275 York Ave, New York, NY, 10065, United States, 1 646 888 3250, shahroka@mskcc.org %K step count %K performance status %K symptom %K wearable %K activity tracker %K gastrointestinal cancer %K monitoring %K cancer %K gastrointestinal %K burden %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: The number of older patients with gastrointestinal cancer is increasing due to an aging global population. Minimizing reliance on an in-clinic patient performance status test to determine a patient’s prognosis and course of treatment can improve resource utilization. Further, current performance status measurements cannot capture patients' constant changes. These measurements also rely on self-reports, which are subjective and subject to bias. Real-time monitoring of patients' activities may allow for a more accurate assessment of patients’ performance status while minimizing resource utilization. Objective: This study investigates the validity of consumer-based activity trackers for monitoring the performance status of patients with gastrointestinal cancer. Methods: A total of 27 consenting patients (63% male, median age 58 years) wore a consumer-based activity tracker 7 days before chemotherapy and 14 days after receiving their first treatment. The provider assessed patients using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale and Memorial Symptom Assessment Scale-Short Form (MSAS-SF) before and after chemotherapy visits. The statistical correlations between ECOG-PS and MSAS-SF scores and patients’ daily step counts were assessed. Results: The daily step counts yielded the highest correlation with the patients' ECOG-PS scores after chemotherapy (P<.001). The patients with higher ECOG-PS scores experienced a higher fluctuation in their step counts. The patients who walked more prechemotherapy (mean 6071 steps per day) and postchemotherapy (mean 5930 steps per day) had a lower MSAS-SF score (lower burden of symptoms) compared to patients who walked less prechemotherapy (mean 5205 steps per day) and postchemotherapy (mean 4437 steps per day). Conclusions: This study demonstrates the feasibility of using inexpensive, consumer-based activity trackers for the remote monitoring of performance status in the gastrointestinal cancer population. The findings need to be validated in a larger population for generalizability. %M 34842527 %R 10.2196/22931 %U https://cancer.jmir.org/2021/4/e22931 %U https://doi.org/10.2196/22931 %U http://www.ncbi.nlm.nih.gov/pubmed/34842527 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e22140 %T Technology-Based Interventions for Cancer Caregivers: Concept Analysis %A Su,Zhaohui %A Li,Xiaoshan %A McDonnell,Dean %A Fernandez,Andrea A %A Flores,Bertha E %A Wang,Jing %+ Florida State University College of Nursing, 98 Varsity Way, Suite 472B, Tallahassee, FL, 32306-4310, United States, 1 850 644 6844, jingwang@nursing.fsu.edu %K concept analysis %K caregivers %K cancer %K oncology %K technology-based interventions %K mobile phone %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective: This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods: The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results: The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions: This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively. %M 34783664 %R 10.2196/22140 %U https://cancer.jmir.org/2021/4/e22140 %U https://doi.org/10.2196/22140 %U http://www.ncbi.nlm.nih.gov/pubmed/34783664 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28322 %T A Digital Self-management Program (Help to Overcome Problems Effectively) for People Living With Cancer: Feasibility Randomized Controlled Trial %A Wright,Hayley %A Martin,Faith %A Clyne,Wendy %A Clark,Cain C T %A Matouskova,Gabriela %A McGillion,Michael %A Turner,Andrew %+ Centre for Intelligent Healthcare, Research Institute for Health and Wellbeing, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 7599782465, hsx116@coventry.ac.uk %K self-management %K cancer %K survivorship %K digital %K positive psychology %D 2021 %7 5.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We present the results of a feasibility, randomized waitlist control group (CG) parallel design study with a 1:1 allocation ratio. Participants were randomized into an intervention group (IG) or a waitlist CG. The intervention was a 6-week digital self-management program, Help to Overcome Problems Effectively (HOPE), for people with cancer. Objective: This study aims to test the feasibility of a digitally delivered self-management program for people with cancer. This will inform the design of a definitive randomized controlled trial. In addition, a preliminary assessment of the impact of the HOPE program via secondary outcomes will be used to assess signals of efficacy in a trial context. Methods: Participants were drawn from an opportunity sample, referred by Macmillan Cancer Support, and were invited via email to participate in the study (N=61). Primary outcomes were rates of recruitment, retention, follow-up, completion and adherence, sample size and effect size estimation, and assessment of progression criteria for a definitive trial. Secondary outcomes were self-report measures of participants’ positive mental well-being, depression, anxiety, and patient activation (ie, confidence in managing their cancer). The intervention and data collection took place on the web. Results: The recruitment rate was 77% (47/61). A total of 41 participants completed the baseline questionnaires and were randomized to either the IG (n=21) or the waitlist CG (n=20). The retention rate (attending all program sessions) was greater than 50% (all: 21/41, 51%, IG: 10/21, 48%; and CG: 11/20, 55%). The follow-up rate (completing all questionnaires) was greater than 80% (all: 33/41, 80%; IG: 16/21, 76%; and CG: 17/20, 85%). The completion rate (attending ≥3 sessions and completing all questionnaires) was greater than 60% (all: 25/41, 61%; IG: 13/21, 62%; and CG: 12/20, 60%). Engagement data showed that participants viewed between half (5.1/10, 51%) and three-quarters (12.2/16, 76%) of the pages in each session. Conclusions: All progression criteria for a definitive trial were met, as supported by the primary outcome data. The IG showed improved postprogram scores on measures of positive mental well-being, depression, anxiety, and patient activation. A full-scale trial of the digital HOPE program for people with cancer will allow us to fully evaluate the efficacy of the intervention relative to a CG. Trial Registration: ISRCTN Registry ISRCTN79623250; http://www.isrctn.com/ISRCTN79623250 International Registered Report Identifier (IRRID): RR2-10.2196/24264 %M 34738912 %R 10.2196/28322 %U https://www.jmir.org/2021/11/e28322 %U https://doi.org/10.2196/28322 %U http://www.ncbi.nlm.nih.gov/pubmed/34738912 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32789 %T Understanding Adolescent and Young Adult 6-Mercaptopurine Adherence and mHealth Engagement During Cancer Treatment: Protocol for Ecological Momentary Assessment %A Psihogios,Alexandra M %A Rabbi,Mashfiqui %A Ahmed,Annisa %A McKelvey,Elise R %A Li,Yimei %A Laurenceau,Jean-Philippe %A Hunger,Stephen P %A Fleisher,Linda %A Pai,Ahna LH %A Schwartz,Lisa A %A Murphy,Susan A %A Barakat,Lamia P %+ Children's Hospital of Philadelphia, University of Pennsylvania, Abramson Pediatric Research Center, Room 1429C, 3615 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 267 314 0164, psihogiosa@email.chop.edu %K mHealth %K ecological momentary assessment %K adolescents %K young adults %K oncology %K cancer %K self-management %K mobile phone %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents and young adults (AYAs) with cancer demonstrate suboptimal oral chemotherapy adherence, increasing their risk of cancer relapse. It is unclear how everyday time-varying contextual factors (eg, mood) affect their adherence, stalling the development of personalized mobile health (mHealth) interventions. Poor engagement is also a challenge across mHealth trials; an effective adherence intervention must be engaging to promote uptake. Objective: This protocol aims to determine the temporal associations between daily contextual factors and 6-mercaptopurine (6-MP) adherence and explore the proximal impact of various engagement strategies on ecological momentary assessment survey completion. Methods: At the Children’s Hospital of Philadelphia, AYAs with acute lymphoblastic leukemia or lymphoma who are prescribed prolonged maintenance chemotherapy that includes daily oral 6-MP are eligible, along with their matched caregivers. Participants will use an ecological momentary assessment app called ADAPTS (Adherence Assessments and Personalized Timely Support)—a version of an open-source app that was modified for AYAs with cancer through a user-centered process—and complete surveys in bursts over 6 months. Theory-informed engagement strategies will be microrandomized to estimate the causal effects on proximal survey completion. Results: With funding from the National Cancer Institute and institutional review board approval, of the proposed 30 AYA-caregiver dyads, 60% (18/30) have been enrolled; of the 18 enrolled, 15 (83%) have completed the study so far. Conclusions: This protocol represents an important first step toward prescreening tailoring variables and engagement components for a just-in-time adaptive intervention designed to promote both 6-MP adherence and mHealth engagement. International Registered Report Identifier (IRRID): DERR1-10.2196/32789 %M 34677129 %R 10.2196/32789 %U https://www.researchprotocols.org/2021/10/e32789 %U https://doi.org/10.2196/32789 %U http://www.ncbi.nlm.nih.gov/pubmed/34677129 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26545 %T An Ostomy Self-management Telehealth Intervention for Cancer Survivors: Technology-Related Findings From a Randomized Controlled Trial %A Weinstein,Ronald S %A Holcomb,Michael J %A Mo,Julia %A Yonsetto,Peter %A Bojorquez,Octavio %A Grant,Marcia %A Wendel,Christopher S %A Tallman,Nancy J %A Ercolano,Elizabeth %A Cidav,Zuleyha %A Hornbrook,Mark C %A Sun,Virginia %A McCorkle,Ruth %A Krouse,Robert S %+ Arizona Telemedicine Program, The University of Arizona Health Sciences, 1501 N Campbell AHSL 1156, Tucson, AZ, 85724, United States, 1 5203733552, rweinstein@telemedicine.arizona.edu %K telehealth %K telemedicine %K cloud computing %K ostomy %K cancer survivors %K family caregivers %K self-management %K patient education %K videoconferencing %K mobile phone %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: An Ostomy Self-management Telehealth (OSMT) intervention by nurse educators and peer ostomates can equip new ostomates with critical knowledge regarding ostomy care. A telehealth technology assessment aim was to measure telehealth engineer support requirements for telehealth technology–related (TTR) incidents encountered during OSMT intervention sessions held via a secure cloud-based videoconferencing service, Zoom for Healthcare. Objective: This paper examines technology-related challenges, issues, and opportunities encountered in the use of telehealth in a randomized controlled trial intervention for cancer survivors living with a permanent ostomy. Methods: The Arizona Telemedicine Program provided telehealth engineering support for 105 OSMT sessions, scheduled for 90 to 120 minutes each, over a 2-year period. The OSMT groups included up to 15 participants, comprising 4-6 ostomates, 4-6 peer ostomates, 2 nurse educators, and 1 telehealth engineer. OSMT-session TTR incidents were recorded contemporaneously in detailed notes by the research staff. TTR incidents were categorized and tallied. Results: A total of 97.1% (102/105) OSMT sessions were completed as scheduled. In total, 3 OSMT sessions were not held owing to non–technology-related reasons. Of the 93 ostomates who participated in OSMT sessions, 80 (86%) completed their OSMT curriculum. TTR incidents occurred in 36.3% (37/102) of the completed sessions with varying disruptive impacts. No sessions were canceled or rescheduled because of TTR incidents. Disruptions from TTR incidents were minimized by following the TTR incident prevention and incident response plans. Conclusions: Telehealth videoconferencing technology can enable ostomates to participate in ostomy self-management education by incorporating dedicated telehealth engineering support. Potentially, OSMT greatly expands the availability of ostomy self-management education for new ostomates. Trial Registration: ClinicalTrials.gov NCT02974634; https://clinicaltrials.gov/ct2/show/NCT02974634 %M 34086595 %R 10.2196/26545 %U https://www.jmir.org/2021/9/e26545 %U https://doi.org/10.2196/26545 %U http://www.ncbi.nlm.nih.gov/pubmed/34086595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28869 %T Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review %A Hopstaken,Jana S %A Verweij,Lynn %A van Laarhoven,Cees J H M %A Blijlevens,Nicole M A %A Stommel,Martijn W J %A Hermens,Rosella P M G %+ Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 10, Nijmegen, 6525 GA, Netherlands, 31 024 36 680 86, jana.hopstaken@radboudumc.nl %K digital care platforms %K cancer care %K eHealth %K telemedicine %K health care services %K fragmentation of care %K health care fragmentation %K oncology %K quality of care %K barriers %K facilitators %K patient experience %D 2021 %7 24.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider–reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. Objective: The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider–reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. Methods: The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. Results: Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. Conclusions: The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels. %M 34559057 %R 10.2196/28869 %U https://www.jmir.org/2021/9/e28869 %U https://doi.org/10.2196/28869 %U http://www.ncbi.nlm.nih.gov/pubmed/34559057 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28695 %T Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study %A Yang,Kyungmi %A Oh,Dongryul %A Noh,Jae Myoung %A Yoon,Han Gyul %A Sun,Jong-Mu %A Kim,Hong Kwan %A Zo,Jae Ill %A Shim,Young Mog %A Ko,Hyunyoung %A Lee,Jungeun %A Kim,Youngin %+ Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 2612, dongryul.oh@samsung.com %K esophageal cancer %K malnutrition %K muscle loss %K sarcopenia %K mobile app %K mHealth %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective: In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods: Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results: Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (–6.7 vs –9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days >10%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions: For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition. %M 34448714 %R 10.2196/28695 %U https://www.jmir.org/2021/8/e28695 %U https://doi.org/10.2196/28695 %U http://www.ncbi.nlm.nih.gov/pubmed/34448714 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e30090 %T Optimizing Oral Targeted Anticancer Therapies Study for Patients With Solid Cancer: Protocol for a Randomized Controlled Medication Adherence Program Along With Systematic Collection and Modeling of Pharmacokinetic and Pharmacodynamic Data %A Bandiera,Carole %A Cardoso,Evelina %A Locatelli,Isabella %A Digklia,Antonia %A Zaman,Khalil %A Diciolla,Antonella %A Cristina,Valérie %A Stravodimou,Athina %A Veronica,Aedo Lopez %A Dolcan,Ana %A Sarivalasis,Apostolos %A Liapi,Aikaterini %A Bouchaab,Hasna %A Orcurto,Angela %A Dotta-Celio,Jennifer %A Peters,Solange %A Decosterd,Laurent %A Widmer,Nicolas %A Wagner,Dorothea %A Csajka,Chantal %A Schneider,Marie Paule %+ School of Pharmaceutical Sciences, University of Geneva, Rue Michel Servet 1, Geneva, 1211, Switzerland, 41 22 379 53 16, Marie.Schneider@unige.ch %K neoplasms %K medication adherence %K oral anticancer therapies %K interprofessional program %K adherence electronic measure %K pharmacokinetics %K pharmacodynamics %K NONMEM %K motivational interviewing %D 2021 %7 29.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The strengthening or substitution of intravenous cytotoxic chemotherapy cycles by oral targeted anticancer therapies, such as protein kinase inhibitors (PKIs), has provided impressive clinical benefits and autonomy as well as a better quality of life for patients with cancer. Despite these advances, adverse event management at home and medication adherence remain challenging. In addition, PKI plasma concentrations vary significantly among patients with cancer receiving the same dosage, which could explain part of the observed variability in the therapeutic response. Objective: The aim of this optimizing oral targeted anticancer therapies (OpTAT) study is to optimize and individualize targeted anticancer treatments to improve patient care and self-monitoring through an interprofessional medication adherence program (IMAP) combined with measurement PKI plasma concentrations. Methods: The OpTAT study has two parts: (1) a 1:1 randomized medication adherence program, in which the intervention consists of regular motivational interviewing sessions between the patient and the pharmacist, along with the delivery of PKIs in electronic monitors, and (2) a systematic collection of blood samples and clinical and biological data for combined pharmacokinetic and pharmacodynamic analysis. On the basis of the electronic monitor data, medication adherence will be compared between groups following the three operational definitions: implementation of treatment during the persistent period, persistence with treatment and longitudinal adherence. The implementation will be described using generalized estimating equation models. The persistence of PKI use will be represented using a Kaplan-Meier survival curve. Longitudinal adherence is defined as the product of persistence and implementation. PKI pharmacokinetics will be studied using a population approach. The relationship between drug exposure and efficacy outcomes will be explored using Cox regression analysis of progression-free survival. The relationship between drug exposure and toxicity will be analyzed using a pharmacokinetic-pharmacodynamic model and by logistic regression analysis. Receiver operating characteristic analyses will be applied to evaluate the best exposure threshold associated with clinical benefits. Results: The first patient was included in May 2015. As of June 2021, 262 patients had participated in at least one part of the study: 250 patients gave at least one blood sample, and 130 participated in the adherence study. Data collection is in process, and the final data analysis is planned to be performed in 2022. Conclusions: The OpTAT study will inform us about the effectiveness of the IMAP program in patients with solid cancers treated with PKIs. It will also shed light on PKI pharmacokinetic and pharmacodynamic properties, with the aim of learning how to adapt the PKI dosage at the individual patient level to increase PKI clinical suitability. The IMAP program will enable interprofessional teams to learn about patients’ needs and to consider their concerns about their PKI self-management, considering the patient as an active partner. Trial Registration: ClinicalTrials.gov NCT04484064; https://clinicaltrials.gov/ct2/show/NCT04484064. International Registered Report Identifier (IRRID): DERR1-10.2196/30090 %M 34185020 %R 10.2196/30090 %U https://www.researchprotocols.org/2021/6/e30090 %U https://doi.org/10.2196/30090 %U http://www.ncbi.nlm.nih.gov/pubmed/34185020 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e22825 %T Evaluation of a Remote Symptom Assessment and Management (SAM) System for People Receiving Adjuvant Chemotherapy for Breast or Colorectal Cancer: Mixed Methods Study %A Whitehead,Lisa %A Emery,Laura %A Kirk,Deborah %A Twigg,Diane %A Brown,Deborah %A Dewar,Joanna %+ Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 63042641 ext 2641, l.whitehead@ecu.edu.au %K self-management %K intervention %K symptom management %K breast cancer %K colorectal cancer %K cancer %K symptom %K monitoring %K online intervention %K development %K implementation %K evaluation %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: The Symptom Assessment and Management (SAM) program is a structured, online, nurse-supported intervention to support symptom self-management in people receiving adjuvant chemotherapy post surgery for breast or colorectal cancer. Objective: The objective of this study was to describe the development, implementation strategy, and evaluation of the SAM system. Methods: The development of the SAM program involved 3 phases. In phase 1, the web app was developed through consultation with consumers and clinicians and of the literature to ensure that the system was evidence-based and reflected the realities of receiving treatment and supporting patients through treatment. In phase 2, 7 participants recorded the severity of 6 symptoms daily over the course of 1 cycle of chemotherapy. In phase 3, 17 participants recorded their symptoms daily over the course of 3 cycles of chemotherapy. Once symptoms were recorded, participants received immediate feedback on the severity of their symptoms and self-management recommendations, which could include seeking immediate medical attention. Data on quality of life, symptom burden, anxiety and depression, distress, and self-efficacy were collected during treatment; participants’ perceptions of the SAM program were evaluated following participation via interview. Results: The outcomes of the SAM project include the development of a system that is reliable and easy to use and navigate. Participants reported benefits related to using the SAM program that included feeling more in control of managing their symptoms and feeling reassured. Engagement with the system on a daily basis was variable, with some participants completing the symptom tracker daily and others engaging some of the time. The feedback from all participants was that the system was easy to navigate and the information was relevant and supportive. Conclusions: The SAM program has the potential to enhance the management of symptoms for people receiving chemotherapy treatment. The system creates an accurate repository of symptoms that can be accessed easily and highlight patterns in symptom experience. These can be shared with clinicians, with patient permission, to inform and support treatment plans. The potential to predict the risk of developing severe symptoms can be developed to anticipate the need for care and support. Further considerations on how to increase engagement with the system, the value of the system for people diagnosed with other tumor types and treatment regimes, and the incorporation of the system into everyday clinical practice are needed. %M 33284122 %R 10.2196/22825 %U http://cancer.jmir.org/2020/2/e22825/ %U https://doi.org/10.2196/22825 %U http://www.ncbi.nlm.nih.gov/pubmed/33284122 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17824 %T Help to Overcome Problems Effectively for Cancer Survivors: Development and Evaluation of a Digital Self-Management Program %A Martin,Faith %A Wright,Hayley %A Moody,Louise %A Whiteman,Becky %A McGillion,Michael %A Clyne,Wendy %A Pearce,Gemma %A Turner,Andy %+ Faculty Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 02477657498, hsx116@coventry.ac.uk %K positive psychology %K self-management %K hope %K quality of life %K survivorship %K cancer %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with cancer face numerous psychosocial challenges, including cancer-related fatigue, fear of recurrence, and depression. There is a lack of digital interventions tailored to the needs of people living with all types of cancer. We developed a 6-week, digital, peer-delivered, self-management program: iHOPE (Help to Overcome Problems Effectively; where ‘i’ indicates the digital version of the program). The program is underpinned by positive psychology and cognitive behavioral therapy to meet these psychosocial challenges. Objective: This study aimed to assess the feasibility of the iHOPE program among people living with cancer. Program adherence and satisfaction along with changes in psychological distress and positive well-being were measured. Methods: A pre-post, acceptability, and feasibility design was used. People living with cancer (N=114) were recruited via a national cancer charity in the United Kingdom and were given access to the iHOPE program. Demographic and other participant characteristics were recorded. Participants completed digital measures at baseline and the end of the 6-week program for depression, anxiety, cancer-related fatigue, cancer worry or fear of cancer recurrence, positive mental well-being, hope, gratitude, and health status. The website’s system recorded data on the usage of the program. Satisfaction with the program was also measured. Results: A total of 114 participants completed the baseline questionnaires. Of these, 70 people (61.4%) participated in all 6 sessions. The mean number of sessions undertaken was 5.0 (SD 1.5). Moreover, 44.7% (51/114) of participants completed at least three sessions and end-of-program outcome measures. A total of 59 participants completed the satisfaction questionnaire, where ≥90% (54/58) of participants reported that the program was easy to navigate and was well managed by the peer facilitators, and that they found the social networking tools useful. Preliminary efficacy testing among the 51 participants who completed baseline and postprogram outcome measures showed that postprogram scores decreased for depression, anxiety, cancer-related fatigue, and fear of recurrence (all P<.001) and increased for positive mental well-being (P<.001), hope (both P<.001), and gratitude (P=.02). Conclusions: The feasibility evidence is promising, showing that the peer-delivered digital iHOPE program is acceptable and practical. Implementation of the iHOPE program on a wider scale will incorporate further research and development to maximize the completion rates of the measures. Initial effectiveness data suggest positive impacts on important cancer-related quality of life and mental well-being outcomes. A randomized controlled trial design with a longer follow-up is needed to confirm the potential of the iHOPE program for improving mental and physical health outcomes for cancer survivors. %M 32209529 %R 10.2196/17824 %U http://www.jmir.org/2020/5/e17824/ %U https://doi.org/10.2196/17824 %U http://www.ncbi.nlm.nih.gov/pubmed/32209529 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17018 %T Web-Based Self-Management for Patients With Lymphoma: Assessment of the Reach of Intervention of a Randomized Controlled Trial %A Arts,Lindy P J %A Oerlemans,Simone %A Posthuma,Eduardus F M %A Issa,Djamila E %A Oosterveld,Margriet %A van der Griend,René %A Nijziel,Marten R %A van de Poll-Franse,Lonneke V %+ Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, Utrecht, 3511DT, Netherlands, 31 882346000, s.oerlemans@iknl.nl %K reach %K uptake %K participation, web-based intervention %K pragmatic %K randomized controlled trial %K population-based registry %K lymphoma %D 2020 %7 14.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Randomized controlled trials (RCTs) often provide accurate estimates of the internal validity of an intervention but lack information on external validity (generalizability). We conducted an RCT on the effectiveness of a self-management intervention among patients with lymphoma in a population-based setting. Objective: The objectives of the current study were to describe the proportion of RCT participants compared to all patients invited to participate, and compare sociodemographic and clinical characteristics of RCT participants with all respondents, all patients invited to participate, and all patients selected from the Netherlands Cancer Registry (NCR) to determine the reach of the intervention. An additional objective was to assess differences on RCT outcome variables between RCT and paper respondents. Methods: Patients with lymphoma or chronic lymphocytic leukemia ≥18 years old at diagnosis from 13 hospitals in the Netherlands were selected from the population-based NCR, which routinely collects data on sociodemographic and clinical characteristics. Eligible patients were invited to participate in an RCT and complete a questionnaire. Web-based completion determined RCT enrollment, whereas paper respondents were followed observationally. Results: A total of 1193 patients were selected from the NCR, 892 (74.77%) of whom were invited to participate in the trial by their hematologist after verifying eligibility. Among those invited, 25.4% (227/892) completed the web-based questionnaire and were enrolled in the RCT. The RCT participants were younger and there was a higher proportion of men than nonparticipants (P<.001). In addition, 25.7% (229/892) of those invited opted to participate in the paper-based observational follow-up study. Compared with paper respondents, RCT participants were younger (P<.001), with a higher proportion of men (P=.002), and had higher education levels (P=.02). RCT participants more often wanted to receive all available information on their disease (P<.001), whereas paper respondents reported higher levels of emotional distress (P=.009). Conclusions: From a population-based sample of eligible patients, the participation rate in the RCT was approximately 25%. RCT participants may not be representative of the target population because of different sociodemographic and clinical characteristics. Since RCT participants represent a minority of the target population, RCT results should be interpreted with caution as patients in the RCT may be those least in need of a self-management intervention. Trial Registration: Netherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790 %M 32406858 %R 10.2196/17018 %U http://www.jmir.org/2020/5/e17018/ %U https://doi.org/10.2196/17018 %U http://www.ncbi.nlm.nih.gov/pubmed/32406858 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15780 %T The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach %A Hou,I-Ching %A Lan,Min-Fang %A Shen,Shan-Hsiang %A Tsai,Pei Yu %A Chang,King Jen %A Tai,Hao-Chih %A Tsai,Ay-Jen %A Chang,Polun %A Wang,Tze-Fang %A Sheu,Shuh-Jen %A Dykes,Patricia C %+ School of Nursing, National Yang-Ming University, No 155, Sec 2, Li-Nong Street, Beitou, Taipei, 11221, Taiwan, 886 28267000 ext 7315, evita@ym.edu.tw %K breast cancer %K mobile health application %K self-management %K design thinking %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient’s perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. %M 32352390 %R 10.2196/15780 %U http://mhealth.jmir.org/2020/4/e15780/ %U https://doi.org/10.2196/15780 %U http://www.ncbi.nlm.nih.gov/pubmed/32352390 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17084 %T Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial %A Hou,I-Ching %A Lin,Hsin-Yi %A Shen,Shan-Hsiang %A Chang,King-Jen %A Tai,Hao-Chih %A Tsai,Ay-Jen %A Dykes,Patricia C %+ School of Nursing, National Yang-Ming University, Number 155, Section 2, Linong Street, Beitou District, Taipei City, 11221, Taiwan, 886 28267000 ext 7315, evita@ym.edu.tw %K breast cancer %K mHealth app %K self-management %K quality of life %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires—the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)—were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248 %M 32130181 %R 10.2196/17084 %U http://mhealth.jmir.org/2020/3/e17084/ %U https://doi.org/10.2196/17084 %U http://www.ncbi.nlm.nih.gov/pubmed/32130181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e17045 %T Gimme My Damn Data (and Let Patients Help!): The #GimmeMyDamnData Manifesto %A deBronkart,Dave %A Eysenbach,Gunther %+ JMIR Publications, 130 Queens Quay E, Ste. 1100, Toronto, ON, Canada, 1 416 583 2040, editor@jmir.org %K data %K participatory medicine %K ehealth %D 2019 %7 22.11.2019 %9 Discussion Paper %J J Med Internet Res %G English %X Ten years ago, in 2009, “e-Patient Dave” deBronkart delivered an influential keynote speech at the Medicine 2.0 conference in Toronto, organized by the Journal of Medical Internet Research’s (JMIR’s) editor-in-chief Gunther Eysenbach, who themed the conference around the topics of participation, openness, collaboration, apomediation, and social networking to improve health care for the 21st century—with patient participation being a major component. Many see this as a defining event within the participatory medicine movement, perhaps the beginning of a social movement, similar to the women’s rights movement, with the title of Dave’s keynote “Gimme my damn data” becoming a rallying cry and hashtag for patients demanding more access to their electronic health records. On the occasion of the 20th anniversary of JMIR (and 10 years after the keynote), we are celebrating the impact of the keynote for the participatory medicine movement and #gimmemydamndata (also #GMDD) by publishing the transcript of these initial conversations as a manifesto of patients’ rights to access their data and their right to save their lives. %M 31755873 %R 10.2196/17045 %U http://www.jmir.org/2019/11/e17045/ %U https://doi.org/10.2196/17045 %U http://www.ncbi.nlm.nih.gov/pubmed/31755873 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13217 %T A Technology-Assisted, Brief Mind-Body Intervention to Improve the Waiting Room Experience for Chemotherapy Patients: Randomized Quality Improvement Study %A Bao,Ting %A Deng,Gary %A DeMarzo,Lauren A %A Zhi,W Iris %A DeRito,Janice L %A Blinder,Victoria %A Chen,Connie %A Li,Qing S %A Green,Jamie %A Pendleton,Eva %A Mao,Jun J %+ Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, United States, 1 646 888 0865, baot@mskcc.org %K mobile app %K acupressure %K meditation %K symptom relief %K chemotherapy %D 2019 %7 7.11.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients waiting for chemotherapy can experience stress, anxiety, nausea, and pain. Acupressure and meditation have been shown to control such symptoms. Objective: This study aimed to evaluate the feasibility and effectiveness of an integrative medicine app to educate patients about these self-care tools in chemotherapy waiting rooms. Methods: We screened and enrolled cancer patients in chemotherapy waiting rooms at two Memorial Sloan Kettering Cancer Center locations. Patients were randomly assigned into an intervention arm in which subjects watched acupressure and meditation instructional videos or a control arm in which they watched a time- and attention-matched integrative oncology lecture video. Before and after watching the videos, we asked the patients to rate four key symptoms: stress, anxiety, nausea, and pain. We performed the analysis of covariance to detect differences between the two arms postintervention while controlling for baseline symptoms. Results: A total of 223 patients were enrolled in the study: 113 patients were enrolled in the intervention arm and 110 patients were enrolled in the control arm. In both groups, patients showed significant reductions in stress and anxiety from baseline (all P<.05), with the treatment arm reporting greater stress and anxiety reduction than the control arm (1.64 vs 1.15 in stress reduction; P=.01 and 1.39 vs 0.78 in anxiety reduction; P=.002). The majority of patients reported that the videos helped them pass time and that they would watch the videos again. Conclusions: An integrative medicine self-care app in the waiting room improved patients’ experiences and reduced anxiety and stress. Future research could focus on expanding this platform to other settings to improve patients’ overall treatment experiences. %M 31697238 %R 10.2196/13217 %U http://cancer.jmir.org/2019/2/e13217/ %U https://doi.org/10.2196/13217 %U http://www.ncbi.nlm.nih.gov/pubmed/31697238 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14187 %T The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study %A Richards,Rebecca %A Kinnersley,Paul %A Brain,Kate %A Staffurth,John %A Wood,Fiona %+ Division of Population Medicine, Cardiff University, 503 Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, United Kingdom, 44 29206 87185, wood@cf.ac.uk %K education, medical %K medical information exchange %K smartphone %K mobile apps %D 2019 %7 31.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. Objective: We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. Methods: Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. Results: Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients’ unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. Conclusions: This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted. %M 31368446 %R 10.2196/14187 %U http://mhealth.jmir.org/2019/7/e14187/ %U https://doi.org/10.2196/14187 %U http://www.ncbi.nlm.nih.gov/pubmed/31368446 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e11395 %T Impact of Electronic Self-Assessment and Self-Care Technology on Adherence to Clinician Recommendations and Self-Management Activity for Cancer Treatment–Related Symptoms: Secondary Analysis of a Randomized Controlled Trial %A Knoerl,Robert %A Hong,Fangxin %A Blonquist,Traci %A Berry,Donna %+ Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, United States, 1 617 632 6386, robert_knoerl@dfci.harvard.edu %K electronic symptom assessment %K self-care %K neoplasms %K treatment adherence and compliance %K quality of life %D 2019 %7 08.01.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients undergoing cancer treatment experience symptoms that negatively affect their quality of life and adherence to treatment. The early identification and management of treatment-related symptoms are critical to prevent symptom distress due to unmanaged symptoms. However, the early identification and management of treatment-related symptoms are complex as most cancer treatments are delivered on an outpatient basis where patients are granted less face-to-face time with clinicians. The Electronic Symptom Assessment and Self-Care (ESRA-C) promotes participant self-management of treatment-related symptoms by providing participants with communication coaching and symptom self-report, education, and tracking features. While the ESRA-C intervention has been demonstrated to improve symptom distress significantly, little is known as to how the ESRA-C influenced participants’ self-management practices and adherence to clinician recommendations for symptom/quality of life issues (SQIs). Objective: To compare participant adherence to clinician recommendations and additional self-management strategy use for SQIs between ESRA-C intervention and control (electronic symptom assessment and participant symptom reports alone) group participants. Secondarily, we explored the impact of participant adherence to clinician recommendations and additional self-management strategy use for SQIs on symptom control, symptom management satisfaction, and symptom distress. Lastly, we examined baseline predictors of participant adherence to clinician recommendations and additional self-management strategy use for SQIs. Methods: This study presents an analysis of a randomized controlled trial. Participants beginning a new chemotherapy or radiotherapy regimen were recruited from oncology outpatient centers and were randomized to receive the ESRA-C intervention or control during treatment. Patients were included in this analysis if they remained on study through the duration of treatment and self-reported at least one bothersome SQI three-to-six weeks after beginning treatment. The Symptom Distress Scale-15 and Self-Management of SQIs Questionnaire were completed two weeks later. Based on Self-Management of SQIs Questionnaire ratings, participants were placed into adherence to clinician recommendations (adhered/did not adhere/did not receive recommendations) and additional self-management strategy use (yes/no) categories. Results: Most participants were adherent to clinician recommendations (273/370, 73.8%), while fewer used additional self-management strategies for SQIs (182/370, 49.2%). There were no differences in the frequency of participant adherence to clinician recommendations (chi-square test, P=.99) or self-management strategy use (chi-square test, P=.80) between intervention (n=182) and control treatment groups (n=188). Participants who received clinician recommendations reported the highest treatment satisfaction (n=355, P<.001 by analysis of variance; ANOVA), although lowest distress was reported by participants who did not follow clinician recommendations (n=322, P=.04 by ANOVA) for top 2 SQIs. Women (n=188) reported greater additional self-management strategy use than men (n=182, P=0.03 by chi-square test). Conclusions: ESRA-C intervention use did not improve participants’ adherence to clinician recommendations or additional self-management strategy use for SQIs in comparison to the control. Future research is needed to determine which factors are important in improving patients’ self-management practices and symptom distress following ESRA-C use. Trial Registration: ClinicalTrials.gov NCT00852852; https://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/73rEhNWkU) %M 30622093 %R 10.2196/11395 %U https://cancer.jmir.org/2019/1/e11395/ %U https://doi.org/10.2196/11395 %U http://www.ncbi.nlm.nih.gov/pubmed/30622093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10771 %T Self-Management Education Through mHealth: Review of Strategies and Structures %A Bashi,Nazli %A Fatehi,Farhad %A Fallah,Mina %A Walters,Darren %A Karunanithi,Mohanraj %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Level 5 - UQ Health Sciences, Building 901/16, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia, 61 7 3253 3611, nazli.bashi@csiro.au %K health education %K mHealth %K mobile apps %K mobile phone %K patient education %K self-management education %D 2018 %7 19.10.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Despite the plethora of evidence on mHealth interventions for patient education, there is a lack of information regarding their structures and delivery strategies. Objective: This review aimed to investigate the structures and strategies of patient education programs delivered through smartphone apps for people with diverse conditions and illnesses. We also examined the aim of educational interventions in terms of health promotion, disease prevention, and illness management. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO for peer-reviewed papers that reported patient educational interventions using mobile apps and published from 2006 to 2016. We explored various determinants of educational interventions, including the content, mode of delivery, interactivity with health care providers, theoretical basis, duration, and follow-up. The reporting quality of studies was evaluated according to the mHealth evidence and reporting assessment criteria. Results: In this study, 15 papers met the inclusion criteria and were reviewed. The studies mainly focused on the use of mHealth educational interventions for chronic disease management, and the main format for delivering interventions was text. Of the 15 studies, 6 were randomized controlled trials (RCTs), which have shown statistically significant effects on patients’ health outcomes, including patients’ engagement level, hemoglobin A1c, weight loss, and depression. Although the results of RCTs were mostly positive, we were unable to identify any specific effective structure and strategy for mHealth educational interventions owing to the poor reporting quality and heterogeneity of the interventions. Conclusions: Evidence on mHealth interventions for patient education published in peer-reviewed journals demonstrates that current reporting on essential mHealth criteria is insufficient for assessing, understanding, and replicating mHealth interventions. There is a lack of theory or conceptual framework for the development of mHealth interventions for patient education. Therefore, further research is required to determine the optimal structure, strategies, and delivery methods of mHealth educational interventions. %M 30341042 %R 10.2196/10771 %U https://mhealth.jmir.org/2018/10/e10771/ %U https://doi.org/10.2196/10771 %U http://www.ncbi.nlm.nih.gov/pubmed/30341042 %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 %@ 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 5 %P e175 %T Development of Trust in an Online Breast Cancer Forum: A Qualitative Study %A Lovatt,Melanie %A Bath,Peter A %A Ellis,Julie %+ Health Informatics Research Group, Information School, University of Sheffield, Regent Court, 211 Portobello, Sheffield,, United Kingdom, 44 114 222 2636, p.a.bath@sheffield.ac.uk %K trust %K online information sharing %K breast cancer %K online health communities %K qualitative research %D 2017 %7 23.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health forums provide peer support for a range of medical conditions including life-threatening and terminal illnesses. Trust is an important component of peer-to-peer support, although relatively little is known about how trust forms within online health forums. Objective: The aim of this paper is to examine how trust develops and influences sharing among users of an online breast cancer forum. Methods: An interpretive qualitative approach was adopted. Data were collected from forum posts from 135 threads on 9 boards on the UK charity, Breast Cancer Care (BCC). Semistructured interviews were conducted with 14 BCC forum users. Both datasets were analyzed thematically using Braun and Clarke’s approach and combined to triangulate analysis. Results: Trust operates in 3 dimensions, structural, relational, and temporal, and these intersect with each other and do not operate in isolation. The structural dimension relates to how the affordances and formal rules of the site affected trust. The relational dimension refers to how trust was necessarily experienced in interactions with other forum users: it emerged within relationships and was a social phenomenon. The temporal dimension relates to how trust changed over time and was influenced by the length of time users spent on the forum. Conclusions: Trust is a process that changes over time and which is influenced by structural features of the forum, as well as informal but collectively understood relational interactions among forum users. The study provides a better understanding of how the intersecting structural, relational, and temporal aspects that support the development of trust facilitate sharing in online environments. These findings will help organizations developing online health forums. %M 28536093 %R 10.2196/jmir.7471 %U http://www.jmir.org/2017/5/e175/ %U https://doi.org/10.2196/jmir.7471 %U http://www.ncbi.nlm.nih.gov/pubmed/28536093 %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