TY - JOUR AU - Backonja, Uba AU - Haynes, C. Sarah AU - Kim, K. Katherine PY - DA - 2018/10/16 TI - Data Visualizations to Support Health Practitioners? Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study JO - JMIR Hum Factors SP - e11826 VL - 5 IS - 4 KW - cancer care facilities KW - informatics KW - patient-centered care KW - patient-generated health data KW - precision medicine KW - visualization AB - Background: There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. Objective: The aim of the study was to assess the health care practitioners? perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care. Methods: Medical doctors (n=4) and registered nurses (n=4) providing cancer care at an academic medical center in the western United States provided feedback on visualization mock-ups. Mock-up designs were guided by current health informatics and visualization literature and the Munzner Nested Model for Visualization Design. User-centered design methods, a mock patient persona, and a scenario were used to elicit insights from participants. Directed content analysis was used to identify themes from session transcripts. Means and SDs were calculated for health care practitioners? rankings of overview visualizations. Results: Themes identified were data elements, supportive elements, confusing elements, interpretation, and use of visualization. Overall, participants found the visualizations useful and with the potential to provide personalized care. Use of color, reference lines, and familiar visual presentations (calendars, line graphs) were noted as helpful in interpreting data. Conclusions: Visualizations guided by a framework and literature can support health care practitioners? understanding of data for individuals with multiple chronic conditions engaged in cancer care. This understanding has the potential to support the provision of personalized care. UR - http://humanfactors.jmir.org/2018/4/e11826/ DO - 10.2196/11826 UR - http://www.ncbi.nlm.nih.gov/pubmed/30327290 ID - info:doi/10.2196/11826 ER - TY - JOUR AU - El Shafie, A. Rami AU - Weber, Dorothea AU - Bougatf, Nina AU - Sprave, Tanja AU - Oetzel, Dieter AU - Huber, E. Peter AU - Debus, Jürgen AU - Nicolay, H. Nils PY - DA - 2018/08/30 TI - Supportive Care in Radiotherapy Based on a Mobile App: Prospective Multicenter Survey JO - JMIR Mhealth Uhealth SP - e10916 VL - 6 IS - 8 KW - mHealth KW - radiotherapy KW - mobile app KW - quality of life KW - surveillance KW - patient-reported outcome KW - acceptance KW - smartphone KW - mobile phone AB - Background: Consumer electronics and Web-enabled mobile devices are playing an increasing role in patient care, and their use in the oncologic sector opens up promising possibilities in the fields of supportive cancer care and systematic patient follow-up. Objective: The objective of our study was to assess the acceptance and possible benefits of a mobile app?based concept for supportive care of cancer patients undergoing radiotherapy. Methods: In total, 975 patients presenting for radiotherapy due to breast or prostate cancer were screened; of them, 200 owned a smartphone and consented to participate in the survey. Patients were requested to complete a questionnaire at 2 time points: prior to the initiation (T0) and after the completion (T1) of radiotherapy. The questionnaire included questions about the habits of smartphone usage, technical knowledge and abilities of the participants, readiness to use a mobile app within the context of radiotherapy, possible features of the mobile app, and general attitude toward the different aspects of oncologic treatments. For quantitative analysis, sum scores were calculated for all areas of interest, and results were correlated with patient characteristics. Additionally, answers were quantitatively compared between time points T0 and T1. Results: Median patient age was 57 (range 27-78) years. Of the 200 participants, 131 (66.2%) reported having the ability to use their smartphones with minimal to no help and 75.8% (150/200) had not used their smartphones in a medical context before. However, 73.3% (146/200) and 83.4% (166/200) of patients showed a strong interest in using a mobile app for supportive care during radiotherapy and as part of the clinical follow-up, respectively. Patients most commonly requested functionalities regarding appointment scheduling in the clinic (176/200, 88.0%) and the collection of patient-reported outcome data regarding their illness, therapy, and general well-being (130/200, 65.0%). Age was identified as the most influential factor regarding patient attitude, with patients aged <55 years being significantly more inclined toward and versed in smartphone use (P<.001). The acceptance of mobile apps was significantly higher in patients exhibiting a Karnofsky performance index <80% (P=.01). Support in the context of therapy-related side effects was judged most important by patients with poor clinical performance (P=.006). The overall acceptance of mobile apps in the context of radiotherapy surveillance was high at a median item sum score of 71.4/100 and was not significantly influenced by tumor stage, age, gender, treatment setting, or previous radiotherapies. Conclusions: The acceptance of mobile apps for the surveillance and follow-up of cancer patients undergoing radiotherapy is high; this high acceptance level will serve as a basis for future clinical trials investigating the clinical benefits of mobile app?based treatment support. Introduction of mobile apps into the clinical routine should be considered as an opportunity to improve and intensify supportive treatment for cancer patients. UR - http://mhealth.jmir.org/2018/8/e10916/ DO - 10.2196/10916 UR - http://www.ncbi.nlm.nih.gov/pubmed/30166275 ID - info:doi/10.2196/10916 ER - TY - JOUR AU - Delrieu, Lidia AU - Pérol, Olivia AU - Fervers, Béatrice AU - Friedenreich, Christine AU - Vallance, Jeff AU - Febvey-Combes, Olivia AU - Pérol, David AU - Canada, Brice AU - Roitmann, Eva AU - Dufresne, Armelle AU - Bachelot, Thomas AU - Heudel, Pierre-Etienne AU - Trédan, Olivier AU - Touillaud, Marina AU - Pialoux, Vincent PY - DA - 2018/08/30 TI - A Personalized Physical Activity Program With Activity Trackers and a Mobile Phone App for Patients With Metastatic Breast Cancer: Protocol for a Single-Arm Feasibility Trial JO - JMIR Res Protoc SP - e10487 VL - 7 IS - 8 KW - metastatic breast cancer KW - physical activity KW - oxidative stress KW - activity trackers KW - feasibility AB - Background: About 5% of breast cancer cases are metastatic at diagnosis, and 20%-30% of localized breast cancer cases become secondarily metastatic. Patients frequently report many detrimental symptoms related to metastasis and treatments. The physical, biological, psychological, and clinical benefits of physical activity during treatment in patients with localized breast cancer have been demonstrated; however, limited literature exists regarding physical activity and physical activity behavior change in patients with metastatic breast cancer. Objective: The primary objective of this study is to assess the feasibility of a 6-month physical activity intervention with activity trackers in patients with metastatic breast cancer (the Advanced stage Breast cancer and Lifestyle Exercise, ABLE Trial). Secondary objectives are to examine the effects of physical activity on physical, psychological, anthropometrics, clinical, and biological parameters. Methods: We plan to conduct a single-center, single-arm trial with 60 patients who are newly diagnosed with metastatic breast cancer. Patients will receive an unsupervised and personalized 6-month physical activity program that includes an activity tracker Nokia Go and is based on the physical activity recommendation. Patients will be encouraged to accumulate at least 150 minutes per week of moderate-to-vigorous intensity physical activity. Baseline and 6-month assessments will include anthropometric measures, functional tests (eg, 6-minute walk test and upper and lower limb strength), blood draws, patient-reported surveys (eg, quality of life and fatigue), and clinical markers of tumor progression (eg, Response Evaluation Criteria In Solid Tumors criteria). Results: Data collection occurred between October 2016 and January 2018, and the results are expected in August 2018. Conclusions: The ABLE Trial will be the first study to assess the feasibility and effectiveness of an unsupervised and personalized physical activity intervention performed under real-life conditions with activity trackers in patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 (Accessed by WebCite at http://www.webcitation.org/71yabi0la) Registered Report Identifier: RR1-10.2196/10487 UR - http://www.researchprotocols.org/2018/8/e10487/ DO - 10.2196/10487 UR - http://www.ncbi.nlm.nih.gov/pubmed/30166274 ID - info:doi/10.2196/10487 ER - TY - JOUR AU - Brinker, Josef Titus AU - Brieske, Martin Christian AU - Esser, Stefan AU - Klode, Joachim AU - Mons, Ute AU - Batra, Anil AU - Rüther, Tobias AU - Seeger, Werner AU - Enk, H. Alexander AU - von Kalle, Christof AU - Berking, Carola AU - Heppt, V. Markus AU - Gatzka, V. Martina AU - Bernardes-Souza, Breno AU - Schlenk, F. Richard AU - Schadendorf, Dirk PY - DA - 2018/08/15 TI - A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic JO - J Med Internet Res SP - e10976 VL - 20 IS - 8 KW - face aging KW - smoking cessation KW - HIV KW - mobile apps KW - HIV patients KW - HIV seropositivity KW - smoking KW - cessation KW - tobacco smoking KW - morphing AB - Background: There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. Objective: The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. Methods: We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. Results: During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). Conclusions: A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking. UR - http://www.jmir.org/2018/8/e10976/ DO - 10.2196/10976 UR - http://www.ncbi.nlm.nih.gov/pubmed/30111525 ID - info:doi/10.2196/10976 ER - TY - JOUR AU - Marzorati, Chiara AU - Renzi, Chiara AU - Russell-Edu, William Samuel AU - Pravettoni, Gabriella PY - DA - 2018/06/18 TI - Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review JO - J Med Internet Res SP - e223 VL - 20 IS - 6 KW - telemedicine KW - family KW - caregivers KW - neoplasms KW - systematic review AB - Background: The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients? well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. Objective: We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples? characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients? caregivers. Methods: We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. Results: We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver?s condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. Conclusions: Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers? needs related to telehealth tools and better defining outcome measures may yield more significant results. UR - http://www.jmir.org/2018/6/e223/ DO - 10.2196/jmir.9812 UR - http://www.ncbi.nlm.nih.gov/pubmed/29914858 ID - info:doi/10.2196/jmir.9812 ER - TY - JOUR AU - Ainsworth, Cole Matthew AU - Pekmezi, Dori AU - Bowles, Heather AU - Ehlers, Diane AU - McAuley, Edward AU - Courneya, S. Kerry AU - Rogers, Q. Laura PY - DA - 2018/05/14 TI - Acceptability of a Mobile Phone App for Measuring Time Use in Breast Cancer Survivors (Life in a Day): Mixed-Methods Study JO - JMIR Cancer SP - e9 VL - 4 IS - 1 KW - cancer KW - technology KW - time management KW - mHealth KW - physical activity AB - Background: Advancements in mobile technology allow innovative data collection techniques such as measuring time use (ie, how individuals structure their time) for the purpose of improving health behavior change interventions. Objective: The aim of this study was to examine the acceptability of a 5-day trial of the Life in a Day mobile phone app measuring time use in breast cancer survivors to advance technology-based measurement of time use. Methods: Acceptability data were collected from participants (N=40; 100% response rate) using a self-administered survey after 5 days of Life in a Day use. Results: Overall, participants had a mean age of 55 years (SD 8) and completed 16 years of school (SD 2). Participants generally agreed that learning to use Life in a Day was easy (83%, 33/40) and would prefer to log activities using Life in a Day over paper-and-pencil diary (73%, 29/40). A slight majority felt that completing Life in a Day for 5 consecutive days was not too much (60%, 24/40) or overly time-consuming (68%, 27/40). Life in a Day was rated as easy to read (88%, 35/40) and navigate (70%, 32/40). Participants also agreed that it was easy to log activities using the activity timer at the start and end of an activity (90%, 35/39). Only 13% (5/40) downloaded the app on their personal phone, whereas 63% (19/30) of the remaining participants would have preferred to use their personal phone. Overall, 77% (30/39) of participants felt that the Life in a Day app was good or very good. Those who agreed that it was easy to edit activities were significantly more likely to be younger when compared with those who disagreed (mean 53 vs 58 years, P=.04). Similarly, those who agreed that it was easy to remember to log activities were more likely to be younger (mean 52 vs 60 years, P<.001). Qualitative coding of 2 open-ended survey items yielded 3 common themes for Life in a Day improvement (ie, convenience, user interface, and reminders). Conclusions: A mobile phone app is an acceptable time-use measurement modality. Improving convenience, user interface, and memory prompts while addressing the needs of older participants is needed to enhance app utility. Trial Registration: ClinicalTrials.gov NCT00929617; https://clinicaltrials.gov/ct2/show/NCT00929617 (Archived by WebCite at http://www.webcitation.org/6z2bZ4P7X) UR - http://cancer.jmir.org/2018/1/e9/ DO - 10.2196/cancer.8951 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759953 ID - info:doi/10.2196/cancer.8951 ER - TY - JOUR AU - Soh, Yeong Ji AU - Cha, Chul Won AU - Chang, Kyung Dong AU - Hwang, Hye Ji AU - Kim, Kihyung AU - Rha, Miyong AU - Kwon, Hee PY - DA - 2018/05/07 TI - Development and Validation of a Multidisciplinary Mobile Care System for Patients With Advanced Gastrointestinal Cancer: Interventional Observation Study JO - JMIR Mhealth Uhealth SP - e115 VL - 6 IS - 5 KW - mobile health KW - health apps KW - mobile phone KW - mobile care system AB - Background: Mobile health apps have emerged as supportive tools in the management of advanced cancers. However, only a few apps have self-monitoring features, and they are not standardized and validated. Objective: This study aimed to develop and validate a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer. Methods: The development of the multidisciplinary mobile health management system was divided into 3 steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. The app was developed to achieve 3 major clinical goals: support for quality of life, nutrition, and rehabilitation. Three main functional themes were developed to achieve clinical goals: a to-do list, health education, and in-app chat. Thirteen clinically oriented measures were included: the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire, Scored Patient-Generated Subjective Global Assessment (PG-SGA), distress, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, International Physical Activity Questionnaire?Short Form, Low anterior resection syndrome score, satisfaction rate, etc. To validate the system, a prospective observational study was conducted. Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited. We followed the subjects for 12 weeks, and selected clinical measures were taken online and offline. Results: After the development process, a multidisciplinary app, the Life Manager, was launched. For evaluation, 203 patients were recruited for the study, of whom 101 (49.8%) had gastric cancer, and 102 (50.2%) were receiving palliative care. Most patients were in their fifties (35.5%), and 128 (63.1%) were male. Overall, 176 subjects (86.7%) completed the study. Among subjects who dropped out, the most common reason was the change of patient?s clinical condition (51.9%). During the study period, subjects received multiple health education sessions. For the gastric cancer group, the ?general gastric cancer education? was most frequently viewed (322 times), and for the colon cancer group, the ?warming-up exercise? was most viewed (340 times). Of 13 measurements taken from subjects, 9 were taken offline (response rate: 52.0% to 90.1%), and 3 were taken online (response rate: 17.6% to 57.4%). The overall satisfaction rate among subjects was favorable and ranged from 3.93 (SD 0.88) to 4.01 (SD 0.87) on the 5-point Likert scale. Conclusions: A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinically oriented measures. A prospective study was performed for its evaluation, which showed favorable satisfaction. UR - http://mhealth.jmir.org/2018/5/e115/ DO - 10.2196/mhealth.9363 UR - http://www.ncbi.nlm.nih.gov/pubmed/29735478 ID - info:doi/10.2196/mhealth.9363 ER - TY - JOUR AU - Zhu, Jiemin AU - Ebert, Lyn AU - Guo, Dongmei AU - Yang, Sumei AU - Han, Qiuying AU - Chan, Wai-Chi Sally PY - DA - 2018/04/11 TI - Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women?s Perceptions JO - JMIR Mhealth Uhealth SP - e85 VL - 6 IS - 4 KW - mobile app KW - breast cancer KW - chemotherapy AB - Background: Women with breast cancer undergoing chemotherapy experience difficulty in accessing adequate cancer care in China. Mobile apps have the potential to provide easily accessible support for these women. However, there remains a paucity of randomized controlled trials to evaluate the effectiveness of app-based programs targeting specifically women with breast cancer undergoing chemotherapy. Moreover, women?s perceptions and experiences related to using and interacting within the app-based program have rarely been reported. Therefore, an app-based Breast Cancer e-Support program was developed and evaluated using a randomized controlled trial. Based on the incorporation of Bandura?s self-efficacy and social exchange theory, Breast Cancer e-Support program lasted for 12 weeks covering 4 cycles of chemotherapy and had 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Objective: As a part of the randomized controlled trial, the aim of this study was to explore the participants? perception of Breast Cancer e-Support program, its strengths and weaknesses, and suggestions to improve the program. Methods: A descriptive qualitative study was employed. Thirteen women with breast cancer from 2 university-affiliated hospitals in China, who were randomly allocated to the Breast Cancer e-Support program in the randomized controlled trial, were interviewed from November 2016 to February 2017. Purposive sampling was used based on women?s scores of self-efficacy after the completion of the intervention. Inductive content analysis was used to analyze the transcripts, allowing the categories and subcategories to flow from the data. Results: The qualitative interviews revealed that participants perceived the Breast Cancer e-Support program to be helpful in enhancing knowledge, improving confidence level, and promoting emotional well-being. Women also identified access to tailored advice from experts and convenience as the benefits of this program. Physical or psychological health status, stigma related with breast cancer, and app instability were mentioned as the challenges to engagement. Suggestions for improvement included adding message reminders to prompt instant communication and search engine to locate information quickly, supplementing more interesting and practical knowledge, updating the information more often, and quickening the responses to women?s questions. The participants recommended the Breast Cancer e-Support program to be incorporated as routine care to support women during chemotherapy. Conclusions: This study demonstrates the potential of the Breast Cancer e-Support program to support women during chemotherapy. Future app-based programs should apply a family-centered approach and provide more support on stigma associated with the disease to encourage engagement with the app. Suggestions of improvement regarding the design, content, and operation of the app-based intervention should be addressed in future studies. It is promising to incorporate the Breast Cancer e-Support program into routine care to generalize the benefits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ ACTRN12616000639426.aspx (Archived by WebCite at http://www.webcitation.org/6v1n9hGZq) UR - http://mhealth.jmir.org/2018/4/e85/ DO - 10.2196/mhealth.9311 UR - http://www.ncbi.nlm.nih.gov/pubmed/29643056 ID - info:doi/10.2196/mhealth.9311 ER - TY - JOUR AU - Jibb, A. Lindsay AU - Stevens, J. Bonnie AU - Nathan, C. Paul AU - Seto, Emily AU - Cafazzo, A. Joseph AU - Johnston, L. Donna AU - Hum, Vanessa AU - Stinson, N. Jennifer PY - DA - 2018/04/06 TI - Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study JO - JMIR Mhealth Uhealth SP - e80 VL - 6 IS - 4 KW - pain KW - adolescent KW - cancer KW - supportive care KW - mHealth KW - qualitative AB - Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. Objective: The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. Methods: Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. Results: Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents? lives, and recommendations for intervention improvement. Conclusions: Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes. UR - http://mhealth.jmir.org/2018/4/e80/ DO - 10.2196/mhealth.9319 UR - http://www.ncbi.nlm.nih.gov/pubmed/29625951 ID - info:doi/10.2196/mhealth.9319 ER - TY - JOUR AU - El Shafie, A. Rami AU - Bougatf, Nina AU - Sprave, Tanja AU - Weber, Dorothea AU - Oetzel, Dieter AU - Machmer, Timo AU - Huber, E. Peter AU - Debus, Jürgen AU - Nicolay, H. Nils PY - DA - 2018/03/06 TI - Oncologic Therapy Support Via Means of a Dedicated Mobile App (OPTIMISE-1): Protocol for a Prospective Pilot Trial JO - JMIR Res Protoc SP - e70 VL - 7 IS - 3 KW - mHealth KW - radiotherapy KW - mobile application KW - quality of life KW - cancer KW - Patient-Reported Outcome Measures (PROMs) AB - Background: The increasing role of consumer electronics and Web-enabled mobile devices in the medical sector opens up promising possibilities for integrating novel technical solutions into therapy and patient support for oncologic illnesses. A recent survey carried out at Heidelberg University Hospital suggested a high acceptance among patients for an additional approach to patient care during radiotherapy based on patient-reported outcomes by a dedicated mobile app. Objective: The aim of this trial (OPTIMISE-1: Oncologic Therapy Support Via Means of a Dedicated Mobile App ? A Prospective Feasibility Evaluation) is to prospectively evaluate the feasibility of employing a mobile app for the systematic support of radiooncological patients throughout the course of their radiotherapy by monitoring symptoms and patient performance, and facilitating the background-exchange of relevant information between patient and physician. Methods: The present single-center, prospective, exploratory trial, conducted at Heidelberg University Hospital, assesses the feasibility of integrating an app-based approach into patient-care during radiotherapy. Patients undergoing curative radiotherapy for thoracic or pelvic tumors will be surveyed regarding general performance, treatment-related quality of life (QoL) and symptoms, and their need to personally consult a physician by means of a mobile app during treatment. The primary endpoint of feasibility will be reached when 80% of the patients have successfully answered 80% of their respective questions scheduled for each treatment day. Furthermore, treatment-related patient satisfaction and health-related QoL is assessed by the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires at the beginning (baseline) and end of radiotherapy, and at the first follow-up. Results: This trial will recruit 50 patients over a period of 12 months. Follow-up will be completed after 18 months, and publication of results is planned at 24 months after trial initiation. Conclusions: This study will serve as a basis for future studies aiming to exploit the constant innovation in mobile medical appliances and integrate novel patient-centered concepts into patient care in the context of radiotherapy. Trial Registration: ClinicalTrials.gov NCT03168048; https://clinicaltrials.gov/ct2/show/NCT03168048 (Archived at WebCite http://www.webcitation.org/6wtWGgi0X) UR - https://www.researchprotocols.org/2018/3/e70/ DO - 10.2196/resprot.8915 UR - http://www.ncbi.nlm.nih.gov/pubmed/29510971 ID - info:doi/10.2196/resprot.8915 ER - TY - JOUR AU - Low, A. Carissa AU - Dey, K. Anind AU - Ferreira, Denzil AU - Kamarck, Thomas AU - Sun, Weijing AU - Bae, Sangwon AU - Doryab, Afsaneh PY - DA - 2017/12/19 TI - Estimation of Symptom Severity During Chemotherapy From Passively Sensed Data: Exploratory Study JO - J Med Internet Res SP - e420 VL - 19 IS - 12 KW - patient reported outcome measures KW - cancer KW - mobile health AB - Background: Physical and psychological symptoms are common during chemotherapy in cancer patients, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in mobile phones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. Objective: The aim of this study was to explore whether passively sensed mobile phone and Fitbit data could be used to estimate daily symptom burden during chemotherapy. Methods: A total of 14 patients undergoing chemotherapy for gastrointestinal cancer participated in the 4-week study. Participants carried an Android phone and wore a Fitbit device for the duration of the study and also completed daily severity ratings of 12 common symptoms. Symptom severity ratings were summed to create a total symptom burden score for each day, and ratings were centered on individual patient means and categorized into low, average, and high symptom burden days. Day-level features were extracted from raw mobile phone sensor and Fitbit data and included features reflecting mobility and activity, sleep, phone usage (eg, duration of interaction with phone and apps), and communication (eg, number of incoming and outgoing calls and messages). We used a rotation random forests classifier with cross-validation and resampling with replacement to evaluate population and individual model performance and correlation-based feature subset selection to select nonredundant features with the best predictive ability. Results: Across 295 days of data with both symptom and sensor data, a number of mobile phone and Fitbit features were correlated with patient-reported symptom burden scores. We achieved an accuracy of 88.1% for our population model. The subset of features with the best accuracy included sedentary behavior as the most frequent activity, fewer minutes in light physical activity, less variable and average acceleration of the phone, and longer screen-on time and interactions with apps on the phone. Mobile phone features had better predictive ability than Fitbit features. Accuracy of individual models ranged from 78.1% to 100% (mean 88.4%), and subsets of relevant features varied across participants. Conclusions: Passive sensor data, including mobile phone accelerometer and usage and Fitbit-assessed activity and sleep, were related to daily symptom burden during chemotherapy. These findings highlight opportunities for long-term monitoring of cancer patients during chemotherapy with minimal patient burden as well as real-time adaptive interventions aimed at early management of worsening or severe symptoms. UR - http://www.jmir.org/2017/12/e420/ DO - 10.2196/jmir.9046 UR - http://www.ncbi.nlm.nih.gov/pubmed/29258977 ID - info:doi/10.2196/jmir.9046 ER - TY - JOUR AU - Pereira-Salgado, Amanda AU - Westwood, A. Jennifer AU - Russell, Lahiru AU - Ugalde, Anna AU - Ortlepp, Bronwen AU - Seymour, F. John AU - Butow, Phyllis AU - Cavedon, Lawrence AU - Ong, Kevin AU - Aranda, Sanchia AU - Breen, Sibilah AU - Kirsa, Suzanne AU - Dunlevie, Andrew AU - Schofield, Penelope PY - DA - 2017/12/06 TI - Mobile Health Intervention to Increase Oral Cancer Therapy Adherence in Patients With Chronic Myeloid Leukemia (The REMIND System): Clinical Feasibility and Acceptability Assessment JO - JMIR Mhealth Uhealth SP - e184 VL - 5 IS - 12 KW - mobile phone KW - neoplasms KW - Internet KW - medication adherence AB - Background: Optimal dosing of oral tyrosine kinase inhibitor therapy is critical to treatment success and survival of patients with chronic myeloid leukemia (CML). Drug intolerance secondary to toxicities and nonadherence are significant factors in treatment failure. Objective: The objective of this study was to develop and pilot-test the clinical feasibility and acceptability of a mobile health system (REMIND) to increase oral drug adherence and patient symptom self-management among people with CML (chronic phase). Methods: A multifaceted intervention was iteratively developed using the intervention development framework by Schofield and Chambers, consisting of defining the patient problem and iteratively refining the intervention. The clinical feasibility and acceptability were examined via patient and intervention nurse interviews, which were audiotaped, transcribed, and deductively content analyzed. Results: The intervention comprised 2 synergistically operating elements: (1) daily medication reminders and routine assessment of side effects with evidence-based self-care advice delivered in real time and (2) question prompt list (QPL) questions and routinely collected individual patient adherence and side effect profile data used to shape nurses? consultations, which employed motivational interviewing to support adoption of self-management behaviors. A total of 4 consultations and daily alerts and advice were delivered over 10 weeks. In total, 58% (10/17) of patients and 2 nurses participated in the pilot study. Patients reported several benefits of the intervention: help in establishing medication routines, resolution of symptom uncertainty, increased awareness of self-care, and informed decision making. Nurses also endorsed the intervention: it assisted in establishing pill-taking routines and patients developing effective solutions to adherence challenges. Conclusions: The REMIND system with nurse support was usable and acceptable to both patients and nurses. It has the potential to improve adherence and side-effect management and should be further evaluated. UR - http://mhealth.jmir.org/2017/12/e184/ DO - 10.2196/mhealth.8349 UR - http://www.ncbi.nlm.nih.gov/pubmed/29212628 ID - info:doi/10.2196/mhealth.8349 ER - TY - JOUR AU - Rincon, Esther AU - Monteiro-Guerra, Francisco AU - Rivera-Romero, Octavio AU - Dorronzoro-Zubiete, Enrique AU - Sanchez-Bocanegra, Luis Carlos AU - Gabarron, Elia PY - DA - 2017/12/04 TI - Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review JO - JMIR Mhealth Uhealth SP - e187 VL - 5 IS - 12 KW - cancer KW - mHealth KW - app KW - mobile phone KW - quality of life KW - well-being AB - Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients? quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients? user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients? disease management. Trial Registration: PROSPERO CRD42017073069; https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID= CRD42017073069 (Archived by WebCite at http://www.webcitation.org/6v38Clb9T) UR - http://mhealth.jmir.org/2017/12/e187/ DO - 10.2196/mhealth.8741 UR - http://www.ncbi.nlm.nih.gov/pubmed/29203459 ID - info:doi/10.2196/mhealth.8741 ER - TY - JOUR AU - Lee, Hee AU - Ghebre, Rahel AU - Le, Chap AU - Jang, Jeong Yoo AU - Sharratt, Monica AU - Yee, Douglas PY - DA - 2017/11/07 TI - Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e154 VL - 5 IS - 11 KW - breast cancer KW - mammogram KW - mobile health KW - mHealth KW - mobile app intervention KW - multimedia text message KW - tailored message KW - Korean immigrant women KW - breast cancer disparity AB - Background: Despite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes. Objective: This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community. Methods: Using a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed. Results: The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group. Conclusions: A mobile phone app?based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens. Trial Registration: Clinicaltrials.gov NCT01972048; https://clinicaltrials.gov/show/NCT01972048 (Archived by WebCite at https://clinicaltrials.gov/archive/NCT01972048/2013_10_29) UR - http://mhealth.jmir.org/2017/11/e154/ DO - 10.2196/mhealth.7091 UR - http://www.ncbi.nlm.nih.gov/pubmed/29113961 ID - info:doi/10.2196/mhealth.7091 ER - TY - JOUR AU - Langius-Eklöf, Ann AU - Christiansen, Mats AU - Lindström, Veronica AU - Blomberg, Karin AU - Hälleberg Nyman, Maria AU - Wengström, Yvonne AU - Sundberg, Kay PY - DA - 2017/10/31 TI - Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data JO - JMIR Cancer SP - e18 VL - 3 IS - 2 KW - mobile apps KW - mHealth KW - prostate cancer KW - symptom assessment AB - Background: Patients undergoing radiotherapy for prostate cancer experience symptoms related to both the cancer itself and its treatment, and it is evident that patients with prostate cancer have unmet supportive care needs related to their disease. Over the past decade, there has been an increase in the amount of research within the field of mobile health and the use of apps as tools for managing illness. The main challenge is to develop a mobile technology to its full potential of being interactive in real time. The interactive app Interaktor, which aims to identify and manage symptoms in real time includes (1) a function for patients? assessment of the occurrence, frequency, and distress of symptoms; (2) a connection to a monitoring Web interface; (3) a risk assessment model that sends alerts via text message to health care providers; (4) continuous access to evidence-based self-care advice and links to relevant websites for more information; and (5) graphs for the patients and health care providers to view the history of symptom reporting. Objective: The aim of the study was to investigate user behavior, adherence to reporting, and the patients? experiences of using Interaktor during radiotherapy for localized advanced prostate cancer. Methods: The patients were instructed to report daily during the time of treatment and then for an additional 3 weeks. Logged data from patients? use of the app were analyzed with descriptive statistics. Interview data about experiences of using the app were analyzed with content analysis. Results: A total of 66 patients participated in the study. Logged data showed that adherence to daily reporting of symptoms was high (87%). The patients used all the symptoms included in the app. Of the reports, 15.6% generated alerts to the health care providers. Overall, the patients found that it was easy and not particularly time-consuming to send a daily report, and many described it as becoming a routine. Reporting symptoms facilitated reflection on their symptoms and gave them a sense of security. Few technological problems were reported. Conclusions: The use of Interaktor increased patients? sense of security and their reflections on their own well-being and thereby served as a supportive tool for the self-management of symptoms during treatment of prostate cancer. Some further development of the app?s content might be beneficial for future use. UR - http://cancer.jmir.org/2017/2/e18/ DO - 10.2196/cancer.7599 UR - http://www.ncbi.nlm.nih.gov/pubmed/29089290 ID - info:doi/10.2196/cancer.7599 ER - TY - JOUR AU - Baseman, Janet AU - Revere, Debra AU - Baldwin, Laura-Mae PY - DA - 2017/09/26 TI - A Mobile Breast Cancer Survivorship Care App: Pilot Study JO - JMIR Cancer SP - e14 VL - 3 IS - 2 KW - breast neoplasms KW - data collection KW - feasibility studies KW - mobile apps KW - survivors KW - telemedicine AB - Background: Cancer survivors living in rural areas experience unique challenges due to additional burdens, such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, poorer mental health and physical functioning, and lower-than-average quality of life compared to urban survivors. Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care app to facilitate care coordination; support medical, psychosocial, and practical needs; and improve survivors' long-term health outcomes. Methods: An interactive prototype app, SmartSurvivor, was developed that included recommended survivorship care plan components. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6), primary care providers (n=4), and an oncologist (n=1). Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Our pilot study indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research. UR - http://cancer.jmir.org/2017/2/e14/ DO - 10.2196/cancer.8192 UR - http://www.ncbi.nlm.nih.gov/pubmed/28951383 ID - info:doi/10.2196/cancer.8192 ER - TY - JOUR AU - Brinker, Josef Titus AU - Brieske, Martin Christian AU - Schaefer, Matthias Christoph AU - Buslaff, Fabian AU - Gatzka, Martina AU - Petri, Philip Maximilian AU - Sondermann, Wiebke AU - Schadendorf, Dirk AU - Stoffels, Ingo AU - Klode, Joachim PY - DA - 2017/09/08 TI - Photoaging Mobile Apps in School-Based Melanoma Prevention: Pilot Study JO - J Med Internet Res SP - e319 VL - 19 IS - 9 KW - melanoma KW - skin cancer KW - prevention KW - mobile apps KW - smartphones KW - photoaging KW - schools KW - secondary schools KW - adolescents AB - Background: Around 90% of melanomas are caused by exposure to ultraviolet (UV) radiation and are therefore eminently preventable. Tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to malignant melanoma and other skin cancers are too far in the future to fathom. Given the substantial amount of time children and adolescents spend in schools, as well as with their mobile phones, addressing melanoma prevention via both of these ways is crucial. However, no school-based intervention using mobile apps has been evaluated to date. We recently released a photoaging mobile app, in which a selfie is altered to predict future appearance dependent on UV protection behavior and skin type. Objective: In this pilot study, we aimed to use mobile phone technology to improve school-based melanoma prevention and measure its preliminary success in different subgroups of students with regard to their UV protection behavior, Fitzpatrick skin type and age. Methods: We implemented a free photoaging mobile phone app (Sunface) in 2 German secondary schools via a method called mirroring. We ?mirrored? the students? altered 3-dimensional (3D) selfies reacting to touch on mobile phones or tablets via a projector in front of their whole grade. Using an anonymous questionnaire capturing sociodemographic data as well as risk factors for melanoma we then measured their perceptions of the intervention on a 5-point Likert scale among 205 students of both sexes aged 13-19 years (median 15 years). Results: We measured more than 60% agreement in both items that measured motivation to reduce UV exposure and only 12.5% disagreement: 126 (63.0%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 124 (61.7%) to increase use of sun protection. However, only 25 (12.5%) disagreed with both items. The perceived effect on motivation was increased in participants with Fitzpatrick skin types 1-2 in both tanning bed avoidance (n=74, 71.8% agreement in skin types 1-2 vs n=50, 53.8% agreement in skin types 3-6) and increased use of sun protection (n=70, 68.0% agreement in skin types 1-2 vs n=52, 55.3% agreement in skin types 3-6), and also positively correlated with higher age. Conclusions: We present a novel way of integrating photoaging in school-based melanoma prevention that affects the students? peer group, considers the predictors of UV exposure in accordance with the theory of planned behavior, and is particularly effective in changing behavioral predictors in fair-skinned adolescents (Fitzpatrick skin types 1-2). Further research is required to evaluate the intervention?s prospective effects on adolescents of various cultural backgrounds. UR - http://www.jmir.org/2017/9/e319/ DO - 10.2196/jmir.8661 UR - http://www.ncbi.nlm.nih.gov/pubmed/28887295 ID - info:doi/10.2196/jmir.8661 ER - TY - JOUR AU - Uy, Catherine AU - Lopez, Jennifer AU - Trinh-Shevrin, Chau AU - Kwon, C. Simona AU - Sherman, E. Scott AU - Liang, S. Peter PY - DA - 2017/08/24 TI - Text Messaging Interventions on Cancer Screening Rates: A Systematic Review JO - J Med Internet Res SP - e296 VL - 19 IS - 8 KW - text messaging KW - early detection of cancer KW - breast neoplasms KW - colorectal neoplasms KW - lung neoplasms KW - mHealth KW - uterine cervical neoplasms AB - Background: Despite high-quality evidence demonstrating that screening reduces mortality from breast, cervical, colorectal, and lung cancers, a substantial portion of the population remains inadequately screened. There is a critical need to identify interventions that increase the uptake and adoption of evidence-based screening guidelines for preventable cancers at the community practice level. Text messaging (short message service, SMS) has been effective in promoting behavioral change in various clinical settings, but the overall impact and reach of text messaging interventions on cancer screening are unknown. Objective: The objective of this systematic review was to assess the effect of text messaging interventions on screening for breast, cervical, colorectal, and lung cancers. Methods: We searched multiple databases for studies published between the years 2000 and 2017, including PubMed, EMBASE, and the Cochrane Library, to identify controlled trials that measured the effect of text messaging on screening for breast, cervical, colorectal, or lung cancers. Study quality was evaluated using the Cochrane risk of bias tool. Results: Our search yielded 2238 citations, of which 31 underwent full review and 9 met inclusion criteria. Five studies examined screening for breast cancer, one for cervical cancer, and three for colorectal cancer. No studies were found for lung cancer screening. Absolute screening rates for individuals who received text message interventions were 0.6% to 15.0% higher than for controls. Unadjusted relative screening rates for text message recipients were 4% to 63% higher compared with controls. Conclusions: Text messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer screening. Benefit was observed in various countries, including resource-poor and non-English-speaking populations. Given the paucity of data, additional research is needed to better quantify the effectiveness of this promising intervention. UR - http://www.jmir.org/2017/8/e296/ DO - 10.2196/jmir.7893 UR - http://www.ncbi.nlm.nih.gov/pubmed/28838885 ID - info:doi/10.2196/jmir.7893 ER - TY - JOUR AU - Sun, Yunheng AU - Jiang, Feng AU - Gu, J. Juan AU - Wang, Ken Y. AU - Hua, Hongwei AU - Li, Jing AU - Cheng, Zhijun AU - Liao, Zhijun AU - Huang, Qian AU - Hu, Weiwei AU - Ding, Gang PY - DA - 2017/07/25 TI - Development and Testing of an Intelligent Pain Management System (IPMS) on Mobile Phones Through a Randomized Trial Among Chinese Cancer Patients: A New Approach in Cancer Pain Management JO - JMIR Mhealth Uhealth SP - e108 VL - 5 IS - 7 KW - cancer pain KW - intelligent pain management system KW - smart phone KW - intervention AB - Background: Cancer has become increasingly prevalent in China over the past few decades. Among the factors that determine the quality of life of cancer patients, pain has commonly been recognized as a most critical one; it could also lead to the ineffective treatment of the cancer. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS). Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system?s usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as ?the Oncology Center?). In a pretest, participants completed a pain management knowledge questionnaire and were evaluated using the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14-day trial period, another round of cancer pain assessment, KPS evaluation and pain management knowledge assessment were repeated. In the trial group, the data were fully automatically collected by the IPMS. In the control group, the data were collected using conventional methods, such as phone interviews or door-to-door visits by physicians. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants successfully completed the trial. First, the feasibility of IPMS by observing the number of daily pain assessments recorded among patients was assessed. Second, the users? satisfaction, effectiveness of pain management, and changes in the quality of their lives were evaluated. All the participants gave high satisfaction score after they used IMPS. Both groups reported similar pain scores and KPS scores at the baseline. At the end of the trial, the mean pain score of the trial group was significantly lower than of the control group (P<.001). The ending KPS score of the trial group was significantly higher than of the control group (P<.001). The improvement of pain management knowledge score in the trial group was more pronounced than that in the control group (P<.001). Conclusions: This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors and to provide real-time supportive intervention on a convenient basis at a low cost. Overall, the IPMS can serve as a reliable and effective approach to control cancer pain and improve quality of life for patients with cancer pain. Trial Registration: Clinicaltrials.gov NCT02765269; http://clinicaltrials.gov/ct2/show/NCT02765269 (Archived by WebCite at http://www.webcitation.org/6rnwsgDgv) UR - http://mhealth.jmir.org/2017/7/e108/ DO - 10.2196/mhealth.7178 UR - http://www.ncbi.nlm.nih.gov/pubmed/28743681 ID - info:doi/10.2196/mhealth.7178 ER - TY - JOUR AU - Voruganti, Teja AU - Grunfeld, Eva AU - Jamieson, Trevor AU - Kurahashi, M. Allison AU - Lokuge, Bhadra AU - Krzyzanowska, K. Monika AU - Mamdani, Muhammad AU - Moineddin, Rahim AU - Husain, Amna PY - DA - 2017/07/18 TI - My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer JO - J Med Internet Res SP - e219 VL - 19 IS - 7 KW - MeSH: Internet KW - professional-patient relations KW - interdisciplinary communication KW - neoplasms KW - adult KW - chronic disease KW - continuity of patient care KW - patient care team KW - communication KW - outcome assessment (health care) AB - Background: The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. Objective: The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. Methods: We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ?3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. Results: Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. Conclusions: The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. Trial Registration: ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb). UR - http://www.jmir.org/2017/7/e219/ DO - 10.2196/jmir.7421 UR - http://www.ncbi.nlm.nih.gov/pubmed/28720558 ID - info:doi/10.2196/jmir.7421 ER - TY - JOUR AU - Kessel, Anne Kerstin AU - Vogel, ME Marco AU - Kessel, Carmen AU - Bier, Henning AU - Biedermann, Tilo AU - Friess, Helmut AU - Herschbach, Peter AU - von Eisenhart-Rothe, Rüdiger AU - Meyer, Bernhard AU - Kiechle, Marion AU - Keller, Ulrich AU - Peschel, Christian AU - Schmid, M. Roland AU - Combs, E. Stephanie PY - DA - 2017/06/14 TI - Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care JO - JMIR Mhealth Uhealth SP - e81 VL - 5 IS - 6 KW - clinical oncology KW - surveys and questionnaires KW - mobile apps KW - mHealth KW - eHealth AB - Background: In the last decade, the health care sector has been enriched by numerous innovations such as apps and connected devices that assist users in weight reduction and diabetes management. However, only a few native apps in the oncological context exist, which support patients during treatment and aftercare. Objective: The objective of this study was to analyze patients? acceptance regarding app use and to investigate the functions of an oncological app that are most required, and the primary reasons for patients to refuse app-assisted cancer care. Methods: We designed and conducted a survey with 23 questions, inquiring patients about their technical knowledge and equipment, as well as the possible advantages and disadvantages, data transfer, and general functionality of an app. Results: A total of 375 patients participated; the participation rate was 60.7% (375/618). Gender distribution was about 3:4 (female:male) with a median age of 59 years (range 18-92 years). Whereas 69.6% (261/375) of patients used mobile devices, 16.3% (61/375) did not own one, and 9.1% (34/375) only used a personal computer (PC). About half of the patients rated their usability skills as very good and good (18.9% 71/375; 35.2% 132/375), 23.5% (88/375) described their skills as intermediate, and 14.4% (54/375) as bad. Of all patients, 182 (48.5%, 182/375) were willing to send data to their treating clinic via an app, that is, to a server (61.0% 111/182) or as email (33.5%, 61/182). About two-thirds (68.7%, 125/182) believed that additional and regularly sent data would be an ideal complement to the standard follow-up procedure. Additionally, 86.8% (158/182) wished to be contacted by a physician when entered data showed irregularities. Because of lack of skills (34.4%, 56/163), concerns about the use of data (35.0%, 57/163), lack of capable devices (25.8%, 42/163), and the wish for personal contact with the treating physician (47.2%, 77/163), a total of 163 (43.5%, 163/375) patients refused to use an app. Pearson correlation showed a significant but mild relationship between age and app use (P=.03, r=?.12), favoring younger age; male gender correlated as well (P=.04; r=?.11). Conclusions: The results show that the introduction of mobile apps needs to follow different strategies depending on the patients? attitude. Age and gender seem to be the strongest predictive factors. For oncology patients, our survey showed that about half of the patients were willing to send data via an app supporting their treatment. In the future, clinical data such as quality of life and treatment satisfaction recorded by mobile health (mHealth) devices could be used to evaluate and improve therapy workflow. Furthermore, apps could support classical visits, document adverse effects, and remind patients of treatment dates or drug intake. UR - http://mhealth.jmir.org/2017/6/e81/ DO - 10.2196/mhealth.7689 UR - http://www.ncbi.nlm.nih.gov/pubmed/28615159 ID - info:doi/10.2196/mhealth.7689 ER - TY - JOUR AU - Urner, Esther AU - Delavy, Martine AU - Catarino, Rosa AU - Viviano, Manuela AU - Meyer-Hamme, Ulrike AU - Benski, Anne-Caroline AU - Jinoro, Jeromine AU - Heriniainasolo, Lea Josea AU - Undurraga, Manuela AU - De Vuyst, Hugo AU - Combescure, Christophe AU - Vassilakos, Pierre AU - Petignat, Patrick PY - DA - 2017/05/29 TI - A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study JO - JMIR Mhealth Uhealth SP - e72 VL - 5 IS - 5 KW - cervical cancer KW - squamous intraepithelial lesions of the cervix KW - HPV KW - acetic acid KW - lugol?s iodine KW - smartphone KW - mobile phone AB - Background: Sub-Saharan African countries are marked by a high incidence of cervical cancer. Madagascar ranks 11th among the countries with the highest cervical cancer incidence worldwide. Objective: The aim of the study was to evaluate the performances of digital smartphone-based visual inspection with acetic acid (D-VIA) and Lugol?s iodine (D-VILI) for diagnosing cervical precancer and cancer. Methods: Human papillomavirus (HPV)-positive women recruited through a cervical screening campaign had D-VIA and D-VILI examinations with endocervical curettage (ECC) and cervical biopsy. Three images were captured for each woman (native, D-VIA, D-VILI) using a smartphone camera. The images were randomly coded and distributed on 2 online databases (Google Forms). The D-VIA form included native and D-VIA images, and the D-VILI form included native and D-VILI images. Pathological cases were defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Physicians rated the images as non-pathological or pathological. Using the ECC and cervical biopsy results as references, the sensitivity and specificity of D-VIA and D-VILI examinations for each and all physicians were calculated. Results: Altogether, 15 clinicians assessed 240 images. Sensitivity was higher for the D-VIA interpretations (94.1%; 95% CI 81.6-98.3) than for the D-VILI interpretations (78.8%; 95% CI 54.1-92.1; P=.009). In contrast, the specificity was higher for the D-VILI interpretations (56.4%; 95% CI 38.3-72.9) than for the D-VIA interpretations (50.4%; 95% CI 35.9-64.8; P=.005). Conclusion: Smartphone-based image for triage of HPV-positive women is more accurate for detecting CIN2+ lesions with D-VIA than D-VILI, although with a small loss of specificity. UR - http://mhealth.jmir.org/2017/5/e72/ DO - 10.2196/mhealth.6697 UR - http://www.ncbi.nlm.nih.gov/pubmed/28554879 ID - info:doi/10.2196/mhealth.6697 ER - TY - JOUR AU - Constantinescu, Gabriela AU - Loewen, Irene AU - King, Ben AU - Brodt, Chris AU - Hodgetts, William AU - Rieger, Jana PY - DA - 2017/03/24 TI - Designing a Mobile Health App for Patients With Dysphagia Following Head and Neck Cancer: A Qualitative Study JO - JMIR Rehabil Assist Technol SP - e3 VL - 4 IS - 1 KW - app design KW - dysphagia KW - games for health KW - gamification KW - head and neck cancer KW - mHealth KW - mobile health KW - patient adherence KW - patient engagement AB - Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health apps with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: The aim of our study was to (1) identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients and (2) identify appealing biofeedback designs that could be used in a health app. Methods: A total of 10 (4 females) HNC patients (mean=60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through 6 themes: patient perceptions on outcomes and progress, clinical appointments, cancer treatment, rehabilitation program, personal factors, and connection. App visuals that provide feedback on performance during swallowing exercises should offer an immediate representation of effort relative to a goal. Simple, intuitive graphics were preferred over complex, abstract ones. Continued engagement with the app could be facilitated by tracking progress and by using visuals that build structures with each use. Conclusions: This is a detailed documentation of the initial steps in designing a health app for a specific patient group. Results revealed the importance of patient engagement in early stages of app development. UR - http://rehab.jmir.org/2017/1/e3/ DO - 10.2196/rehab.6319 UR - http://www.ncbi.nlm.nih.gov/pubmed/28582245 ID - info:doi/10.2196/rehab.6319 ER - TY - JOUR AU - Ginossar, Tamar AU - Shah, Ali Sayyed Fawad AU - West, J. Andrew AU - Bentley, M. Joshua AU - Caburnay, A. Charlene AU - Kreuter, W. Matthew AU - Kinney, Y. Anita PY - DA - 2017/03/13 TI - Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis JO - JMIR Mhealth Uhealth SP - e20 VL - 5 IS - 3 KW - mobile phones KW - mobile apps KW - breast cancer KW - cancer-related content AB - Background: Breast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps. Objective: This study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price. Methods: Following identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM). Results: The most common aim of apps was educational (73/101, 72.3%), followed by behavior change (24/101, 23.9%), fundraising (20/101, 19.8%), and advocacy (14/101, 13.9%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7%). Less than half of the apps (46/101, 45.5%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5%). Information about breast cancer diagnosis was included in 42 apps (41.58%) and 43 (42.6%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8%) apps. Only one (1.0%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6%) and few (24/101, 23.8%) defined key terms. Conclusions: Current breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities. UR - http://mhealth.jmir.org/2017/3/e20/ DO - 10.2196/mhealth.7073 UR - http://www.ncbi.nlm.nih.gov/pubmed/28288954 ID - info:doi/10.2196/mhealth.7073 ER - TY - JOUR AU - Robertson, C. Michael AU - Tsai, Edward AU - Lyons, J. Elizabeth AU - Srinivasan, Sanjana AU - Swartz, C. Maria AU - Baum, L. Miranda AU - Basen-Engquist, M. Karen PY - DA - 2017/01/24 TI - Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study JO - JMIR Mhealth Uhealth SP - e3 VL - 5 IS - 1 KW - mHealth KW - physical activity KW - survivors KW - technology KW - focus groups KW - smartphone AB - Background: Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective: The aim of this study was to take a qualitative approach to provide practical insight regarding this population?s preferences for the features and messages of an app to increase PA. Methods: A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results: Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions: Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors? preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors. UR - http://mhealth.jmir.org/2017/1/e3/ DO - 10.2196/mhealth.6970 UR - http://www.ncbi.nlm.nih.gov/pubmed/28119278 ID - info:doi/10.2196/mhealth.6970 ER - TY - JOUR AU - Pugh, Gemma AU - McCann, Lisa PY - DA - 2017/01/17 TI - Assessing the Quality, Feasibility, and Efficacy of Electronic Patient Platforms Designed to Support Adolescents and Young Adults With Cancer: A Systematic Review Protocol JO - JMIR Res Protoc SP - e4 VL - 6 IS - 1 KW - adolescent KW - neoplasms KW - telemedicine KW - review AB - Background: A range of innovative websites, mobile technologies, eHealth and mHealth platforms have emerged to support adolescents and young adults (AYAs) with cancer. Previous reviews have identified these various applications and solutions, but no review has summarized the quality, feasibility, and efficacy of existing patient platforms (inclusive of websites, mobile technologies, mHealth and eHealth platforms) developed specifically for young people with cancer. Objective: This paper describes the design of a protocol to conduct a review of published studies or reports which describe or report on an existing platform designed specifically for AYAs who have had a cancer diagnosis. Methods: A search string was developed using a variety of key words and Medical Subject Heading and applied to bibliographic databases. General data (sample characteristics, patient platform development, design and, if applicable, pilot testing outcomes) will be extracted from reports and studies. Drawing on a previously developed coding schematic, the identified patient platforms will be coded for mode of delivery into (1) automated functions, (2) communicative functions, and (3) use of supplementary modes. An adapted version of the Mobile App Rating Scale (MARS) will be used to assess the of quality of each identified patient platform. The methodological quality of included studies will be assessed using the Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst). Both authors will independently screen eligible studies for final inclusion and will both be responsible for data extraction and appraisal. Data will be synthesized narratively to provide an overview of identified patient platforms. Results: The review began in October 2016 and is currently in progress. The review paper will be submitted for peer-review and publication in the summer of 2017. Conclusions: This review will be unique in its focus on assessing, where possible, the quality and efficacy of patient platforms for adolescents and young adults diagnosed with cancer. Results generated from this review will provide an invaluable insight into the utility of modern technology in supporting young people with cancer. UR - http://www.researchprotocols.org/2017/1/e4/ DO - 10.2196/resprot.6597 UR - http://www.ncbi.nlm.nih.gov/pubmed/28096067 ID - info:doi/10.2196/resprot.6597 ER - TY - JOUR AU - Pereira-Azevedo, Nuno AU - Osório, Luís AU - Fraga, Avelino AU - Roobol, J. Monique PY - DA - 2017/01/06 TI - Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone App JO - JMIR Cancer SP - e1 VL - 3 IS - 1 KW - mHealth KW - prostate cancer KW - nomogram AB - Background: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. Objective: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Methods: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. Results: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ?7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high?92% (27.7/30), 87% (26.2/30), and 89% (13.4/15), respectively. No usability problems were identified. Conclusions: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app?s interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care. UR - http://cancer.jmir.org/2017/1/e1/ DO - 10.2196/cancer.6750 UR - http://www.ncbi.nlm.nih.gov/pubmed/28410180 ID - info:doi/10.2196/cancer.6750 ER -