Feasibility of introducing a smartphone navigation application into the care of breast cancer patients (The FIONA Study)

Patient sample, demographics, and baseline preferences for information

Between June 1st, 2020 and December 31st, 2020, 110 patients were recruited and registered to the study. Three patients withdrew consent prior to downloading the app and completing the baseline survey, resulting in 107 evaluable at baseline, and 82 patients (75%) completed the final survey. Details of patient disposition including screening and recruitment are presented in Fig. 1.

Fig. 1figure 1

Screening and Enrollment to the FIONA Study

Demographics and clinical characteristics of enrolled participants is shown in Table 1. All 107 were women, with average age 53 (range 27 to 77). Twenty percent were newly diagnosed and 45% were receiving adjuvant treatment, of whom 52% and 19% were receiving chemotherapy, respectively, and 36% had metastatic breast cancer.

Table 1 Clinical and demographic characteristics of study participantsBaseline patient preferences on information sources

At baseline, patients were asked which sources of information they relied upon for information about their cancer. Most patients reported relying on their doctors (99%), other people on their cancer care team (82%), cancer organizations (64%), and family and friends (55%). Forty two percent of patients used a general internet search for information, and 25% relied on patient support groups. At baseline, 93% of patients reported that they did not use any healthcare related apps (Table 1) and only 2% of participants listed health as one of the top uses for their mobile device.

Feasibility and usability

Integration of the Outcomes4Me app into the routine care of patients with breast cancer in active treatment was deemed feasible with 60% of participants engaging with the app at least 3 times during the study period, exceeding the prespecified target of 40%. There was wide variation in the level of engagement with the app during the study period among all participants, as shown in Fig. 2. Across all participants and for the subset with metastatic disease, median engagement was 3. Among all newly diagnosed patients the median engagement was 6, and for patients receiving chemotherapy for early-stage disease it was 4. Patients who engaged with the app 3 or more times were more likely to have at least a college degree (94% v. 74%, p = 0.02) and more likely to be newly diagnosed (34% v. 13%, p = 0.03) than those with less frequent engagement.

Fig. 2figure 2

Patient Engagement with Outcomes4Me App. The distribution of individual patient engagement for all 107 patients during the study period is shown. Orange line denotes patients who engaged 3 or more times with the app; green line denotes patients who engaged 4 or more times with the app

The mean usability score, as demonstrated by the SUS was 70 (median 76), exceeding the threshold for “above average” usability of 68 [18]. Among patients receiving chemotherapy for early-stage disease, it was 74, for newly diagnosed patients it was 74, and for patients with metastatic disease it was 66. Among patients between 18 and 39 years old, the usability score was 75, for patients 40–69 it was 70 and for patients older than 70 it was 74.

The overall NPS was − 37, suggesting 37 more detractors (respondents with a score of 0–6 on 10-point scale of willingness to recommend the app to other patients) then promotors (respondents with a score of 9 or 10) out of 100 app user. While the ratio of promotors to detractors of the app increased among more frequent users, the NPS was still negative, at—28 among those who engaged with the app 5 times or more, compared to − 41 among those who were less engaged. Among patients receiving adjuvant chemotherapy the NPS was balanced, with a score of 0 (promotors equal detractors). Tendency to promote the app, based on NPS, seemed to vary with stage with an NPS score of—47 among patients with stage I disease (n = 32) 0 among patients with stage II (n = 18), and 14 among patients with stage III (n = 7). However, among patients with metastatic disease it was -57.

Symptom reporting and tracking

At least one symptom was reported by 43% (46) of participants, and 40% (43) reported multiple symptoms through the app. The most commonly reported symptoms were: GI issues (30%), sleep disturbance (29%), pain (28%), mood issues (18%), and neurologic issues (17%) (Supplementary Materials Table 1).

Interestingly, several symptoms were reported more frequently by patients in the app than documented by providers in the EHR. Cognitive issues, sexual health problems (decreased libido), and depression were rare (< 10%), but were reported in the app by at least 5% of participants, and virtually never reported in the EHR (Table 2). This trend was even more pronounced when analysis was restricted to the subset of participants with at least one follow-up clinic visit during the study period and at least 5 episodes of engagement with the app. Nausea was more frequently recorded in the EHR than reported in the app. Most differences observed between symptom reporting in the app vs. documentation in the EHR were not statistically significant.

Table 2 Most Commonly Reported Symptoms in App and Electronic Health Record (EHR) among Total Study Population and Population Highly Engaged with App

Among patients with metastatic cancer, 41% reported that the app helped them track their symptoms. Fifty-five percent of patients on adjuvant or neoadjuvant chemotherapy found the app helpful for symptom tracking, as did 57% of newly diagnosed patients.

Clinical trial matching

At baseline, 47% of participants reported interest in information about clinical trials, and 54% reported awareness of clinical trial options while 34% did not. When asked at follow-up about their experience with the app, 35% reported that they were able to identify a clinical trial they were interested in learning about, including 50% of patients with a new diagnosis and 38% with metastatic disease. Overall, 33% of participants reported that they were more likely to consider a clinical trial after using the app.

Patient experience and satisfaction with care

There was no significant change in patient distress or satisfaction with cancer care over the course of the study. At baseline, 56% of participants reported distress of 4 or greater on the NCCN distress thermometer, compared to 43% at the end of the study (P = 0.08). Patients generally reported high satisfaction with their patient/doctor relationship at baseline, with mean score on the PDRQ9 of 4.78, and it remained high at the end of the study period with mean score of 4.83.

At baseline, we asked participants what healthcare information they were most interested in and the top areas of interest were: possible side effects of treatment (78%), prognosis (72%), and best treatment options (71%). Among the 82 participants who completed the end of study survey, the app features deemed most helpful were: Information about their specific type of breast cancer (76%), information about treatment options (74%), the personalized breast cancer newsfeed (70%), symptom tracking (65%), and clinical trial information (65%), as demonstrated in Fig. 3. Overall, 83% (68) of participants reported that the app was easy to use and 40% (33) reported that they plan to continue using the app following completion of the study.

Fig. 3figure 3

Participant Experience with Specific Features of the Outcomes4Me App. At the end of the 12 week study period, patients were asked which features of the app were most helpful. The top 5 categories from respondents (N = 82) are shown. Dark blue bars = Helpful/very helpful, light blue bars = somewhat helpful, gray bars = not helpful/minimally helpful

留言 (0)

沒有登入
gif