Abstract
BackgroundImprovements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy.ObjectiveThe primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions.MethodsBetween March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients’ demographics, interval from enrollment to first self-report, baseline Beck’s Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process.ResultsA total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0%, 1215/2700). The median value of individual patient-level reporting rates was 41.1% (range 6.7-95.6%). The longitudinal day-level compliance curve fell to 50.0% at day 34 and reached a nadir of 13.3% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50% at day 70 and continued to fall to 45% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6%, SD 24.0 and 29.6%, SD 25.3, respectively; P=.03).ConclusionsThe 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care.
Highlights
Electronic health can be defined as the practice of medicine and public health using information and communication technology (ICT), such as computers, mobile phones, and satellite communications [1]
We found that in this population, depression, health-related quality of life (HRQOL) status, and demographic characteristics such as age and educational level did not affect compliance, but the results suggest that women who were not currently in employment and those who started to use the app on the day immediately after enrollment exhibited greater compliance with daily self-reporting
Previous studies not involving the use of smartphones found that the completion of online questionnaires on toxicity in patients receiving chemotherapy was associated with a high compliance rate for self-reporting at office visits, but only 15.0% actively self-reported from home between visits [7,8]
Summary
Electronic health (eHealth) can be defined as the practice of medicine and public health using information and communication technology (ICT), such as computers, mobile phones, and satellite communications [1]. The advent of ICT, which can build survey systems with a broad range of clinical uses, has made it possible to capture PRO data in real time and broken through a key barrier to the use PRO data in the clinical-care setting. These kinds of electronic PROs (ePROs) from waiting rooms in the hospital [7,8], as well as from home [9], have reportedly been successfully collected with high mean compliance rates and patient satisfaction and are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy
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