Patient engagement with a smartphone mobile app for adherence to oral chemotherapy.

Abstract

243 Background: Patients prescribed oral chemotherapy receive minimal supervision and support for adherence. We developed a smartphone mobile app consisting of medication reminders, symptom reporting, clinician communication, and educational resources for improving adherence and symptom management. In this study, we sought to identify potential correlates of app usage. Methods: From 12/2014 to 08/2016, 181 patients with diverse malignancies prescribed oral chemotherapy enrolled in a randomized trial to test the efficacy of a smartphone mobile app to improve adherence and symptoms. Medication adherence was monitored using electronic pill caps (MEMScaps). At baseline and 12 weeks, participants completed a measure of treatment satisfaction (FACIT-TS). We gathered clinical and treatment data from the electronic health record. Through the app we collected data on engagement: total number of minutes, days of usage, and number of completed symptom reports. We calculated Pearson correlations to identify associations between app engagement, using a latent variable for overall engagement, with adherence, treatment satisfaction and healthcare utilization. Results: 91 patients were randomly assigned to receive the mobile app. Over the 12-week study period, participants used the mobile app for a mean of 59 minutes (SD = 68) and 21.75 discrete days (SD = 21.24 days), completing 15.92 symptom reports (SD = 14.15) on average. Higher app engagement was associated with having a lower proportion of missed doses (r = -.248, p = .035) over the study period. Patients who became less satisfied with their communication with physicians (r = -.278, p = .019) and nurses (r = -.238, p = .047) used the app more. Higher app engagement was associated with fewer emergency department visits resulting in hospitalizations (r = -.252, p = .029). Conclusions: Among patients prescribed oral chemotherapy, higher usage of a mobile app targeting adherence was related to fewer missed doses and ED visits leading to hospitalization. Fostering patient engagement with the app may also serve to buffer difficulties in patient-clinician communication about care. Clinical trial information: NCT02157519.