Perspectives of patients with advanced cancer on mobile health interventions to support coping with cancer pain.

Abstract

277 Background: Pain is common among people with advanced cancer. While opioids are important for management, incorporating behavioral and psychological treatments may improve pain outcomes. We systematically evaluated patients' experiences with pain self-management and their perspectives on using a mobile health (mHealth) intervention that integrates cancer pain management support with pain-Cognitive Behavioral Therapy. Methods: This study recruited adult patients from Stephenson Cancer Center in Oklahoma and Dana Farber Cancer Institute in Massachusetts who had an incurable solid or hematologic malignancy, chronic pain related to cancer, and were using opioids. Following a semi-structured interview guide, participants shared feedback on educational web-based content and app-based wireframes from a behavioral pain management mHealth application. Participants were also asked about their experiences self-managing cancer pain and encouraged to reflect on the ideal role of mHealth interventions in their existing care. Interviews were transcribed verbatim and analyzed using a combination of thematic and framework analysis. Results: Patients (n=28; 54% female; mean age=53) experienced substantial challenges related to their pain, including new physical limitations, distress, and side effects from treatments and medications. Patients used physical/behavioral (e.g., using tools/devices, physical activity, modifying routines, opioid therapy) and psychological strategies (e.g., reframing negative thoughts, distraction, pain acceptance, social support) to self-manage chronic cancer-related pain. One notable theme that emerged was that clinicians’ hesitance to prescribe and patients’ hesitance to take opioids represented a significant barrier to adequate pain management. Patient recommendations for how mHealth interventions could best address their needs coalesced around two additional themes, both of which were related to patients’ experience of pain self-management. First, patients felt that content should be directly relevant to the advanced cancer experience. Second, patients wanted convenient access to symptom and medication tracking in addition to informational resources describing how to better cope with pain and communicate with healthcare providers. Conclusions: Many patients felt that for pain management strategies to be successful, medical and psychological pain treatments must be integrated, and contain guidance about appropriate analgesic use. This underscores the importance of coordinating complementary approaches when developing cancer pain management interventions. Given their existing pain self-management strategies and challenges, patients with advanced cancer viewed mHealth interventions that support pain self-management as a promising avenue to provide integrated pain treatment.