A Palliative Care mHealth Intervention to Support Advanced Cancer Patients and Oncology Providers in Opioid Management

Dana-Farber Cancer Inst, Boston MA

Investigators

Linked publications & trials

Abstract

PROJECT SUMMARY The object of this proposal is to develop a mobile health (mHealth) application to optimize management of moderate-to-severe cancer pain with opioids. Despite availability of effective treatments, cancer pain is often poorly controlled due to a variety of patient, clinician, and systems-level barriers. Patients lack the knowledge, support, and self-management skills needed to best use opioids and navigate their side effects. Frequent opioid and other medication adjustments are needed to ensure symptom control. Unfortunately, systems are lacking to help patients track and communicate symptoms to their care teams between routine clinic visits. As a result, problems are often not recognized or acted upon until patients are in crisis. Moreover, clinicians often lack the time and knowledge base needed to assess symptoms, and appropriately adjust management. Interventions that educate patients, enable symptom self-report, and promote algorithm-based treatment have shown promise for cancer pain - yet, benefits have been modest, and these interventions have failed in implementation. mHealth strategies are scalable, and able to integrate many of these goals, while also supporting patients in self-management. The applicants propose to develop STAMP: Smartphone Technology to Alleviate Malignant Pain. Grounded in Wagner's Chronic Care Model, STAMP will support self-management through symptom-tracking, tailored education, medication reminders, and specific behavioral/medication advice. A clinician portal with generative capacity for alerts and summary reports will present symptom/opioid use data, with clinical decision support to promote timely medication adjustments. By importing key data from the Epic electronic health record, decision support features will be tailored to patients' medication regimens. The project is made feasible by the teams' ability to 1) harness an existing mHealth platform, and 2) adapt validated, computable algorithms for cancer pain management. In Aim 1, STAMP will be developed in a rigorous three-phase process of 1) content development by multidisciplinary working groups, with cognitive and qualitative interviews to ensure clarity and acceptability; 2) programming and testing of decision support algorithms using an automated stack-traversal tree-spanning methodology, and 3) development of usable, acceptable interfaces through ?look and feel testing,? and iterative rounds of laboratory and field user acceptability testing. In Aim 2, STAMP will be piloted among 20 patients with advanced incurable cancer receiving opioids for moderate-to-severe cancer pain, and their outpatient oncologists. The primary outcomes of this 8-week pilot will be patients' adherence to symptom self-reporting, and clinician adherence to STAMP recommendations. Surveys, app data, chart abstraction, and qualitative debriefing will explore patient/provider use of STAMP and satisfaction, pain severity, quality of life, and healthcare utilization. If feasibility is shown, pilot results will be used to plan a randomized study to examine the impact of STAMP on the severity of chronic cancer pain, symptom related quality of life, distress, care satisfaction, and care utilization.