Accepted for/Published in: JMIR Formative Research
Date Submitted: May 26, 2025
Date Accepted: Dec 15, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluating a Wearable-Based Pain Monitoring System in Palliative Cancer Care: A Usability Study
ABSTRACT
Background:
Effective pain management is a cornerstone of cancer palliative care, yet it remains challenging in low- and middle-income countries (LMICs) due to limited resources, regulatory constraints, and a lack of objective tools. While wearable technologies offer promise for augmenting pain-related patient-reported outcomes (PROs) with physiological data, their usability in LMIC palliative settings is underexplored.
Objective:
This article introduces and evaluates the NEST system, a low-cost, smartwatch-based pain monitoring solution co-designed with healthcare staff from a cancer hospital in Ecuador. The system integrates a wearable device, a mobile app, and a web dashboard to collect photoplethysmography (PPG)-based heart rate data and structured pain-related PROs for outpatient palliative care.
Methods:
An observational usability study was conducted with seven cancer patients receiving palliative care treatment, combining hospital- and home-based monitoring phases. The study aimed to assess the feasibility and usability of the NEST system and to identify sociotechnical factors affecting adoption using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework.
Results:
Quantitative results showed strong preference for the smartwatch over the mobile phone for submitting PROs (83%), with wear-time adherence of the smartwatch ranging from 36% to 92% of the time. Qualitative feedback from patients and healthcare staff indicated good usability and perceived clinical value, though technical and organizational challenges such as charging habits, training needs, and dashboard integration into daily workflow of healthcare staff were noted.
Conclusions:
This article contributes one of the first usability evaluations of wearable pain monitoring in palliative cancer care within an LMIC context, highlighting both the potential and the complexity of deploying such systems in under-resourced environments. Our main insight is that, in a LMIC setting, most of the complexity was found on the health condition while the technology shows clear promising signs of having value to patients and healthcare staff.
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Copyright
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