JMIR Publications

ABSTRACT

Background:

Routine monitoring of patient-reported outcomes (PROs) during cancer treatment improves symptom control, quality of life, and in some cases even survival, yet real-world uptake and sustained engagement with PRO monitoring remains suboptimal. One barrier is patients’ motivation to complete repeated assessments over extended periods of time. Gamification has been shown to improve engagement with digital health interventions, but its application to PRO monitoring has been minimally explored. User-centered design approaches are needed to ensure that gamified PRO tools are acceptable, usable, and responsive to patient and clinician needs, especially for older adult users.

Objective:

The study aimed to develop a gamified symptom monitoring web app for older adult cancer patients using a multi-stage, iterative, and user-centered approach.

Methods:

Phase 1 involved a survey of 216 older adults with chronic health conditions on mHealth and gamification preferences. Phase 2 involved interviews with seven older adult cancer survivors on the app concept and wireframes. Phase 3 involved an iterative process of interviews with five clinicians and usability tests with nine older adult cancer survivors to refine the web-app prototype for deployment.

Results:

In Phase 1, older adults with chronic conditions reported high overall familiarity with mobile technology and generally favorable attitudes towards gamification, with learning-oriented elements rated mostly appealing (mean = 4.3/5). Concerns for a gamified mHealth app included data privacy and perceived trivialization of health. Phase 2 interviews demonstrated strong interest in longitudinal symptom visualization and clinician-sharable reports; gamified travel-based learning content was viewed as engaging by most participants but was preferred as optional rather than mandatory. In Phase 3, iterative clinician interviews and patient usability testing led to substantial refinements, including simplified navigation, enhanced accessibility for older users, clearer score interpretation with embedded educational videos, and de-emphasis of the gamified travel learning component. Across usability testing rounds, the number of user experience problems decreased substantially, indicating improved usability of the final prototype.

Conclusions:

Using a multi-stage, mixed-methods, user-centered design process, we developed AthenaCompanion, a gamified web-based app for PRO monitoring tailored to older adults undergoing cancer treatment. Findings highlight the importance of emphasizing clinical utility, clarity of symptom feedback, and low-pressure, optional gamification elements. This work demonstrates the feasibility of integrating gamification into PRO monitoring and provides a foundation for future work evaluating long-term usability, engagement, and clinical effectiveness in real-world oncology care. Clinical Trial: N/A