JMIR Publications

ABSTRACT

Background:

People living with advanced cancer experience more frequent and severe symptoms than people living with early-stage disease. Four common and distressing symptoms include sleep difficulties, worry-anxiety, fatigue, and depression. Cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) interventions are effective for managing these symptoms but are often too time-intensive for people with multiple appointments, limited energy, and competing priorities. Brief, mobile health (mHealth) interventions provide an accessible alternative, particularly for those in rural communities with limited access to palliative and/or psychosocial oncology services.

Objective:

Based on our successful in-person/DVD-based pilot trial of a four session, integrated CBT-ACT symptom management intervention for advanced cancer patients, Finding Our Center Under Stress (FOCUS), this study tests the feasibility and acceptability of a mHealth translation of this intervention.

Methods:

In this single-group, feasibility trial, 11 people with advanced cancer were recruited through hospital-based oncology clinics representing four cancer types (breast, melanoma, multiple myeloma, prostate). Patients completed sociodemographic questions, initial patient-reported outcomes including sleep (ISI), anxiety (GAD-7, PSWQ), fatigue (FSI), and depression (CES-D) and a 7-day sleep diary via the mobile app. They then completed four modules focused on the self-management of sleep difficulties, worry-anxiety, fatigue, and depression. To assess feasibility, we examined recruitment, retention, and module completion. At the end of six weeks, to assess acceptability, participants completed the Internet Evaluation and Utility Scale and some participants completed a qualitative interview assessing their experience with the FOCUS app. We present quantitative and qualitative results as well as lessons learned in designing the application for this patient population.

Results:

Sixty-five percent entered the trial (N =11) and seventy percent completed more than half of the app. These participants gave strong ratings for FOCUS ease of use (3/4), convenience (3.7/4), utility (3.3/4), and ease of understanding (3.83/4). All participants (10/10) said they would recommend the app to other people with cancer and would return to the app with future problems. Participants’ favorite components were video recordings of other patients and the sleep and worry/uncertainty modules. Areas for improvement based on participant feedback included video quality for some components (i.e., lighting, sound), sleep diary ease of use, and a desire for professional guidance.

Conclusions:

The FOCUS intervention was successfully delivered via mobile technology and was feasible and acceptable per beta testing. The FOCUS mHealth app provides an evidence-based, accessible symptom management intervention for people with advanced cancer in rural communities. In accordance with participant feedback, for FOCUS 2.0 we will enhance video segments, incorporate a telehealth component to support app usage, and further develop the interactive and motivational features of the app. Future research will explore the effectiveness of this mHealth symptom management application via a randomized controlled trial.