JMIR Publications

ABSTRACT

Background:

Digital symptom monitoring programs (SMP) improve patients’ health-related quality of life through early symptom identification during cancer care. Palliative care also improves patients’ health-related quality of life by delivering specialty-level management for cancer symptoms. Through complementary approaches, SMPs and palliative care align with symptom management theory by linking the patient-reported symptom experience with clinician recommendations for symptom management to improve health outcomes for patients with serious illness. While both SMPs and palliative care reduce healthcare utilization and improve survival through detection and treatment of cancer symptoms, few studies have attempted to integrate palliative care into SMPs for cancer symptom management.

Objective:

This study aimed to assess patients’ perspectives about the feasibility and acceptability of an SMP with a prompted palliative care self-referral option delivered via a mobile health application (app).

Methods:

This is a single-institution qualitative study of patients with lung cancer enrolled in a single-arm feasibility pilot of a mobile health app that facilitates on-demand reporting of cancer-related symptoms and prompts patients to self-refer to palliative care for symptom management. Interview participants were purposefully sampled based on high (≥3 uses) versus low (0-2 uses) app engagement during the first 3 months of the SMP. Questions focused on program feasibility and acceptability as well as perceptions of the five main components of the SMP intervention (introduction to palliative care, reminders, symptom reporting, palliative care self-referral, oncology team callback). Individual interviews were conducted from May 2024 – May 2025 by telephone, recorded, transcribed verbatim, and analyzed using thematic analysis.

Results:

Thirty-one patients were interviewed; 21 with high and 10 with low app engagement. Participants were mostly white (93.5%), female (67.7%), and ≥60 years of age (61.3%). Participants voiced willingness and ability to report symptoms through the study app and self-refer to palliative care if needed for symptom management. Participants described technology concerns and low understanding of palliative care as primary barriers to app engagement and palliative care self-referral, respectively.

Conclusions:

Patients reported that an app-based SMP with integrated palliative care self-referral was both feasible and acceptable. Incorporation of educational outreach, improved digital accessibility, customized reminders, and recommendations for help-seeking behaviors based on symptom scoring thresholds may improve participant engagement with future iterations of this SMP intervention.