Clare Flanagan, Partners HealthCare Center for Connected Health, Boston, United States Shiyi Zan, Partners Healthcare Center for Connected Health / Harvard Medical School, Boston, United States Meghan Searl, artners Healthcare Center for Connected Health / Brigham & Women's Hospital, Boston, United States Mihir Kamdar, Harvard Medical School / Massachusetts General Hospital, Boston, United States Stephen O. Agboola, Partners Healthcare Center for Connected Health / Harvard Medical School / Massachusetts General Hospital, Boston, United States Kamal Jethwani*, Partners HealthCare Center for Connected Health / Harvard Medical School / Massachusetts General Hospital, Boston, United States Track: Research Presentation Topic: Mobile & Tablet Health Applications Presentation Type: Rapid-Fire Presentation Submission Type: Single Presentation Building: Sheraton Maui Resort Room: B - Kapalua Date: 2014-11-13 11:50 AM – 12:35 PM Last modified: 2014-11-24

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Background: In addition to the inherent pathophysiological effects associated with any cancer, pain continues to be one of the most feared consequences of the disease; upwards of 14% of patients experiencing cancer pain (CP) have inadequate analgesia. CP can be present at any phase of the disease process, and is associated with distressing psychosocial discomforts that adversely impact a patient’s quality of life. Clinical guidelines recommend that patients be screened for CP at any encounter with their providers, but physicians generally under-assess pain given their busy clinic schedules. Furthermore, many physicians have misconceptions about drug tolerance, addiction, routes of administration, and exaggerated fear of adverse effects. On the other hand, many patients want to be ‘good’ patients and do not want to ‘trouble’ their physicians. They may have misconceptions about pain as an ‘unavoidable consequence’ of cancer, fear of addiction, issues regarding medication compliance, and side-effects from their pain medication. These provider and patient-based barriers can culminate in a burden on the patient-provider relationship and result in sub-optimal management of CP. As CP is multi-dimensional in nature and requires intensive self-management, it is important for affected patients to be coached, educated, and motivated to understand and feel empowered to manage the pain they experience. Mobile applications offer a convenient and timely means to deliver appropriate interventions.

Objective: To evaluate the effect of a tailored, multi-dimensional mobile application intervention in reducing the intensity of CP and improving quality of life in cancer patients with moderate to severe CP. Secondary objectives are to assess the effect of the intervention on hospital utilization and urgent non-scheduled clinic visits for pain crises, adherence to analgesic and opioid medications, perceived barriers and knowledge regarding pain management, and patient engagement with the mobile app.

Methods: 110 ambulatory, adult cancer patients diagnosed with moderate or severe CP who own a smartphone and are willing to download the study mobile app will be randomized to either the intervention group using the mobile app or to a control group receiving usual care, and followed up for 2 months. Patients in the intervention group will be prompted to rate their pain over the past 24 hours through the app using the pain intensity numerical rating scale 3 times per week, and based on their response, will be guided through an algorithm that will educate (“coach”) them on ways to help them manage their pain. Patients with persistent or worsening pain intensity will be identified and connected directly to their palliative care team via a phone call, or if after hours, to the appropriate emergency phone or paging service. Patients in the intervention group will also receive educational messages (“tips”) each evening to help them learn to better manage their CP and other side effects. For both the intervention and control group, an adapted brief pain inventory will be administered using an interactive voice response phone call at week 2 and 6 of the study to assess pain intensity and interference with daily life.

Results & Conclusions: Research in Progress