Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016

Life and Death in a Prescription Bottle: Design of

Mobile Health Education to Transform Self-care in

Cancer Medication Regimens

Andrew D. Boyd, MD

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, Claire Heshmat

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, Ashwin K Nayak

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, Sandra C. Puri, PharmD

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, Scott M. Wirth, PharmD

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, Neeta

K. Venepalli, MD, MBA

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, Stephanie Y. Crawford, PhD, MPH

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P

owerful medications used to treat cancer are increasingly available in oral formulations (i.e., tablets and

capsules). Shifting cancer care away from infused therapies in physician offices and hospitals into residential

settings with oral therapies offers convenience, but increases patient responsibility for managing complex ther-

apy and monitoring adverse effects. Medication adherence is the extent to which patient behavior corresponds

with the prescribed regimen. Adherence to oral anticancer medications (OAMs) can lead to improved outcomes, while non-

adherence (typically up to 40%) can result in accelerated disease progression or death. Novel communication methods are

needed as patients are distanced from their healthcare providers when taking OAM regimens that are often complex, often

adjusted, and may produce strong to unbearable side effects. Adequate opportunity is needed for patients to receive and

process information, reflect upon therapy, and actively engage in transformative processes following diagnosis of cancer. We

will describe development and feasibility testing of a customized mobile health education technology platform designed to

facilitate better patient-provider communication, greater adherence, and improved outcomes for patients with cancer.

Methods: With input from patient advocates, an interdisciplinary team developed a tablet-based application (app) called

Mobilizing for Patient Adherence to Cancer Therapies (mPACT) that targets 12 oral anticancer medications with education

and text messaging. The program focuses on 3 to 4 common barriers to medication use [dosage change, timely refills, side

effects, complex schedule for on-off medication schedule (as applicable)]. Nineteen interviews were conducted with research

participants in the outpatient oncology pharmacy and oncology clinic at the study setting, which is located in an urban

academic health center. In addition to animations on common barriers, each participant was shown app content for two

different OAMs, one with a continuous medication cycle and a second with an on-off medication cycle. Qualitative data were

collected in August 2016 and analyzed on app feasibility and preferences of participants.

Results: Eleven participants were men and 8 were women. The racial and ethnic breakdown was Asian-American 1, African-

American 8, Hispanic 3, and Caucasian 7. Resp onses ranged from a simple nod of the head throughout the entire patient

education program, to laughter, and agreement and explanation of how they have lived through the side effects or barriers to

adherence. Participants differed in desired frequency for text messages. Two participants mentioned only having a landline

and were unable to receive text messages. The usability of the program was demonstrated when users tapped through the

program. The responses from the patients went from excitement and wanting to know when this would be deployed to one

tech-savvy participant who said this needs to be more advanced. Concern from multiple participants was their perception

older patients would not want to interact with the application due to a technology generational divide. One participant

described the desire for comfort from the doctor and pharmacists when hearing the information instead of the information

from a tablet. Patients discussed how the patient stories were relatable about challenges to medication adherence.

Discussion: Bringing the tablet to a patient’s home via nurse or home aide is another method to reinforce the OAM edu-

cation on the complex medication schedule, the information and technology would be similar. All participants were able to

navigate the program and were able to discussion the content. Transforming OAM medication instructions to patient stories

and animations delivered on a tablet was received well by participants in this new method.

Conclusion: Feedback from the multiple interviews will be used to improve the mPACT program before the future ran-

domized control trial to measure medication adherence and satisfaction with patient care. The challenge with developing

tablet applications is to meet the needs of the novice user as well as the digital natives. Delivering tailored health information

to a patient’s mobile phone (enabling in-home provider communication) to increase OAM medication adherence is a novel

challenge, and meeting the challenge requires a multifaceted approach.

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University of Illinois at Chicago, Chicago, IL, USA

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