A Web-Based Mobile App (INTERACCT App) for Adolescents Undergoing Cancer and Hematopoietic Stem Cell Transplantation Aftercare to Improve the Quality of Medical Information for Clinicians: Observational Study

Abstract

Background: A growing number of cancer and hematopoietic stem cell transplant (HSCT) survivors require long-term follow-up with optimal communication schemes, and patients' compliance is crucial. Adolescents have various unmet needs. Regarding self-report of symptoms and health status, users of mobile apps showed enhanced compliance. Currently, HSCT aftercare at the HSCT outpatient clinic of the St. Anna Children's Hospital in Vienna, Austria, is based on handwritten diaries, carrying various disadvantages. Recently, we developed the prototype of a web-based, self-monitoring gamified mobile app tailored for adolescents: the INTERACCT (Integrating Entertainment and Reaction Assessment into Child Cancer Therapy) app.

Objective: This observational, prospective study evaluated the usability of the INTERACCT app for tracking real-time self-reported symptoms and health status data in adolescent HSCT patients and a healthy matched control group. The primary outcome of the study was the quality of the self-reported medical information. We hypothesized that the mobile app would provide superior medical information for the clinicians than would the handwritten diaries.

Methods: Health data were reported via paper diary and mobile app for 5 consecutive days each. The quality of medical information was rated on a 5-point scale independently and blinded by two HSCT clinicians, and the duration of use was evaluated. A total of 52 participant questionnaires were assessed for gaming patterns and device preferences, self-efficacy, users' satisfaction, acceptability, and suggestions for improvement of the mobile app. Interrater reliability was calculated with the intraclass correlation coefficient, based on a two-way mixed model; one-way repeated-measures analysis of variance and t tests were conducted post hoc. Descriptive methods were used for correlation with participants' demographics. For users' satisfaction and acceptability of the mobile app, the median and the IQR were calculated.

Results: Data from 42 participants-15 patients and 27 healthy students-with comparable demographics were evaluated. The results of our study indicated a superiority of the quality of self-reported medical data in the INTERACCT app over traditional paper-and-pencil assessment (mobile app: 4.14 points, vs paper-based diary: 3.77 points, P=.02). The mobile app outperformed paper-and-pencil assessments mainly among the patients, in particular among patients with treatment-associated complications (mobile app: 4.43 points, vs paper-based diary: 3.73 points, P=.01). The mobile app was used significantly longer by adolescents (≥14 years: 4.57 days, vs ≤13 years: 3.14 days, P=.03) and females (4.76 days for females vs 2.95 days for males, P=.004). This corresponds with a longer duration of use among impaired patients with comorbidities. User satisfaction and acceptability ratings for the mobile app were high across all groups, but adherence to entering a large amount of data decreased over time. Based on our results, we developed a case vignette of the target group.

Conclusions: Our study was the first to show that the quality of patient-reported medical information submitted via the INTERACCT app embedded in a serious game is superior to that submitted via a handwritten diary. In light of these results, a refinement of the mobile app supported by a machine learning approach is planned within an international research project.

Keywords: adolescents; cancer; medical information exchange; mobile app; mobile phone; self-reported heath status; stem cell transplant.

Figure 1

Study overview. The diagram was adapted from the CONSORT (Consolidated Standards of Reporting Trials) 2010 flow diagram (Eysenbach, 2011, and CONSORT, 2020). Malignant diseases include all malignant underlying diseases. Comorbidity is deemed severe when graded as 3-4 on the Common Terminology Criteria for Adverse Events (CTCAE). cGVHD: chronic graft-versus-host disease; HSCT: hematopoietic stem cell transplantation; Q: question; T1: time point 1 at study entry; T2: time point 2 at study termination.

Figure 2

INTERACCT (Integrating Entertainment and Reaction Assessment into Child Cancer Therapy) app screenshots. A: Icons for the domains of self-reported health status—fluid and food intake (amount and difficulties); urine and stool (frequency, quality, and pain); physical exercise and play (duration in minutes); nausea and vomiting (frequency); fatigue (frequency); mouth complaints (frequency, quality, and pain); body temperature; and skin complaints (localization, frequency, and quality). B: Input for amount of fluid intake and difficulties, as an example.

Figure 3

Comparison of the paper diary with the mobile app. The plot shows the clinician-reviewed quality of medical information regarding patient-reported health status on a 5-point scale, ranging from 1 (low) to 5 (high). Malignant refers to malignant underlying disease. cGVHD: chronic graft-versus-host disease; CTCAE 3-4: National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) grade of 3-4.

Figure 4

Comparison of the paper diary versus mobile app: duration in days of data entry. Malignant refers to malignant underlying disease. cGVHD: chronic graft-versus-host disease; CTCAE 3-4: National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) grade of 3-4.