Using smartphone-based ecological momentary assessment and personalized feedback for patients with chronic cancer-related fatigue: A proof-of-concept study

Abstract

Introduction: Chronic cancer-related fatigue (CCRF) is a complex multidimensional problem warranting person-centered care. Providing patients and therapists personalized feedback based on network analysis applied to ecological momentary assessment (EMA) data could facilitate case conceptualization in psycho-oncological care. The aim was to explore patients' and therapists' experiences of using an EMA app and personalized feedback based on network theory to aid case conceptualization in psycho-oncological care.

Methods: A n = 5 proof-of-concept study was implemented in routine psycho-oncological care. We purposively selected adult cancer patients suffering from severe CCRF who were on the waitlist for psycho-oncological care. During a 3-week period participants filled out the EMA app Energy InSight (fatigue, mood, activity, responding, and context) five times a day. Participants received a descriptive and network feedback report, which they reflected upon during the first therapy sessions. Thematic analysis was used to analyze user experiences.

Results: Patients experienced that filling out the Energy InSight app, as well as receiving descriptive and network-based personalized feedback provided them with insight into their CCRF. Although therapists experienced the discussion of network feedback as challenging, it facilitated the case conceptualization.

Discussion: Using EMA during waitlist for psychological care seemed feasible. Patients experienced beneficial effects from filling out the EMA app and talking over the personalized feedback reports, which in turn aided case conceptualization and personalized care. Based on this evaluation, an improved version of the Energy InSight app and a therapist training for providing network feedback is developed for implementation in psycho-oncological care.

Keywords: CBT, cognitive behavioral therapy; CCRF, chronic cancer-related fatigue; CIS-FS, Checklist Individual Strength-Fatigue Severity subscale; Chronic cancer-related fatigue (CCRF); EMA, ecological momentary assessment; Ecologically momentary assessment (EMA); HADS, Hospital Anxiety Depression Scale; HDI, Helen Dowling Institute; MBI, mindfulness-based interventions; Network approach; PAI, physical activity intervention; Personalized feedback; Proof-of-concept study; User experiences; eMBCT, online mindfulness-based cognitive therapy.

Fig. 1

Flowchart study procedures.

Fig. 2

EMA app Energy InSight.

Fig. B.1

Average fatigue level from day to day of Cassie.

Fig. B.2

Contemporaneous network of Cassie. Note. A connection between two nodes in this network is based on partial contemporaneous correlation. The stronger a connection between two nodes, the thicker and more saturated the edge. Positive and negative connections are denoted by green and red edges, respectively. FATIG = fatigue; CONCE = concentration; MOTIV = motivation; PAIN = pain; P_ACTI = physically active; M_ACTI = mentally active; PONDE = pondering; REST = allowing rest; HOPEL = feeling hopeless; CONTR = feeling in control.