Mobile Postoperative Symptom Intervention Tool and Biometric Monitoring After Radical Cystectomy: Pilot Study Evaluating Feasibility, Usability, and Potential Utility

Abstract

Purpose: Mobile health technology and integration of patient-reported outcome measures into clinical interventions have the potential to transform patient care. Though patient-reported outcome measure management has been shown to improve outcomes in ambulatory care settings, few studies have examined remote patient-reported outcome measure assessment after major cancer surgery.

Materials and methods: A multiphased feasibility and usability study was designed. A mobile app-based postoperative symptom intervention tool was developed and evaluated by a focus group of bladder cancer patients and caregivers. Patients were prospectively accrued prior to cystectomy and asked to complete the daily mobile postoperative symptom intervention tool and wear biometric monitoring devices for 30 days post discharge. Retention, postoperative symptom intervention tool completion, and usability were assessed. Exploratory analysis of daily symptoms and patient-generated health information correlated signals with postsurgical complications and hospital readmission.

Results: Fifteen patients with a median age of 72 years completed 78% of daily surveys over the 30-day recovery period. Average time to complete the postoperative symptom intervention tool was 152 seconds. All patients agreed that the daily survey was easy to use, and most reported it would be a better way to communicate with the care team about symptoms than calling the clinic. Frequency and severity of patient-reported symptoms appeared to cluster prior to or at the time of complication or unplanned health care encounters on visual-analogue mapping.

Conclusions: Using smartphone and wearable technology to capture patient-reported symptoms and biometric data is feasible and rated as highly usable by bladder cancer patients after cystectomy. Symptom scores may signal developing complications and help clinicians identify postsurgical patients who may benefit from intervention.

Keywords: cystectomy; feasibility studies; mobile applications; patient reported outcome measures; urinary bladder neoplasms.

Figure 1.

Example of patient symptom reporting application. Example of patient-facing mobile application format of postcystectomy symptom assessment questionnaire designed to skip irrelevant questions to reduce participant burden. For example, participants who reported no nausea frequency were not asked to report on nausea severity. PRO-CTCAE indicates PatientReported Outcomes version of the Common Terminology Criteria for Adverse Events.

Figure 2a.

Daily symptom report visualization grouped according to recovery and health care encounters. Visualization of symptom assessment tool response profiles in absence of an unanticipated health care encounter or complication (study IDs 8, 12, 14); complication noted at routine clinic evaluation (study ID 13); patient-initiated phone call without complication (study IDs 9, 15, 17, 18, 19, 21); add-on clinic visit with complication (study ID 11); emergency room visit with complication (study ID 16); patientinitiated phone call with complication (study ID 20); and patient-initiated phone call with readmission (study IDs 10 and 22). Time of unanticipated health care encounter is denoted with thin red line, complication is denoted with thin black line, and readmission denoted with thick black line.

Figure 2b.

Exemplar symptom response profile correlated with clinical events. Symptom assessment response profile for study ID 11 with clinical course and symptom domains denoted.

Figure 3.

Exemplar patient-reported outcomes (PRO) and patient-generated health data panels according to presence or absence of complications. Exemplar patient-generated health information for a patient with no complication or unanticipated health care encounter (study ID 12), unplanned health care encounter and complication (study ID 11), and readmission due to complication (study ID 10) in columns with rows demonstrating mean heart rate, percent of daily tachycardia with heart rate >100 beats per minute, mean daily stress level, total daily steps, and daily POSIT (postoperative symptom intervention tool) score profiles starting the first day after hospital discharge. Grey shading denotes confidence intervals of the expected trend for patients without complications. Red vertical lines indicate the time of complication or readmission for each patient. For daily steps, the green line represents the reference trend for mean daily steps resulting from multi-level modeling. Dehisc indicates dehiscence; GI, gastrointestinal.