Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study.

BACKGROUND Older patients with cancer are at an increased risk of adverse outcomes A geriatric assessment GA is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality and it can be used to guide interventions However the implementation of GA and GA driven interventions is low due to resource and time limitations GA driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers OBJECTIVE We aimed to evaluate the feasibility and usability of a novel app TouchStream and to identify barriers to its use As an exploratory aim we gathered preliminary data on symptom burden health care utilization and satisfaction METHODS In a single site pilot study we included patients aged 65 years undergoing treatment for systemic cancer and their caregivers TouchStream consists of a mobile app and a Web portal Patients underwent a GA at baseline with the study team on paper and the results were used to guide interventions delivered through the app A tablet preloaded with the app was provided for use at home for 4 weeks Feasibility metrics included usability system usability scale of 68 is considered above average recruitment retention number of subjects consented who completed postintervention assessments and percentage of days subjects used the app For the last 8 patients we assessed their symptom burden severity and interference with 17 items scored from 0 10 where a higher score indicates worse symptoms using a clinical symptom inventory health care utilization from the electronic medical records and satisfaction 6 items scored on a 5 point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction using a modified satisfaction survey Barriers to use were elicited through interviews RESULTS A total of 18 patients mean age 76 8 range 68 87 and 13 caregivers mean age 69 8 range 38 81 completed the baseline assessment Recruitment and retention rates were 67 and 80 respectively The mean SUS score was 74 0 for patients and 72 2 for caregivers Mean percentage of days the TouchStream app was used was 78 7 Mean symptom severity and interference scores were 1 6 and 2 8 at preintervention and 0 9 and 1 5 at postintervention respectively There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period week 5 8 One patient was hospitalized during the intervention period week 1 4 and two patients during the postintervention period week 5 8 Mean satisfaction scores of patients and caregivers with the mobile app were 20 4 and 23 4 respectively Barriers fell into 3 themes general experience design and functionality CONCLUSIONS TouchStream is feasible and usable for older patients on cancer treatment and their caregivers Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion