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Rethinking M-health in Cancer Care: From the Perspective of Patient Participation

Yuan, Changrong PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000401
DEPARTMENTS: Guest Editorial
Free

Editorial Board Member, Cancer Nursing School of Nursing Second Military Medical University Shanghai, China

The author has no funding or conflicts of interest to disclose.

Several years have passed since mobile health (m-health), defined as medical and public health practices supported by mobile devices,1 was first introduced to the nursing world including oncology. Numerous cancer patients, nurses, and other healthcare professionals benefit from m-health because of its conveniences of unlimited time and space. Undoubtedly, we can predict that the next decade will be the era of m-health.

According to one estimate,2 the number of research studies involving m-health and funded by the National Institutes of Health in the past 5 years is now more than 90. The most common foci of these funded studies are breast cancer and HIV populations and chronic disease–related management model and health behavior promotion. For example, a team from Northeastern Illinois University3 is conducting research that aims at connecting physically disabled breast cancer patients with matched disabled survivors by a smartphone application to receive peer support. Another team from the Cancer Institute of New Jersey4 is conducting research that aims at developing a mobile health fitness program for childhood cancer survivors to promote healthy behaviors and enhance quality of life. Similar support is evident in China as well. The Natural Science Foundation of China, a similar organization to the National Institute of Nursing Research in the United States, is providing support to m-health studies in long-term care, especially with cancer survivors. For example, the Natural Science Foundation of China has funded my research team to study improving quality of self-care self-management behaviors during treatment of breast cancer patients via smartphone assistance. With sufficient funds, fast development of Internet options and the sustained interest from policy makers, research outputs such as wearable devices, smartphone applications, and intellectual management systems have been emerging and making a positive difference in various fields including cancer nursing.

It would seem, then, that the use of m-health in oncology is advancing well. However, some perplexities and confusion still exist. One of the most important considerations is patient participation, which means providing patients with the chance to engage in the management of the whole disease process according to their own needs. Patient participation in treatment decision making and patient safety initiatives has yielded positive care outcomes.5 Likewise, patient participation is also a key component in m-health and refers to patients' initiative to use m-health services and keep the interaction active.

To achieve full patient participation in m-health technology, the first step is to design m-health services based on the needs of patients, which is the premise to attract target populations. Because of the variety of cancer treatments, it is necessary to adapt m-health service for cancer patients with different types of cancer and at diverse phases of treating periods. Second, diversified forms of patient participation should be adopted. For example, medical records by patients themselves, interaction between patients and medical staff, and communication with other patients are all positive approaches when designing m-health services. Third, it is of the essence to increase the usability of m-health service, which means making it easier for patients to get involved. For example, when it is difficult for elderly cancer patients to record their treatment symptoms by texting, they should be able to use photos and voice memos instead.

Cancer patient participation using m-health may, as with other methods, need attentive monitoring by oncology professionals. Patient participation without monitoring could contribute to negative care or treatment outcomes. Therefore, patient participation via m-health needs to reflect input from healthcare experts. Defining the boundary of patient participation is important.

Patient participation can be measured. However, there are few tools to measure patient participation in m-health services because the development of m-health in cancer nursing is in the initial stage. As oncology nurses, it is our responsibility to establish a systemic evaluation framework with subjective and objective indicators that reflect the strength and outcomes of patient participation in m-health services to advance this new technology.

Although obstacles have been encountered, m-health technology has already led an unparalleled revolution in cancer care. Encountered obstacles need to be resolved to allow oncology nurses to fully embrace the era of m-health in cancer nursing.

My best to you,

– Changrong Yuan, PhD, RN, FAAN

Editorial Board Member, Cancer Nursing

School of Nursing

Second Military Medical University

Shanghai, China

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References

1. World Health Organization. Global Observatory for eHealth Series. Volume 3. June 7, 2011. http://www.who.int/goe/publications/ehealth_series_vol3/en/. Accessed November 18, 2013.
2. National Institutes of Health. Grants and funding. http://www.nih.gov/grants-funding. Accessed March 12, 2016.
3. Northeastern Illinois University. iCanConnect: using mHealth to connect physically disabled breast cancer patients with matched disabled survivors. National Institutes of Health. Grants and funding. https://projectreporter.nih.gov/project_info_description.cfm?aid=9044490&icde=28675012&ddparam=&ddvalue=&ddsub=&cr=9&csb=default&cs=ASC. Accessed March 12, 2016.
4. RBHS-Cancer Institute of New Jersey. A novel mobile health fitness program for AYA childhood cancer survivors. National Institutes of Health. Grants and funding. https://projectreporter.nih.gov/project_info_description.cfm?aid=8995639&icde=28688978. Accessed March 12, 2016.
5. Vahdat S, Hamzehgardeshi L, Hessam S, et al. Patient involvement in health care decision making: a review. Iran Red Crescent Med J. 2014;16(1):e12454.
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