Birnie Kathryn A, Campbell Fiona, Nguyen Cynthia, Lalloo Chitra, Tsimicalis Argerie, Matava Clyde, Cafazzo Joseph, Stinson Jennifer
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
JMIR Form Res. 2019 Apr 22;3(2):e12028. doi: 10.2196/12028.
Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management.
This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app.
Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain.
Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education).
The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care.
儿童术后中重度疼痛很常见。儿科日间手术的增加已将术后疼痛管理主要转移到家庭环境中。移动健康技术有可能通过改善自我管理资源的获取来克服疼痛护理的障碍。然而，疼痛应用程序通常缺乏科学证据，并且由于终端用户未参与其开发而未得到充分利用。因此，一个基于证据的、纳入儿童和青少年（终端用户）需求和观点的疼痛自我管理智能手机应用程序有潜力改善术后疼痛管理。
本文旨在描述以用户为中心的设计原则如何应用于iCanCope PostOp的开发，这是一款用于儿童和青少年术后的基于智能手机的疼痛自我管理应用程序。具体而言，它展示了iCanCope PostOp应用程序以用户为中心的设计过程的2个完整阶段（概念生成和构思）。
第1阶段是从19名接受过各种日间手术的儿童和青少年、19名家长以及32名多学科医疗保健提供者的角度进行的多地点需求评估。儿童、青少年和家长完成了个人半结构化访谈，医疗保健提供者参加了焦点小组。使用定性内容分析对数据进行总结。第2阶段通过德尔菲调查和为期2天的面对面设计研讨会，与11名多学科儿科术后疼痛专家和2名有术后疼痛亲身经历的人，为该应用程序开发了一种疼痛护理算法。
第1阶段确定了术后疼痛管理和恢复的自我管理挑战；可用资源有限以及依赖药物作为主要的术后疼痛管理策略；以及儿童和青少年、家长和医疗保健提供者对术后疼痛护理的共同责任。跟踪疼痛、疼痛自我管理策略和目标设定等关键应用功能被确定为优先事项。第2阶段成功且高效地为iCanCope PostOp应用程序生成了一个完整的初步疼痛护理算法，包括用于可行评估和重新评估疼痛及功能（休息或睡眠、运动或玩耍、情绪或担忧）的临床相关输入，以及将推送给终端用户的疼痛管理建议目录（心理、身体、药理和教育方面）。
iCanCope PostOp应用程序成功完成了以用户为中心的设计方法的概念构思和生成阶段。接下来的步骤将包括最终确定设计、应用程序开发（iOS或安卓）、通过随机对照试验进行评估，以及随后在临床护理中实施iCanCope PostOp应用程序。
