Clinic for Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
J Altern Complement Med. 2021 Mar;27(S1):S115-S123. doi: 10.1089/acm.2020.0111.
Cancer patients often suffer from high levels of distress. Mobile health (mHealth) applications might be an innovative way to deliver mindfulness and relaxation interventions for cancer patients. However, data about the implementation of apps in health care are lacking. Adherence to mHealth interventions is an important indicator for a successful implementation and might be needed to maximize treatment effects. However, the decrease in distress might reduce the motivation of patients to engage in such self-care tools in the long run. Therefore, the aim of this analysis was to investigate the association between the course of distress over time and the adherence to a relaxation self-care app in cancer patients. We developed an app for cancer patients (CanRelax) and 83 patients who participated in the prospective observational study used the app at least once. The evaluation was guided by the RE-AIM framework, and this analysis focused on the implementation of the app. Patients were grouped into five subgroups according to their course of distress over 10 weeks (Distress Thermometer). These subgroups of patients were compared with each other to identify different user groups. About half of the patients were adherent over 10 weeks. However, a decrease in distress was associated with lower adherence to the app intervention, whereas patients with moderate distress or an increase in distress showed more adherence. Adherence to an app intervention might be also driven by patients' distress level. A decrease in distress might reduce patients' motivation to continue with a self-care intervention. The interplay between adherence and treatment outcomes should be explored in upcoming mHealth trials to get a better understanding for the implementation of such interventions. Encouraging patients to continue self-care interventions is a major challenge in integrative medicine if they are delivered digitally. The Clinical Trial Registration number: DRKS00010481.
癌症患者常常承受着高度的痛苦。移动健康（mHealth）应用程序可能是为癌症患者提供正念和放松干预的创新方式。然而，关于应用程序在医疗保健中的实施数据却很缺乏。mHealth 干预措施的依从性是成功实施的一个重要指标，可能需要最大限度地提高治疗效果。然而，随着痛苦的减轻，从长远来看，患者参与这种自我保健工具的动机可能会降低。因此，本分析的目的是调查随时间推移痛苦程度的变化与癌症患者对放松自我保健应用程序的依从性之间的关联。我们为癌症患者开发了一个应用程序（CanRelax），83 名参加前瞻性观察性研究的患者至少使用过一次该应用程序。评估是在 RE-AIM 框架的指导下进行的，本分析重点关注应用程序的实施。根据 10 周内的痛苦程度（痛苦温度计），患者被分为五个亚组。将这些患者亚组相互比较，以确定不同的用户群体。大约一半的患者在 10 周内是依从的。然而，痛苦的减轻与对应用程序干预的依从性降低有关，而中度痛苦或痛苦增加的患者则表现出更高的依从性。应用程序干预的依从性也可能受到患者痛苦程度的驱动。痛苦的减轻可能会降低患者继续进行自我保健干预的动机。在未来的 mHealth 试验中，应该探讨依从性和治疗结果之间的相互作用，以更好地理解此类干预措施的实施。如果以数字方式提供，鼓励患者继续自我保健干预是综合医学中的一个主要挑战。临床试验注册号：DRKS00010481。
