Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer

There are a growing number of pain self-management applications (apps) available for users to download on personal smartphones. The purpose of this study was to critically appraise the content and self-management functionality of currently available pain apps. An electronic search was conducted between May and June 2014 of the official stores for the 4 major operating systems. Two authors independently identified patient-focused apps with a stated goal of pain management. Discrepancies regarding selection were resolved through discussion with a third party. Metadata from all included apps were abstracted into a standard form. The content and functionality of each app as it pertained to pain self-management was rated. A total of 279 apps met the inclusion criteria. Pain self-care skill support was the most common self-management function (77.4%). Apps also purported providing patients with the ability to engage in pain education (45.9%), self-monitoring (19%), social support (3.6%), and goal-setting (0.72%). No apps were comprehensive in terms of pain self-management, with the majority of apps including only a single self-management function (58.5%). In addition, only 8.2% of apps included a health care professional in their development, not a single app provided a theoretical rationale, and only 1 app underwent scientific evaluation. Currently available pain self-management apps for patients are simplistic, lack the involvement of health care professionals in their development, and have not been rigorously tested for effectiveness on pain-related health outcomes. There is a need to develop and test theoretically and evidence-based apps to better support patients with accessible pain care self-management.

Co-design has been suggested to improve intervention effectiveness and sustainability. However, digital health intervention co-design is inconsistently reported. This umbrella review aims to synthesize what is known about co-design of digital health interventions. We searched five databases from inception. Reviews which reported on co-design methodologies used in digital health were eligible. Information on review type, health conditions, and reported specifics of co-design were extracted and synthesized. Methodological quality was assessed using the AMSTAR2 tool. We included 21 reviews published between 2015 and 2023. Co-design participants included patients, caregivers and healthcare professionals. The frequency and breadth of participant involvement in co-design activities were reported in less than half of reviews. Participants evaluated intervention co-design as a positive process. All reviews were rated as critically low quality. This umbrella review highlights the inconsistent reporting of co-design in digital health. Here, we emphasize the importance of creating guidelines to direct co-design activities.

Objectives: Pain is a common and distressing symptom of pediatric cancer, as reported by both children and their parents. Increasingly, children with cancer are cared for as outpatients, yet little is known about how parents manage their cancer-related pain. The aim of the current study was to examine pain prevalence and characteristics, and the pharmacological, physical, and psychological pain management strategies used by parents to manage their child’s cancer pain. Materials and Methods: In total, 230 parents and caregivers (89% mothers) of children (mean age=8.93 y, SD=4.50) with cancer currently in treatment or who are survivors completed an online survey about their child’s pain in the preceding month. Results: Results indicated that children with cancer who were on active treatment and who were posttreatment experienced clinically significant levels of pain. Parents reported using more physical and psychological strategies than pharmacological strategies to manage their child’s pain. The most frequently used physical/psychological strategy was distraction and acetaminophen was the most frequently administered pain medication. Parents’ confidence in managing their child’s pain was inversely associated with both how much pain they perceived their child had, and also whether they had given any pain medication. Discussion: The results of this study suggest that despite parents’ use of pain management strategies, management of cancer-related pain continues to be a problem for children during treatment and into survivorship.

Purpose: A user-centered design approach was used to refine the mHealth Pain Squad+ real-time pain self-management app for adolescents with cancer for its usability (defined as being easy to use, easy to understand, efficient to complete, and acceptable). Method: Three iterative usability testing cycles involving adolescent observation and interview were used to achieve this objective. During each cycle, adolescents used the app while “thinking aloud” about issues encountered. Observed difficulties and errors were recorded and a semistructured interview about the experience was conducted. Using a qualitative conventional content analysis approach, themes related to app usability were identified. Results: Participants required an average of 4.3 minutes to complete the pain assessment component of Pain Squad+. Overall, the app was acceptable. Problematic issues related to software malfunction, interface design flaws, and confusing text. Software revisions were made to address each issue. Conclusion: The multifaceted usability approach used provided insight into how a real-time app can be made acceptable to adolescents with cancer and succeeded in developing a Pain Squad+ app that is fit for future effectiveness testing.