EVALUATION OF A MOBILE APPLICATION TO PREPARE AND ENGAGE CANCER PATIENTS PRIOR TO A PALLIATIVE CARE (PC) VISIT: RESULTS OF A RANDOMIZED, CONTROLLED TRIAL.Fred Friedman, Jonathan Nicolla, Debra Davis, Arif Kamal

FIGURE 2: Demographics

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

FIGURE 1: Screenshot of PCforMe Website

Despite the growth in guidelines and evidence supporting routine PC for patients with advanced cancer, up to 40% of patients referred and given an appointment never show up. This high “no show” rate stems from patients harboring misconceptions about PC (e.g. confusing with hospice care) and not knowing its value. No tool to educate patients on the value of PC and prepare them for an upcoming visit has been tested.

We conducted a randomized, controlled trial of PCforMe, a web-based mobile education and engagement tool, from December 2016 through February 2018. Patients were randomly assigned prior to a new PC clinic appointment to either PCforMe or an active control on a tablet device. The active control included three popular websites about PC developed by major specialty societies. We collected demographics and assessed system usability scores, patient preparedness (PEPPI), change in knowledge about PC, and change in no-show rate.

80 patients were enrolled. Mean age was 61.4 (range 20-88) with 56.25% with less than a Bachelors education. The mean usability score was 78.2, putting PCforMe usability in the 90th percentile of mobile health tools. Scores on the single-item “I know what questions to ask” improved significantly (p < 0.002) after using PCforMe. Similar improvements were not seen in the control arms. Scores on the knowledge survey improved more in the intervention arm (p < 0.05). No show rates for new visits during the course of the trial decreased by 35%.

Even among an elderly population with advanced cancer, a novel, mobile tool to prepare and engage cancer patients prior to a PC appointment is highly usable. The tool led to greater sense of readiness and familiarity with PC and reductions in the no-show rate to palliative care clinic. Larger, multi-site trials are needed to further test this novel tool.

Gender

Female Male

Ethnicity

Non-Hispanic Hispanic Unknown

Race

White Black or African-American Asian American Indian

Marital Status

Married Not married

Education Level

Less Than a Bachelor's Degree Bachelor's Degree or Higher

FIGURE 3: Comparative Results

3.6

3.7

3.8

3.9

4

4.1

4.2

4.3

4.4

4.5

Intervention Non-Intervention

Average Preparedness: Intervention vs. Non-Intervention

Preparedness Before Preparedness After

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Intervention Non-Intervention

Knowledge: Intervention vs. Non-Intervention

Knowledge Before Knowledge After

PCforMeSUS Results

Average 78.2

Median 77.5

Range 50-100

TABLE 1: System Usability Scale Results

The System Usability Scale is a ten-item likert scale used to assess the usability of a tool. According to usability.gov, a score above 68 is considered an above average score. According to UX Expert Jeff Sauro, the average and median scores of PCforMe correspond to the 83rd percentile for systems, which equates to a letter grade of B+.

Preparedness was assessed using a single-item likert scale where participants responded to the statement, “I feel prepared for my palliative care appointment,” before and after the intervention or control. On the scale, a response of 1 indicated they strongly disagreed with the statement, while a score of 5 indicated they strongly agreed. Below is a comparison between average scores for both groups.

Knowledge was assessed using a five-question quiz that participants completed before and after the intervention and control. Below is a comparison between average number of correct answers for both groups.

SUS Score

Letter Grade % Rank SUS

ScoreLetter Grade % Rank

90 A+ 99% 72 C+ 63%

82 A 93% 68 C 50%

80 A- 88% 63 C- 36%

78 B+ 83% 55 D 20%

75 B 73% 50 F 13%

73 B- 67% 44 F 8%Source: https://measuringu.com/ux-benchmarks/

Poster Presented at CAPC National Meeting 2018