The 12 interviewed participants were 35 to 74 years old and had been treated for uterine, ovarian, cervical, or vulvar cancer of FIGO stages I, II, or III. The median age was 51.5 years. All but one patient had received surgical treatment, half had undergone additional chemotherapy, and some had received radiation therapy. Most women in the pilot study had finished their treatment less than two years prior to inclusion in the study. Some had previously been treated for cancer recurrence, with no signs of active disease. Most participants explained that they participated in the study to support further research and development in the area of cancer care. The results are divided into themes and subthemes as they emerged from the analyses (Figure 1). The four core themes illustrate how the patients could gain useful knowledge on cancer survivorship and lifestyle change while feeling reassured and well taken care of in the LETSGO pilot study, although some technical app issues arose: “Satisfied with the provided care” highlights the trust in the nurse’s expertise and perception of the app as an easily accessible information tool, “Increased their focus on physical activity” presents the expressed motivation to become more physically active, “Feeling of increased self-management” highlights the participants’ perception of gained ability to recognize worrying symptoms, and “Technical issues and limitations” describes problems encountered with the app software. The main emphasis of the participants was on experiences with nurse-led consultations.
Satisfied with the Provided Care
“You feel taken care of and safe, and that is very important.” Participant 5
When asked about their overall opinions on partly nurse-led consultations and the supplementation of eHealth technology, all participants expressed feeling safe and well taken care of. The participants appeared open-minded, with great trust in the healthcare system.
“I think I have to trust that the follow-up program the health care system recommends is up to standard. And if they say that a nurse and a physician can perform an equally good job, then I’ll have to trust that.” Participant 12
Almost all participants thought that the nurse-led consultations were appropriate and a useful alternative to traditional physician-led consultations and found it easy to initiate contact with the nurse.
“It felt very natural because we established a relationship, as I had been to the same nurse before. I think that is really nice.” Participant 10
The participants described the nurse as educated and qualified and that they could discuss physical, lifestyle, and psychological concerns with her.
“She had lots of knowledge, and I thought it was good to have someone to talk to. It is nice to know you are taken seriously.” Participant 11
Because of the nurse’s invitation to freely address concerns, some women found the nurse-led consultations too short in time to adequately discuss the many relevant survivor-related issues they had. Some of the participants reported that it was equally easy to bring up concerns with the physician, while others reported it easier to talk with nurses, as they perceived physicians as preoccupied, with limited time to talk to patients.
“You are aware of it – ‘Oh, she’s so busy!’ – but then, to be able to sit and talk with a nurse, I think that is very nice.” Participant 2
Perceived time constraints among physicians also resulted in several participants expressing relief in having the possibility of calling a nurse between visits if emerging concerns were to occur. They considered the nurse to be a screening gateway for symptoms, with the ability to spare physician resources if further examinations were considered unnecessary.
“When you know that if there is something and you can meet a nurse…then you don't have to steal time from the doctor, if you don't really need it.” Participant 2
They appreciated the fact that the app provided a contact number of whom to contact if they had questions or worries, and described it as an opportunity to relieve anxiety related to emerging concerns, as well as a pleasing feeling of being taken seriously.
No Need for Frequent Physical Examination
Most women did not feel they needed a physical examination more than once every 6 months and, thus, felt confident with the alternation between nurse- and physician-led scheduled consultations. Three believed that they did not need a nurse-led appointment at all, while most found it reassuring to talk to a nurse in between physician consultations and felt confident that the nurse would consult the physician if necessary.
“I think it is fine to have nurse consultations because if there’s something in particular that needs examination, then I assume I would be referred to a doctor.” Participant 6
One woman stated that she would like to have a physical examination as often as possible and would, therefore, have preferred exclusively physician consultations, preferably more often than the traditionally scheduled ones.
User-Friendly and Informative LETSGO Application
Half of the participants reported using the LETSGO app regularly, contrary to one woman who refrained from using the app at all. She argued that reading and hearing about her disease made her feel overly conscious of and defined by her disease, even though she felt well—which, in turn, could affect her recovery.
“You don’t get healthy, reading about illnesses, you know.” Participant 7
Most participants, irrespective of the cancer diagnosis, found the app user-friendly and easily accessible, with concise information on their cancer disease and links to recommended websites if they wanted further information.
“I read everything. I think the information was excellent – good to know that there’s a place to obtain valid information, not just Google.” Participant 4
One woman used the app as a tool to answer questions from her friends and family about her disease because she found it hard to explain the condition in her own words.
“…when the family asked, I had a good answer to provide.” Participant 11
There were different opinions on the various contents of the app. Many participants would have liked the app to contain more detailed information on their disease, but very few used nutrition advice, and no participants mentioned relaxation exercises during the interviews.
Increased their Focus on Physical Activity
All participants discussed suitable physical activities during the nurse-led consultations, and some were happy to learn that even small increases in activities could result in health benefits. Several women emphasized that the encouragement to set a weekly activity goal and logging achievements in the app motivated them to become physically more active.
“It inspired me to start working out, which I did. I would probably not have started if I hadn’t been a part of this. It would probably have taken longer. This fall, I started a Tabata workout, which involves strength and condition exercises.” Participant 1
Some participants, however, perceived the app’s physical activity module as too basic and uninspiring compared to other training apps. For example, only one weekly goal could be entered into the app, limiting the participants to mainly focus on that one activity. Furthermore, some of the younger participants would have liked their achieved activities to be displayed graphically. Additionally, one participant preferred that healthcare providers receive her submitted physical activity achievements. As a result of these limitations, some stopped using the LETSGO app for physical activity, while others started using established training apps instead. The activity tracker, in contrast, was well-appreciated by almost all participants. They reported that the tracker was motivating and encouraged them to walk or run, which helped them reach their daily step goals.
“I used the activity tracker. So, if I hadn’t walked enough steps to meet the goal I’d set, then I just went for another walk to reach my goal.” Participant 6
Some participants competed against themselves, while others competed against friends or family. Some participants said that by using the activity tracker, they not only increased their own physical activity, but consequently also motivated their surroundings to become more physically active.
“Oops, today I haven’t walked much. Maybe we should do something. Do you want to go out in the garden for a while?” Participant 4
Those who refrained from using the activity tracker stated the design of the device and its inability to register steps from bike cycling as reasons.
Feeling of increased self-management
Most women explained that they became relaxed and felt safe knowing what to look for after engaging in monthly symptom ratings in the app and participating in the nurse-led consultations. They reported that they had gained new and important insights regarding their cancer disease.
“When I finished the cancer treatment, I didn’t know that symptoms were an important way of discovering a recurrence. I thought that it would be by a CT scan and examinations at the hospital, I mean, what the doctors do. But then, I was taught to be more aware of my body.” Participant 12
Consequently, most participants found the app reassuring and reported that the regular symptom questions provided a feeling of security, mainly because they gave them an opportunity to rate their own health condition.
“To look for and notice symptoms and such – it’s been reassuring because I’m new to this. I called and asked for an appointment when I experienced some bleeding.” Participant 11
“I believe the best thing about answering the symptom questions is that I thought them through. And if I were to experience those worries, I would know who to get in touch with.” Participant 5
Another said that she had an epiphany when she answered the symptom questions:
“Aha, that could be a sign of something wrong. I didn’t know that!” Participant 9
No Perceived Need for Self-Management Interventions
Two participants reported feeling healthy and cured and, thus, disregarded the information on their diagnosis and found the symptom questions irrelevant.
“Everything is okay with me, so I don’t feel the need for an app.” Participant 8
Another participant emphasized that the nurse should have provided a clearer goal for the appointment, including both physical and psychological aspects of cancer survivorship.
“I talk a lot, so I felt that I took over and controlled what we were talking about.” Participant 9
Although everyone expressed confidence in the follow-up model, not all felt prepared to take responsibility for monitoring the potential symptoms of cancer recurrence.
“You are supposed to monitor symptoms yourself, but how can you monitor your own genitals? You may be able to see bleeding or if you gain weight, but you can’t check yourself.” Participant 8
In addition, some participants stated to prefer that health officials received the symptom scores and physical activity achievements they had submitted.
“I would have liked if what I registered in the app was seen by someone on the other end. One believes that it will be sent out, and when it isn’t, then it’s not that valuable.” Participant 3
Technical Issues and Limitations
Several software issues with the app emerged during the interviews. One was that physical activity had to be manually entered into the app before noon the following day. If the achievements were entered too late, the participant did not obtain credit for reaching her goal.
“Oh no, it’s noon and I forgot to register. Now it’s too late!” Participant 3
In addition, the number of steps counted by the activity tracker had to be manually entered into the LETSGO app. This was perceived as inconvenient, and several participants recommended automatic step registration as a useful app improvement.
“Ideally, I wish the activity tracker was connected to the app. If I wanted to really evaluate activities and get motivated and such, then I used the Garmin app as well. To see how far I had run.” Participant 10.
Some participants did not receive monthly reminders to submit answers to the recurrence-specific questions, while others experienced frozen app software or were evicted from the app during the symptom evaluation.
“You can register the activity—for example, the walk you’ve had—but when you register, it freezes. And these questions you’re supposed to answer now and then… It stops at the fourth question, and then I’m not able to continue.” Participant 2