Development of a supportive care needs eHealth application for patients with cervical cancer undergoing surgery: a feasibility study

doi:10.21203/rs.3.rs-2320222/v1

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Research Article

Development of a supportive care needs eHealth application for patients with cervical cancer undergoing surgery: a feasibility study

https://doi.org/10.21203/rs.3.rs-2320222/v1

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Purpose

To inform the development of an eHealth application for patients with cervical cancer for monitoring supportive care needs, perceived care supply and quality of life.

Methods

A mixed-method design was conducted. The 19-month process involved: (a) a literature review to screen the components of applications, (b) a cross-sectional needs assessment for patients with cervical cancer to define the needs and application program draft, (c) expert consultation to refine the draft, (d) software development, and (e) a pilot testing and users experience description. Patients in the intervention group received a 7-day application intervention combined with usual care. Supportive care needs, perceived care supply, quality of life and user experience were collected.

Results

Literature review results conducted the importance of fully preparation before application development, especially the supportive care needs assessment. Subsequent supportive care needs investigation revealed the most urgent needs were informational needs and privacy protection. 43 expert suggestions for application improvement were refined. The new application contained the patient and the healthcare professional portal. At day 7, the pretest/posttest changes significant between-group differences in increasing perceived care supply and quality of life, with the intervention group exhibiting larger tendency on needs and supply than the control. Users had positive experience with the application.

Conclusions

This study provides feasibility of the application targeting access to supportive care, which may be effective for relieving patients’ needs and improving perceived supply and quality of life.

cervical cancer

supportive care needs

supply

application

eHealth

feasibility study

Cervical cancer is one of the most common malignant tumors that threatens women’s health worldwide. Surgery remains one of the main treatment methods [1]. Patients with cervical cancer had to face the specific adverse effects of cancer and surgical treatment that are not found in other cancers, which might lead to a negative impact on supportive care needs [2]. Additionally, supportive care needs for patients with cervical cancer varied depending on different treatment stages [3], such as information about cancer diagnosis stage, specific confront postoperative dysuria after surgery and sexual dysfunction needs during survivorship [4].

Healthcare professionals had the responsibility to promote matching between patients’ supportive care needs and supportive care services for their medical specialty [5]. While due to the lack of awareness of actively utilization of supportive care services for patients and insufficient needs identification for healthcare professionals, various unmet supportive care needs for patients exhibited [6]. Study had showed that 88% long-term cancer survivors (N = 2,107) preferred oncologists involved in cancer follow-up care, but only 60% reported an oncologist visit after treatment [7]. Kuroki et al’s needs investigation among women with abnormal cervical cancer screening also found that 59% (N = 100) women had one or more unmet basic needs which urgently required professional needs management guidance from healthcare professionals [8]. An awareness of the above problems might facilitate early identification of women’s unmet needs and enable individualized follow-up care adjusted for these needs [7].

Interventions aimed at monitoring supportive care needs should be available. Yet, how to help women undergoing cervical cancer treatment manage the supportive care needs throughout hospital and home was less explored [4]. Evidence for supportive care needs management strategies provided for women mainly focused more on stage of cervical cancer screening, cancer prevention systems [9], informal social support system and follow-up monitoring for postoperative patients with early-stage [10], and symptom management during oncological treatment [11]. Tailoring of interventions to cancer patients’ needs was argued to be a prerequisite for their successful rehabilitation [12]. Virtually, the needs management intervention approaches mainly focused on face-to-face counseling, telephone follow-up, web-based intervention, or the combination of the three and were typically offered by healthcare professionals [6, 13]. Such approaches, although promising, had encountered problems of effectively mobilizing the motivation of individual self-management and hard to act as a navigation instrument to personalized supportive care [14].

In recent years, mobile applications have been gradually applied to manage supportive care needs in patients with cancer due to their accessible, real-time and social-distancing support advantages. The China mobile consumer survey report released by Deloitte Consulting found that mobile phone ownership in China was as high as 96%, exceeding the global average of 6% in 2018 [15]. In addition, the frequency of mobile phone use was high, over 90% of users used it every day [15]. Even one in five mobile phone users had already downloaded at least one health-related application [16]. The effects of mobile health promotion intervention had been skyrocketing with demonstrated efficacy and considered as a solution to meet patients’ supportive care needs [14]. For example, the application “Oncokompas”, designed to provide personalized information through physical and psychological assessment of patients with cancer, had demonstrated the effects of continuously improving quality of life [17]. The rapid penetration and demonstrated efficacy of mobile phones suggested the feasibility of using mobile technologies to manage supportive care needs among patients with cancer. However, the effect of supportive care needs management using mobile phone programs for patients with cervical cancer undergoing surgery warrants further study. This study aims to develop a mobile application and inform the targeting management of supportive care needs for patients with cervical cancer undergoing surgery, thus improving personalized access to supportive care.

The study was carried out between 15 September 2019 and 20 March 2022, and a part of series of supportive cancer care study. A five-phase method was conducted to develop the application. The CONSORT diagram of the study shows in Fig. 1.

Figure 1here

Phase 1: Application Program Components Screening

We conducted a literature review concerning the development and usability evaluation approaches for mobile applications in supportive care interventions in patients with cancer. The eligible criteria of the original studies show in supplementary information 1. Methodological quality evaluation of the included articles was conducted using the critical appraisal checklist for randomized controlled trails designed by Joanna Briggs Institute. Information about the mobile application program details, intervention components, and outcome measures was extracted and summarized.

Phase 2: New Application Program Draft Forming (Dup: Abstract ?)

Patients supportive care needs were assessed by common and specific needs assessment scales. The common scale was a 49-item professional nursing support scale (PNSS), using to test the common supportive care needs and perceived support supply for patients with cancer from nurses [18]. It contained four domains, named informational needs, technical needs, psychological/ emotional needs and care coordination and communication needs. The specific scale was a 25-item specific professional nursing support scale- gynecological cancer (PNSS-GC), using to evaluate the specific professional supportive care needs and supply for patients with gynecological cancer. The two scales were rated for “needs” and “supply” part, which provided responses on a five-point Likert scale (ranging from 1 = no need/supply to 5 = always need/supply). The higher scores indicating more supportive care needs and more perceived supply. Cervical cancer inpatients’ eligible criteria show in supplementary information 1.

Phase 3: Application Program Draft Refining (Dup: Abstract ?)

Delphi expert consultation focused on issues regarding whether the structure and content of the application program was readable and suitable for the target population. The inclusion criteria for experts were majored in medicine, nursing and engaged in gynecology and obstetrics, had over five years of work experience in oncology or gynecology and obstetrics, and had a bachelor’s or higher degree. As for determining the expert sample size of a Delphi panel, generally a panel of 10 was required [19]. The suggestions on the structure, content and implementation of the draft were collected. The feedback of the expert consultation enriched the prototype of the application.

Phase 4: Application Preinstallation

We would complete the human-computer interaction, application data manipulation logic and interface to match the prototype mobile application supporting from the software engineer. Then, we would test loopholes and disadvantages of the iterative testing system of the mobile application. Five brands (Oppo, Huawei, Xiaomi, Vivo and Samsung) of Android mobile systems were selected and preinstalled. The phenomena of whether system ran slowly and flashed back when the system had too much cache was monitored to judge the compatibility and stability of the application. Measures of guiding user to clean the cache, close possible conflicting applications, or restart the application was taken to minimize the unstable phenomena. Frequency of flashbacks were collected and the flashbacks less than three times per day per user were allowed.

Phase 5: Pilot Testing & User Experience Collection (Dup: Abstract ?)

This phase was a quasi-experimental design. Inpatient were recruited from gynecological oncology department in an affiliated hospital of a medical university. Participants in two groups would complete PNSS, PNSS-GC and quality of life (Qol) scale (Functional Assessment of Cancer Therapy- Cervix subscale, FACT-Cx) at baseline and a week after. The FACT-Cx was the Functional Assessment of Cancer Therapy-general scale (27 items) plus the Cervix subscale (15 additional items) [20]. A five-point scale from 0 to 4 was applied to the FACT-Cx, where 0 was “not at all”, 4 was “very much”. The range of possible scores was 0 to 168. Patients were asked to score how they felt today and during the previous 7 days, with a higher score indicating better Qol.

Participants were grouped according to the order of admission. Within the control group (CG) there would be no additional intervention, care would continue as normal received from health care professionals (see Fig. 2). There were no restrictions related to accessing the Internet or participating in other self-help activities. Participant in the CG would also install the application after the pilot study. Participant allocated to the intervention group (IG) were given access to the mobile-based 7-day application on the day of admission. In the IG, we recruited users included both patients with cervical cancer and healthcare professionals by using purposive sampling method. The eligible criteria of participants also shows in supplementary information 1. Healthcare professionals were nurses and physicians who would provide supportive care for patients during these 7 days by using the web-based portal through the interaction module. The web-based portal would record each user’s login information. The page views for the portal and records of platform interactions were captured.

Information of the mobile-portal was presented in modules using texts or videos based on the above application development process. In addition, a push notification reminded participant to participate in modules and the date of next follow-up. Upon login the WG, a participant was guided to complete a baseline quick needs assessment (both “needs” and “supply” part) and Qol evaluation. The web-based portal then would fetch the warning values and push supportive notification according to the results. We had used the four quadrants degree division method and critical value of needs and supply to set a warning value [21]: the higher needs and the lower supply would be set as evidence for the interactive platform and pushing notification (see Fig. 3). The using experience of patients and healthcare professionals was collected after intervention.

Figure 2 & 3 here

Data analysis

Quantitative data like the scores of needs, were entered and analyzed using IBM software, SPSS version 24.0. Categorized variables, such as gender, were presented as percentage and frequency. Data were examined to evaluate normal distribution. Continuous variables were presented as the mean and standard deviation (SD) or as the median and interquartile range (IQR). A paired or independent student t test or Mann-Whitney U non-parametric test was completed to determine inter- or between-group differences on variables of scores of needs, supply and Qol. All analyses of significance were two-sided, and p < 0.05 was regarded as statistically significant. The using experience was analyzed by content analysis to identify the major themes and key exemplary quotes.

Phase 1: Application Program Components Screening

As for needs management on treatment-stage patients with cervical cancer had been poorly studied. In this phase, we systematically reviewed the development methods of mobile phone-based application for patients with no restrictions on cancer types, so that to screen the application components of needs management suited for cervical cancer. Totally 13 articles with 16 applications were included. Information about cancer type, primary outcomes, name of the application, application module, application developing method, and usability evaluation method was extracted. The PRISMA flow diagram and an overview of the application construction shows in supplementary information 2 and 3. Unfortunately, there was no such application acting as a navigation instrument to personalized supportive care needs and supply for cervical cancer patients undergoing surgery.

Phase 2: New Application Program Draft Forming

In total, 111 patients with cervical cancer undergoing surgery were recruited for needs assessment by using the “needs” part of the PNSS and PNSS-GC to define the common and specific supportive care needs. These participants aged from 23 to 67 years (mean: 47.94; SD: 8.10). Among them, 99 out of a total of 111 patients (89.2%) were married, 94 of them (84.7%) obtained a high school degree or below, and 54 of them (48.6%) were from the countryside. Informational needs was the highest common needs (mean: 3.80; SD: 0.91), see supplementary information 4. The top three specific needs were ranked as follows, “protecting my privacy” (81.1%), “telling me the correct way to clean my perineum in daily life” (75.7%) and “reducing the possible discomfort caused by gynecological examination” (71.2%). The information needs, skills guidance about specific symptom management, and dignity maintaining were urgent to manage. These results provided evidence to help further push targeted support measures relation to patients’ perceived needs, so that to enrich the content of the program draft.

On the basis of phase 1 and 2, we formed a 4 first-level, 17 second-level and 47 third-level application indexes program draft. The first-level indexes were also the source catalog of the application, which contained four different time intervals, namely the hospital admission stage, presurgery stage, post-surgery (hospitalization) stage and post-surgery (home interval) stage. The second- and third-level indexes corresponded to the sub-catalog related to supportive care measures under the source catalog. The detailed information of each module of the prototype application (version 1.0) displays in Table 1.

Table 1

Detail functions of modules of the mobile phone portal and web-based portal.
Portal	Major modules	Function	Remarks
Mobile-based	Quick Assessment	· Assessing the supportive care needs,psychological health at two intervals. . Forming a warning value if existed.	· Respectively on the day of admission, 7 days after admission. · Measured by the needs and supply part of PNSS, PNSS-GC, and FACT-Cx. · According to the assessment results, tracking warning value record to provide evidence for customized support.
Mobile-based	Professional Support	· Pushing individual information or services about professional supportive care according to the Quick Assessment and warning value reminders.	· Focus on professional supportive care about informational, technical, psychological/ emotional and care coordination and communication and specific supportive care needs range from hospital admission to post-surgery. · Pop-up messages with quick links of the professional support would display if warning value existed.
Mobile-based	Interactive Platform	· Pushing specific suggestions and providing a real-time online consultation according to the Quick Assessment and warning value reminders. · Message board and interactive feedback.	· Mainly focus on supportive care needs during home rehabilitation period. · Information records of the interactive platform.
Mobile-based	Personal Information	· Application login. · Providing basis on information fetch for the backstage.	· Basic login information. · Results of the Quick Assessment. · Notes of the use time, frequency, and support provision.
Mobile-based	Reminders	· Waring value of reminder, the fill-out surveys and messages alert (such as date of the follow-up).	· Pop-up messages launched. · Pushing notification.
Web-based	User Permission Setting	· Healthcare professional and researcher login port.	· Basic login information.
Web-based	Module Management	· Providing consultation feedback and managing the warning value by healthcare professional.	· Manage the mobile phone administration portal. · Sending message alert. · Waring value management.
Web-based	Data Statistics	· Primary data of the application influx linked with mobile phone portal.	· Users’ basic login information. · Application time use, frequency and interactive records. · Results of the needs, supply and quality of life.

Table 1 here

Phase 3: Application Program Draft Refining

Expert reviews were described to validate the requirements of the program draft (version 1.0). The draft was sent to ten experts by e-mail. The experts ranged in age from 30 to 57 years (mean: 42.80; SD: 9.97) and had 8 to 28 years of work experience (mean: 15.60; SD: 9.20). Six experts were engaged in gynecological supportive care provision, while the other four were concentrated on researches about cancer nursing or women’s psychological behaviors. Experts were instructed to read the draft in detail and needed to write suggestions as tracked changes in the text of the draft. The comments were returned to the first author via e-mail. Total 43 suggestions were subsequently implemented to improve the application interface. The suggestions mainly focused on the index construction, language expression, content and structure of the application (see supplementary information 5). According to the suggestions, we revised and formed 4 first-level, 21 second-level and 42 third-level indexes of the mobile application prototype (version 2.0) (the first and second indexes shows in supplementary information 6).

Phase 4: Application Preinstallation

The prototype application (version 2.0) used Linux of the Android system as the core of the mobile phone console. After completing data interaction between the mobile-based portal and web-based healthcare professional portal, the mobile-based portal for patients would acquire data from the server or save operating data roots from the user interaction to the server. The web-based portal adopted the web application open source Spring plus springMVC plus Hibernate as the framework. Then the mobile system was layered through springMVC. The management of the web-based portal was displayed through browser access to realize the intuitive display of the system. The mobile application named Womb Guard (WG) refers to the health assistant of the female womb. After testing the compatibility and stability in five different mobile phone systems, there was no frequency of flashbacks. Part of the interface of WG shows in Fig. 4.

Figure 4 here

Phase 5: Pilot Testing & User Experience Collection

Total 14 patients with cervical cancer who were undergoing surgery (both IG and CG was seven, paired with age) and four healthcare professionals (a software development engineer, two gynecological nurses and a gynecological doctor) were invited to participate the pilot testing. Patients in the IG and healthcare professionals were asked to download and install the application on the day of patients’ admission. The detailed testing procedure shows in Fig. 5. The mean age of patients was 48.21 years (SD: 7.19) and the average using time of mobile phone was 3.16 (SD: 1.58). About 71.43% patients were from urban area and obtained a middle school degree or high, 78.57% had no religious belief and 92.86% had married. The characteristics of patients in each group shows in supplementary information 7. The healthcare professionals aged from 28 to 36, and had 3 to 13 years of working experience. A total of 294 page views for portal of patients and 10 platform interactions were captured, and 91 person-time viewed the interactive results on the platform.

Figure 5 here

Table 2 presents the outcome measures at baseline and over time by group. There were no group differences at baseline. The perceived supportive care supply part of both groups increased by a week, as measured by their perceived care coordination and communication needs scores (IG: 2.72 vs. 4.22; CG: 2.60 vs. 3.34), Qol (physical well-being subscale [IG: 22.00 vs. 27.43; CG: 18.14 vs. 26.57] and cervix subscale [IG: 28.43 vs. 35.29; CG: 30.71 vs. 27.86]). The IG had a better Qol than the CG did after a week (p < 0.05), including the total score (IG: 76.12 vs. 93.25), emotional well-being (IG: 13.43 vs. 16.15]) and cervix subscale (IG: 28.43 vs. 35.29). There existed a tendency of supportive care needs and perceived supply between two groups, and there was an upward trend of the supply in the IG (see Fig. 6). Unfortunately, although we had set the warning value to help provide personalized supportive notification, there was no warning value appeared in our pilot study. Overall, the feedback on using experience showed that the users had positive evaluation with the application, which was designed to be user-friendly, and provided support to post surgery recovery. The suggestions raised among users voiced their expectation about extending the functions of the application and prolonging the usage (see supplementary information 8).

Table 2

Outcome measures at baseline and over time by group.
Variables	Intervention group mean(SD)		Control group mean(SD)		p value (at baseline)	p value (IG: between-group comparison)	p value (CG: between-group comparison)	p value (inter-group comparison)
Variables	Baseline	A week	Baseline	A week	p value (at baseline)	p value (IG: between-group comparison)	p value (CG: between-group comparison)	p value (inter-group comparison)
Total score of the PNSS- Needs part	3.30(0.84)	3.88(0.79)	3.08(0.73)	4.07(0.60)	0.61	0.37	0.01	0.62
Informational needs	3.85(0.62)	4.31(0.69)	3.56(0.76)	4.30(0.58)	0.46	0.24	0.01	0.97
Technical needs	3.34(1.13)	3.82(0.88)	2.95(0.88)	4.10(0.68)	0.49	0.49	0.01	0.51
Psychological/ emotional needs	3.09(1.02)	3.93(0.96)	3.09(0.86)	3.79(0.73)	0.99	0.21	0.02	0.76
Care coordination and communication needs	3.07(1.04)	3.48(1.09)	2.89(0.86)	4.11(0.82)	0.72	0.51	0.02	0.25
Total score of the PNSS-GC- Needs part	4.11(0.47)	3.99(0.59)	3.51(0.81)	3.79(0.78)	0.12	0.12	0.01*	0.60
Total score of the PNSS- Supply part	2.72(1.00)	4.22(0.46)	2.60(0.50)	3.34(1.07)	0.79	< 0.001**	0.01*	0.06
Informational needs	2.94(1.02)	4.59(0.25)	3.27(0.66)	3.82(0.92)	0.48	< 0.001**	< 0.001**	0.05
Technical needs	2.71(1.16)	4.36(0.32)	2.53(0.34)	3.47(1.09)	0.69	< 0.001**	< 0.001**	0.06
Psychological/ emotional needs	2.41(1.39)	3.90(0.55)	2.12(1.07)	3.23(1.35)	0.67	< 0.001**	0.01*	0.25
Care coordination and communication needs	2.55(1.30)	4.07(0.46)	2.51(0.28)	2.88(1.16)	0.94	< 0.001**	0.19	0.03*
Total score of the PNSS-GC- Supply part	2.94(1.21)	3.96(0.68)	2.79(0.79)	3.94(0.84)	0.79	< 0.001**	0.19	0.97
Total score of the FACT-Cx	76.12(5.85)	93.25(6.33)	76.05(5.79)	86.89(14.16)	0.98	< 0.001**	0.06	0.30
Physical well-being	22.00(5.80)	27.43(0.16)	18.14(7.03)	26.57(0.98)	0.29	0.05	0.02*	0.04*
Functional well-being	14.00(6.43)	18.71(3.15)	20.29(5.56)	22.00(2.71)	0.07	0.12	0.58	0.06
Social/family well-being	17.57(6.45)	19.29(2.56)	13.71(5.09)	14.14(6.26)	0.24	0.45	0.92	0.07
Emotional well-being	13.43(3.26)	16.15(3.13)	12.71(3.99)	19.00(6.61)	0.72	0.02*	0.06	0.32
Cervix subscale	28.43(4.12)	35.29(2.21)	30.71(3.90)	27.86(8.55)	0.31	< 0.001**	0.42	0.04*
Note: IG: intervention group, CG: control group. SD: standard deviation. PNSS: professional nursing support scale, PNSS-GC: professional nursing support scale- gynecological cancer, FACT-Cx: functional assessment of cancer therapy- cervix subscale. * p < 0.05, ** p < 0.001.

Table 2 and Fig. 6 here

The study documented the process and feasibility test of a mobile application conducted using multiple methods focused on patients’ professional supportive care needs. Before a standard randomized confirmatory trial (RCT) was undertaken, components in the intervention also needed to be identified [22]. This kind of component identification process could compensate for the defects of traditional intervention development approaches, which involved the cycle of constructing an intervention (by evaluating in a standard RCT and performing post-hoc analyses to explain how and why it worked) and then constructing a second intervention revision (by evaluating in a new RCT) [22]. Collins et al’s review of the shortcomings of the traditional approach to intervention development recognized that the cycle of the development process might lead to the delayed effect of the intervention, and an alternative approach of building, optimizing and evaluating eHealth interventions was needed [23].

For the purpose of identifying the intervention components, we used a multiple phases design and presented the co-creation process of an application for patients with cervical cancer and healthcare professionals. We developed not only a mobile application for patients but also a web-based portal for healthcare professionals. The close cooperation with patients and healthcare professionals provided valuable insight into critical requirements for both the development and implementation of applications [24].

It was noticed that the feasibility process of the application had the following advantages. On the aspect of the application content, it specifically focused on supportive care needs for patients with cervical cancer undergoing surgery. As to the platform management and function settings, the application was designed to give the consideration of realizing the online communication or interaction between healthcare professionals and patients. The alert function and warning value setting were the main innovations of the application, which were expected to help dynamically monitor supportive care needs and provide supportive care supply. Despite of the confirmed effectiveness of previous eHealth applications, most of them were centered on the stage of cervical cancer screening [25]. On the phase of pilot testing, although we had only undertaken a quasi-experimental design instead of a standard RCT, the short-term effects of the Qol and upward trend of supportive care supply were already being seen. We anticipated various advantages from using an eHealth application, including increased supportive care supply and higher Qol in our further RCT.

Limitations

There were some limitations with this study. In phase 1, only Chinese and English articles were included. This may introduce language bias, as articles written in other languages with relevant outcomes might be missed. In phase 2, as for the cross-sectional design we just investigated the needs in a natural state and did not interfered. In phase 3, only experts in gynecology and gynecological cancer research were invited. There might be lack of authority in obstetrics although we have collected related recommendations about fertility. And in the phase of pilot study, the health outcomes required continuous observation since we just collected the data for only a week. With some regret, we had not tracked a warning value during the pilot study, the limited sample and short interval time might be our explanation. Further we would observe the long-term effect through increasing the intervention intervals. Although there was a pity that we had not used any well-known questionnaire, the exploring of the user experience might more closer to the real thought of users during the application using. In addition, our program is only suitable for patients who have an Android mobile phone system presently. Future we will continue to expand the application development of different mobile systems.

The WG was specifically developed for managing supportive care needs of patients with cervical cancer undergoing surgery. It contained a mobile portal and a web-based portal. The application was expected to allow users to identify supportive care needs in the perioperative period, set and track goals for supportive care, and receive professional and evidence-informed healthcare tips. The feasibility study had confirmed the short-term effects of the Qol and upward trend of supportive care supply. The long-term effects for increasing supportive care supply, improving supportive care needs and Qol were expected in our further RCT (Trial registration: Chinese Clinical Trails Registry number ChiCTR 2000033316).

Ethics approval

All procedures in this study involving human participants were performed in accordance with the ethical standards of the institutional research committee (approved by the Ethics Committee of Anhui Medical University [approval number 20170190]) and the World Medical Association Declaration of Helsinki. The research participants were informed of the overall aims of the study and their right to discontinue participation at any time. In addition, the participants provided verbal and written informed consent before the start of their participation. Participants were assured that all information would be kept confidential. The access of information and data copy would be limited only to the researchers of the study. The healthcare professionals would be compensated through monetary payment for their time devoted in setting up the application and in the online interaction. They could have a flexible schedule for online interaction at their convenient time. The manuscript has not been published and is not under consideration for publication elsewhere.

Competing interests: All the authors declare that there is no known relationship that may pose any conflicts of interest.

Funding: This study was funded by the National Natural Science Foundation of China [grant number 82272926, 81573017]; the University Natural Science Research Project of Anhui Province [Grant number KJ2020A0194]; and the Quality Engineering Project of Higher Education Institutions of Anhui Province [Grant number 2020szsfkc0496].

Author contributions

SY, XL, JX and HJ are contributed to the design and manuscript writing of this study, critically reviewed the manuscript and supervised the overall study process. WW and GX are contributed to the data collection and data analysis. Approved the version to be published. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content. The statistics were checked prior to submission by an expert statistician (HJ).

ACKNOWLEDGEMENTS

We appreciate technical support from engineer Lin Chen and software development team from Jiangsu Xinzhou Medical Software Technology Co. LTD and thank all participants in

this study.

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No competing interests reported.

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Development of a supportive care needs eHealth application for patients with cervical cancer undergoing surgery: a feasibility study

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Abstract

Purpose

Methods

Results

Conclusions

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Introduction

Methods

Phase 1: Application Program Components Screening

Phase 2: New Application Program Draft Forming (Dup: Abstract ?)

Phase 3: Application Program Draft Refining (Dup: Abstract ?)

Phase 4: Application Preinstallation

Phase 5: Pilot Testing & User Experience Collection (Dup: Abstract ?)

Data analysis

Results

Phase 1: Application Program Components Screening

Phase 2: New Application Program Draft Forming

Phase 3: Application Program Draft Refining

Phase 5: Pilot Testing & User Experience Collection

Discussion

Limitations

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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