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mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer

Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based...

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Autores principales: Ngoma, Mamsau, Mushi, Beatrice, Morse, Robert S., Ngoma, Twalib, Mahuna, Habiba, Lambden, Kaley, Quinn, Erin, Sagan, Sarah B., Ho, Yun Xian, Lucas, F. Lee, Mmari, Joshua, Miesfeldt, Susan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457843/
https://www.ncbi.nlm.nih.gov/pubmed/34406856
http://dx.doi.org/10.1200/GO.21.00122
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author Ngoma, Mamsau
Mushi, Beatrice
Morse, Robert S.
Ngoma, Twalib
Mahuna, Habiba
Lambden, Kaley
Quinn, Erin
Sagan, Sarah B.
Ho, Yun Xian
Lucas, F. Lee
Mmari, Joshua
Miesfeldt, Susan
author_facet Ngoma, Mamsau
Mushi, Beatrice
Morse, Robert S.
Ngoma, Twalib
Mahuna, Habiba
Lambden, Kaley
Quinn, Erin
Sagan, Sarah B.
Ho, Yun Xian
Lucas, F. Lee
Mmari, Joshua
Miesfeldt, Susan
author_sort Ngoma, Mamsau
collection PubMed
description Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response. METHODS: Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey. RESULTS: Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women (P = .07) and higher discharge morphine use (P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types (P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group (P < .0001), and symptom severity decreased over time in both groups (P = .0001); however, between-group change in overall symptoms over time did not vary significantly (P = .34). Care satisfaction was generally high in both groups. CONCLUSION: Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed.
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spelling pubmed-84578432021-09-23 mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer Ngoma, Mamsau Mushi, Beatrice Morse, Robert S. Ngoma, Twalib Mahuna, Habiba Lambden, Kaley Quinn, Erin Sagan, Sarah B. Ho, Yun Xian Lucas, F. Lee Mmari, Joshua Miesfeldt, Susan JCO Glob Oncol ORIGINAL REPORTS Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response. METHODS: Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey. RESULTS: Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women (P = .07) and higher discharge morphine use (P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types (P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group (P < .0001), and symptom severity decreased over time in both groups (P = .0001); however, between-group change in overall symptoms over time did not vary significantly (P = .34). Care satisfaction was generally high in both groups. CONCLUSION: Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed. Wolters Kluwer Health 2021-08-18 /pmc/articles/PMC8457843/ /pubmed/34406856 http://dx.doi.org/10.1200/GO.21.00122 Text en © 2021 by American Society of Clinical Oncology https://creativecommons.org/licenses/by/4.0/Licensed under the Creative Commons Attribution 4.0 License: http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/)
spellingShingle ORIGINAL REPORTS
Ngoma, Mamsau
Mushi, Beatrice
Morse, Robert S.
Ngoma, Twalib
Mahuna, Habiba
Lambden, Kaley
Quinn, Erin
Sagan, Sarah B.
Ho, Yun Xian
Lucas, F. Lee
Mmari, Joshua
Miesfeldt, Susan
mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
title mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
title_full mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
title_fullStr mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
title_full_unstemmed mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
title_short mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
title_sort mpalliative care link: examination of a mobile solution to palliative care coordination among tanzanian patients with cancer
topic ORIGINAL REPORTS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457843/
https://www.ncbi.nlm.nih.gov/pubmed/34406856
http://dx.doi.org/10.1200/GO.21.00122
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