Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT).

Authors

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Desiree Rachel Azizoddin

Dana-Farber Cancer Institute, Boston, MA

Desiree Rachel Azizoddin, Kris-Ann S. Anderson, Ashton Riley Baltazar, Meghan R Beck, James A. Tulsky, Robert R. Edwards, Michael Businelle, Andrea Catherine Enzinger

Organizations

Dana-Farber Cancer Institute, Boston, MA, Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, Brigham and Women's Hospital, Boston, MA

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health, National Palliative Care Research Center.

Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Tools for Management of Treatment and Adverse Effects

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 418)

DOI

10.1200/JCO.2022.40.28_suppl.418

Abstract #

418

Poster Bd #

F21

Abstract Disclosures

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