Mobile health interventions are an acceptable approach that may improve adherence outcomes in patients with cancer, similar to findings in other chronic diseases, according to a review published recently in the Clinical Journal of Oncology Nursing. To be effective, however, the interventions need to be tailored to individual patients’ specific needs and multidimensional in approach, cautioned the author of the review, Naomi Cazeau, RN, MSN, ANP-BC, AOCNP®, a nurse practitioner at Memorial Sloan Kettering Cancer Center, New York.
Mobile health interventions using smartphones have been shown to be feasible in the oncology setting, but less research has been carried out into their effect on adherence than in other healthcare specialties, Ms Cazeau noted. In order to determine whether mobile health interventions can effectively improve medication adherence among cancer patients, she carried out a review of the relevant literature published up to November 2020.
Database searches were made of PubMed®, MEDLINE®, and CINAHL® to identify primary research focused on mobile health, medication adherence, and oncology. Studies had to include a mobile technology-based medication adherence intervention and quantitative measures. The search strategy located 11 eligible studies published between 2013 and 2020, all but one of which were conducted in the United States.
The interventions fell into three general categories: automated phone calls, text message reminders, and mobile apps. Samples included a variety of cancer types, and intervention designs, features, and durations varied greatly. Only four of the studies appeared to have a large enough sample size to make statistical inferences. Measures of medication adherence differed between studies but mostly included subjective assessments such as self-report.
The interventions identified were associated with mixed results. Neither of two automated phone call interventions significantly improved medication adherence. One of the five text message reminder interventions demonstrated significant differences between the intervention and control groups, as did two of the four mobile health apps. Despite these variations in efficacy, participants rated the interventions as “satisfactory” and “helpful.”.
The mixed results may be a result of the diverse interventions and trial designs, which Ms Cazeau noted as a limitation of similar reviews. Notably, the studies had different definitions of adherence, making uniform assessment and interpretation impossible.
The interventions most associated with improved adherence, according to the review, were those that leveraged interactive components (e.g., provision of feedback, platforms for communicating directly with oncology providers, social networking opportunities, and/or educational resources). Having multiple ways to use and return to the technology may have increased participants’ use of and benefit from the intervention. Having opportunities to connect to clinicians and social networks also appeared to increase interventions’ efficacy.
The review concludes that use of mobile interventions alone may not be enough to achieve “demonstrable improvement” in adherence outcomes. The ability to social network and receive feedback on adherence is a significant component of its success, “which nurses are well-positioned to provide,” Ms Cazeau stressed. She noted that in future, new screening instruments currently under development may allow nurses to identify patients at greatest risk of nonadherence who would benefit most from mobile health interventions.