The use of an eHealth application to assess symptom burden as a basis for symptom management in hospice care, a mixed-method feasibility study

Abstract

Background: Patient reported outcomes are the gold standard to assess symptom intensity of hospice patients. The Utrecht Symptom Diary application (USD-app) is an eHealth self-assessment tool to measure symptom intensity. Research Question: Is the eHealth USD-app, which assesses hospice patients’ symptom intensity, feasible as a basis for symptom management in daily hospice care? Method: This sequential, explanatory mixed-method feasibility study was performed from February to June 2017. The study parameters were; demand of the USD-app for hospice patients, acceptability of the USD-app for hospice nurses and integration of the outcomes of the USD-app in symptom management in daily hospice care. Data were collected using 1) a self- designed questionnaire and 2) focus groups. Data analysis were performed using descriptive statistics and content analysis respectively. Results: 80/151 nurses were enrolled. On average the app was used for 332/413 patients, mostly with help from a nurse. Overall 63% of nurses were satisfied with the USD-app. The use of the app supported deploying appropriate interventions and improved insight into the course of symptoms and the patients’ well-being. Nurses specifically found the introduction of the app and the evaluation of interventions difficult. Conclusion: Overall the USD-app is feasible indicated by a demand of over 70% of hospice patients using the USD-app and high acceptability by nurses. Nevertheless some improvements were suggested since the USD-app not fully integrated in to daily care. Knowledge, competences, the nurses being aware and changing their gatekeeper attitude and support from the multiprofessional team are key for a successful adoption. Recommendations: The implementation of the USD-app should be imbedded in the implementations of symptom management. Nurses should learn the competences associated with eHealth. Using additional scales in the USD-app should be explored in future research.