mPalliative Care Link (mPCL): Examination of Mobile Palliative Care Coordination Among Tanzanian Cancer Patients
Improved end-of-life symptom control is a priority in Tanzania due to limited palliative care access. mPCL is a mobile solution aimed at coordinating care for community-based cancer patients through symptom monitoring. The study assesses the effectiveness of mPCL in interdisciplinary care coordination using the African Palliative Care Outcome Scale (POS).
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mPalliative Care Link (mPCL): Examination of a mobile solution to palliative care coordination among Tanzanian cancer patients African POS Background Improved end-of-life symptom control for cancer patients is a public health priority in Tanzania impacted by limited palliative care (PC) specialist access The African Palliative care Outcome Scale (POS) is a validated brief Likert- scaled assessment and used to collect patient/caregiver-reported symptoms Community-based cancer patients and their family caregivers lack an easy way to report symptoms and receive prompt symptom-responsive care Mobile health solutions hold promise Q1. Please rate your pain during the last 3 days 0 (none) - 5 (worst) Q2. Have any other symptoms (e.g. nausea, coughing or constipation) been affecting how you feel in the last 3 days? 0 (none) - 5 (overwhelming) Q3. Have you been feeling worried about your illness in the past 3 days? 0 (not at all) - 5 (overwhelming) Q4. Over the past 3 days, have you been able to share how you are feeling with your family or friends? 0 (not at all) - 5 (freely) Q5. Over the past 3 days have you felt that life was worthwhile? 0 (not at all) - 5 (all the time) Q6. Over the past 3 days, have you felt at peace? 0 (not at all) - 5 (all the time) Q7. Have you had enough help and advice for your family to plan for the future? 0 (not at all) - 5 (as much as wanted) Study Goal To assess the effectiveness of a mobile/web application, mPCL, to facilitate interdisciplinary care coordination (specialists and local health workers) aimed at community-based symptom monitoring and control among Tanzanian cancer patients
Methods Design: Field study of untreatable cancer patients randomized at discharge from a large urban Tanzanian cancer hospital to mPCL (intervention) or phone contact for POS collection Data Collection: Baseline sociodemographic, clinical and POS data POS responses collected twice-weekly and managed via mPCL versus via phone-contact with study personnel in mPCL and non-mPCL arms, respectively for up to 4 months Patient end-of-study care satisfaction assessed via phone survey Analysis: Baseline characteristics, POS score trajectories & end of study survey results analyzed by group and compared mPCL Built on cloud-based, open-source, HIPPA-compliant CommCare platform Smartphone/web accessible Interfaces for specialists, local health workers, and patients/caregivers for symptom collection and control via community-based interdisciplinary care coordination
Results Average POS item scores by group with comparisons Pain 5 mPCL (p = 0.0002) Time (p = 0.0001) mPCL * Time (p = 0.03) 4 98 patients completed study (n=49/arm) 3 mPCL Phone Contact 2 There were more women and cervical cancer patients plus higher use of discharge morphine in the mPCL vs phone-contact arm 1 0 Feels life is worthwhile Worry 5 mPCL (p = 0.0001) Time (p = 0.008) mPCL * Time (p = 0.16) 4 3 2 mPCL (p<0.0001) Time (p=0.14) mPCL*Time (p=0.27) Near-equal numbers of participants/arm died within the study period (n=27 and 29 mPCL vs phone-contact, respectively) 1 0 Feels at Peace Other Symptoms 5 mPCL (p < 0.0001) Time (p = 0.01) mPCL * Time (p = 0.03) 4 3 2 mPCL (p<0.0001) Time (p=0.14) mPCL*Time (p=0.02) 1 0 0 2 4 6 8 10 12 14 16 Week 0 2 4 6 8 10 12 14 16
Conclusions Symptom severity scores were significantly higher in the mPCL arm across the study period compared with phone-contact arm Between-group sociodemographic/clinical differences, unintended additional support provided through phone-contact coupled with a potential bias posed by phone collection of POS responses likely explain some of these findings Symptoms decreased over time in both arms, likely reflecting cumulative deaths Post-intervention assessment of quality-of-care revealed near-equal satisfaction between the two arms Limitations included small sample size and lack of true usual care group As access to phone-based palliative care is not generalizable or sustainable, a larger randomized study of mPCL to study its cost-effectiveness and impact on clinical outcomes throughout Tanzania is needed to assess the true value of this innovation *Dr Mamsau Twalib Ngoma Phone:+255685377273 email: mamsaungoma@yahoo.com Address: Ocean Road Cancer Institute P.O Box 3592 Dar es Salaam, Tanzania Mamsau Ngoma*, Beatrice Mushi, Robert Morse, Twalib Ngoma, Habiba Mahuna, Kaley Lambden, Y Xian Ho, F Lee Lucas, Joshua Mmari, Susan Miesfeldt *corresponding author Supported by the National Institutes of Health Fogarty International Center (Grant award no. R21 TW010190)
