Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives.

BACKGROUND: Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. OBJECTIVE: We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. METHODS: We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. RESULTS: Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. CONCLUSIONS: Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed.

A mobile health application for patients eligible for statin therapy: app development and qualitative feedback on design and usability.

BACKGROUND: Cardiovascular disease is the leading cause of death in the United States (US). Despite the well-recognized efficacy of statins, statin discontinuation rates remain high. Statin intolerance is a major cause of statin discontinuation. To accurately diagnose statin intolerance, healthcare professionals must distinguish between statin-associated and non-statin-associated muscle symptoms, because many muscle symptoms can be unrelated to statin therapy. Patients' feedback on muscle-related symptoms would help providers make decisions about statin treatment. Given the potential benefits and feasibility of existing apps for cardiovascular disease (CVD) management and the unmet need for an app specifically addressing statin intolerance management, the objectives of the study were 1) to describe the developmental process of a novel app designed for patients who are eligible for statin therapy to lower the risk of CVD; 2) to explore healthcare providers' feedback of the app; and 3) to explore patients' app usage experience. METHODS: The app was developed by an interdisciplinary team. Healthcare provider participants and patient participants were recruited in the study. Providers were interviewed to provide their feedback about the app based on screenshots of the app. Patients were interviewed after a 30 days of app usage. RESULTS: The basic features of the app included symptom logging, vitals tracking, patient education, and push notifications. Overall, both parties provided positive feedback about the app. Areas to be improved mentioned by both parties included: the pain question asked in symptom tracking and the patient education section. Both parties agreed that it was essential to add the trend report of the logged symptoms. CONCLUSIONS: The results indicated that providers were willing to use patient-reported data for disease management and perceived that the app had the potential to facilitate doctor-patient communication. Results also indicated that user engagement is the key to the success of app efficacy. To promote app engagement, app features should be tailored to individual patient's needs and goals. In the future, after it is upgraded, we plan to test the app usability and feasibility among a more diverse sample.

Understanding Information Processing and Protective Behaviors during the Pandemic: A Three-Wave Longitudinal Study.

BACKGROUND: Few existing studies have examined information processing as an independent variable to predict subsequent information behaviors in a pandemic context, and the mechanism of subsequent information behavior processing following the initial or prior information behavior is unclear. OBJECTIVE: Our study aims to apply the risk information seeking and processing model to explain the mechanism of subsequent systematic information processing in the context of the COVID-19 pandemic. METHODS: A three-wave longitudinal online national survey was administered during the period of July 2020 to September 2020. Path analysis was conducted to test the relationships between prior and subsequent systematic information processing and protective behaviors. RESULTS: One important finding was the key role of prior systematic information processing, as indirect hazard experience was found to be a direct predictor of risk perception (ß = 0.15, p = 0.004) and an indirect predictor of protective behaviors. Another important finding was the central role of information insufficiency as a mediator/driving force in subsequent systematic information processing and protective behavior. CONCLUSIONS: The study has made important contributions in that it extends the scholarship on health information behaviors by (a) highlighting that relevant hazard experience in risk information seeking and processing model should be expanded to include indirect experience, and (b) providing the mechanism of subsequent systematic information processing following prior information processing. Our study also provides practical implications on health/risk communication and protective behaviors' promotion in the pandemic context.

Analysis of the Influencing Factors of Seeking Intention on COVID-19 Risk Information: A Cross-Sectional Study.

Background: Information seeking, as an important part of the prevention and control of infectious diseases, can lead to positive outcomes by reducing uncertainty and alleviating panic. However, most previous studies have limited their analysis to individual-level psychosocial factors, and little is known about how social-level factors influence individuals' information-seeking intentions. Methods: The cross-sectional survey was conducted from July 30, 2020 to August 15, 2020 in China. We used a convenience sampling strategy to recruit participants from among the Internet users. The structural equation model was used to identify the incentives associated with coronavirus disease 2019 (COVID-19) risk information-seeking intention. Results: In this study, the responses of 871 Internet users who reflected a response rate of 85% were analyzed. Information-seeking intention was found to be directed by informational subjective norms (ISNs), perceived information need, risk knowledge, the sense of community (SOC), and negative affective responses, and ISNs were found to be the strongest driving factor. Individuals with a stronger SOC, which was associated with greater pressure and expectations, show negative affective responses. COVID-19 risk knowledge can affect the information-seeking intention of Internet users not only directly but also indirectly through their perceived information need. In addition, more risk knowledge was associated with a lower perceived risk likelihood. Conclusion: When formulating risk communication strategies, governments and health institutions should take targeted measures to improve the public's SOC and knowledge. This will provide an opportunity to explore the role of individual cognition and environmental risk information in public health.

Health Disparities in Online COVID-19 Information Seeking and Protective Behaviors: A Two-Wave Longitudinal Study.

The COVID-19 outbreak was declared a pandemic by the World Health Organization and claimed hundreds of thousands of lives in the U.S. However, the adoption of protective behaviors in response to COVID-19 varies among sociodemographic groups. To better understand the disparities in U.S. adults' adoption of protective behaviors in relation to sociodemographic factors, we conducted a two-wave panel survey in the U.S. Although sociodemographic factors were not found to be significant predictors in lagged regression analysis, results from a cross-sectional analysis showed that the White, younger, and higher educated individuals were more likely to take protective behaviors. Furthermore, based on the structural equation modeling, indirect effects were observed. Specifically, online COVID-19 information seeking mediated the effects of age and education on performance of protective behaviors, and subjective norms and online COVID-19 information seeking were found to be significant serial mediators of these relationships. The study not only extends the health disparities and health information seeking literature, but also offers practical insights to health campaigns and interventions promoting protective behaviors during a pandemic and reducing health disparities.

mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring.

BACKGROUND: Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown. OBJECTIVE: This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented. METHODS: A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review. RESULTS: The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs. CONCLUSIONS: Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology.

A pharmacovigilance study of pharmacokinetic drug interactions using a translational informatics discovery approach.

BACKGROUND: While the pharmacokinetic (PK) mechanisms for many drug interactions (DDIs) have been established, pharmacovigilance studies related to these PK DDIs are limited. Using a large surveillance database, a translational informatics approach can systematically screen adverse drug events (ADEs) for many DDIs with known PK mechanisms. METHODS: We collected a set of substrates and inhibitors related to the cytochrome P450 (CYP) isoforms, as recommended by the United States Food and Drug Administration (FDA) and Drug Interactions Flockhart table™. The FDA's Adverse Events Reporting System (FAERS) was used to obtain ADE reports from 2004 to 2018. The substrate and inhibitor information were used to form PK DDI pairs for each of the CYP isoforms and Medical Dictionary for Regulatory Activities (MedDRA) preferred terms used for ADEs in FAERS. A shrinkage observed-to-expected ratio (Ω) analysis was performed to screen for potential PK DDI and ADE associations. RESULTS: We identified 149 CYP substrates and 62 CYP inhibitors from the FDA and Flockhart tables. Using FAERS data, only those DDI-ADE associations were considered that met the disproportionality threshold of Ω > 0 for a CYP substrate when paired with at least two inhibitors. In total, 590 ADEs were associated with 2085 PK DDI pairs and 38 individual substrates, with ADEs overlapping across different CYP substrates. More importantly, we were able to find clinical and experimental evidence for the paclitaxel-clopidogrel interaction associated with peripheral neuropathy in our study. CONCLUSION: In this study, we utilized a translational informatics approach to discover potentially novel CYP-related substrate-inhibitor and ADE associations using FAERS. Future clinical, population-based and experimental studies are needed to confirm our findings.

A multistate transition model for statin-induced myopathy and statin discontinuation.

The overarching goal of this study was to simultaneously model the dynamic relationships among statin exposure, statin discontinuation, and potentially statin-related myopathic outcomes. We extracted data from the Indiana Network of Patient Care for 134,815 patients who received statin therapy between January 4, 2004, and December 31, 2008. All individuals began statin treatment, some discontinued statin use, and some experienced myopathy and/or rhabdomyolysis while taking the drug or after discontinuation. We developed a militate model to characterize 12 transition probabilities among six different states defined by use or discontinuation of statin and its associated myopathy or rhabdomyolysis. We found that discontinuation of statin therapy was common and frequently early, with 44.4% of patients discontinuing therapy after 1 month, and discontinuation is a strong indicator for statin-induced myopathy (risk ratio, 10.8; p < 0.05). Women more likely than men (p < 0.05) and patients aged 65 years and older had a higher risk than those aged younger than 65 years to discontinue statin use or experience myopathy. In conclusion, we introduce an innovative multistate model that allows clear depiction of the relationship between statin discontinuation and statin-induced myopathy. For the first time, we have successfully demonstrated and quantified the relative risk of myopathy between patients who continued and discontinued statin therapy. Age and sex were two strong risk factors for both statin discontinuation and incident myopathy.

Culture in Cancer Survivorship Interventions for Asian Americans: A Systematic Review and Critical Analyses.

Frequently hard to reach and underserved, Asian Americans are the racial group whose chief cause of mortality is cancer. Efficacious survivorship care is important, but little is known about extant intervention efforts for this community and how culture has been integrated into these efforts. This study examined cancer survivorship interventions for Asian Americans and how culture has been addressed, using an integrated framework consisting of goals, theory, methods, and cultural concordance in the persons of the interventions. Mixed methods comprising a systematic review and critical analyses were employed. Results indicate that only 13 interventions have been delivered to this community, with six of them pilot studies, and that they used a narrow range of focus on cancer type, with all interventions focusing on breast cancer survivorship. Applications of theory and methods were incongruent with cultural valuation of emotion expression and help seeking behavior. Cultural concordance was operationalized mostly as the racial ethnic match between interventionists and survivors. Deep culture factors including cultural beliefs and values were rarely specified. Theory and research should move beyond the currently prevalent definition of culture as race, ethnicity, or language, and interventions should consider the role of culture in their goals, theory, methods, and persons. Advances in theory and research are needed, as neither reliance on the Western paradigm nor assumptions about Asian Americans can be appropriate for achieving cultural validity. Future conceptualization and operationalization should consider culture more than race, ethnicity, or language.

Modeling posttraumatic growth among cancer patients: The roles of social support, appraisals, and adaptive coping.

OBJECTIVE: The purpose of the study was to build a model to explain the relationships between social support, uncontrollability appraisal, adaptive coping, and posttraumatic growth (PTG) among cancer patients in China. METHODS: The participants who were cancer patients in a cancer hospital in China filled out a survey. The final sample size was 201. Structural equation modeling was used to build a model explaining PTG. RESULTS: Structural equation modeling results indicated that higher levels of social support predicted higher levels of adaptive coping, higher levels of uncontrollability appraisal predicted lower levels of adaptive coping, and higher levels of adaptive coping predicted higher levels of PTG. Moreover, adaptive coping was a mediator between social support and growth, as well as a mediator between uncontrollability and growth. The direct effects of social support and uncontrollability on PTG were insignificant. CONCLUSIONS: The model demonstrated the relationships between social support, uncontrollability appraisal, adaptive coping, and PTG. It could be concluded that uncontrollability appraisal was a required but not sufficient condition for PTG. Neither social support nor uncontrollability appraisal had direct influence on PTG. However, social support and uncontrollability might indirectly influence PTG, through adaptive coping. It implies that both internal factors (eg, cognitive appraisal and coping) and external factors (eg, social support) are required in order for growth to happen.

How doctors communicate the initial diagnosis of cancer matters: cancer disclosure and its relationship with Patients' hope and trust.

OBJECTIVE: The study is to examine the relationships between perceived initial cancer disclosure communication with doctors, levels of hope, and levels of trust in doctors among cancer patients in China. METHODS: A total number of 192 cancer inpatients in a cancer hospital in China were surveyed. Perceived disclosure strategies, levels of hope, levels of trust in their doctors, as well as the demographic information were obtained from the participants. RESULTS: In addition to age, patients who had higher levels of perceived emotional support from doctors, or higher levels of perceived personalized disclosure from doctors, or higher levels of perceived discussion of multiple treatment plans with doctors were more likely to have higher levels of trust in doctors. In addition to perceived health status, perceived emotional support from doctors significantly predicted participants' levels of hope. That is, patients who had higher higher levels of perceived doctors' emotional support were more likely to have higher levels of hope. Key disclosure person was a marginally significant variable, that is, patients who were mainly disclosed by family members might have higher levels of hope compared with patients who were mainly disclosed by doctors. CONCLUSIONS: When communicating with a cancer patient, doctors might not ignore the importance of emotional support during cancer diagnosis communication. Doctors might want to involve family and collaborate with family to find out ways of personalized disclosure. During the communication process, doctors could provide their patients with multiple treatment options and discuss the benefits and side effects of each treatment. Copyright © 2016 John Wiley & Sons, Ltd.

Modeling Online Health Information-Seeking Behavior in China: The Roles of Source Characteristics, Reward Assessment, and Internet Self-Efficacy.

The outbreak of severe acute respiratory syndrome (SARS) in 2003 marked the explosion of health information seeking online in China and the increasing emergence of Chinese health websites. There are both benefits and potential hazards of people's online health information seeking. This article intended to test part of Wilson's second model of information behavior, including source characteristics and activating mechanisms, and to identify the relationships among perceived access, perceived expertise credibility, reward assessment, Internet self-efficacy, and online health information-seeking behavior. Data were drawn from face-to-face surveys and an online survey of health information seekers (N = 393) in China. The results showed that source characteristics predicted activating mechanisms, which in turn predicted online health information-seeking behavior. Activating mechanisms, that is, reward assessment and Internet self-efficacy, mediated the relationship between source characteristics (i.e., access and credibility) and online health information-seeking behavior. Strategies for improving information access, expertise credibility, and Internet self-efficacy are discussed in order to maximize the benefits of online health information seeking and to minimize the potential harm.

Learning by aggregating experts and filtering novices: a solution to crowdsourcing problems in bioinformatics.

BACKGROUND: In many biomedical applications, there is a need for developing classification models based on noisy annotations. Recently, various methods addressed this scenario by relaying on unreliable annotations obtained from multiple sources. RESULTS: We proposed a probabilistic classification algorithm based on labels obtained by multiple noisy annotators. The new algorithm is capable of eliminating annotations provided by novice labellers and of providing a more accurate estimate of the ground truth by consensus labelling according to higher quality annotations. The approach is evaluated on text classification and prediction of protein disorder. Our study suggests that the higher levels of accuracy, effectiveness and performance can be achieved by the new method as compared to alternatives. CONCLUSIONS: The proposed method is applicable for meta-learning from multiple existing classification models and noisy annotations obtained by humans. It is particularly beneficial when many annotations are obtained by novice labellers. In addition, the proposed method can provide further characterization of each annotator that can help in developing more accurate classifiers by identifying the most competent annotators for each data instance.