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Use of Mobile Messaging System for Self-Management of Chemotherapy Symptoms in Patients with Advanced Cancer

The use of an automated text messaging intervention provided a cost-effective option for symptom management for patients experiencing cancer-related symptoms.
Federal Practitioner. 2019 August;36(5)s:S54-S57
August 7, 2019|Federal Practitioner
Connie Jaenicke, FNP-BC, BMTCN;Dan Greenwood, MS, RD, LD, CNSC;Kathleen Nelson, MS, CNS, ONS;Mark Klein, MD;Bev Foss, RN;Lara Carson, RN, BAN;Kim Smith, MS, PA-C;Evan Mariash, MD
Author and Disclosure Information

Connie Jaenicke and Kathleen Nelson are Nurse Navigators, Mark Klein and Evan Mariash are Oncologists, Bev Foss is a Registered Nurse, and Kim Smith is a Physician Assistant; all in the Hematology/ Oncology Department at the Minneapolis VA Medical Center in Minnesota. Dan Greenwood is Veterans Health Education Coordinator and Lara Carson is a My HealtheVet Coordinator, both in the Education Department at the Minneapolis VA Medical Center.
Correspondence: Connie Jaenicke (connie.jaenicke@va.gov)

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. The manufacturers did not provide equipment or other forms of material support.

Staff time for this intervention was minimal. A nurse navigator offered the texting program to the patient during chemotherapy education, along with some instructions, which generally took about 5 minutes. One of the Annie program staff enrolled the patient. From that point forward, this was a self-management tool, beyond checking to ensure that the patient was successful in starting the program and evaluating use for the purposes of this quality improvement project. This self-management tool did not replace any other mechanism that a patient would normally have in our department for seeking help for symptoms. The MVAHSC typical process for symptom management is to have patients call a 24/7 nurse line. If the triage nurse feels the symptoms are related to the patient’s cancer or cancer treatment, they are referred to the physician assistant who is assigned to take those calls and has the option to see the patient the same day. Patients could continue to call the nurse line or speak with providers at the next appointment at their discretion.

Conclusion

Although Annie has the option of using either text messaging or a mobile application, this project only utilized text messaging. The study by Basch and colleagues was the closest randomized trial we could identify to compare to our quality improvement intervention.5 The 2 main, distinct differences were that Basch and colleagues utilized online monitoring; and nurses were utilized to screen and intervene on responses, as appropriate.

The ability of our program to text patients without the use of an application or tablet, may enable more patients to participate due to ease of use. There would be no increased in expected workload for clinical staff, and may lead to decreased call burden. Since our program is automated, while still providing patients with the option to call and speak with a staff member as needed, this is a cost-effective, first-line option for symptom management for those experiencing cancer-related symptoms. We believe this text messaging tool can have system wide use and benefit throughout the VHA.

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