mPalliative care link: examination of a mobile solution to palliative care coordination among Tanzanian patients with cancer.

Abstract

ABSTRACT In sub-Saharan Africa, there are at least 500,000 cancer deaths/year with a projected doubling of mortality rates by 2030.1-6 A two-country study showed unnecessary suffering among African patients with late-stage cancer, often uncontrolled pain.7 Relevant to countries such as Tanzania with high cancer mortality rates,8 palliative care (PC) improves patient and caregiver outcomes, including patient quality of life (QoL) and caregiver burden.9 Furthermore, studies in the high-resource setting reveal prolonged life expectancy among patients with cancer offered specialized PC.10 PC access for patients with cancer is a Tanzanian priority, calling for evidence-based, culturally relevant, and scalable community-based solutions because of a limited pool of PC specialists and restricted access to support resources.11-13 As 66% of Tanzania's population is rural,14 research must be focused on the geographically remote. Purpose: Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response. Methods: Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey. Result: Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women (P = .07) and higher discharge morphine use (P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types (P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group (P < .0001), and symptom severity decreased over time in both groups (P = .0001); however, between-group change in overall symptoms over time did not vary significantly (P = .34). Care satisfaction was generally high in both groups.Conclusion: Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed.