European Journal of Oncology Nursing 19 (2015) 523e528

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European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon

Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer € f a, Karin Blomberg b, Ann-Kristin Isaksson b, Kay Sundberg a, *, Ann Langius Eklo b €m Yvonne Wengstro a b

Department of NVS, Division of Nursing, Karolinska Institutet, Stockholm, Sweden € € School of Health and Medical Sciences, Orebro University, Orebro, Sweden

a b s t r a c t Keywords: Information and communication technology (ICT) Patient reported outcomes Nursing care Self-care Symptom management Prostate cancer Radiotherapy

Purpose: The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing patient reported symptoms during radiotherapy for prostate cancer. Methods: In cooperation with a health management company, using a patient experience co-design, we developed the platform operated by an interactive application for reporting and managing symptoms in real time. Nine patients diagnosed with prostate cancer and receiving radiotherapy were recruited from two university hospitals in Sweden. Evidence-based symptoms and related self-care advice specific to prostate cancer were implemented in the application based on a literature review and interviews with patients and health care professionals. In the test of the platform the patients reported symptoms, via a mobile phone, daily for two weeks and were afterwards interviewed about their experiences. Results: Overall, the patients found the symptom questionnaire and the self-care advice relevant and the application user friendly. The alert system was activated on several occasions when the symptoms were severe leading to a nurse contact and support so the patients felt safe and well cared for. Conclusions: The platform enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. © 2015 Elsevier Ltd. All rights reserved.

Introduction At the heart of person-centered care delivery is the development of services in health care that enable patients to have the most efficient and effective care, which is also experienced as respectful and promoting patient involvement in the therapeutic relationships (Leplege et al., 2007). Patients with cancer cared for as outpatients, frequently experience multiple symptoms and problems that, when not diagnosed, influence the patients' quality of life (QoL) and recovery (Pachman et al., 2012). For immediate and continuous dialogue between patients and health care professionals, innovative e-health services using Information and

* Corresponding author. Department of NVS, Division of Nursing 23 300, S-14183 Huddinge, Sweden. Tel.: þ46 852483572; fax: þ46 19 30 36 01. E-mail address: [email protected] (K. Sundberg). http://dx.doi.org/10.1016/j.ejon.2015.02.013 1462-3889/© 2015 Elsevier Ltd. All rights reserved.

Communication Technologies (ICT) are encouraged. Appropriate tools for communication are needed to enable patients to report events that health care providers may respond to effectively (Mazor et al., 2012). There is a broad market for technology and devices for the self-monitoring of symptoms and problems. Some of these solutions are evidence-based and others not, and few include interactive components for immediate clinical management. Hence, the objective of our research program is to develop and evaluate an interactive ICT-platform for reporting and managing symptoms in real time during treatment for cancer. The ICTplatform, for use in smartphones and tablets, was developed in cooperation with a Swedish company, Health Navigator (specialized in health care management consulting and new innovative care solutions) responsible for the technical development and support. The platform is generic and the idea for the future is to test it for several diagnoses and in larger trials. In this first study, patients with prostate cancer during radiotherapy were included.

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Patient-reported outcomes (PROs) may be defined as any aspect of a patient's health status (including disease symptoms, functioning, and health-related quality of life) that is directly reported by the patient with no interpretation of the patient's responses by a caregiver or anyone else (U.S. Department of Health Human Services and Research, 2006). Routine clinical use of PROs in real time may facilitate the assessment of problems, provide information on the effects of treatment, facilitate patienteclinician communication, promote shared decision making, improve patient satisfaction, and monitor quality improvement (Snyder and Aaronson, 2009; Valderas et al., 2008). Traditionally, PROs have been collected using pen and paper, but now more frequently a broad range of ICT solutions have been employed, including mobile phones, web-based systems and applications for smartphones and touch screens (Rose and Bezjak, 2009). In the UK, patients using a mobile phone-based system reported improved communication with health care professionals and improved symptom management when their symptoms were being monitored (Maguire et al., 2008; McCann et al., 2009). Moreover, a mobile phone-based monitoring system for heart failure patients developed and tested in a Canadian setting provided some evidence for improved selfcare and clinic management (Seto et al., 2012a). In a recent RCT a web-based interactive health communication application monitoring symptoms and providing self-management support and access to e-communication with expert cancer nurses and other patients was tested by patients with breast and prostate cancer during any treatment (Ruland et al., 2013). The results showed a slight favor in the intervention group overall but additional research is needed. Mobile phone systems and applications have just begun to offer great opportunities in health care settings however, data showing sufficient evidence of feasibility and efficacy of these solutions has so far not been concluded. The importance of integrating the patients into the process (Donaldson, 2008) and to ensure user friendly data for both patients and health care professionals has been emphasized (Rose and Bezjak, 2009; Snyder and Aaronson, 2009). In Sweden, prostate cancer is the most common cancer among men, representing 36% of all cancer cases in male adults in 2011 (National Board of Health and Welfare, 2011). Through early detection and improved therapies many are cured, but a major number of men need continuous surveillance and treatment (e.g., surgery, brachytherapy, radiotherapy, hormonal therapy). All the treatments available for local and advanced prostate cancer have side effects with a significant impact on the patients' QoL (Katz, 2007). Howlett et al. (2010) highlight the importance of evaluating, during and after radiotherapy, influences of treatment on various aspects of health and QoL. Patients with prostate cancer are commonly cared for as outpatients, visiting hospitals only to receive treatment, and this arrangement places great demands on them and their significant others. The aim of this study was to test the feasibility and acceptability of an interactive ICT-platform for smartphone use which collect and manage patient reported symptoms during radiotherapy for prostate cancer. Methods The design of our research program is underpinned by the Medical Research Council's (MRC) complex intervention evaluation framework (Campbell et al., 2007). The framework uses a stepwise approach for; i) defining and understanding the problem and the context; ii) developing the intervention and; iii) developing and optimizing the evaluation. In the first step patients and health care professionals were interviewed and a literature review was conducted to define the problem and the context (Author blinded, submitted). Based on this, the ICT-platform was developed and in

the present feasibility study tested for optimizing before further evaluation in a larger study. Development of the ICT-platform The foundation for the platform's development was that it should: 1) Include symptom assessment by the patient and, via a secure server, an immediate transmission to health care professionals, 2) Be interactive and adaptable to a smartphone application, 3) Be connected to a monitoring web interface with a risk assessment model based on symptom occurrence and frequency sending alerts to nurses by text message (SMS) if any symptom readings are of concern) and 4) Offer continuous access to evidence-based self-care advice related to symptoms and links to relevant websites for more information as well as symptom history presented in graphs over time (Fig. 1). In the first step for defining and understanding the problem symptoms and self-care advice related to the side effects of radio and hormonal treatments during the first 6 months in newly diagnosed patients with prostate cancer were identified. This was conducted through a literature review and through interviews with patients and health care professionals (Author blinded, submitted). The symptom assessment included in the ICT-platform were mainly related to bladder and bowel function, sexual function, fatigue, pain, worries and distress, sleep, and flushing. The structure of the assessments was based on a standardized symptom and QoL questionnaire (Browall et al., 2013; Portenoy et al., 1994) in which the questions address occurrence, frequency, and distress level. For example, if the question “Do you experience urinary urgency?” is responded by “yes”, the patient is asked how often it occurs, rated by frequency: never, sometimes, rather often, or very often. Furthermore, the patient is asked how distressing the symptom is: not at all, a little, rather, or very much. The patients report on a daily basis via their smartphones and receive a reminder message if a report has not been submitted. Nurses view the data via the web interface and in case of an alert the interaction is initiated whereby a nurse contacts the patient by telephone to discuss the reported problems. There are two kinds of alerts; yellow and red. A yellow alert indicates that the nurse should contact the patient sometime during the day. In the case of a red alert, the priority is higher, and contact should be made within an hour. For example, a yellow alert appears if the patient reports urinary retention “rather often”; a red alert, when the patient reports hematuria “very often”. Feasibility study Samples A convenience sample of ten patients diagnosed with prostate cancer and receiving radiotherapy at two university hospitals in Sweden were invited to participate in the study. One of the radiotherapy centers was located in a large city in Sweden and the other in a rural area. The patients were during one week invited by the radiotherapy coordinators at the two centers to participate in the study. They were selected according to where in the treatment period they were, ranging from just starting treatment up to a period of six weeks of treatment, each of the six weeks were represented. Inclusion criteria were; a prostate cancer diagnosis; receiving first-line radiation therapy; being able to read and understand Swedish, and; being considered by the clinical team physically, psychologically, and cognitively able to participate in the study. One patient declined to participate not providing any other explanation apart from not wanting to be involved in a study. The mean age of the patients was 69 years old. Clinical characteristics of the patients are shown in Table 1. There were altogether eight nurses (four at each treatment center) who agreed to be directly

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525

Fig. 1. Conceptual illustration of the ICT-platform.

Table 1 Clinical characteristics of study sample (n ¼ 9). n Clinical T stage 1 2 3 Gleason score 7 8 10 Treatment Radiotherapy Brachytherapy Neoadjuvant hormonal therapy

2 4 3 5 2 1 9 5 6

involved in monitoring the study participants and to be interviewed after the study period. Procedure Each patient was equipped with a smartphone and was given instructions about how to use the application. They were asked to submit daily reports during two weeks and were informed that during the study period the alerting system was monitored only during office hours. A study period of two weeks was chosen since this was considered sufficient time to evaluate any technical issues and the user friendliness of the platform. The nurses were given instructions regarding how to operate the ICT-platform. Ethical approval was obtained from the Regional Ethical Review Board of Uppsala University (dnr 2011/256). Interviews At the end of the reporting period, a focus-group discussion took place with the six patients at one of the centers. This method was chosen as we considered the sample size appropriate and that the group interaction could give a rich material (Barbour and Kitzinger, 1999). One of the two researchers led the discussion and asked questions such as “what was it like to report symptoms in the smartphone” and “were the included symptoms relevant or were

there any concerns lacking?” At the smaller center, individual interviews (n ¼ 3) took place as the sample size was too small for a focus-group. The interviews were conducted by one of the authors using an interview guide. The patients at both centers were also asked to note any thoughts they had regarding the system or any technical incidents that occurred during the study period. The nurses were according to an interview guide individually interviewed regarding their experiences related to using the platform. Analysis Logged data on the frequency of symptom reports, alerts, and page views of self-care advice were collected via the web interface and analyzed. The tape-recorded interviews were transcribed by the first and third author these texts, together with any notes written down by the patients, were analyzed using inductive €s, 2008). Content analqualitative content analysis (Elo and Kynga ysis was chosen as a method for analysis as it can be used to draw valid conclusions about a manifest message by systematic identification of specified communication characteristics. The text from the different interviews was put together into one unit of analysis. The first author read the entire text through several times to become immersed in the data and to obtain a sense of whole. The next step was open coding; text and headings were written down in the margins while reading, to describe all aspects of the content. The headings were transferred to a coding sheet and through an abstraction process the codes with shared messages were grouped together into subcategories. Subsequently, subcategories with similar events and incidents were grouped as main categories (Table 2). Through the whole analyzing process all the authors critically discussed the differences and similarities of the codes and categories to achieve trustworthiness. Selected quotations are presented to illustrate the results. Results Symptoms reported in the smartphone application by patients at baseline report are shown in Table 3.

Table 2 Example of the abstraction process in the analysis. Text

Codes

Subcategory

Category

“I think it's good to have access to relevant information in the application …”

access to relevant information

“… I have previously looked at different websites related to prostate cancer but found it hard to know which ones to rely on.” “Reporting the pain through the smartphone made it easy to handle my problems due to the alarm … there was no need to for an emergency visit at the hospital”. “I was contacted by a nurse on one occasion; it wasn't a red alert though. I was going to see the nurse anyway the next day, but it felt secure that she called me”

hard to know which websites to rely on

Use of health information Use of health information Alert system

Symptom management and self-care

alarm made it easy to handle problems contacted by nurse alert

Alert system

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Table 3 Symptoms reported by patients at baseline report in application. Patient

1

2

3

4

5

6

7

8

9

Weeks of treatment Urinary urgency Urinary pain Difficulties urinating Hematuria Urinary leakage Diarrhea Obstipation Stool leakage Blood in stool Fatigue Insomnia Depressed Worry

6

2 x

4 x x

3

1

0

0 x

1 x

5 x

x x

x

“Being able to explain to the nurse or doctor regarding perceived symptoms and problems before the next hospital visit is something which is lacking today.”

x

x

x x

x

considered it appropriate to report symptoms once a day during treatment; having their symptoms monitored daily reassured patients and fostered a sense of security. Some said it was a little bit difficult to remember to report every day and had even forgotten on a few occasions Several patients pointed out that a message function explaining more about the reported symptoms could make the health care provider more prepared of the patient's needs.

x x

x x

x

x x

The participants reported for a mean period of 10 days (Fig. 2), and they estimated the time required for each report at about 5 min. All symptoms included in the assessment had been reported by the participants, and the most frequently reported symptoms were flushing (n ¼ 52), urinary urgency (n ¼ 50), and fatigue (n ¼ 44). During the study period, a total of 59 alerts were sent: 55 yellow and 4 red. The yellow alerts mostly concerned urinary urgency and urinary retention. The red alerts were: hematuria (n ¼ 2); worry (n ¼ 1); and urinary pain (n ¼ 1). Self-care advice was accessed by a majority (85%) of the participants, who logged a total of 20 viewing occasions at 34 symptoms. The analysis of the transcripts from the interviews with the patients and nurses revealed various experiences of communicating symptoms and problems and of symptom management. The main categories were; Ease of use and acceptability and Symptom management and self-care. Ease of use and acceptability Technical aspects There were no reports from either the patients or the nurses of technical problems during the pilot study. Four patients had prior experience of using a smartphone. Despite that, all the patients indicated that the application was easy to use. One participant reported that his finger once “stuck on the wrong button,” resulting in an alert to the nurse. This did not bother him since he could explain the incident when he spoke with the nurse who called in response to that alert. Reporting symptoms The majority of the patients stated that using the smartphone application was an interesting and worthwhile experience. They

Comprehensible content Overall, the symptoms were considered relevant, and the questionnaire was described as easy to understand and quick to respond to. The font size in the application was considered adequate by all patients but one who reported having impaired vision. Some patients commented on the ways the symptoms and concerns were defined, indicating that clarification might be helpful, for example, the meanings of the words worry and distress were mentioned. Reporting “pain” was sometimes confusing if pain only was experienced occasionally as the question could be interpreted as indicating that pain had been experienced throughout the last 24 h. Also, when reporting pain, it was not possible to point out the location of a given sensation, and the patients highlighted a need for a free text message in the application. An aspect that arose was that a glossary in the application might be useful, defining certain words and illustrating the connotation of the terms used in the questionnaire. Another consideration was the scaling of the symptoms related to the question “How often have you experienced sleeping problems the last 24 h?” This was considered difficult to rate, as sleeping should preferentially occur during night time only. Monitoring patient reports The nurses' responses overall were positive regarding the platform's potential to support patients during treatment. They had noticed that the patients using the application did not bring up as many concerns as usual during scheduled appointments and suggested using the application may have prevented patients from simply dropping by for unscheduled visits. The nurses thought that patients undergoing brachytherapy might have benefitted most from using the application, as their contact with the hospital after the treatment usually is minimal. The nurses explained that symptom distress often increases a few days after brachytherapy. An example was given of a patient who reported severe pain and worry after brachytherapy and who could be helped immediately via comforting dialogue and advice administered over the phone. Most of the nurses stated that they had viewed the patients' graphs the morning before they came for treatment and found this useful. Nevertheless, the response to monitoring the symptoms every morning was not entirely positive among the nurses: some indicated that it was time consuming, and they worried that it would cause increased workload. Nurses also suggested ways to make the web interface more user-friendly. Another concern was if more than one nurse noticed an alert from a patient some uncertainty might occasionally arise regarding who was responsible for seeing to the patients' potential needs. Symptom management and self-care

Fig. 2. Number of symptom assessment reports submitted by each patient during the 2-week study period.

Use of health information Not all the patients viewed their personal history graphs during the study, though those who had done so expressed a liking for this

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function. Most of the patients had accessed the self-care advice, and some of those who did found this useful. Some had followed the links to suggested websites for further reading, but most acknowledged the function's potential usefulness. “I think it's good to have access to relevant information in the application, I have previously looked at different websites related to prostate cancer but found it hard to know which ones to rely on.”

Alert system The alert system was activated on several occasions and found to be helpful for both patients and nurses in detecting symptoms of concern in good time. One patient had reported severe pain, resulting in a red alert; he was contacted by the nurse immediately. When he came for treatment the following day, a doctor's appointment had been scheduled and pain relief was prescribed. The patient experienced a sense of involvement and collaboration with the nurse. “Reporting the pain through the smartphone made it easy to handle my problems due to the alarm … there was no need to for an emergency visit at the hospital”. Another patient who had reported symptoms that worried him was immediately contacted by a nurse with whom he could discuss the problem. A third patient had reported symptoms that generated a yellow alert and was contacted by phone later that day. “I was happy that the nurse called me. I did not have to go through issues of being connected or waiting in a telephone queue.”

Discussion In this study, we tested a newly developed ICT-platform unique in the sense of being interactive for reporting and managing symptoms and problems during radiotherapy for prostate cancer. Overall, the patients found the application acceptable and userfriendly, despite the fact that most participants had never used a smartphone before and being older adults. Confidence among older individuals in their ability to use mobile phone and tablet applications has been shown in previous studies (Fromme et al., 2011; Seto et al., 2012b). The present study demonstrates that both patients and nurses responded positively to the platform and saw that it could enhance symptom management and self-care during cancer treatment, a finding likewise supported by earlier studies using ICT (Maguire et al., 2008; McCann et al., 2009). The nurses in the present study perceived that because of the patients' continuous symptom assessment and reporting, fewer symptoms and problems needed attention when patients came for treatment. Furthermore, one emergency room visit was avoided by the early detection of pain, and the nurse could support the patient with appropriate help. The patient stated that he was very pleased and had felt a sense of being involved in his own treatment, of collaborating with the nurse. In addition, the nurse felt confident attending to the patients' needs in such a timely manner. Nurses have a responsibility to focus on symptom management and selfcare, making them particularly well-suited for monitoring the impact of treatment on daily life. Key facilitators for rendering care more person-centered are the active assessment of and feedback regarding the patient's experience (Luxford et al., 2011). Using this kind of innovations in clinical practice may introduce an important tool to support outpatients during ongoing cancer treatment.

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However, some nurses expressed worries about using the monitoring system long-term, as they thought it may increase their clinical workload. This aligns with other reported clinicians' concerns about using ICT in health management (Maguire et al., 2008; Seto et al., 2012b). We hypothesize, however, that the use of the platform may in the future decrease clinical workload by identifying symptoms of concern earlier and thereby prevent long-term problems for the patient and the health care setting. Applying PROs in clinical practice may require health care staff to rethink the way work is organized which could mean shifting the format of care delivered from a reactive to a proactive approach (Donaldson, 2008). With an interactive system, the goal is that patients receive help when it is most needed; this notion is highly supported by the principles of person-centered care (McCormack et al., 2010). Due to treatment, patients with prostate cancer often suffer from various symptoms. It is known that inadequately managed symptoms can cause poor QoL and even interrupt treatment (Given, 2010). Reporting symptoms daily could of course be a disturbing reminder for the participant about the illness and may lead to negative consequences. However, a recent study of patients with prostate cancer shows that a higher number of symptoms reported during treatment are associated with greater engagement in selfcare (Hsiao et al., 2013). Thus, regular assessment and appropriate information regarding the self-management of symptoms may be imperative to early symptom identification and management. It was interesting to learn that most of the patients had viewed a site presenting advice for self-care; some had found this feature useful, and most acknowledged the potential usefulness of the suggested websites. This concurs with other research findings regarding mobile phone monitoring, including guided selfmanagement (Hung et al., 2007; Liu et al., 2011). All feasibility studies involve limitations, and in particular this study involves a homogenous sample regarding age and clinical characteristics. Another limitation is that we do not know the details of the participants' demographics, although age and clinical data reflect the characteristics of the target population. Moreover, the patients reported that their symptoms for a mean period of ten days which for most patients was less than a third of the treatment period. However, study strengths are the reporting that took place at different time points during treatment representing a period of six weeks of treatment and that the findings concur with those of other feasibility studies in the same research field (Kearney et al., 2009; Maguire et al., 2008). Furthermore, the patients were a mix coming from both urban and suburban areas. The sample size is small and it is based on the pragmatics of recruitment. The purpose for the study was to be an initial step in exploring a novel intervention and to examine the feasibility of an approach intended to be used in larger scale study (Leon et al., 2011). Only one patient declined participation and all patients reported their symptoms which indicate that the study was perceived interesting and important. The patients had been instructed to report daily for two weeks but we learnt that sometimes they forgot. Moreover, since the patients had been told that it was only possible to be monitored and contacted by the nurses during weekdays some of them chose not to submit their report the last weekend. Despite this and also by using two different interviewing methods, there was a sufficient amount of data generated, rich enough for analysis. The combination of quantitative and qualitative data is a strength (Williams et al., 2003) and some results have led to suggestions for adjustments to both the application and the web interface in order to optimize use in the design of further research. For instance, the logged data revealed that some alerts were considered less significant. The yellow alerts were “too liberal” in that nurses were alerted even when patients did not seem so worried. Moreover, the participants provided information that will be useful for improving

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the electronic questionnaire's reliability. Further research is needed in larger populations as well as in different settings in order to determine the usefulness and effects of the ICT-platform. In a recent review, in which the importance of research of interventions with health-related smartphone applications was highlighted, the authors concluded that the use of applications in long-term health management of people with different chronic diseases is still at an early stage and there is a need for more applications to be introduced in various health care settings (Wang et al., 2014). In conclusion, the interactive ICT-platform for smartphones and tablets showed high feasibility and acceptability when used in patients during radiotherapy for prostate cancer. The smartphone application enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. Although the symptoms and the self-care advice for this study were specific to prostate cancer the ICTplatform can be adapted for other patient populations as the underlying principles are generic. Based on suggestions for further development the present results provide support to test the platform in full-scale studies also in other patient populations. Conflict of interest Authors of this manuscript declare no conflict of interests. Acknowledgments We would like to thank all the participants in this study and the staff at the two centers who assisted us with support. We would also like to thank Health Navigator for the collaboration and technical support in this project. References Barbour, R., Kitzinger, J., 1999. Developing Focus Group Research. Politics, Theory and Practice. Sage Publications, London. € m, Y., Gaston-Johansson, F., Browall, M., Kenne Sarenmalm, E., Nasic, S., Wengstro 2013. Validity and reliability of the Swedish version of the Memorial Symptom Assessment Scale (MSAS): an instrument for the evaluation of symptom prevalence, characteristics, and distress. Journal of Pain Symptom Management 46 (1), 131e141. Campbell, N.C., Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F., et al., 2007. Designing and evaluating complex interventions to improve health care. British Medical Journal 334 (7591), 455e459. Donaldson, M.S., 2008. Taking PROs and patient-centered care seriously: incremental and disruptive ideas for incorporating PROs in oncology practice. Quality of Life Research 17 (10), 1323e1330. €s, H., 2008. The qualitative content analysis process. Journal of Elo, S., Kynga Advanced Nursing 62 (1), 107e115. Fromme, E.K., Kenworthy-Heinige, T., Hribar, M., 2011. Developing an easy-to-use tablet computer application for assessing patient-reported outcomes in patients with cancer. Supportive Care in Cancer 19 (6), 815e822. Given, B.A., 2010. Symptom management in oncology care e where are we? European Journal of Oncology Nursing 14 (5), 357e358. Howlett, K., Koetters, T., Edrington, J., West, C., Paul, S., Lee, K., et al., 2010. Changes in sexual function on mood and quality of life in patients undergoing radiation therapy for prostate cancer. Oncology Nursing Forum 37 (1), E58eE66. Hsiao, C.P., Moore, I.M., Insel, K.C., Merkle, C.J., 2013. Symptom self-management strategies in patients with non-metastatic prostate cancer. Journal of Clinical Nursing 23, 440e449. Hung, S.H., Tseng, H.C., Tsai, W.H., Lin, H.H., Cheng, J.H., Chang, Y.M., 2007. Care for Asthma via Mobile Phone (CAMP). Studies of Health Technology Information 126, 137e143.

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Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer.

The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing...
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