Jennifer Stinson*, The Hospital for Sick Children, Toronto, Canada Lindsay Jibb*, University of Toronto, Toronto, Canada Paul Nathan, The Hospital for Sick Children, Toronto, Canada Anne-marie Maloney, The Hospital for Sick Children, Toronto, Canada Donna Johnston, Children's Hospital for Eastern Ontario, Ottawa, Canada Carol Portwine, McMaster University, Hamilton, Canada Lee Dupuis, The Hospital for Sick Children, Toronto, Canada Track: Research Presentation Topic: Web 2.0 approaches for clinical practice, clinical research, quality monitoring Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2012-09-12 Free Full Paper

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Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer (AWC). Despite advancements in pain assessment and management research, pain due to cancer and/or its treatment continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the AWC group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration and location and the impact pain has on an adolescent’s life (i.e., relationships, schoolwork, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 25 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a web interface. Each diary entry represents a pain case filed by an AWC and a reward system (i.e., moving up through the police team ranks, built-in videotaped acknowledgements from other ‘officers’) encourages consistent use of the diary.
Objective: To evaluate the usability and content validity of the multidimensional Pain Squad app in AWC.
Methods: Study Phases 1 and 2 involved qualitative usability testing with iterative cycles of semi-structured interviews. In Phase 1, 15 adolescents (9-18 years) participated in 3 iterative cycles of low-fidelity usability testing (i.e. likeability of prototype screenshots). In Phase 2, 18 adolescents (9-18 years) participated in 2 iterative cycles of high-fidelity usability testing (i.e. understandability and satisfaction with the app prototype). Usability themes were analyzed using the constant comparative method for both phases. Phase 2 participants also completed content validity testing (Phase 3) by rating the importance of each app question on a scale from ‘not at all important’ to ‘very important’.
Results: Data from iterative cycles 1 and 2 of Phase 1 revealed that body maps, visual analogue scales and the app theme required modification. Cycle 1 of Phase 2, revealed that question wording, placement of selectable buttons and the body map (i.e. inability to select certain body parts) required modification. No new issues arose in cycle 2. Phase 3 revealed that for 87.5% of questions, most participants (> 50%) rated the question as ‘important’ or ‘very important’. Questions that did not achieve this rating related to how much pain interfered with: (1) things participants did, (2) participants’ relationships, and (3) participants’ schoolwork. However for these questions, less than 22.3% of participants rated the question as ‘not at all important’.
Conclusions: Next steps involve feasibility, reliability, validity and responsiveness testing of the app. An acceptable, feasible, reliable and valid electronic cancer pain app is expected to help adolescents and clinicians better understand and manage cancer pain.