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Development and pre-pilot testing of STAMP + CBT: an mHealth app combining pain cognitive behavioral therapy and opioid support for patients with advanced cancer and pain

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Abstract

Purpose

We developed and piloted a mobile health app to deliver cognitive behavioral therapy for pain (pain-CBT), remote symptom monitoring, and pharmacologic support for patients with pain from advanced cancer.

Methods

Using an iterative process of patient review and feedback, we developed the STAMP + CBT app. The app delivers brief daily lessons from pain-CBT and pain psychoeducation, adapted for advanced cancer. Daily surveys assess physical symptoms, psychological symptoms, opioid utilization and relief. Just-in-time adaptive interventions generate tailored psychoeducation in response. We then conducted a single-arm pilot feasibility study at two cancer centers. Patients with advanced cancer and chronic pain used the app for 2 or 4 weeks, rated its acceptability and provided feedback in semi-structured interviews. Feasibility and acceptability were defined as ≥ 70% of participants completing ≥ 50% of daily surveys, and ≥ 80% of acceptability items rated ≥ 4/5.

Results

Fifteen participants (female = 9; mean age = 50.3) tested the app. We exceeded our feasibility and accessibility benchmarks: 73% of patients completed ≥ 50% of daily surveys; 87% of acceptability items were rated ≥ 4/5. Participants valued the app’s brevity, clarity, and salience, and found education on stress and pain to be most helpful. The app helped participants learn pain management strategies and decrease maladaptive thoughts. However, participants disliked the notification structure (single prompt with one snooze), which led to missed content.

Conclusion

The STAMP + CBT app was an acceptable and feasible method to deliver psychological/behavioral treatment with pharmacologic support for cancer pain. The app is being refined and will be tested in a larger randomized pilot study. TRN: NCT05403801 (05/06/2022).

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Acknowledgements

The Insight™ mHealth platform was developed by the University of Oklahoma Health Sciences Center and funded by the P30 and Tobacco Settlement Endowment Trust grants.

Funding

This work was funded by the National Palliative Care Research Center (PI Azizoddin), the National Institutes of Health-National Cancer Institute (NIH-NCI R21CA263838, PI Azizoddin; NIH-NCI K08CA266937, PI Azizoddin), and Tobacco Settlement Endowment Trust (TSET- R23-02).

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Authors and Affiliations

  1. Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Desiree R. Azizoddin, Sara M. DeForge, Ashton Baltazar & Michael S. Businelle

  2. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Desiree R. Azizoddin & James A. Tulsky

  3. Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Robert R. Edwards & Kristin L. Schreiber

  4. Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK

    Matthew Allsop

  5. Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA

    Andrea C. Enzinger

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  1. Desiree R. Azizoddin
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Contributions

Conceptualization: DRA, ACE, RRE, JT; methodology: DRA, ACE, RRE, JT, MA; software: DRA, AB, MB; formal analysis: DRA, ACE, SMD; investigation: DRA, KS, KA, MB, AB, SMD; resources: MSB, DRA, AE: writing—original draft preparation: DRA, SMD, AB; writing: DRA, SMD, AB, RRE, MA, JAT, MSB, KLS, ACE; supervision: DRA, ACE; project administration: DRA, AB; Funding acquisition: DRA, ACE, RRE, JT.

Corresponding author

Correspondence to Desiree R. Azizoddin.

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Ethics approval and consent to participate

The study protocol was approved by Dana-Farber Cancer Institute (No: 20–453 exempted 12/07/2020; No: 21–719 approved 5/23/2022, TRN: NCT05403801 registered 05/06/2022) and Stephenson Cancer Center (No: 13725 approved 12/13/2021) Institutional Review Boards. Participants provided informed consent to participate and study activities conformed to the 1964 Helsinki Declaration and following amendments.

Competing interests

MSB is the primary inventor of the Insight™ mHealth Platform, which was used to develop the app described in this manuscript. MSB receives royalties related to the Insight™ Platform, but he did not receive royalties in this case. The remaining authors have no relevant financial or non-financial interests to disclose.

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Azizoddin, D.R., DeForge, S.M., Baltazar, A. et al. Development and pre-pilot testing of STAMP + CBT: an mHealth app combining pain cognitive behavioral therapy and opioid support for patients with advanced cancer and pain. Support Care Cancer 32, 123 (2024). https://doi.org/10.1007/s00520-024-08307-7

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