Introduction

With the continuing improvement in treatment approaches, 84% of children with cancer survive five years or more. Survivors, however, remain at risk for cancer recurrence, secondary cancers, and late effects of treatment. In response, we collaborated with the Children’s Oncology Group (COG) to develop the Passport for Care (PFC-SW), a web-based clinical decision support tool in English and Spanish that employs COG’s long-term follow-up survivorship guidelines to generate a personalized survivorship care plan based on their treatment summary. Access to care is particularly challenging for low-income Latinos living in medically underserved areas and rural counties. Recommendations for bridging the divide include (1) enhancing Latino relationships with providers and care facilities, (2) increasing access to health information and involvement in decision making, and (3) employing technology including the Internet, text messaging and smartphone applications to further engage patients. 

Our overall strategy is to develop a PFC mobile health (mhealth) app to engage medically underserved Latino adolescent and young adult cancer survivors and childhood cancer survivors (via parents) through their smart phones—where they are. 

Methods

We have drawn heavily on the RE-AIM Planning and Evaluation Framework to develop our dissemination plan. This framework contains both dissemination and implementation elements. We have (1) used participatory design involving Latino and other survivors in converting the PFC Survivor Website to a mobile health app and (2) developed an implementation plan for deployment and utilization of the mHealth app. Recruitment challenges for participatory contributors in the designing and design implementation processes have delayed our advancing to (3) the evaluation of app dissemination, enrollment, engagement, and satisfaction in usage.  

Project work to date has focused extensively on in-depth user testing of app prototypes, implementation guide, and user instructions, with technical and content-based enhancements arising from the participatory evaluation process incorporated between assessment stages. 

The mobile app was written in React Native for cross platform (iOS and Android) compatibility. GraphQL is used to communicate with the PFC Web server and transmit survivor data securely. All communications are encrypted. These tools were used to create the user interfaces, display the Treatment Summary and the Care Summary. GraphQL queries were used to facilitate bi-directional secure messaging between the clinic and the mHealth app.

Results

With the recruitment challenges, final conclusions must await the mhealth app release. Testers made very useful suggestions, many of which were incorporated, and others that are worthy of deployment in a future version. To date, the mHealth app has been constructed and includes Treatment Plans and the care summary that includes potential late effects listed by system. The care summary includes risks for specific late effects (because of specific treatment exposures), suggested screenings, suggested actions, and Health Links to education relevant to the late effects written in lay language. Complementing the summaries is a list of the question-and-answer feature displayed in videos using a format reminiscent of a videoconferencing call between a survivor and a healthcare provider. The topics were the results of the participatory design process; videos were also reviewed by survivors in testing. This format was particularly appealing to users. 

Conclusion

The mhealth app provides many of the features available from the survivor portal with additional interactivity (two-way messaging), new content and formats for answering the questions important to survivors, new features, simplified enrollment designed to reduce burdens for survivors and clinics, and the potential capability to reach survivors where they are—on their mobile devices.