Improving Symptom Communication Through Personal Digital Assistants: The CHAT (Communicating Health Assisted by Technology) Project

Cancer patients often experience multiple physical, functional, and psychosocial symptoms while undergoing chemotherapeutic treatment (1–3). Fatigue is considered one of the most problematic side effects of chemotherapy, with high and fluctuating prevalence rates (4). Levels of emotional distress can also be high, and depression may worsen during treatment (5,6). Difficulties with pain during chemotherapy are also common, particularly stomach pain and muscular aches and pains, and pain symptoms can last 1 week or more during half the cycles (7,8) The diagnosis and treatment of cancer generates a threat to patients’ well-being, one that necessitates effective health communication (9). During cancer treatment, patient–clinician communication is important to the effective management of physical and psychological symptoms (10,11). Unfortunately, despite the high incidence of fatigue, depression, and pain in cancer patients, evidence suggests that patient–physician communication regarding these symptoms is deficient (12). Studies have documented numerous barriers that contribute to negative outcomes, such as undertreated pain and increased risk of hospitalization (13,14). Yet, improving patients’ communication skills may benefit not only individual patients but also cancer care as a whole (15). Interactive health communication tools have proliferated in recent years, together with a growing trend toward empowering patients to take a more active role in treatment (16). Mobile devices have experienced tremendous growth in health-care settings (17,18). For instance, personal digital assistants (PDAs) have been used for symptom monitoring and education for patients receiving cancer treatment (19–21). Previous research has indicated that teaching effective communication strategies to patients may increase their participation in health care, in addition to improving adherence and health outcomes (22–24). To the authors’ knowledge, however, mobile devices have not been used for patient communication training (20,25–27). We designed a pilot randomized controlled trial to test the effects of a personal digital assistant–delivered communication intervention on patients’ perceptions of pain, depression, and fatigue symptoms among breast cancer patients undergoing chemotherapy. Secondary aims included assessment of 1) study feasibility, 2) patient and clinician responses to participation in the study, and 3) intervention effects on measures of health-related quality of life (HRQoL) and communication self-efficacy.