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Cited by 6Cancer survivorship and careMobile Health and mHealth ApplicationsDigital Mental Health Interventions

Addressing the unmet needs of women with breast cancer in Mexico: a non-randomised pilot study of the digital ePRO intervention

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Contreras Sánchez, Saúl Eduardo, Doubova, Svetlana V, Martinez Vega, Ingrid Patricia, Grajales Álvarez, Rocío, Villalobos Valencia, Ricardo, Dip Borunda, Abdel Karim, Lio Mondragón, Lorena, Martínez Pineda, Wendy Jazmín +14 more·2024·BMJ Open
DOI 10.1136/bmjopen-2024-087240PMC PMC11328655
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Abstract

Objectives: This study aimed to explore the acceptability, feasibility, usability, and preliminary effect of an electronic patient-reported outcome (ePRO) intervention for patients with breast cancer in Mexico. Design: We conducted a multimethod non-randomised pilot study. We used a pre-test/post-test design for quantitative assessment of the intervention’s effect on patients’ supportive care needs and quality of life. We conducted in-depth interviews (IDIs) with participants and healthcare workers to explore the intervention’s benefits and barriers and understand its feasibility. Participants: 50 women aged 20–75 diagnosed with stage I–III breast cancer were enrolled within 2 weeks of starting neoadjuvant or adjuvant treatment with chemotherapy or radiotherapy. We excluded illiterate women and those with visual impairment, cognitive disability or severe depression. IDIs were conducted with 18 participants and 10 healthcare providers. Setting: Oncology services in three public hospitals of the Mexican Social Security Institute. Intervention: The ePRO intervention consisted of a responsive web application for weekly symptom reporting combined with proactive follow-up by nurses guided by predefined clinical algorithms for 6 weeks. Results: 50 women were enrolled out of 66 eligible patients approached (75.8%). All 50 completed the 4-week follow-up assessment (100% retention). Completion of the symptom registry declined from 100% in week 1 to 66% in week 6. Participants experienced decreases in supportive care needs and increased quality of life. The ePRO application was rated highly usable. Participants and health professionals both perceived intervention benefits. Drawbacks included poor fit for women receiving radiotherapy and challenges using the application for women with low digital literacy or experiencing severe symptoms. Conclusions: This pilot study provided evidence of the high usability and potential efficacy of a web-based ePRO intervention. We revised recruitment during the pilot to include multiple facilities, and we will further revise for the randomised trial to address barriers to successful ePRO implementation. Trial registration number: ClinicalTrials.gov ID:NCT05925257.

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  • Digital literacy, language, access to devices, reliable internet connectivity, and confidence using technology affected participation across several studies.

    “Digital literacy, language, access to devices, reliable internet connectivity, and confidence using technology affected participation across several studies [25,37,46,48,50,58].”

    From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [37]

    The Results (Research area II, individual-level barriers; page unavailable) report that low digital literacy made the ePRO app difficult to use and led some women to seek help. The Methods (Quantitative stage; page unavailable) require internet access through a phone, computer or tablet for eligibility, and the Results (Research area I; page unavailable) describe the value of mobile-data support to some participants. This study does not report language barriers or show that device access, reliable connectivity, and confidence using technology each affected participation. (LLM, conf=0.87)

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Research works printed but not linked: 27

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Cited by

Sorted by citations

Authors
Contreras Sánchez, S. E., Doubova, S. V., Martinez Vega, I. P., Grajales Álvarez, R., Villalobos Valencia, R., Dip Borunda, A. K., Lio Mondragón, L., Martínez Pineda, W. J., Nuñez Cerrillo, J. G., Huerta López, A. D., Zalapa Velázquez, R., Mendoza Ortiz, V., Vázquez Zamora, V. J., Montiel Jarquín, Á. J., García Galicia, A., Talamantes Gómez, E. I., Sánchez Reyes, R., Aguirre Gómez, J., Ayala Anzures, M. E., Zapata Tarrés, M., Monroy, A., & Leslie, H. H.
Affiliations
  • Mexican Social Security Institute (MX)
  • Hospital General de México (MX)
  • University of California, San Francisco (US)
Corresponding author
Doubova, Svetlana V
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2024-06
Volume
14
Issue
6
Pages
e087240
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2024-087240
PMC
PMC11328655
OpenAlex
W4399921374
Cited by
6
References
5
Citations by year
2026: 3 · 2025: 3
FWCI
1.02
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Research Funding Program of the Mexican Institute of Social Security (N/A)
  • University of California San Francisco (UCSF) Global Cancer Program at the Helen Diller Family Comprehensive Cancer Care Center and the UCSF Academic Senate Committee (N/A)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
breast cancer, electronic patient-reported outcomes, supportive care needs, quality of life, symptom reporting, online intervention, usability, digital literacy, nurse follow-up, clinical algorithms, radiotherapy, chemotherapy, women with cancer, Mexico
MeSH terms
Patient Reported Outcome Measures, Internet-Based Intervention, Adult, Aged, Breast Neoplasms, Feasibility Studies, Female, Humans, Mexico, Middle Aged, Pilot Projects, Quality of Life, Young Adult

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