Effects of an interactive mHealth innovation for early detection of patient-reported symptom distress with focus on participatory care: protocol for a study based on prospective, randomised, controlled trials in patients with prostate and breast cancer
Open accessAbstract
BACKGROUND: Cancer patients are predominantly treated as out-patients and as they often experience difficult symptoms and side effects it is important to facilitate and improve patient-clinician communication to support symptom management and self-care. Although the number of projects within supportive cancer care evaluating mobile health is increasing, few evidence-based interventions are described in the literature and thus there is a need for good quality clinical studies with a randomised design and sufficient power to guide future implementations. An interactive information and communications technology platform, including a smartphone/computer tablet app for reporting symptoms during cancer treatment was created in collaboration with a company specialising in health care management. The aim of this paper is to evaluate the effects of using the platform for patients with breast cancer during neo adjuvant chemotherapy treatment and patients with locally advanced prostate cancer during curative radiotherapy treatment. The main hypothesis is that the use of the platform will improve clinical management, reduce costs, and promote safe and participatory care. METHOD: The study is a prospective, randomised, controlled trial for each patient group and it is based on repeated measurements. Patients are consecutively included and randomised. The intervention groups report symptoms via the app daily, during treatment and up to three weeks after end of treatment, as a complement to standard care. Patients in the control groups receive standard care alone. Outcomes targeted are symptom burden, quality of life, health literacy (capacity to understand and communicate health needs and promote healthy behaviours), disease progress and health care costs. Data will be collected before and after treatment by questionnaires, registers, medical records and biomarkers. Lastly, participants will be interviewed about participatory and meaningful care. DISCUSSION: Results will generate knowledge to enhance understanding about how to develop person-centred care using mobile technology. Supporting patients' involvement in their care to identify problems early, promotes more timely initiation of necessary treatment. This can benefit patients treated outside the hospital setting in regard to maintaining their safety. CLINICAL TRIAL REGISTRATION: June 12 2015 NCT02477137 (Prostate cancer) and June 12 2015 NCT02479607 (Breast cancer).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Researchers evaluated a range of measures that aligned with their target chronic condition, such as blood glucose, weight, symptoms, patient-reported outcomes, diary entries, and steps.
“Researchers evaluated a range of measures that aligned with their target chronic condition, such as blood glucose [56,60,61,64,73], weight [56,73,74], symptoms [66,68,69], patient-reported outcomes [38,46,52,65,71], diary entries [47,66], and steps [51].”
From A Library of Analytic Indicators to Evaluate Effective Engagement with Consumer mHealth Apps for Chronic Conditions: Scoping Review (2019) · cites this paper as [69]
Reviewed studies assessed the number of videos watched from a playlist, educational modules completed, or self-care advice accessed.
“Others assessed the number of videos watched from a playlist [36,55], educational modules completed [52], or self-care advice accessed [69].”
From A Library of Analytic Indicators to Evaluate Effective Engagement with Consumer mHealth Apps for Chronic Conditions: Scoping Review (2019) · cites this paper as [69]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D. M., Forman, D., & Bray, F. (2015) · International Journal of Cancer · doi:10.1002/ijc.29210 · Cited by 28,766 · see citing works
The qualitative content analysis process
Elo, S., & Kyngäs, H. (2008) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2007.04569.x · Cited by 22,617 · see citing works
Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., Filiberti, A., Flechtner, H., Fleishman, S. B., Haes, J. C. J. M. D., et al. (1993) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/85.5.365 · Cited by 16,005 · see citing works
Developing and evaluating complex interventions: the new Medical Research Council guidance
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008) · BMJ · doi:10.1136/bmj.a1655 · Cited by 10,995 · see citing works
Unraveling the Mystery of Health: How People Manage Stress and Stay Well
Antonovsky, A. (2002) · SAGE Publications Ltd eBooks · doi:10.4135/9781446221129.n9 · Cited by 5,525 · see citing works
U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research, U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research, & U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health (2006) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-4-79 · Cited by 2,856 · see citing works
Basch, E., Deal, A. M., Kris, M. G., Scher, H. I., Hudis, C. A., Sabbatini, P., Rogak, L., Bennett, A. V., Dueck, A. C., Atkinson, T. M., et al. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2015.63.0830 · Cited by 2,593 · see citing works
Hagenaars, J. A. P., & McCutcheon, A. L. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511499531 · Cited by 1,983 · see citing works
Collins, G. S., Reitsma, J. B., Altman, D. G., & Moons, K. (2015) · BMC Medicine · doi:10.1186/s12916-014-0241-z · Cited by 1,927 · see citing works
Developing and evaluating complex interventions: the new Medical Research Council guidance
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.09.010 · Cited by 1,658 · see citing works
Portenoy, R. K., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., Sobel, K., Coyle, N., Kemeny, N. E., Norton, L., et al. (1994) · European Journal of Cancer · doi:10.1016/0959-8049(94)90182-1 · Cited by 1,580 · see citing works
Bolla, M., González, D., Warde, P. R., Dubois, J. B., Mirimanoff, R., Storme, G. A., Bernier, J., Kuten, A., Sternberg, C. N., Gil, T., et al. (1997) · New England Journal of Medicine · doi:10.1056/nejm199707313370502 · Cited by 1,547 · see citing works
Validity of Antonovsky’s sense of coherence scale: a systematic review
Eriksson, M., & Lindström, B. (2005) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2003.018085 · Cited by 1,542 · see citing works
Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data
Cnaan, A., Laird, N. M., & Slasor, P. (1997) · Statistics in Medicine · doi:10.1002/(sici)1097-0258(19971030)16:20 · Cited by 1,227 · see citing works
Kotronoulas, G., Kearney, N., Maguire, R., Harrow, A., Domenico, D. D., Croy, S., & MacGillivray, S. A. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2013.53.5948 · Cited by 953 · see citing works
Employment and work-related issues in cancer survivors
Mehnert, A. (2010) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2010.01.004 · Cited by 827 · see citing works
Chen, J., Ou, L., & Hollis, S. J. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-211 · Cited by 796 · see citing works
Valderas, J. M., Kotzeva, A., Espallargues, M., Guyatt, G., Ferrans, C. E., Halyard, M. Y., Revicki, D. A., Symonds, T., Parada, A., & Alonso, J. (2008) · Quality of Life Research · doi:10.1007/s11136-007-9295-0 · Cited by 775 · see citing works
Mobile medical and health apps: state of the art, concerns, regulatory control and certification
Kamel Boulos, M. N., Brewer, A. C., Karimkhani, C., Buller, D. B., & Dellavalle, R. P. (2014) · Online Journal of Public Health Informatics · doi:10.5210/ojphi.v5i3.4814 · Cited by 659 · see citing works
O’Connor, S., Hanlon, P., O’Donnell, C. A., Garcia, S., Glanville, J., & Mair, F. S. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0359-3 · Cited by 636 · see citing works
Telemedicine, Telehealth, and Mobile Health Applications That Work: Opportunities and Barriers
Weinstein, R. S., López, A. M., Joseph, B. A., Erps, K. A., Holcomb, M. J., Barker, G. P., & Krupinski, E. A. (2013) · The American Journal of Medicine · doi:10.1016/j.amjmed.2013.09.032 · Cited by 595 · see citing works
Mapping mHealth research: a decade of evolution
Fiordelli, M., Diviani, N., & Schulz, P. J. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2430 · Cited by 570 · see citing works
Howell, D., Molloy, S., Wilkinson, K., Green, E., Orchard, K., Wang, K., & Liberty, J. (2015) · Annals of Oncology · doi:10.1093/annonc/mdv181 · Cited by 538 · see citing works
WorldWide Antimalarial Resistance Network (WWARN) Lumefantrine PK/PD Study Group (2015) · BMC Medicine · doi:10.1186/s12916-015-0456-7 · Cited by 467 · see citing works
Broos, A. (2005) · CyberPsychology & Behavior · doi:10.1089/cpb.2005.8.21 · Cited by 359 · see citing works
Understanding critical health literacy: a concept analysis
Sykes, S., Wills, J., Rowlands, G., & Popple, K. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-150 · Cited by 351 · see citing works
Review of Electronic Patient-Reported Outcomes Systems Used in Cancer Clinical Care
Jensen, R. E., Snyder, C. F., Abernethy, A. P., Basch, E., Potosky, A. L., Roberts, A. C., Loeffler, D. R., & Reeve, B. B. (2014) · Journal of Oncology Practice · doi:10.1200/jop.2013.001067 · Cited by 296 · see citing works
Montazeri, A., Vahdaninia, M., Harirchi, I., Ebrahimi, M., Khaleghi, F., & Jarvandi, S. (2008) · BMC Cancer · doi:10.1186/1471-2407-8-330 · Cited by 283 · see citing works
Troublesome Symptoms in Cancer Survivors: Fatigue, Insomnia, Neuropathy, and Pain
Pachman, D. R., Barton, D. L., Swetz, K. M., & Loprinzi, C. L. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2012.41.7238 · Cited by 282 · see citing works
Users of Internet Health Information: Differences by Health Status
Houston, T. K., & Allison, J. J. (2002) · Journal of Medical Internet Research · doi:10.2196/jmir.4.2.e7 · Cited by 252 · see citing works
Health literacy – a heterogeneous phenomenon: a literature review
Mårtensson, L. I., & Hensing, G. K. E. (2011) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2011.00900.x · Cited by 240 · see citing works
Symptom Experience and Quality of Life of Women Following Breast Cancer Treatment
Janz, N. K., Mujahid, M. S., Chung, L. K., Lantz, P. M., Hawley, S. T., Morrow, M., Schwartz, K., & Katz, S. J. (2007) · Journal of Women s Health · doi:10.1089/jwh.2006.0255 · Cited by 233 · see citing works
Emergency department visits for symptoms experienced by oncology patients: a systematic review
Vandyk, A. D., Harrison, M. B., Macartney, G. M., Ross‐White, A., & Stacey, D. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1459-y · Cited by 230 · see citing works
Effects of an Internet Support System to Assist Cancer Patients in Reducing Symptom Distress
Ruland, C. M., Andersen, T., Jeneson, A., Moore, S. M., Grimsbø, G. H., Børøsund, E., & Ellison, M. C. (2012) · Cancer Nursing · doi:10.1097/ncc.0b013e31824d90d4 · Cited by 219 · see citing works
Determinants of Internet use as a preferred source of information on personal health
Lemire, M., Paré, G., Sicotte, C., & HARVEY, C. (2008) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2008.03.002 · Cited by 219 · see citing works
A Review of the Prevalence and Impact of Multiple Symptoms in Oncology Patients
Kim, J.-E. E., Dodd, M. J., Aouizerat, B. E., Jahan, T. M., & Miaskowski, C. A. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2008.04.018 · Cited by 209 · see citing works
Hopwood, P., Haviland, J., Mills, J., Sumo, G., & Bliss, J. M. (2007) · The Breast · doi:10.1016/j.breast.2006.11.003 · Cited by 206 · see citing works
Gewandter, J. S., Fan, L., Magnuson, A. M., et al. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1766-y · Cited by 172 · see citing works
Schougaard, L. M. V., Larsen, L. P., Jessen, A., Sidenius, P., Dørflinger, L., de Thurah, A. L., & Hjøllund, N. H. (2016) · Quality of Life Research · doi:10.1007/s11136-015-1207-0 · Cited by 158 · see citing works
Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study
McKenzie, H. A., Hayes, L. J., White, K., et al. (2010) · Supportive Care in Cancer · doi:10.1007/s00520-010-0913-y · Cited by 154 · see citing works
The Role of Mobile Technologies in Health Care Processes: The Case of Cancer Supportive Care
Nasi, G., Cucciniello, M., & Guerrazzi-Young, C. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3757 · Cited by 153 · see citing works
Børøsund, E., Cvancarova, M., Moore, S. M., Ekstedt, M., & Ruland, C. M. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3348 · Cited by 148 · see citing works
Rai, A., Chen, L., Pye, J., & Baird, A. M. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2635 · Cited by 140 · see citing works
Development and psychometric properties of the Individualized Care Scale
Suhonen, R., Leino‐Kilpi, H., & Valimaki, M. A. (2005) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2003.00481.x · Cited by 137 · see citing works
Browall, M., Ahlberg, K., Karlsson, P., Danielson, E., Persson, L., & Gaston‐Johansson, F. (2008) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2008.01.005 · Cited by 126 · see citing works
Development of a Novel Remote Patient Monitoring System
Maguire, R., Ream, E., Richardson, A. M., Connaghan, J., Johnston, B. M., Kotronoulas, G., Pedersen, V. H., McPhelim, J., Pattison, N. A., Smith, A., et al. (2014) · Cancer Nursing · doi:10.1097/ncc.0000000000000150 · Cited by 120 · see citing works
Cooper, A. F., Hankins, M. C., Rixon, L., Eaton, E., & Grunfeld, E. A. (2012) · Psycho-Oncology · doi:10.1002/pon.3049 · Cited by 102 · see citing works
Sundberg, K. K., Wengström, Y., Blomberg, K., Nyman, M. H., Frank, C., & Langius‐Eklöf, A. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3625-8 · Cited by 98 · see citing works
Self-citationBennion, A. E., & Molassiotis, A. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1573-x · Cited by 96 · see citing works
Børøsund, E., Cvancarova, M., Ekstedt, M., Moore, S. M., & Ruland, C. M. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2285 · Cited by 80 · see citing works
Fransson, P.-A., Lund, J., Damber, J. ‐., Klepp, O., Wiklund, F. E., Fosså, S. D., & Widmark, A. (2009) · The Lancet Oncology · doi:10.1016/s1470-2045(09)70027-0 · Cited by 80 · see citing works
Spichiger, E., Rieder, E., Müller-Fröhlich, C., & Kesselring, A. (2012) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2011.05.002 · Cited by 63 · see citing works
Quality of Life for Men With Prostate Cancer
Katz, A. (2007) · Cancer Nursing · doi:10.1097/01.ncc.0000281726.87490.f2 · Cited by 62 · see citing works
Johnsen, A. T., Petersen, M. A., Pedersen, L., Houmann, L. J., & Grøenvold, M. (2012) · Psycho-Oncology · doi:10.1002/pon.3204 · Cited by 59 · see citing works
A perspective on the role of quality-of-life assessment in clinical trials
Pocock, S. J. (1991) · Controlled Clinical Trials · doi:10.1016/s0197-2456(05)80029-7 · Cited by 56 · see citing works
Measuring health literacy – the Swedish Functional Health Literacy scale
Wångdahl, J. M., & Mårtensson, L. I. (2014) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12125 · Cited by 55 · see citing works
Sprangers, M. A. G. (2010) · Acta Oncologica · doi:10.3109/02841860903440288 · Cited by 55 · see citing works
Emergency oncology: development, current position and future direction in the USA and UK
Cooksley, T., & Rice, T. W. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3470-1 · Cited by 50 · see citing works
Sundberg, K. K., Langius‐Eklöf, A., Blomberg, K., Isaksson, A., & Wengström, Y. (2015) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2015.02.013 · Cited by 48 · see citing works
Self-citationDesigning tailored Internet support to assist cancer patients in illness management.
Ruland, C. M., Jeneson, A., Andersen, T., Andersen, R., Slaughter, L. A., Bente-Schjødt-Osmo, & Moore, S. M. (2007) · PubMed Central · Cited by 43 · see citing works
van der Meer, D. M., Weiland, T. J., Philip, J. A. M., et al. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2921-4 · Cited by 38 · see citing works
Blomberg, K., Wengström, Y., Sundberg, K. K., Browall, M., Isaksson, A., Nyman, M. H., & Langius‐Eklöf, A. (2015) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2015.09.004 · Cited by 35 · see citing works
Self-citationSymptom self‐management strategies in patients with non‐metastatic prostate cancer
Hsiao, C., Moore, I. M., Insel, K. C., & Merkle, C. J. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12178 · Cited by 33 · see citing works
The Challenge of Individualizing Treatments for Patients With Breast Cancer
Morrow, M. (2012) · JAMA · doi:10.1001/jama.2012.409 · Cited by 32 · see citing works
European Commission activities in eHealth*
Olsson, S., Lymberis, A., & Whitehouse, D. (2004) · International Journal of Circumpolar Health · doi:10.3402/ijch.v63i4.17747 · Cited by 29 · see citing works
Howlett, K., Koetters, T., Edrington, J., West, C. M., Paul, S. M., Lee, K. A., Aouizerat, B. E., Wara, W., Swift, P. S., & Miaskowski, C. A. (2009) · Oncology nursing forum · doi:10.1188/10.onf.e58-e66 · Cited by 26 · see citing works
Riva, S., Iannello, P., Pravettoni, G., & Antonietti, A. (2015) · Patient Preference and Adherence · doi:10.2147/ppa.s90207 · Cited by 26 · see citing works
Drott, J., Wilhelmson, M., Kjellgren, K. I., & Berterö, C. (2016) · JMIR mhealth and uhealth · doi:10.2196/mhealth.5426 · Cited by 26 · see citing works
Making sense of technology adoption in healthcare: meso-level considerations
May, C. R. (2015) · BMC Medicine · doi:10.1186/s12916-015-0305-8 · Cited by 25 · see citing works
Toxicity-Related Factors Associated With Use of Services Among Community Oncology Patients
Harrison, J. M., Stella, P. J., Lavasseur, B. I., Adams, P. T., Swafford, L., Lewis, J., Mendelsohn‐Victor, K., & Friese, C. R. (2016) · Journal of Oncology Practice · doi:10.1200/jop.2016.010959 · Cited by 21 · see citing works
Zhao, S. S., Urdaneta, A. I., & Anscher, M. S. (2016) · Expert Review of Anticancer Therapy · doi:10.1080/14737140.2016.1218279 · Cited by 4 · see citing works
Valuing Diagnostic Innovations: Towards Responsible Health Technology Assessment
Moors, E. H. M., & Peine, A. (2016) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-54097-3_13 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pham, Q., Graham, G., Carrion, C., Morita, P. P., Seto, E., Stinson, J. N., & Cafazzo, J. A. (2019) · JMIR mHealth and uHealth · doi:10.2196/11941 · Cited by 131 · see citing works
- Authors
- Langius-Eklöf, A., Crafoord, M.-T., Christiansen, M., Fjell, M., & Sundberg, K.
- Affiliations
- Karolinska Institutet (SE)
- Venue
- BMC Cancer
- Published
- 2017-07-04
- Volume
- 17
- Issue
- 1
- Pages
- 466-466
- ISSN
- 1471-2407 (ISSN-L)
- PMC
- PMC5496395
- OpenAlex
- W2732199202
- Cited by
- 51
- References
- 72
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 1 · 2020: 10 · 2019: 5 · 2018: 5
- FWCI
- 8.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Cancer (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DiVA (University of Gävle) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Familjen Kamprads stiftelse (20150015)
- Vetenskapsrådet (521-2014-2723)
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd (2014-4713)
- Cancerfonden (140711)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mobile health, symptom distress, early detection, participatory care, person-centred care, breast cancer, prostate cancer, neoadjuvant chemotherapy, radiotherapy, patient-clinician communication, health literacy, quality of life, health care costs, cancer supportive care, self-care
- MeSH terms
- Patient Reported Outcome Measures, Breast Neoplasms, Clinical Protocols, Female, Humans, Male, Prostatic Neoplasms, Outcome Assessment, Health Care, Telemedicine, Early Detection of Cancer, Workflow, Health Communication, Standard of Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review