The object of this proposal is to develop and pilot I-STAMP (Integrated Smartphone Technology to Alleviate Malignant Pain), an EHR-integrated mobile health (mHealth) application designed to support patients and care teams in the management of advanced cancer pain. Pain is among the most common and feared symptoms of cancer, affecting over two-thirds of patients with advanced disease. Pain takes a major toll on patients’ quality of life and is a leading cause of emergency department visits and hospitalizations. Managing cancer pain is complex and stressful for patients who are often given multiple opioid and non-opioid analgesics, which provide unpredictable relief, and cause bothersome side effects. Patients largely learn to self-manage by trial and error and receive little education or structured support from cancer care teams. Although opioids require close monitoring and frequent dose titration, there is a lack of existing tools to allow care teams to proactively monitor and support patients.
 
In response, our team at Dana-Farber has developed STAMP, a novel mobile health (mHealth) application designed to optimize opioid management for advanced cancer pain. STAMP includes a patient-facing smartphone app that hosts patients’ analgesics and laxatives (for opioid-induced constipation); adaptive symptom and medication-use surveys generate tailored psychoeducation and self-management support. STAMP features a wide array of patient-centered multimedia content supporting pharmacologic and behavioral aspects of self-management. A HIPPA-compliant clinician portal provides real-time information about patients’ symptoms and medication use to support timely outreach and medication changes. In a recent pilot study involving 20 patients with pain-related advanced cancer and their care providers, STAMP was found to be highly acceptable and useful. However, the lack of EHR integration was seen as an important limitation.
 
Building upon this strong existing intervention, I-STAMP will import supportive care medications from the EHR, assess their use and effects within the context of symptom reporting, and offer patients real-time coaching and medication advice for pain and opioid-induced constipation. EHR-compatible notes/reports will facilitate clinical documentation and lay the groundwork for bi-directional EHR integration. Development of I-STAMP will involve a rigorous 5-phase research process with extensive patient/clinician review and revisions. This new EHR-integrated tool will be programmed using CardinalKit, an open-source code base designed to promote digital health innovation. Where possible, it will also contribute back new “modules” of open-source code related to secure integration with a leading EHR. After developing and refining I-STAMP, we will conduct a small pre-pilot involving 10 advanced cancer patients and their care teams to identify optimization needs and plan for efficacy testing and dissemination. Our ultimate goal is to produce an efficacious and scalable mHealth intervention that makes a large impact on cancer pain. I-STAMP could also become a useful platform to accelerate the development of other digital symptom management interventions.