The app industry has its sights set on health care, and it’s targeting more than the latest fitness tracker. Mobile applications may soon play an integral role in pain management.
A preliminary assessment of Panda, a smartphone app designed to aid parents in managing their child’s postoperative pain, has yielded positive feedback from users. Given Panda’s success in the controlled setting of the hospital, researchers are planning an at-home feasibility trial.
“Parents found Panda easy to learn and easy to interact with,” said Matthias Görges, PhD, assistant professor of anesthesiology, pharmacology and therapeutics at the University of British Columbia and an investigator at BC Children’s Hospital, in Vancouver. “We’ve since added prerecorded videos that provide more detailed answers to questions. The next step is to test our app at home with parents to determine if it’s safe and feasible.”
As Dr. Görges reported at the 2017 annual meeting of the International Anesthesia Research Society (abstract 4204), the shift to outpatient surgery has placed a greater burden on caregivers to manage postoperative pain at home, but recent studies have identified barriers to effective care (Paediatr Anaesth 2014;24:239-248). Furthermore, research has shown that inadequate pain control can lead to slower recovery and long-term detrimental effects.
“We know that suffering from postoperative pain is associated with a lot of undesired outcomes,” Dr. Görges said. “Additionally, we know from audits that parents are not always great at following or understanding instructions when it comes to pain management and administering medication.”
Researchers at the University of British Columbia designed Panda to help parents assess their child’s pain, administer pain medications at appropriate times, and track pain scores and medications given. As Dr. Görges explained, “Panda supports parental decision making with the goal of reducing unnecessary and severe postoperative pain experienced by children.” The flowchart of Panda is shown in the Figure.
Dr. Görges and his colleagues enrolled 20 parents of children admitted to the ward for an overnight stay. Before the stay, parents were shown a brief introductory video and received basic training on the application. Parents were then left with Panda overnight and responded to scheduled medication alerts.
Despite these prompts, it was the nurses—not the parents—who ultimately administered pain medications, which was required per hospital policy. While nurses followed standard procedures, parents went through medication safety checks and used the app to keep track of pain scores. All screen interactions were recorded by the app, and after use, parents completed a questionnaire and interview about their experience.
Easy to Learn and Navigate
As Dr. Görges reported, a total of 20 parents participated in the study, all of whom had previously operated a smartphone. Eighteen of 20 participants (90%) rated themselves as having medium to high knowledge regarding mobile technology. In total, 90 of 114 medication alerts (79%) were responded to before the next alert occurred, but only 72 (63%) of the alerts provoked a response within an hour.
When asked if they would use the Panda app at home, 70% of patients answered yes, with the majority indicating that the app was both “easy to learn” and “easy to navigate.”
While the interface was generally easy to use, when problems were encountered it was not always obvious how to resolve them. “We still need to work on providing support for parents who might have questions,” said Dr. Görges, who noted that prerecorded videos now provide more detailed explanations. “Some parents also indicated that notifications were not loud or long enough, and there was some confusion surrounding generic drug names.”
The researchers hope that the app may one day be responsive to patient needs. If pain scores exceed a certain threshold, for example, the app might encourage parents to call the hospital or automatically adjust medication, but these features are still hypothetical. The next step in the app’s development is to demonstrate efficacy in the outpatient setting.
“We didn’t change any hospital policies with this study,” said Dr. Görges, referring to the actual administration of pain medication. “We wanted to demonstrate efficacy in a safe setting [the hospital] first before we felt comfortable sending parents home with the app, but we’re testing Panda with parents in the outpatient setting … to determine if it’s safe and feasible.”
The moderator of the session, Anis Dizdarevic, MD, assistant professor of anesthesiology and pain management at NewYork-Presbyterian/Columbia University Medical Center, in New York City, commended the app’s incorporation of education and instruction. “It would also be great to have these data tied to physicians as a portal so providers can follow the trends post-op,” he said.
“We’re considering that feature,” Dr. Görges said. “We do follow up with some patients, but for the most part, after they leave the hospital, we have no idea how they’re doing. We could also use this app for personalized feedback, so that providers could be aware of their patients’ pain control outside of the hospital and modify prescriptions if needed.”