Design and evaluation of a novel mobile phone application to improve palliative home-care in resource-limited settings.

Abstract Context Mobile health (mhealth) provides an opportunity to utilise internet coverage in low and middle income countries (LMICs) to improve palliative care access and quality. Objectives This study aimed to design a mobile phone application (app) to enable or improve communication between family caregivers, community caregivers, and palliative care teams; to evaluate its acceptability, processes, and mechanisms of action; and to propose refinements. Methods A co-design process entailed collaboration between a Project Advisory Group and collaborators in India, Uganda and Zimbabwe. We then trained community and family caregivers to use an app to communicate patient-reported outcomes to their palliative care providers each week on a data dashboard. App activity was monitored, and qualitative in-depth interviews explored experience with the app and its mechanisms and impact. Results N=149 caregivers participated and uploaded n=837 assessments of patient-reported outcomes. These data were displayed to the palliative care team on an outcomes dashboard on n=355 occasions. Qualitative data identified: 1) high acceptability and data usage; 2) improved understanding by team members of patient symptoms and concerns; 3) A need for better feedback to caregivers, for better prioritisation of patients according to need, for enhanced training and support to use the app, and for user-led recommendations for ongoing improvement. Conclusion An outcomes-focused app and data dashboard are acceptable to caregivers and health care professionals. They are beneficial in identifying, monitoring and communicating patient outcomes, and in allocating staff resource to those most in need.