Desiree R. Azizoddin

Background: Palliative care is a key component of comprehensive humanitarian health; yet, access and service capacity remain limited in displacement settings, where fragile health systems struggle to meet the complex needs of people living with advanced illness. Digital health technologies have the potential to enhance the reach and delivery of palliative care; yet, their feasibility and acceptability in humanitarian settings remain underexplored. Objective: We evaluated the feasibility and acceptability of mPallCare, a mobile health intervention integrating patient-reported symptom and outcome monitoring with a clinician dashboard, to support palliative care delivery in the Bidibidi Refugee Settlement, Uganda. Methods: A 6-week, uncontrolled, exploratory concurrent mixed methods feasibility study was conducted, involving 32 participants with advanced cancer. Community health workers (ie, village health teams) used the mobile app to document patient-reported symptoms and multidimensional outcomes, which were accessible to clinical teams via a dashboard. Following the use of mPallCare, patient and clinical team participants participated in face-to-face interviews. Data collected via mPallCare were analyzed using descriptive statistics to assess feasibility (ie, compliance with reporting, with a feasibility threshold of ≥65% of scheduled reports), and interview data from a subsample of patient and clinical team participants were analyzed using framework analysis to assess acceptability. Results: Participants completed 84.9% (163/192) of symptom reports and 59.4% (266/448) of outcome reports, with a combined 67% (429/640) of all scheduled reports completed. A modest decline in engagement with report submissions occurred across the 6-week study period. Commonly reported symptoms included headache (27/32, 84.4%), muscle pain (27/32, 84.4%), and dizziness (26/32, 81.3%). Interview findings indicated strong acceptability among patients and clinicians, who described improved communication, enhanced symptom management, and greater continuity of care. Reported challenges included initial navigation difficulties, limited translation accuracy, and technical synchronization issues. Participants and clinical leaders identified the potential for integrating mPallCare within Uganda’s district health information system to strengthen data use and visibility of palliative care within health reporting structures. Conclusions: mPallCare is a feasible and acceptable digital health intervention for palliative care in a humanitarian setting. While initial uptake was high, sustaining engagement over time may require simplified reporting processes, enhanced language accessibility, and optimizing the mobile app’s connectivity and usability. This feasibility phase highlights key priorities for scale-up, including integration with existing health information systems and adaptation for sustained, equitable use across low-resource and displaced populations.

PURPOSE: In advanced cancer, pain symptoms, opioid use, and cognitive-emotional processes fluctuate day to day and may mutually reinforce one another. We used 28-day ecological momentary assessments (EMAs) to quantify within-person associations between daily pain and (a) interference, (b) opioid use and perceived efficacy, and (c) mood, and to test whether variability in pain catastrophizing moderates these associations. METHODS: Patients with advanced cancer receiving outpatient oncology care at a comprehensive cancer center completed once-daily EMAs for 28 days (N = 26 analyzed). Measures included worst/average/least pain, pain interference, short-acting opioid tablets (count) and perceived opioid efficacy, negative and positive affect, and daily catastrophizing. Multilevel models estimated same-day within-person associations, controlling for study day and between-person mean pain. Individuals' standard deviation of daily catastrophizing changes (catastrophizing variability) was tested as a moderator. RESULTS: Across 477 daily assessments (median 21/28 per participant), higher-than-usual worst pain was consistently associated with worse pain interference, higher short-acting opioid use, lower perceived opioid efficacy, and higher negative affect (all P < .01); Average and least pain showed smaller or nonsignificant effects. Greater day-to-day variability in catastrophizing was associated with worse pain. Among individuals whose pain catastrophizing fluctuated more, there was a stronger relationship between pain severity and interference, affect, and perceived opioid efficacy (inverse; P ≤ .01). CONCLUSION: Greater day-to-day fluctuations in pain catastrophizing were associated with magnified correspondence of pain severity with interference, mood disruption, and perceived opioid inefficacy. Routine monitoring of pain severity combined with tracking catastrophizing variability may help identify high-risk days and inform in-the-moment support to better personalize pain management.

Background: Pain is common among patients with advanced cancer and is often inadequately controlled. Opioids are central to treatment; yet, self-management is challenging, and clinicians lack scalable tools to monitor and support patients between visits. Objective: This study aimed to evaluate the feasibility and acceptability of MyPainPal (Dana-Faber Cancer Institute), a novel mobile health app designed to optimize cancer pain management. MyPainPal combines daily surveys assessing symptoms and analgesic use, algorithmic self-management support, tailored psychoeducation, and clinician monitoring. Secondary objectives were to explore preliminary clinical impact and identify priorities for refinement. Methods: This single-arm pilot study enrolled adults with advanced malignancies using opioids for moderate-to-severe pain from an outpatient palliative care clinic at a comprehensive cancer center. Participants used MyPainPal for 28 days while nurses monitored symptom responses via a secure portal, and also completed structured surveys at end-of-study. Primary assessment of usability and acceptability included the System Usability Scale (SUS; range 0-100), the Acceptability E-Scale (range 6-30), and ratings of satisfaction using a 5-point Likert scale. Semistructured debriefing interviews explored user experience, perceived impact, and suggestions for optimization. Results: Twenty participants with advanced cancer enrolled, with a mean age of 57 (SD 12.3) years, 55% (11/20) female, 80% (16/20) non-Hispanic White, with mixed cancer types. Over the 28-day study, patients logged into MyPainPal a median of 14 (IQR 8-17) times, and completed a median of 8 (IQR 5-14) symptom surveys, reflecting mean of 36% (SD 20%) of eligible (out-of-hospital) days on study. Usability and acceptability ratings of MyPainPal were high (mean SUS 78.3, SD 16.2; mean Acceptability E-Scale 24.0, SD 4.4); 79% rated overall satisfaction of greater than or equal to 4/5. Twenty percent of surveys generated an alert, prompting nurse outreach. In response, 5 participants had symptom medications changed and 2 had medication errors corrected. In debriefing interviews, many participants described that the intervention reduced barriers to pain reporting and facilitated timely and constructive interactions with care teams for symptom management. Several noted that the intervention validated their pain experience, reduced stigma around opioid use, enabled constructive conversations with providers, and promoted self-management. Patients recommended several survey modifications, including reducing their frequency and enabling more nuanced pain assessments. Participants underused the educational resources and suggested that they be featured more prominently. Some patients suggested that the MyPainPal app should be introduced earlier in patients’ cancer pain trajectory when pain needs are higher and opioid management is novel. Conclusions: In this pilot study, MyPainPal demonstrated feasibility, acceptability, and preliminary evidence of potential clinical impact among patients with advanced cancer receiving palliative care. The app has been rebuilt and optimized with attention to patient feedback and in preparation for a future efficacy study. Trial Registration: ClinicalTrials.gov NCT03717402; https://clinicaltrials.gov/study/NCT03717402

PURPOSE: Patients with advanced cancer often experience pain symptoms. Pain-cognitive behavioral therapy (pain-CBT) represents an effective psychological treatment for chronic pain, yet access remains limited. We conducted a pilot study to assess the feasibility and acceptability of a mobile health (mHealth) intervention that integrates pain-CBT with opioid education and tracking to improve chronic pain management in patients with advanced cancer. METHODS: Adults with advanced cancer and pain (≥4/10, Numeric Rating Scale) using opioids tested the smartphone-based intervention for 28 days, completed baseline, end-of-study, and 2-week postintervention surveys, and participated in optional qualitative interviews. The intervention assessed pain, mood, catastrophizing, sleep, and opioid use, and provided tailored just-in-time adaptive interventions, and daily psychoeducation (articles, serious game). We assessed feasibility (≥50% app-use), acceptability (acceptability E-scale), and pre-post intervention changes in pain, and conducted thematic analysis of perceived impact and usefulness. RESULTS: Among 64 eligible patients, 32 (mean age, 55.41 years; 55% female; 32% rural-dwelling) enrolled. Of those, 59% (n = 19) used the app ≥50% of days on study, and rated the intervention with good acceptability (mean, 24.85; standard deviation, 3.72). Nonsignificant reductions in pain intensity, pain interference, and pain catastrophizing were observed from baseline to 4- and 6-week follow-ups. In debriefing interviews, patients described that the intervention contributed to pain self-management knowledge, promoted pain coping skills, and reduced opioid stigma. CONCLUSION: Study results support feasibility and acceptability of a pain-CBT intervention for patients with advanced cancer pain. Although exploratory analyses showed nonsignificant improvements in pain outcomes, qualitative findings indicate meaningful engagement and skill development. Future testing is needed to determine intervention efficacy.

Cancer pain is a complex, multifactorial, and growing public health challenge affecting millions of Americans. Effective pain management is essential for comprehensive cancer care, influencing physical and mental health, quality of life, and functional ability. However, progress in cancer pain management is hindered by the complexity of the issue and a fragmented understanding of the myriad factors shaping the pain experience. Additionally, traditional pain terminology—“acute” (<6 months) and “chronic” pain (≥6 months)—offers limited utility in cancer contexts, highlighting the need for a more nuanced framework. To address this gap, we propose the 3P‐CP model, which conceptualizes cancer pain through three interconnected phases: predisposing factors that increase cancer pain risk, precipitating factors that trigger cancer pain onset, and perpetuating factors that sustain or exacerbate cancer pain over time. This model provides a structured approach to assess the dynamic nature of cancer pain across the entirety of the cancer trajectory. In this paper, key factors associated with each phase of the 3P‐CP model are outlined and their implications for research and clinical care explored. Aligning with the oncology field's shift toward precision medicine, the 3P‐CP model has the potential to guide comprehensive assessment, risk mitigation, prevention, and intervention strategies—supporting efforts to deliver the right targeted and tailored treatments, to the right patients, at the right time.