Usability and Usefulness Testing of a Symptom Management and Coaching System for Cancer Patients treated with Immune Checkpoint Inhibitors: a Comparative Qualitative Study (Preprint)

Abstract

The prognosis for patients with several types of cancer has substantially improved since the introduction of immune checkpoint inhibitors. However, patients may experience symptoms both from the cancer itself and from the medication. EHealth applications can help support patients, their informal caregivers, and care providers during cancer treatment and follow-up. A prototype of the eHealth tool Cancer Patients Better Life Experience (CAPABLE) was developed to facilitate symptom reporting, patient education, and wellbeing interventions, aimed for melanoma and renal cell carcinoma patients treated with immunotherapy.

To evaluate the CAPABLE prototype by conducting tests to assess usability, user experience and perceived acceptability amongst end-users, and secondarily to assess any agreements or differences in the results of our wide range of participants.

This usability study was executed by interviewing patients with melanoma, renal cell carcinoma or other cancer types. Participants were asked to give their opinion on the concept of the tool, to perform think-aloud tasks and to complete the System Usability Scale and a Perceived Usefulness questionnaire. The interviews were analyzed by independent coding. The extracted usability problems were mapped to an eHealth Usability Problem Framework.

We included 21 participants in the study, aged 29 to 73 years; 13 melanoma or renal cell carcinoma patients who had received immunotherapy and 8 patients with other types of cancer who had not received immunotherapy. In total, 76 usability issues were identified. Most usability problems were in the task-technology fit category of the framework. Critical problems regarding the symptom monitoring functionality were mainly found by participants who had received immunotherapy.

Despite identified usability issues, participants responded positively in the perceived acceptance and usefulness questionnaire regarding the evaluated tool. Further analysis of the usability problems indicates that it was essential to include participants who matched the target end-users. Participants treated with immunotherapy, specifically with previous experience in immune-related adverse events encountered critical problems with symptom reporting that would not have been identified if these participants were not included. For other tasks and functionalities, it seems likely that loosening the inclusion criteria would have resulted in sufficient feedback without critical missing usability issues.

Not applicable.