The proposed K23 award supports the career development of Dr. Lauri Linder into a principal investigator capable of leading effective, interprofessional, multi-site teams to transform symptom management research for children with cancer. Her long-term goal is to implement innovative child-centric approaches for communicating symptoms that are actionable by healthcare providers to support initiation of evidence-based symptom management interventions. The initial step in this effort is to develop a child-centric symptom assessment tool that is actionable by healthcare providers and can be integrated into health information systems as a component of evidence-based symptom management interventions This K23 proposal supports this goal by providing Dr. Linder with training in 1) participatory research methods with children with attention to eliciting children's preferences for representing and reporting their symptoms, 2) mobile technology as a health management intervention for school-age children with chronic illness that can be integrated into health information systems, and 3) team science leadership skills through conducting a study with an interprofessional team with attention to strategies for promoting and sustaining effective collaborations. The training plan incorporates coursework, individual tutorials, conference-based learning, and participation in national and international meetings, leading an interprofessional team to carry out the proposed scientific aims, participating in her primary mentor's research team meetings, and participating in local and national networking opportunities. Dr. Linder's primary mentor, Dr. Kathi Mooney (nursing), and co- mentor, Dr. Robert Kessler (computer science), provide expertise in cancer symptom science and using game- based principles to promote health. She has assembled an inter-professional advisory team of nationally and internationally recognized experts in participatory research methods with children, symptom measurement and management for children with cancer, video game design and development, and biomedical informatics. The proposed research addresses a critical need to develop child-sensitive measures to identify symptoms and decrease their impact and/or persistence. Children's developmental abilities, including their verbal and cognitive abilities, also are barries for having their symptoms understood by parents and healthcare providers. Paper-and-pencil self-report measures using numeric ratings are based on adults'cognitive abilities and do not incorporate children's internal processes for appraising and organizing information. Mobile technology applications support novel approaches for children to represent their symptom experience, allowing children to communicate the context and meaning of their symptoms, aspects that are missing from existing tools. The scientific aims will be conducted in two phases. The first phase will use participatory methods to engage school-age children with cancer and pediatric oncology healthcare providers in the co-design of a mobile technology-based symptom assessment application to be delivered via an iPad. The proposed app will include arts-based approaches for symptom representation and incorporate video game-based features. This phase will conducted through an iterative process using participatory teams with low tech and high tech prototyping. Programming support will be provided by the University of Utah's nationally-ranked Engineering Arts and Entertainment (EAE) program in the newly established Therapeutic Games and Applications Lab. The second phase will evaluate the feasibility and acceptability of the application from the perspectives of children, their parents, and pediatric oncology healthcare providers in a clinical setting. Twenty children with cancer 6-12 years of age will be provided with cellular-enabled iPads to complete the app each day for 5-days. Data generated through the app will be transmitted to the child's electronic medical record for review by healthcare providers. Feasibility will be evaluated through identifying children's adherence in completing the app, time to complete the app, review of patterns of missing data, healthcare providers'acknowledgement of reported symptoms in the medical record, and initiation of interventions based on identified symptoms. Acceptability will be evaluated through questionnaires and semi-structured interviews of child participants, their parents, and healthcare providers. The University of Utah provides an excellent environment for achieving the career development and scientific aims of this proposal. The College of Nursing is recognized for expertise in cancer symptom management and quality of life research and provides support services to facilitate faculty success. The Therapeutic Games and Applications lab located in the Eccles Health Sciences Library provides a unique environment for interdisciplinary collaboration to support achievement of the scientific aims of the proposal. The focus of this K23 proposal is consistent with the strategic plan of the National Institute of Nursing Research to advance quality of life through symptom management, invest in innovative technology to improve health outcomes, and support the career development of the next generation of nurse scientists. Achieving the award aims will support additional refinements to the app prior to its testing in an efficacy trial to determine if use of the app improves symptom outcomes. Future directions for the app include incorporation of daily child- centric health promotion activities an symptom management strategies in response to identified symptoms as well as its use within rapid learning environments to compare symptom outcomes across institutions.
Children receiving treatment for cancer experience multiple symptoms that negatively impact their quality of life;however, because of their developmental abilities, they may have difficulty relating their symptoms to healthcare providers. Mobile technology offers innovative options to create symptom assessment tools that support children in communicating their symptoms to healthcare providers and allow children's symptom reports to be transmitted into electronic medical record systems. This award will engage children with cancer in designing a mobile technology symptom assessment app and evaluate the app's feasibility and acceptability in a clinical setting from the perspectives of children with cancer, their parents, and healthcare providers.