• Richard Harding, José Miguel Carrasco, Jordi Serrano-Pons, Jeannine Lemaire, Eve Namisango, Emmanuel Luyirika, Terrymize Immanuel, Anil Kumar Paleri, Lulu Mathews, Dickson Chifamba, Lovemore Mupaza, Cristina Lasmarías Martínez, Ludoviko Zirimenya, Marie-Charlotte Bouësseau, and Eric L Krakauer.
• Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College Liondon, Cicely Saunders Institute, London, UK. Electronic address: richard.harding@kcl.ac.uk.
• J Pain Symptom Manage. 2021 Jul 1; 62 (1): 1-9.

ContextMobile health (mHealth) provides an opportunity to use internet coverage in low- and middle-income countries to improve palliative care access and quality.ObjectivesThis 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.MethodsA codesign 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.ResultsN = 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.ConclusionAn 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.Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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