Jennifer Stinson, PhD, RN-EN, CPNP, is a clinician-scientist at The Hospital for Sick Children (SickKids) in Toronto, Canada. She is a nurse practitioner in the chronic pain program whose major clinical research area focuses on pain and symptom management, and the use of e-health (internet) and m-health (mobile phones) technologies to improve the assessment and management of pain and other symptoms in children with chronic illnesses. During her PhD, she created one of the first electronic pain diaries using the Palm Tungsten PDA to help adolescents record arthritis-related pain.
She and her team developed Pain Squad, a smartphone-based electronic pain management tool that helps users keep a journal of their pain and communicate with their health provider team. Its user-friendly interface, ease of use, and gamification elements help to motivate children and teens with cancer (8 to 18 year olds) to keep track of and inform doctors with detailed reports of their pain. The app’s theme puts the patient in the midst of a crime-solving police squad, where filling out pain reports helps the squad solve a mystery. As more reports are submitted, the patient is rewarded with promotions up the ladder, and encouragement from video clips of real actors from popular Canadian television shows (we hope Bubbles from “Trailer Park Boys” makes an appearance). Pain Squad has won numerous awards, and is now continuing its testing in multiple centres across Canada.
Ben Ouyang, Medgadget: How did the idea for Pain Squad come about?
Jennifer Stinson: We decided to look into issues related to pain that arise with cancer and its treatments. Cancer pain is one of the most distressing symptoms for kids. There weren’t a lot of great tools out there for pain reporting, and many ask to recall episodes from a week or two ago, which has been shown to be unreliable. We wanted to create a tool that would allow patients to track their pain over time, whether it was acute pain from headaches and surgeries for example, or chronic pain that spanned days. We built off the tools we had from my PhD – using the same question set, bolstered by help from a team of pediatric oncologists. The original idea for Pain Squad came from the “Gumshoe” app. We decided to emulate mystery-solving in our model, and used it to gamify pain journaling for kids.
Medgadget: What was it about Pain Squad that motivated better pain self-reporting?
Jennifer Stinson: Before the app, we used paper-based diaries to record pain, and we saw pain self-reporting compliance rates of just 11%. With the introduction of Pain Squad, we saw a jump to 90% compliance. Our kids were really engaged, and when we asked what kept them going, they said it was the gamification, and how they had more control now. They enjoyed that the types of questions were the same as the ones that their doctors and nurses asked, and that Pain Squad helped them relay their problems to their health teams, especially if they were afraid to speak with them in person.
Medgadget: What challenges did you face?
Jennifer Stinson: On the technical side, we spent a while developing the alarms that prompted users to do their journal reporting. We had to make adjustments around each child’s schedule.
In terms of logistics: We’ve run into unforeseen barriers while developing for iOS, so the app has not been posted to the App Store yet. I get emails from clinicians, patients, and families, asking when Pain Squad will be in the store. In retrospect, it’s a good idea to begin projects with long-term planning strategies to ensure that we have enough resources and infrastructure to bring developments to the market upon completion of the studies.
Medgadget: What are the next steps for Pain Squad?
Jennifer Stinson: Pain Squad is currently in testing at 4 paediatric centres across Canada to ensure its reliability and validity. We’re also in the process of developing Pain Squad+, an algorithm-based treatment tool that tracks entries, and based on the type of pain, will suggest solutions to try. If the self-reported pain persists, Pain Squad+ will send a notification to the health-care providers. If the pain subsides, then the app learns to give the same recommendation next time. The algorithm we’re building is currently evidence-based, and we hope that as we get more data entries in the future, we can also employ probability models to help us continue to refine our recommendations.
We aim to better understand the epidemiology of the pain that patients experience. For example: tracking the effects of chemotherapy versus radiation on headaches. Pain is a big problem, but the current tools aren’t sensitive enough to give us a good understanding. With better tracking, we can find out more precisely when in a cancer cycle do patients develop symptoms, and hopefully this will help to treat them more accurately.
Medgadget: How do you feel about Pain Squad’s progress?
Jennifer Stinson: I’m delighted! It’s fantastic just to see the kids’ faces, and know that they don’t feel that their pain-reporting is a burden. The kids say “yeah for sure I’d like to try this!” We’ll have a big celebration when Pain Squad gets into the App Store, hopefully by April/May of 2014!
Medgadget: Medical apps prescriptions and billing in hospitals has been a controversial topic. What do you think about the billing for Pain Squad?
Jennifer Stinson: In my mind, it should be free for patients. We must make sure the products are correct, verified, and help patients. We could license the app to drug companies who may want to conduct drug trials and track outcomes with apps like Pain Squad. The revenues from these companies could come back to help development and sustainability of the app.
Medgadget: If someone in a healthcare profession had an idea for an app, what tips would you want to give them?
Jennifer Stinson: First, check if there are resources and support available through your organization. Speak to app developers to learn about the barriers and facilitators to learn about how to get to market. For Pain Squad, Cundari became a mentor. They knew what elements people liked, and provided the creative element to the project. They were really creative in coming up with solutions and were very passionate about helping SickKids. They also helped our IT staff to gain experience in app development. It’s all about being collaborative.