Development of the App

The major goals of the proposed App are to:

  1. Promote individuals' understanding of cancer screening,
  2. Facilitate their decision making about cancer screening,
  3. Encourage individuals to make cancer screening decisions that are congruent with their values and preferences
  4. Translate the cancer screening decision action.

To achieve these goals, we plan to design an App that contains evidence-based, balanced, understandable, easy to read (i.e., written at a 6th-Grade reading level), appropriate, and succinct information about:

  1. cancer (i.e., prostate, breast, colon, cervical cancer) as well as screening procedures;
  2. risks and benefits of screening methods to help individuals make deliberative choices among screening options (including not to opt for screening or deferring the decision to be screened for cancer),
  3. information on other people's opinion and experiences (i.e., narratives and testimonials), and
  4. a value clarification exercise to guide the treatment decision making and to further enhance communication with healthcare providers.

Platforms

The App will be developed for a variety of platforms including the web, iPhone, Android, Blackberry, and Windows Phone 7.

Data from NCI publicly available data bases.

Screening recommendations will be generated from NCI- provided recommendations available from PDQ and Medline+. Prevalence data by state and county level for all major cancers will be generated from http://statecancerprofiles.cancer.gov.

User-generated tailoring data.

There are two possibilities for data input to generate personalized screening recommendations.

  1. Users are asked to answer a few simple questions, such as month and year of birth, gender, race, and family history of cancer and enter the information into the App; or
  2. The App can be linked via a website to EPIC and relevant data from a person's individual record can be transferred into the App. Joe Kannery, MD, the Lead Technical Informatics at MSSM confirmed that EPIC has built in capability for such a one-way data transfer.

Development process.

Focus Groups

We are following an established protocol for developing the software that consists of alternating closely between development and evaluation. This process has informed the development of PIES and the V-CIS web-based patient education and decision tools. Specifically, we will conduct focus groups (N = 3) with members of the target audience (i.e., men eligible for prostate cancer screening; women eligible for breast and cervical cancer screening; from diverse racial, educational, and socio-economic backgrounds). Focus group members will comment on screen shots of the proposed application, including illustrations, text and layout of the app. Focus groups will be audio-taped, transcribed and coded. The app will be revised based on consensus results of the focus groups.

Usability testing

The revised version of the app will undergo usability testing with members of the target audience (identical inclusion criteria than for focus group). We will be using the talk-aloud method, during which users are asked to describe what they want to do with the app while they are interacting with it. All successes and failures in using the app will be recorded and the App will be revised if there are persistent usage difficulties.