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Palliative medicine and smartphones: an opportunity for innovation?
  1. Amara Callistus Nwosu and
  2. Stephen Mason
  1. Marie Curie Palliative Care Institute, Liverpool (MCPCIL), Liverpool, UK
  1. Correspondence to Amara Callistus Nwosu, Marie Curie Palliative Care Institute, Liverpool (MCPCIL), Speke Road, Liverpool L25 8QA, UK; amaranwosu{at}doctors.org.uk

Abstract

Background The use of smartphones and their software applications (apps) provides health professionals with opportunities to integrate technology into clinical practice. Increasing numbers of work-related apps are available to health professionals, especially in certain specialties such as orthopaedics. However, so far the availability of apps specific to palliative medicine is limited.

Objectives To review all smartphone apps targeted at health professionals within palliative medicine and available for the five most popular operating systems (iPhone, Blackberry, Android, Palm and Windows) .

Methods Each smartphone app store was systematically searched with a combination of the following keywords: palliative, pain, cancer, symptoms, medicine. Identified apps were purchased and tested to determine if their title and/or description was relevant to palliative care.

Results Six apps specific to palliative medicine were identified across all five operating systems. These consisted of blog orientated apps (Pallimed and Geripal), an app containing guidelines from eight cancer networks (PalliApp), an educational app (Palliative Care) and opioid dose converter apps (eOpioid and PalliCalc).

Conclusions There is a lack of palliative medicine specific resources for smartphones and no studies have been published which examine the potential benefits of mobile technology for learning, clinical practice and professional development. This provides an opportunity for further research and development. Academic institutions could work with technological developers to improve access to, and dissemination of, key information for practice. Considered development of mobile technology has the potential to improve patient care, data sharing and education within the palliative medicine specialty.

  • Received 6 October 2011.
  • Accepted 17 October 2011.

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Background

As mobile technology continues to improve, new opportunities to integrate technology in support of clinical practice have developed.1 The mobile phone is a standard piece of technology which has become commonplace in health professionals' pockets,2 while the emergence of third generation technology in 2001 improved the capabilities and performance of mobile technology. A smartphone is a combination of a mobile phone, personal digital assistant and laptop computer.2 3 The most popular smartphones are the iPhone and Blackberry devices.

An online survey by d4 (a non-profit organisation which aims to increase the use of mobile technology in the National Health Service)of 474 health professionals in the UK showed that 81% use a smartphone for work-related reasons, such as communicating with colleagues (82%), accessing information (46%) and running work-related apps (18%).3

An app is a piece of software designed to run on computers, phones or other electronic devices.3 The market for apps aimed at doctors is increasing. Generic resources such The Oxford Handbook for Clinical Medicine and the British National Formulary are available on line. The BMJ Group have various apps to help doctors, such as the Doctor's Toolbag, Best Practice decision support and the Differential Diagnosis apps.4 Several specialties have embraced the use of mobile technology. For example, orthopaedics have 61 custom made smartphone apps available5 and the Royal College of Anaesthetists uses a mobile version of their evidence log for trainees.6

Both health and academic institutions are beginning to embrace the possibilities of mobile technology in supporting practice and development. The Welsh Deanery has invested £500 000 in providing their foundation house officers with smartphones preloaded with iDoc, which is a compendium of 20 medical textbooks.7 8 In 2010, Leeds University issued more than 500 medical students with iPhones to enable access to online textbooks.9

The availability of apps specific to palliative medicine is, as yet, limited. The aim of this article is to review all smartphone apps targeted at health professionals within palliative medicine and available for the five most popular operating systems (iPhone, Blackberry, Android, Palm and Windows).

Methods

Each of the five current popular smartphone operating systems has an app store for browsing and downloading software for use on the devices. Each app store was systematically searched using a combination of the following terms: palliative, pain, cancer, symptoms, medicine. Only apps written in the English language were included. To ensure no apps were overlooked, apps listed on each database were examined alphabetically and the description read if the title suggested they might be relevant to palliative medicine.

Results

The search of the iPhone app store yielded a total of six apps, and a search of the Android app store yielded two apps (these were duplicates of apps available for the iPhone). No Blackberry, Palm or Windows apps were identified. The results of the search are presented in table 1.

Table 1

Description of reviewed smartphone apps

Discussion

Portable mobile technology could influence the education of clinicians in palliative medicine. However, only six palliative medicine smartphone apps of various functions were identified in this review; compared to other specialties, the availability of mobile technology specific to palliative medicine is limited. Although smartphones have the potential to improve knowledge and therefore patient care, there is no evidence of effect as yet.

Academic institutions could work with technology developers to improve access to, and the dissemination of, information. Areas for attention could include the following:

  • Development of a mobile educational logbook for palliative medicine trainees and consultants

  • Regular audio and video podcasts of educational material, topical news summaries and journal articles

  • Streaming of presentations from national and international conferences

  • Development of patient record systems

  • Tracking of hospitalised palliative patients

  • Communication in different languages

  • Development of drug formulary databases.

Smartphones can also be used as portable media players, allowing the user to watch or listen to podcasts (a series of digital audio or videos files released at regular intervals on the internet). Various medical and surgical journals now provide free podcasts with each edition. Although this was not the main focus of our review, we were not able to identify any podcasts specific to palliative medicine. Further, social network websites such as Facebook and Twitter are readily accessible from mobile devices and allow users to quickly share information and educational resources, for example the Facebook page posts of BMJ Supportive & Palliative Care10 and the Twitter Journal Club.11

There are, however, a number of potential problems. For existing apps, ongoing concerns about the accuracy of opioid equivalence and variations in practice12 may hinder the general acceptability of opioid dose converter apps. Concerns about the quality of the information accessed may be also raised. However, recognised organisations such as the Association of Palliative Medicine and the National Council for Palliative Care could develop or approve apps to assist clinicians and ensure regulation and monitoring of information.

Other concerns include potential confidentiality issues for patients and staff, especially in the event of the loss or theft of a device.3 Also, the use of smartphones in clinical areas may be viewed negatively by patients, relatives and staff, if their use is misinterpreted as social rather than work-related. Limitations on network and mobile internet coverage in workplaces may hinder the use of many smartphone apps.

Conclusion

The potential benefits of mobile technology for learning, clinical practice and professional development have not been examined in the literature, providing an opportunity for further research and development. Accordingly, mobile technology has the potential to improve patient care, data sharing and education within the specialty.

  • Received 6 October 2011.
  • Accepted 17 October 2011.

References

View Abstract

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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