University of Oulu

Wan SW, Chong CS, Toh E, Lim SH, Loi CT, Lew YFH, Chua MCH, Jee XP, Liu G, Zhu L, Pikkarainen M, He H. A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study. J Med Internet Res 2021;23(12):e31917. doi: 10.2196/31917

A theory-based, multidisciplinary approach to cocreate a patient-centric digital solution to enhance perioperative health outcomes among colorectal cancer patients and their family caregivers : development and evaluation study

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Author: Wan, Su Wei1,2; Chong, Choon Seng2,3,4; Toh, Ee-Lin4,5,6;
Organizations: 1Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
2National University Health System, Singapore, Singapore
3Division of Colorectal Surgery and Surgical Oncology, Department of Surgery, National University Cancer Institute, National University Hospital, Singapore, Singapore
4Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
5Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
6Duke-NUS Medical School, Singapore, Singapore
7Division of Nursing, Singapore General Hospital, Singapore, Singapore
8Centre of Psychosocial Support, Singapore Red Cross Academy, Singapore, Singapore
9Department of Psychology, School of Humanities and Behavioural Science, Singapore University of Social Sciences, Singapore, Singapore
10Medical and Cybernetics Systems, Institute of Systems Science, National University of Singapore, Singapore, Singapore
11Division of Colorectal Surgery, Department of Nursing, National University Hospital, Singapore, Singapore
12Faculty of Health Sciences and Faculty of Technology, Art and Design, Oslomet - Oslo Metropolitan University, Oslo, Norway
13Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
14Faculty of Medicine and Oulu Business School, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: JMIR Publications, 2021
Publish Date: 2022-01-31


Background: Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes.

Objective: The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers.

Methods: A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties.

Results: Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period.

Conclusions: This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run.

Trial Registration: NCT04159363;

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Series: Journal of medical internet research
ISSN: 1439-4456
ISSN-E: 1438-8871
ISSN-L: 1439-4456
Volume: 23
Issue: 12
Article number: e31917
DOI: 10.2196/31917
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Funding: The team deeply appreciates the funding provided by the Singapore Cancer Society and Business Finland. This research work is funded by the Singapore Cancer Society Cancer Research Grant 2018 and the Business Finland Grant 203/31/2018.
Copyright information: © Su Wei Wan, Choon Seng Chong, Ee-Lin Toh, Siew Hoon Lim, Carol TT Loi, Yuen Foong Henry Lew, Matthew Chin Heng Chua, Xin Pei Jee, Guangyu Liu, Lixia Zhu, Minna Pikkarainen, Hong-Gu He. Originally published in the Journal of Medical Internet Research (, 07.12.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.