RPD116 - EMA-Pal: Co-Creating a Remote Symptom Assessment Platform for Palliative Care

Key Message : Ambulatory palliative care patients and clinicians endorse ecological momentary assessment (EMA) for real-time symptom tracking to reduce recall bias and enhance communication. Guided by qualitative findings, we co-designed EMA-Pal, a dual-interface application that visualizes daily Edmonton Symptom Assessment System trends for patients and clinicians, emphasizing usability, equity, and workflow integration.

Abstract: Background/Rationale:
Gaps in symptom assessment between palliative care (PC) visits limit clinicians’ ability to address fluctuating distress and symptom burden. Ecological momentary assessment (EMA) offers real-time, repeated remote symptom assessment that may improve communication and timely intervention (1,2), but must be tailored to PC contexts characterized by high symptom burden and limited clinical bandwidth.

Objectives:
To explore patient and clinician perspectives on EMA in ambulatory PC and use these insights to co-create a usable, equitable, and workflow-integrated EMA platform prototype.

Methods:
We conducted semi-structured interviews with 10 patients and 9 clinicians from an academic ambulatory PC clinic. Transcripts were analyzed using hybrid inductive–deductive thematic analysis. Based on data from these interviews, we developed a prototype symptom assessment web-based application. Subsequently, we conducted two clinician focus groups (n = 10) and iterative usability sessions with 3 patients to inform prototype refinement.

Results:
Four themes emerged from the initial interviews (1) EMA tools can enhance symptom tracking and patient–clinician communication; (2) equity and access are critical to prevent digital exclusion; (3) balancing simplicity and personalization is key to minimizing burden; and (4) integration into workflows is essential for adoption. These insights directly informed development of EMA-Pal, a secure, web-based application where patients complete 10 daily ESAS items, view color-coded symptom trends, and see alerts for high or rapidly worsening symptoms. Clinicians access corresponding dashboards summarizing patient trajectories. Co-design participants prioritized minimal notifications, proxy-report capability, EHR compatibility, and clear triage visualization to mitigate burden.
Conclusion/Implications:
Stakeholder-informed co-design demonstrated that EMA-based tools are feasible and valued when developed with attention to usability, equity, and integration. The EMA-Pal prototype exemplifies how participatory design can translate qualitative insights into digital innovations to support continuous, patient-centered symptom management in serious illness care. Future work will evaluate usability, feasibility, and clinical impact in routine PC workflows.

References: 1. Brasky TM, Newton AM, Stephens JA, et al. Testing the feasibility of mobile ecological momentary assessment for symptom burden and management among metastatic cancer patients. Digit Health. 2024;10:20552076241261843. doi:10.1177/20552076241261843
2. Brusco NK, Watts JJ. Empirical evidence of recall bias for primary health care visits. BMC Health Serv Res. 2015;15:381. doi:10.1186/s12913-015-1039-1