Home-Based Spirometry Telemonitoring After Allogenic Hematopoietic Cell Transplantation

By: Ajay Sheshadri1*, MSc, MD; Sukh Makhnoon2*, MSc, PhD; Amin M Alousi3, MD; Lara Bashoura1, MD; Rene Andrade2, BS; Christopher J Miller2, MPH; Karen R Stolar3, MS; Muhammad Hasan Arain1, MBBS; Laila Noor1, MBBS; Amulya Balagani1, MD; Akash Jain1, MD; David Blanco1, RPFT; Abel Ortiz1, CRT; Michael S Taylor4, BS; Alex Stenzler4, MD; Rohtesh Mehta3, MD; Uday R Popat3, MD; Chitra Hosing3, MD; David E Ost1, MD, MPH; Richard E Champlin3, MD; Burton F Dickey1, MD; Susan K Peterson2, PhD

1Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States 2Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States 3Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, United States 4Monitored Therapeutics, Inc, Dublin, OH, United States *these authors contributed equally

Background Home-based spirometry (HS) allows for the early detection of lung complications in recipients of an allogeneic hematopoietic cell transplant (AHCT). Although the usability and acceptability of HS are critical for adherence, patient-reported outcomes of HS use remain poorly understood in this setting.

Objective The aim of this study is to design a longitudinal, mixed methods study to understand the usability and acceptability of HS among recipients of AHCT.

Methods Study participants performed HS using a Bluetooth-capable spirometer that transmitted spirometry data to the study team in real time. In addition, participants completed usability questionnaires and in-depth interviews and reported their experiences with HS. Analysis of interview data was guided by the constructs of performance expectancy, effort expectancy, and social influence from the Unified Theory of Acceptance and Use of Technology model.

Results Recipients of AHCT found HS to be highly acceptable despite modest technological barriers. On average, participants believed that the HS was helpful in managing symptoms related to AHCT (scores ranging from 2.22 to 2.68 on a scale of 0-4) and for early detection of health-related problems (score range: 2.88-3.12). Participants viewed HS favorably and were generally supportive of continued use. No significant barriers to implementation were identified from the patient’s perspective. Age and gender were not associated with the patient perception of HS.

Conclusions Study participants found HS acceptable and easy to use. Some modifiable technical barriers to performing HS were identified; however, wider implementation of pulmonary screening is feasible from the patient’s perspective.