JMIR Cancer最新文献

{"title":"Exploring Older Adult Cancer Survivors' Digital Information Needs: Qualitative Pilot Study.","authors":"Lorelei Newton, Helen Monkman, Claire Fullerton","doi":"10.2196/59391","DOIUrl":"10.2196/59391","url":null,"abstract":"<p><strong>Background: </strong>Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults' transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns.</p><p><strong>Objective: </strong>This pilot study, which examined older adult cancer survivors' use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors' perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers.</p><p><strong>Methods: </strong>A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (#21-0421) was obtained. Interpretive description inquiry-a practice-based approach suitable for generating applied knowledge-supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes).</p><p><strong>Results: </strong>Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors.</p><p><strong>Conclusions: </strong>Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelin","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e59391"},"PeriodicalIF":3.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study.","authors":"Zakery Dabbagh, Reem Najjar, Ariana Kamberi, Ben S Gerber, Aditi Singh, Apurv Soni, Sarah L Cutrona, David D McManus, Jamie M Faro","doi":"10.2196/60034","DOIUrl":"10.2196/60034","url":null,"abstract":"<p><strong>Background: </strong>Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer.</p><p><strong>Objective: </strong>The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial.</p><p><strong>Methods: </strong>Participants were identified from one academic medical center's electronic health records, referred by a clinician, or self-referred to participate in the study. Participants were screened for eligibility, enrolled, provided a Fitbit activity tracker, and instructed to download the Fitbit: Health & Wellness and MyDataHelps apps. They completed usability surveys at 1 and 3 months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess the acceptability of the intervention and the implementation of the intervention into clinical practice, respectively. Descriptive statistics were calculated for demographics, usability surveys, and Fitbit adherence and step counts. Rapid qualitative analysis was used to identify key findings from interview transcriptions.</p><p><strong>Results: </strong>Of the 100 patients screened for eligibility, 31 were enrolled in the trial (mean age 64.8, SD 11.1 years; female patients=17/31, 55%; Hispanic or Latino=7/31, 23%; non-White=11/31, 35%; less than a bachelor's degree=14/31, 45%; and household income <US $75,000=11/31, 35%). The mean (SD) years since diagnosis was 7.1 (8.2), and the two most frequent cancer diagnoses were prostate (9/31, 29%) and breast (4/31, 13%) cancer. Participants provided positive feedback on the MyDataHelps app usability; the overall app quality received a mean score of 3.79 (SD 0.82) on a 5-point Likert scale (1=worst, 5=best). Interviews with 10 patients yielded four themes: (1) Fitbit and app setup was easy but the research team provided assistance, when needed, which was helpful, (2) motivational messages within the app were not memorable, (3) step counts and Fitbit notifications were motivating, and (4) medical professionals viewing their data were acceptable. Interviews with 5 cancer care clinicians yielded four themes: (1) some patients used wearables but rarely discussed data with clinicians; (2) activity trackers can be helpful to motivate patients and keep them accountable; (3) objective activity measures-similar to BMI, weight, and blood pressure- that they can track over time and refer to afterward were preferred; and (4) training and systematic processes to view these data as part of active workflow were desired.</p><p><strong>Conclusions: <","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e60034"},"PeriodicalIF":3.3,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Douyin Short Videos on Mammography in China: Quality and Reliability Analysis.","authors":"Hongwu Yang, Chuangying Zhu, Chunyan Zhou, Ruibin Huang, Lipeng Huang, Peifen Chen, Shanshan Zhu, Huanpeng Wang, Chunmin Zhu","doi":"10.2196/59483","DOIUrl":"10.2196/59483","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common malignant tumor and the fifth leading cause of cancer death worldwide, imposing a significant disease burden in China. Mammography is a key method for breast cancer screening, particularly for early diagnosis. Douyin, a popular social media platform, is increasingly used for sharing health information, but the quality and reliability of mammography-related videos remain unexamined.</p><p><strong>Objective: </strong>This study aimed to evaluate the information quality and reliability of mammography videos on Douyin.</p><p><strong>Methods: </strong>In October 2023, a search using the Chinese keywords for \"mammography\" and \"mammography screening\" was conducted on Douyin. From 200 retrieved videos, 136 mammography-related videos were selected for analysis. Basic video information, content, and sources were extracted. Video content was assessed for comprehensiveness across 7 categories: conception, examination process, applicable objects, precautions, combined examinations, advantages, and report. Completeness was evaluated using a researcher-developed checklist, while reliability and quality were measured using 2 modified DISCERN (mDISCERN) tool and the Global Quality Score (GQS). Correlations between video quality and characteristics were also examined.</p><p><strong>Results: </strong>Among the video sources, 82.4% (112/136) were attributed to health professionals, and 17.6% (24/136) were attributed to nonprofessionals. Among health professionals, only 1 was a radiologist. Overall, 77.2% (105/136) of the videos had useful information about mammography. Among the useful videos, the advantages of mammography were the most frequently covered topic (53/105, 50.5%). Median values for the mDISCERN and GQS evaluations across all videos stood at 2.5 (IQR 1.63-3) and 2 (IQR 1-2), respectively. Within the subgroup assessment, the median mDISCERN score among the useful and professional groups stood at 2 (IQR 2-3) and 3 (IQR 2-3), respectively, surpassing the corresponding score for the unhelpful and nonprofessional groups at 0 (IQR 0-0) and 0 (IQR 0-0.75; P<.001). Likewise, the median GQS among the useful and professional groups was evaluated at 2 (IQR 1.5-2) and 2 (IQR 1-2), respectively, eclipsing that of the unhelpful and nonprofessional groups at 1 (IQR 1-1) and 1 (IQR 1-1.37; P<.001). The GQS was weak and negatively correlated with the number of likes (r=-0.24; P=.004), comments (r=-0.29; P<.001), and saves (r=-0.20; P=.02). The mDISCERN score was weak and negatively correlated with the number of likes (r=-0.26; P=.002), comments (r=-0.36; P<.001), saves (r=-0.22; P=.009), and shares (r=-0.18; P=.03).</p><p><strong>Conclusions: </strong>The overall quality of mammography videos on Douyin is suboptimal, with most content uploaded by clinicians rather than radiologists. Radiologists should be encouraged to create accurate and informative videos to better educate patients. As Douyin grows as a ","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e59483"},"PeriodicalIF":3.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing Effective Frameworks for Large Language Model-Based Medical Chatbots: Insights From Radiotherapy Education With ChatGPT.","authors":"James C L Chow, Kay Li","doi":"10.2196/66633","DOIUrl":"10.2196/66633","url":null,"abstract":"<p><p>This Viewpoint proposes a robust framework for developing a medical chatbot dedicated to radiotherapy education, emphasizing accuracy, reliability, privacy, ethics, and future innovations. By analyzing existing research, the framework evaluates chatbot performance and identifies challenges such as content accuracy, bias, and system integration. The findings highlight opportunities for advancements in natural language processing, personalized learning, and immersive technologies. When designed with a focus on ethical standards and reliability, large language model-based chatbots could significantly impact radiotherapy education and health care delivery, positioning them as valuable tools for future developments in medical education globally.</p>","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e66633"},"PeriodicalIF":3.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Implementation of a Personal Virtual Assistant for Patient Engagement and Communication in Postsurgical Cancer Care: Feasibility Cohort Study.","authors":"Miguel Bargas-Ochoa, Alejandro Zulbaran-Rojas, M G Finco, Anthony B Costales, Areli Flores-Camargo, Rasha O Bara, Manuel Pacheco, Tina Phan, Aleena Khichi, Bijan Najafi","doi":"10.2196/64145","DOIUrl":"10.2196/64145","url":null,"abstract":"<p><strong>Background: </strong>Cancer-care complexity heightens communication challenges between health care providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge in patients undergoing surgical procedures. Digital health tools offer potential solutions to address communication challenges seen in current discharge protocols. We aim to explore the usability and acceptability of an interactive health platform among discharged patients who underwent oncology-related procedures.</p><p><strong>Methods: </strong>A 4-week exploratory cohort study was conducted. Following hospital discharge, a tablet equipped with an integrated Personal Virtual Assistant (PVA) system was provided to patients who underwent oncology-related procedures. The PVA encompasses automated features that provide personalized care plans, developed through collaboration among clinicians, researchers, and engineers from various disciplines. These plans include guidance on daily specific assignments that were divided into 4 categories: medication intake, exercise, symptom surveys, and postprocedural specific tasks. The aim was to explore the acceptability of the PVA by quantification of dropout rate and assessing adherence to each care plan category throughout the study duration. The secondary aim assessed acceptability of the PVA through a technology acceptance model (TAM) questionnaire that examined ease of use, usefulness, attitude toward use, and privacy concerns.</p><p><strong>Results: </strong>In total, 17 patients were enrolled. However, 1 (5.8%) patient dropped out from the study after 3 days due to health deterioration, leaving 16/17 (94.2%) completing the study (mean age 54.5, SD 12.7, years; n=9, 52% Caucasian; n=14, 82% with a gynecological disease; n=3, 18% with a hepatobiliary disease). At the study end point, adherence to care plan categories were 78% (SD 25%) for medications, 81% (SD 24%) for exercises, 61% (SD 30%) for surveys, and 58% (SD 44%) for specific tasks such as following step-by step wound care instructions, managing drains, administering injectable medications independently, and performing pelvic baths as instructed. There was an 80% patient endorsement (strongly agree or agree) across all TAM categories.</p><p><strong>Conclusions: </strong>This study suggests the potential acceptability of the PVA among patients discharged after oncology-related procedures, with a dropout rate of less than 6% and fair-to-good adherence to tasks such as medication intake and exercise. However, these findings are preliminary due to the small sample size and highlight the need for further research with larger cohorts to validate and refine the system.</p>","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e64145"},"PeriodicalIF":3.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11855163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing health information seeking behaviors among targeted social media users using an infotainment video about a cancer clinical trial: a Population-based Descriptive Study.","authors":"Jonathan Sommers, Don S Dizon, Mark A Lewis, Erik Stone, Richard Andreoli, Vida Henderson","doi":"10.2196/56098","DOIUrl":"https://doi.org/10.2196/56098","url":null,"abstract":"<p><strong>Background: </strong>Lack of information, awareness, and misconceptions about clinical trials are major barriers to cancer clinical trial participation. Digital and social media are dominant sources of health information and offer optimal opportunities to improve public medical awareness and education by providing accurate and trust-worthy sources of health information from reliable sources. Infotainment, material intended to both entertain and inform, is an effective strategy for engaging and educating audiences that can be easily disseminated using social media and may be a novel way to improve awareness of and recruitment in clinical trials.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate whether an infotainment video promoting a clinical trial, disseminated using social media, could drive health information seeking behaviors.</p><p><strong>Methods: </strong>As part of a video series, we created an infotainment video focused on promotion of a specific cancer clinical trial. We instituted a dissemination and marketing process on Facebook to measure video engagement and health information seeking behaviors among targeted audiences who expressed interest in breast cancer research and organizations. To evaluate video engagement, we measured reach, retention, outbound clicks, and outbound click-through rate. Frequencies and descriptive statistics were used to summarize each measure.</p><p><strong>Results: </strong>The video substantially increased health information seeking behavior by increasing viewership from 1 visitor one month prior to launch to 414 outbound clicks from the video to the clinical trial webpage during the 21-day social media campaign period.</p><p><strong>Conclusions: </strong>Our study shows that digital and social media tools can be tailored for specific target audiences, are scalable, and can be disseminated at low cost, making it an accessible educational, recruitment, and retention strategy focused on improving awareness of clinical trials.</p><p><strong>Clinicaltrial: </strong>ClinicalTrials.gov NCT03418961.</p>","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Benefits of Remote-Based Mindfulness on Physical Symptom Outcomes in Cancer Survivors: Systematic Review and Meta-Analysis.","authors":"Maria Komariah, Sidik Maulana, Shakira Amirah, Hesti Platini, Laili Rahayuwati, Ah Yusuf, Mohd Khairul Zul Hasymi Firdaus","doi":"10.2196/71958","DOIUrl":"10.2196/71958","url":null,"abstract":"","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e71958"},"PeriodicalIF":3.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of Cross-Sectoral Video Consultation in Cancer Care on Patients' Perceived Coordination: Randomized Controlled Trial.","authors":"Fereshteh Baygi, Theis Bitz Trabjerg, Lars Henrik Jensen, Maria Munch Storsveen, Sonja Wehberg, Jeffrey James Sisler, Jens Søndergaard, Dorte Gilså Hansen","doi":"10.2196/60158","DOIUrl":"10.2196/60158","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer need coordinated care for both treatment and concurrent health conditions. This requires collaboration among specialists when using telemedicine services, emphasizing the importance of care continuity.</p><p><strong>Objective: </strong>This study aimed to explore the effects of cross-sectorial video consultation involving oncologists, general practitioners, and patients with cancer on patients' perceived coordination of care, compared with usual care.</p><p><strong>Methods: </strong>This study describes the primary outcomes from a 7-month follow-up of patients in the Partnership Project, a randomized clinical trial. Patients in the intervention group were randomized to receive a \"partnership consultation,\" a shared video consultation with an oncologist, general practitioners, and the patient, in addition to their usual care. Questionnaires were completed for both groups at baseline and 7 months to assess the primary outcome, \"global assessment of inter-sectorial cooperation,\" from the Danish questionnaire \"Patients' attitude to the health care service.\" The questionnaire also included 2 single items and 5 index scales, examining patients' attitude toward cooperation in the health care system. Change in perceived global coordination from baseline to 7 months was compared between intention-to-treat groups using generalized estimating equations in a linear regression model.</p><p><strong>Results: </strong>A total of 278 participants were randomized with 1:1 allocation, with 80 patients receiving the intervention. Further, 210 patients completed the questionnaire at baseline, while 118 responded at 7-month follow-up. The estimated difference in the primary outcome between usual care (-0.13, 95% CI -0.38 to 0.12) and intervention (0.11, 95% CI -0.11 to 0.34) was 0.24 (95% CI -0.09 to 0.58) and not statistically significant (P=.15).</p><p><strong>Conclusions: </strong>Low rates of intervention completion and high levels of missing data compromised the interpretability of our study. While we observed a high level of global assessment of coordination, the estimated intervention effect was smaller than anticipated, with no significant difference in perceived coordination between control and intervention groups. Future studies should explore strategies like patient incentives to increase response rate and improve the evaluation of this innovative health care model.</p>","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e60158"},"PeriodicalIF":3.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable Machine Learning to Predict the Malignancy Risk of Follicular Thyroid Neoplasms in Extremely Unbalanced Data: Retrospective Cohort Study and Literature Review.","authors":"Rui Shan, Xin Li, Jing Chen, Zheng Chen, Yuan-Jia Cheng, Bo Han, Run-Ze Hu, Jiu-Ping Huang, Gui-Lan Kong, Hui Liu, Fang Mei, Shi-Bing Song, Bang-Kai Sun, Hui Tian, Yang Wang, Wu-Cai Xiao, Xiang-Yun Yao, Jing-Ming Ye, Bo Yu, Chun-Hui Yuan, Fan Zhang, Zheng Liu","doi":"10.2196/66269","DOIUrl":"10.2196/66269","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diagnosing and managing follicular thyroid neoplasms (FTNs) remains a significant challenge, as the malignancy risk cannot be determined until after diagnostic surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to use interpretable machine learning to predict the malignancy risk of FTNs preoperatively in a real-world setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study at the Peking University Third Hospital in Beijing, China. Patients with postoperative pathological diagnoses of follicular thyroid adenoma (FTA) or follicular thyroid carcinoma (FTC) were included, excluding those without preoperative thyroid ultrasonography. We used 22 predictors involving demographic characteristics, thyroid sonography, and hormones to train 5 machine learning models: logistic regression, least absolute shrinkage and selection operator regression, random forest, extreme gradient boosting, and support vector machine. The optimal model was selected based on discrimination, calibration, interpretability, and parsimony. To address the highly imbalanced data (FTA:FTC ratio&gt;5:1), model discrimination was assessed using both the area under the receiver operating characteristic curve and the area under the precision-recall curve (AUPRC). To interpret the model, we used Shapley Additive Explanations values and partial dependence and individual conditional expectation plots. Additionally, a systematic review was performed to synthesize existing evidence and validate the discrimination ability of the previously developed Thyroid Imaging Reporting and Data System for Follicular Neoplasm scoring criteria to differentiate between benign and malignant FTNs using our data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort included 1539 patients (mean age 47.98, SD 14.15 years; female: n=1126, 73.16%) with 1672 FTN tumors (FTA: n=1414; FTC: n=258; FTA:FTC ratio=5.5). The random forest model emerged as optimal, identifying mean thyroid-stimulating hormone (TSH) score, mean tumor diameter, mean TSH, TSH instability, and TSH measurement levels as the top 5 predictors in discriminating FTA from FTC, with the area under the receiver operating characteristic curve of 0.79 (95% CI 0.77-0.81) and AUPRC of 0.40 (95% CI 0.37-0.44). Malignancy risk increased nonlinearly with larger tumor diameters and higher TSH instability but decreased nonlinearly with higher mean TSH scores or mean TSH levels. FTCs with small sizes (mean diameter 2.88, SD 1.38 cm) were more likely to be misclassified as FTAs compared to larger ones (mean diameter 3.71, SD 1.36 cm). The systematic review of the 7 included studies revealed that (1) the FTA:FTC ratio varied from 0.6 to 4.0, lower than the natural distribution of 5.0; (2) no studies assessed prediction performance using AUPRC in unbalanced datasets; and (3) external validations of Thyroid Imaging Reporting and Data System for Follicular Neoplasm scoring criteria underperformed relative to the original ","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e66269"},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study.","authors":"Fiona Kennedy, Susan Smith, Rebecca J Beeken, Caroline Buck, Sarah Williams, Charlene Martin, Phillippa Lally, Abi Fisher","doi":"10.2196/64747","DOIUrl":"10.2196/64747","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH rand","PeriodicalId":45538,"journal":{"name":"JMIR Cancer","volume":"11 ","pages":"e64747"},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}