138 Chapter 6 testing before the app was registered in the app stores. This is a vital step in building good apps, as apps can provide many ways of providing information. Although apps have great potential to improve and support healthcare, it is crucial that these apps are thoughtfully designed in terms of content and user-interface, maintain technical stability, and adhere to privacy and medical device legislation to ensure their effectiveness and safety. 29 When developing an app, one must realize that app features are sometimes costly to build, protect and maintain; and there is a ‘nice to have’ and ‘need to have’ that needs to be explored. It is important to acknowledge that apps are at risk of poor implementation and underutilization in healthcare if not built well. Addressing these concerns is crucial, as apps have additional features and benefits in comparison to a website or digital paper, which may positively impact patient care.16 Therefore, to optimize and prepare for future implementation in standard care, the Stoma App was provided by ostomy nurses to their patients in this trial. And also, our partner in development and spreading insights -the Dutch patient associations- propagated the app and patient stories about it on their website and in their newsletters. We deliberately chose not to compare the full version of the app with ‘care as usual’ –as we expected this outcome evaluation would be biased. Normal routine of stoma care consists of a one-time informative conversation with a physician or stoma nurse before surgery, possibly supported by a paper folder or a referral to a website. Providing information on a stoma -especially if the conversation immediately follows a conversation in which the message is given that one is diagnosed with cancer or another illness, is often not remembered by patients.30 Thus, it is highly likely that having easily accessible information in an app on the own smartphone as an extra to normal routine will be valued more highly than not having such an app. Therefore, we compared two versions of the app to strengthen the evidence supporting the app’s impact and adequately evaluate the effectiveness the design’s add-ons, as suggested by patients. As the app was built with a subsidiary that is to be depleted, insurers require robust evidence to financially support an app built as ‘software as a medical device’. We aim to keep offering this app free of charge to all stoma patients, in and outside of the Netherlands for many more patients to benefit from. For that, one needs evidence on the effect of the app as a medical device in patients as a whole; whilst considering the proposed benefits of the costly elements. Although there was a significant increase in the quality of life of patients using the intervention version of the Stoma App, the uptake and utilization of the app can be further optimized. It is important to acknowledge that the Stoma App suffered from technical issues during the trial. Some of these were not adequately addressed or resolved in a timely manner by the app developer. These technical issues mainly affected the timed information feature of sending out push notifications to patient. This must be considered a crucial component of the timed intervention version of the app. This issue has now been
RkJQdWJsaXNoZXIy MTk4NDMw