Ecological Momentary Assessment for Assessing Affect Patterns Associated With Depression in Cancer Survivors in Primary Care: A Pilot Study

INTRODUCTION: Depressive symptoms are common in cancer survivors. Recognizing depression can be complicated due to recall bias or oncological treatment-related symptoms including cognitive problems, which in turn may undermine the reliability of self-report questionnaires.

AIM: To explore the feasibility and patient satisfaction of smartphone-based Ecological Momentary Assessment (EMA) in primary care cancer survivors.

METHODS: Patients > 18 years, curatively treated for cancer within the past two years, regardless whether they experienced depressive symptoms, were selected based on the GPs' health records. EMA questionnaires were sent three times daily for 6 weeks, covering positive and negative affect, along with related experiences. Patients received weekly EMA feedback reports. After the EMA period, they completed an evaluation questionnaire and participated in a follow-up phone call to discuss their EMA experiences.

RESULTS: Patient recruitment achieved a reach of 17.0% who were invited for participation (158/931), of whom 33/158 agreed to participate yielding a response rate of 20.9%. Patients found the EMA questions clear and study participation easy with a completion rate of 67% among those who started. However, 64% felt the frequency of EMA prompts was excessive, with 52% considering the 6-week duration appropriate and 48% feeling it was too long. During phone call evaluations, patients reported becoming inattentive with filling out the EMA's. Weekly reports were viewed as relevant and provided valuable insights into levels and changes in their mood.

CONCLUSION: The relatively low reach and response rate do not entirely support the feasibility and acceptability of a 6-week EMA in cancer survivors in primary care without depressive symptoms. EMA was, however, completed by a majority among those who started and was regarded as a user-friendly tool that offered valuable insights to individuals. It could potentially benefit cancer survivors or other patients who do experience depressive symptoms in primary care.