Navigating wearable technology in oncology nursing while avoiding data fatigue

Collecting data on a patient’s physical activity, sleep habits and other objective information has become easier with wearable technology, but an expert explained how important it is to determine what information can benefit a cancer patient’s care.

Oncology Nursing News spoke with Eileen D. Hacker, Ph.D., APRN, AOCN, FAAN, professor and chair in the department of nursing in the department of senior vice president and chief nursing officer at the University of Texas MD Anderson Cancer Center in Houston on how wearable technology can be used in clinical and research settings while determining what tactics can be most beneficial to patient care.

Can you discuss how wearable technology can be used in oncology nursing?

In fact, it can be used for a number of different reasons. It can be used to collect objective data, such as physical activity data, sleep data, temperature data. There is a whole range of biological parameters that it can be used for.

Wearable technology is truly revolutionizing the way we can collect objective data in real-world settings. Previously, you had to be in a clinical setting or in a lab to collect some of this data. Now, research participants can wear these devices and go about their work. Many times these devices are unobtrusive, so participants don’t even remember they’re wearing them. This really gives us some real-world parameters of how these variables are affected. When they wear these devices in the real world, we can see our research participants living their lives, getting up, getting dressed, being active, sitting, standing, whatever they’re doing. We can capture that data and be able to make some real decisions to help them improve their physical activity, their sleep, whatever we’re trying to do, and then we can monitor it over time.

In your research, do you use devices that everyone has access to or are they medical?

We have used both. To collect the physical activity data, we used research-grade accelerometers. Fitbits [and] Garmins are used in research to help people monitor their own physical activity and help them reach pre-set physical activity goals. We have used them as part of the intervention, some people also use them for outcome variables. It’s great if people choose to wear them.

Can you discuss the digital vital signs aspect of wearable technology?

One of the most important parts of any type of wearable technology is determining the weight of the participant. Wearable technology that is too burdensome for participants will not be effective, people will not like wearing the devices.

One of the challenges with wearable technology is really distinguishing between research and everyday class. Now, these are great for everyday purposes, for people who aren’t doing research, but for a research degree, we really have to be careful because we don’t want to introduce measurement error.

How can oncology nurses use physical activity and sleep data from wearable devices while avoiding data fatigue?

This is a real problem. And it’s not just data fatigue, it’s device fatigue. Many research participants – and just regular people like us who want to wear these devices – may get tired of wearing them. And I’ve found, at least in some cases, that it’s wonderful for many participants, but some participants can become overly concerned about their health. For example, if they set a physical activity goal and keep falling short of it, or look at their sleep, see a cycle of poor or poor sleep, then they may start to worry about their sleep. This actually happened to me, I stopped wearing my Fitbit for probably a month because I was too concerned about my sleep.

Typically, the raw data from these types of devices is extensive. There are 1040 minutes in each day, if you wear a device and collect data or are a study participant, that’s 1040 pieces of data for each day multiplied by 7 days or 14 days. Multiplied by 30, or 50, or 100, that’s an incredible amount of data. This can be great data, but analyzing it to ensure that the data is clean takes a lot of time and effort. Then you have to make decision rules, like do you include them in your survey if they only wear the device 4 hours a day? You need to make these decisions in advance. And then you have to hope that the participants agree to wear the device. At least in our survey, most of them were very willing to wear the devices and really provided us with great data.

With almost 40 years of experience in oncology nursing, did you think we would reach a time like this where wearable technology is integrated into the care of cancer patients?

Well, I started using wearable technology before Fitbits, before any of these other devices, when it was super new. We thought, “Oh my God, you can wear this device, it will measure physical activity or sleep. It’s not intrusive, it’s like wearing a watch, people won’t even remember they’re wearing it. It looks like a clock because it shows the time. And I remember thinking how amazing it was to gather important information from patients while minimizing the burden on them. And that maximizes compliance because they don’t have to do anything. They don’t have to keep these extensive logs etc.

Over time, as I’ve watched the number of wearables increase, trying to keep your finger on all the different devices can be a challenge. I think the key is really making sure that we can minimize the burden on the participants so that we can maximize compliance, because every time you wear something, do something it becomes too burdensome, people start to drop out of your study.

What advice would you give to oncology nurses about using wearable technology and the data it can generate in patient care?

The advice I would give is: do your homework beforehand. Personally, I think it’s important to test the device yourself in a number of different situations before you start using it in your own research. That’s something I’ve done with almost all of my studies, every intervention study, I do the intervention myself for a few weeks. I try to find the pitfalls or any potential unintended consequences or little obstacles. It helps to iron out some of these things up front. Pilot studies are always incredibly important before embarking on large scale studies.

This transcript has been edited for clarity and brevity.