Navigating Wearable Technology in Oncology Nursing While Avoiding Data Fatigue

Close up of hand touching smartwatch with health app on the screen, gadget for fitness active lifestyle. © sitthiphong - stock.adobe.com

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 it is important to determine what information can benefit the care of a patient with cancer.

Oncology Nursing News spoke with Eileen D. Hacker, Ph.D., APRN, AOCN, FAAN, professor and chair in the department of nursing in the division of the 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 a clinical and research setting, while determining what tactics may be most helpful for patient care.

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

It actually can be used for a number of different reasons. It can be used to collect objective data, like physical activity data, sleep data, temperature data. There's a whole slew of biological parameters that it can be used for.

Wearable technology has really revolutionized the way we're able to collect objective data in real-world settings. Before, you needed to be in a clinical environment or in a laboratory to collect some of this data. Now, participants in research can wear these devices and go about their business. Many times, these devices are non-intrusive, so participants don't even remember that they're wearing it. It really gives us some real-world parameters for how these variables are impacted. When they're wearing these devices in the real world, we can see how participants in our research live their lives, get up, get dressed, are active, sit, stand, whatever they may be doing. We can capture that data and be able to make some real decisions to help them improve their physical activity, sleep, whatever it is we're trying to do, then we can monitor it over time.

In your research, are you using devices that anyone could access or are they medical grade?

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

Can you discuss the digital vital sign monitoring aspect of wearable technology?

One of the most important pieces of any type of wearable technology is determining the burden to the participant. Wearable technology that is overly burdensome to the participants will not be effective, people won’t like to wear the devices.

One of the challenges with wearable technology is really making distinctions between research grade and everyday grade. Now they're great for everyday purposes, for people that aren’t doing research, but for research-grade, we really need to be careful because we don't want to introduce measurement error.

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

It's a real issue. And it's not only data fatigue, it's device fatigue. A lot of participants for research—and just regular everyday people like us that want to wear these devices—can get sick of wearing it. And I have found, at least in some cases, it's wonderful for many participants, but some participants can become overly concerned about their health. For instance, if they set a goal for physical activity and they continue to not reach it, or they look at their sleep, see a cycle of bad sleep or poor sleep, then they may start worrying about their sleep. This actually happened to me, I stopped wearing my Fitbit for probably a month because I was getting overly concerned about my sleep.

Typically, the raw data from these types of devices are extensive. There are 1040 minutes in every single day, if you're wearing a device and collecting data or are a research participant, that's 1040 pieces of data for every single day, times 7 days or 14 days. Multiplied that by 30, or 50, or 100, and it’s an incredible amount of data. It can be wonderful data, but to analyze it to ensure the data are clean is very time and labor intensive. Then you have to make decision rules, like do you include them in your study if they only wore the device for 4 hours a day? You have to make these decisions up front. And then you have to hope that the participants agree to wear the device. At least in our research, most of them have been very willing to wear the devices and really provided us with great data.

With nearly 40 years of oncology nursing experience, did you think we'd reach a time like this where wearable technology is being integrated into the care of patients with cancer?

Well, I started using wearable technology before Fitbits, before any of these other devices, when it was super novel. We thought, “My gosh, you could wear this device, it will measure physical activity or measure sleep. It's non-intrusive, it's like wearing a watch, people won't even remember they have it on. It looks like a watch because it shows the time.” And I remember thinking how incredible it felt to collect important information from patients while minimizing the burden on them. And it maximizes compliance because they don't have to do anything. They don't have to keep these extensive diaries, etc.”

Over time, as I've watched the number of wearable devices proliferate, trying to keep your finger on all the different devices can be challenging. I think the key though is really making sure that we can minimize the burden on the participants so that we can maximize compliance because anytime wearing something, doing something becomes overly burdensome, people start dropping out of your study.

What advice would you give oncology nurses on the use of wearable technology and the data they can produce in patient care?

The advice I would give is: do your homework up front. Personally, I think it's important to try out 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 my studies, any intervention study, I do the intervention myself for a number of weeks. I try to find the pitfalls or any potential unintended consequences or little roadblocks. It's helpful to smooth some of those things out up front. Pilot studies are always incredibly important before embarking on large studies.

This transcript has been edited for clarity and conciseness.