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Every year, thousands of children with cancer are treated at Toronto’s Hospital for Sick Children (or SickKids). The pain these children endure is one of the worst parts of their sickness. Doctors, nurses and researchers continually work on innovative ways to manage and minimize the pain their patients experience during treatments. To help the children do this, these individuals ask their young patients
to record how they feel twice a day in their pain journals. The more information on pain the researchers receive, the better the pain protocols for current and future patients. However, unless this pain data is collected consistently, it cannot be utilized. The reality is that after treatments many of the patients are too tired or discouraged to keep detailed, handwritten
As a result, SickKids approached us to help find a digital solution to collect this vital data every single day. This was how the Pain Squad Mobile App was born. This innovative app motivates the children to track the intensity of their pain, how long it lasts and where it occurs through the use of a crime-fighting game.
To better understand the issues that prevent patients from chronicling their pain, we met with children at SickKids. The interaction with the children provided a better understanding of their daily life. We had the opportunity to interview and, even more importantly, observe them.
What we discovered is that children with cancer are still children: they love to play and have fun. And, because their playtime may be limited due to scheduled hospital appointments throughout the day, they cherish their free time even more then most kids their age. And, like any other children, they don’t always do what you tell them.
We needed to find a way to motivate these children to comply. We quickly realized that the incentive for these
cancer-stricken children was not monetary or material—they aren’t looking for free things. Therefore, we determined that the incentive would need to be intrinsic.
To motivate our audience to complete their pain reports, we surmised we could tap into their inherent love of video games. This realization helped to shape not only the mechanism and usability of the game-based app, but also the styling and even the name of the app. By embracing gaming and technology that children enjoyed and were accustomed to interacting with, we found a way to take what was previously a tedious task and make it a fun and empowering activity.
This approach marks the first time a hospital handled the problem of pain reporting from the perspective of what the patient wanted—not simply what the hospital needed. Our targets understood that we were trying to make their pain reporting more fun and they responded positively.
Each patient was given an iPhone loaded with the Pain Squad Mobile App. Twice a day, they received an alert via their phone informing them that it was time to complete their pain report. The app was designed to feel like a crime-fighting video game and contains many police clichés, including a spiral notebook, a dark office and a steaming cup of coffee on an old-school desk. Each pain report was stylized to look like a detective’s notepad. Diagrams of the body looked as if they were sketched on the pad and, after each question regarding the patient’s pain is completed, the pages appeared to “flip” over the wire spirals. Each of these stylistic choices was made to keep the patients engaged and entertained.
Additionally, the reports were designed to be easy to navigate and completely intuitive to Apple’s native functionality. With a simple flick of the finger, kids can easily identify exactly where their pain is located and how bad the pain is.
Making the reports easy to fill out was the easy part; our real challenge was ensuring that our patients completed two reports a day, every day. To do this, we built in a reward-based graduation structure. After completing three reports in a row, “recruits” receive a message from the Chief informing them that they are moving up the ranks. These messages aren’t just simple text messages—they’re videos featuring the casts of Canada’s top police dramas, Flashpoint and Rookie Blue. We created dozens of these motivational videos that pop up throughout the Pain Squad mission. Once a child completes their last pain report, they are sent a final video informing them that they are being “retired from the field.”
Our challenge was very direct and simple: to get young cancer patients at SickKids to keep detailed reports of their pain and to complete these reports as consistently as possible. When we launched this initiative, less than half of the patients were submitting their handwritten pain journals. And those who did submit their journals were submitting incomplete reports.
Nurses at SickKids reported that due to the fatigue caused by multiple radiation and chemotherapy treatments, pain reports were often completed by the parents of the patient and resulted in less-than-precise reporting. We sought to find a solution that would encourage the patients to fill out their own pain reports and motivate them to complete their reports every single day.
The results have been exceptional. Since Pain Squad’s launch, compliance rates for our pain journals have been over 90 percent. This type of completion percentage is unheard of in pediatric medicine (80 percent is medically recognized as good compliance). And because the app is used with the patient’s iPhone, we know the data being collected is far more likely to be coming from the patients themselves. It can be concluded that the information now being collected is more accurate and, therefore, more valuable to medical professionals.
As a result of our success at SickKids, the Pain Squad is now set to roll out to four other
pediatric facilities in Canada. As of July 2012, McMaster Children’s Hospital in Hamilton, Children’s Hospital of Eastern Ontario in Ottawa, Winnipeg Children’s Hospital and BC Children’s Hospital in Vancouver will all be implementing Pain Squad for their young patients. In early 2013, this app will be made available internationally.
Our case study video is available here: campaignpage.ca/sickkidsapp
This case study is supported in part by an award from the National Endowment for the Arts.
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