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Home-monitoring system BESI-C aims to reduce cancer pain

A University team wants to make cancer pain management more effective and personalized using a smart health system

Nursing Prof. Virginia LeBaron, former Engineering Prof. John Lach and a team of graduate and undergraduate students implemented Behavioral and Environmental Sensing and Intervention for Cancer to find personalized solutions for cancer pain intervention. BESI-C is a smart health home-monitoring system that aims to reduce cancer pain by detecting it before it arises and helps healthcare workers effectively intervene with the goal of limiting negative patient outcomes.  

The project was inspired by LeBaron's personal and professional experiences.   

"My clinical work as a nurse in oncology and palliative care involved caring for many cancer patients suffering with unrelieved pain," LeBaron said in an email to The Cavalier Daily. "These professional experiences, combined with the personal loss of a family member from cancer, prompted my interest in conducting research to improve cancer pain management."

When LeBaron arrived at the School of Nursing, she connected with Lach who was working on Behavioral and Environmental Sensing and Intervention for Dementia, a project designed to detect early agitation in dementia patients. They decided to adapt BESI-D's technology for patients with cancer and BESI-C was born. The team that works on BESI-C — much like the project — is interdisciplinary in that it is composed of nurses and engineers. 

Kate Gordon is a former graduate nursing student who was a research assistant on the project. 

"The BESI-C system is comprised of three primary components — environmental sensors which are designed to collect data about factors such as temperature, noise and light; Bluetooth beacons which collect data about where the patient and caregiver are in the home; and smartwatches that are worn by both the patient and caregiver," Gordon said in an email to The Cavalier Daily. 

Gordon explained that the smartwatch allows users to mark pain events and describe these events. The smartwatches also store data on factors like movement and heart rate. 

"BESI-C integrates environmental data via the sensors, social dynamic information via the beacons and personal activity and self-reported pain episodes via the wearable sensor," Gordon said. "All of this information helps to create a holistic picture of the cancer pain experience." 

This holistic picture is referred to as a patient's pain profile. LeBaron explained that understanding a patient's pain profile allows for more effective and personalized interventions to reduce cancer pain.

Because both caregivers and patients wear the smartwatches, both parties mark the patient's pain events.

"BESI-C collects data from both the patient and the caregiver about their own experience but also about their perceived experience of their partner," LeBaron said. "This is incredibly important as it will help us better understand how to tailor effective interventions not only to support and empower patients, but family caregivers as well."

The information that BESI-C collects is of high interest to patients and caregivers. Gordon said that patient confidentiality was an important factor in the design of BESI-C — all the data collected during this study was not identifiable. 

"The interviews with the patient-caregiver dyads identified that privacy was the biggest concern," Gordon said. "To address that, we did not capture raw audio — you cannot detect actual conversations with the noise sensor. We did not use cameras. We only put sensors in locations approved by participants and never in areas such as bathrooms, and participants could turn off sensors at any time or simply stop wearing Smart Watch."

According to Lebaron, for the future, the team is focused on deciding how to share data with key stakeholders like patients, family caregivers and healthcare providers.  

“We hypothesize that different ‘buckets’ of data exist, and who needs access to these data, when and how and in what ways will vary,” LeBaron said. “An important goal of our NIH study will be to generate and share data visualizations with key stakeholders and talk with them about their preferences.” 

Yudel Martinez, a fourth-year Engineering student on the BESI-C team, explained that before the pandemic, the team of nurses and engineers would go into patients' homes to set up the system and teach patients and caregivers how to use it. Once the pandemic began, the team had to halt deployments and reconfigure their system to allow it to be set up by patients and caregivers. The team developed the BESI-Box which allows for contactless delivery and a simplified setup with remote support from the team. 

"We have gone through multiple iterations because we have innovated and then presented it to people within our demographic," Martinez said. "We have found that they still have some pain points and we're still in the process of fixing those to make this system as inclusive and easy to use as possible because this is a system that we want people to set up in their lives and use for the length of the deployment without it really affecting their lifestyle and without them noticing it's there."

Martinez is motivated by the importance of BESI-C’s mission. 

"This project is trying to make the last moments of a person's life the most comfortable we possibly can," Martinez said.

The team has plans to expand BESI-C’s reach and impact. According to LeBaron, the team is analyzing feasibility and acceptability testing data and planning to launch a bigger study with a larger sample size. The original study observed 5 dyads — or a pair of one patient and one family caregiver. The team plans to have 50 dyads for the future study.

"For this next study, we will be recruiting patients and family caregivers from the palliative care clinic here at U.Va. and also from a local hospice program — Hospice of the Piedmont — and deploying our revised system using the BESI-Box," LeBaron said. "Looking further into the future, we will use the data collected by BESI-C to develop, deliver in real-time and test personalized interventions, both for patients and caregivers." 

According to a University press release, pilot grants from the U.Va. Center for Engineering in Medicine and the American Cancer Society enabled LeBaron and her team to design and deploy BESI-C.  This year, LeBaron received a $3.4 million grant from the National Institute of Nursing Research, which is part of the National Institutes of Health, that will allow the BESI-C team to expand on their work over the next four years.

LeBaron would like to see BESI-C integrated into routine cancer patient care. She hopes integration will particularly help patients living in rural areas and help patients to avoid unwanted hospitalizations.