Paces Header


Supporting Communication and Shared Decision-Making for Patients, Caregivers, and Providers


Moffitt Cancer Center, Karmanos Cancer Institute


Mobile, Web, and Healthcare

The Challenge

Caregivers play a critical role in patient-provider interactions as advocates and significant social support for cancer patients. Yet, Dr. Maija Reblin, from Moffitt Cancer Center, and Dr. Susan Eggly, from the Karmanos Cancer Institute, looked to their research and discovered that during a medical visit, the communication needs of caregivers accompanying cancer patients were often not met. Recognizing the challenge, Moffitt Cancer Center aimed to create an application with the goal to help patients and their caregivers better clarify roles, including whether caregivers should be active or silent participants in multiple aspects of care and discussions with a physician. Moffitt Cancer Center partnered with CrossComm to develop PACES, an app to help patients and caregivers engage in conversations and shared-decision making with their providers.

Our Approach

Moving From a Paper-Based Intervention to App-Based

Building from the body of health communication research, CrossComm worked with Moffitt to translate a question prompt list (QPL) intervention into an app-based format. Traditionally, QPL interventions have been delivered in paper form, but in a move to tailor the questions towards the individual needs of both patients and caregivers, CrossComm was tasked with providing a digital solution. Watch Dr. Eggly talk about the benefits of creating an electronic version of a QPL.

Determining Necessary Features

CrossComm worked with Moffitt Cancer Center to think through ways technology can help the patient and caregiver improve communication with each other. Blending research knowledge and technological expertise, PACES was created with features that provide the ability for patients and caregivers to separately log in and rank questions based on their individual preferences, and allows them to add their own questions to the QPL. The application also takes the individual user responses, merges the ranked information, and displays easy-to-understand visualizations of the similarities and differences in priorities from the patient and caregiver’s perspective.

“What we wanted to do was to not only facilitate the conversation between patients and doctors, but also between patients and caregivers, and caregivers and doctors.”

Dr. Susan Eggly, Professor/Researcher @ Wayne State University / Karmanos Cancer Institute

"We really appreciated that they took the time to translate their processes for us. CrossComm was a true partner who wanted us to be involved in the process."

Dr. Maija Reblin, Assistant Professor @ Moffitt Cancer Center

Read the entire review in Clutch

Building Out Functional Requirements

To that effect, CrossComm built PACES as an interactive web application optimized to use on mobile devices. CrossComm developers devised a customizable user flow so that both patients and caregivers can complete questionnaires in any order, and retake them at will. CrossComm additionally ensured the confidentiality of users by excluding personally identifiable information and protected health information from data collection and data flow in the app. Keeping in mind the needs of researchers and providers, a web interface was additionally built to manage administrators and patient users, view patients’ study progress and survey data, and generate and download study data in .CSV format.

Screenshots from Paces app


Pilot Testing in Rural and Urban Settings

The PACES app is currently undergoing pilot testing to address multiple research questions, in rural and urban areas, with diverse racial and ethnic patient populations. CrossComm continues to work with Moffitt Cancer Center to modify the application based on empirical data and feedback from community partners. Preliminary responses from community-based groups indicate caregivers and patients felt an app like PACES would be helpful to them. As the PACES app is a novel electronic approach in the use of QPL in patient-caregiver-provider cancer communication, continued testing is underway to address acceptability and feasibility. Additional studies will explore the impact of PACES on quality of communication and the exchange of information between cancer patients, caregivers, and providers.