DiGA: Learning Self-Management Skills with Evidence-Based Information

Digitization continues to open vast opportunities in medical technology. As a result, Germany reimburses the prescription of an increasing number of approved digital health applications (German: Digitale Gesundheitsanwendungen, DiGA). Specialists collaborate to develop these apps, which offer a variety of low-threshold services to help patients get informed and take charge of their health and disease self-management.

Professor Anja Mehnert-Theuerkauf was involved in the development of a digital health application (DiGA) for cancer patients. The Mika app provides information and accompanies patients through treatment with a personalized support program that caters to all types of cancer. In this MEDICA-tradefair.com interview, she explains the opportunities and the limits of digital health applications.

Professor Mehnert-Theuerkauf, what prompted the development of Mika and how were you involved in this process?

Prof. Anja Mehnert-Theuerkauf: Our collaboration with Fosanis GmbH and Dr. Jan Simon Raue began in 2017 when we were asked to offer scientific support throughout the Mika app development and provide input for its psycho-oncology content. This process has continuously evolved – we kept getting together to specify and create content for the app ever since. We had to address many important questions pertaining to the tracking of the psychosocial effects of cancer on patients or the types of resources that can help patients to cope with their disease. We also discussed how this app can provide emotional support and foster self-management of psychological distress. One question in this setting was to determine at which point of self-assessment a patient should be prompted to seek professional support or psychotherapeutic intervention. We had to find the best way to support patients at higher stress levels: The app must first raise patient awareness by providing comprehensive content, but it must also not overwhelm them with unnecessary details.

What prompted you as a psychotherapist to help develop an app that benefits cancer patients?

Mehnert-Theuerkauf: I am very interested in this subject. As with all new media, we will see an ever-increasing plurality of offers. But although we will have more diverse options, I do not think apps or digital alternatives will replace the doctor-patient relationship and personal interaction. Yet digital options will increase personal flexibility as the coronavirus pandemic has shown us over the past few months.

Digital applications are extremely helpful in oncology as cancer limits many patients, who may be unable or do not want to visit the hospital every week. This is where apps like this one offer low-threshold support. In oncology, many patients are very motivated to make healthy lifestyle changes at the start of therapy – an app makes an excellent digital companion in this setting.

How can a digital health application support cancer patients?

Mehnert-Theuerkauf: The Mika app focuses on three key areas: First, the app works as an information resource that gives patients customized evidence-based information that is tailored to the patient's interests.

The second area pertains to symptom tracking. This feature allows patients to track their psychosocial stress over time, enabling them to monitor their level of stress and determine whether they should seek professional support.

The third area pertains to the app being a low-threshold intervention. For example, patients can learn relaxation techniques or achieve self-empowerment and strength with the help of self-management tools (themed trips). This makes apps like Mika incredibly useful for cancer patients: apart from counseling for cancer and specific psycho-oncology support options, apps help patients during the different stages of the disease to help themselves. A cancer diagnosis is a life-changing experience, and for many patients, it presents seemingly insurmountable obstacles. Their lives change from one day to the next and patients must reorganize the different areas of their existence, which can be overwhelming at times. The app’s focus on these three key areas makes it uniquely helpful. 

Where do you see the limits of digital healthcare applications?

Mehnert-Theuerkauf: I think a DiGA should be a self-help or self-management tool that gives patients specific information and advice or makes suggestions on how they can cope with certain issues. I believe an app has reached its limits when the person must seek professional help or therapy, when a person's stress levels are too high, and he/she can longer cope with their everyday problems without external support. Take depression, for example: the app features a tool where patients can check their level of depression and decide whether it would be best to talk to an expert. This allows patients to get faster professional support.

Does this mean you consider DiGAs a complementary tool for your work?

Mehnert-Theuerkauf: I do. We provide patients with a great tool to be able to do something themselves and manage their daily life. That being said, an app cannot replace a substantiated clinical and psychological diagnosis and professional conversation or psychotherapeutic interventions, respectively. 

What is your take on the impact digital health apps will have on the future of healthcare?

Mehnert-Theuerkauf: They will have an enormous impact as they open up so many possibilities, ranging from symptom tracking to using AI for better diagnostic oncology of early disease stages. We will see more advances in diagnostics and medicine in the future.

The question that arises for me in this setting pertains to who really owns this sensitive private medical data – does it belong to private entities or public authorities? We need more public discourse on this issue.