Emojis show promise as quality-of-life tracking tool

Volume 7, Issue 1, 2018


Electronic emoji scales and wearable technology have the potential to improve patient care.

Carrie A. Thompson, M.D.

Carrie A. Thompson, M.D.

Using emojis instead of traditional emotional scales is helpful in assessing physical, emotional and overall quality of life for patients, Mayo Clinic researchers have found.

Patients also favor using iPhones and Apple Watches, and the technology helps collect study data accurately and efficiently, the researchers found.

"Cancer patients receive complex medical care, including surgery, radiation, chemotherapy and targeted agents that may result in physical, emotional, financial and spiritual consequences that can negatively impact quality of life and the ability to perform certain activities without help," said Carrie A. Thompson, M.D., a hematologist at Mayo Clinic in Rochester, Minnesota, who presented findings about the emoji scale study. "These quality-of-life factors play an important role in predicting survival and determining the best treatment options."

Gauging patient quality of life and performance status can be challenging because it typically involves completing lengthy paper questionnaires, which can be burdensome for patients and may be inaccurate. "In our study, we wanted to determine if wearable technology data could be correlated with traditional, validated patient-reported outcome measures in cancer patients," Dr. Thompson explained.

The researchers recruited 115 patients with either lymphoma or multiple myeloma at Mayo Clinic with expected life spans of less than five years and who owned an iPhone 5 or newer version. All patients were provided an Apple Watch and downloaded a study app at enrollment.

The researchers collected baseline data that included information about physical function, fatigue, sleep, social role and quality of life. In addition, the researchers developed two electronic emoji scales to measure quality of life.

"Emojis are a near universal, popular form of communication, understandable by diverse populations, including those with low health literacy," Dr. Thompson said. "There are several studies that attempt to predict individual well-being based on analysis of social media postings on Facebook and Twitter, but these studies do not focus on emojis as a mechanism for patients to express how they are feeling on a given day. If we can demonstrate that simple emojis are a valid and reliable measure of patient well-being, it could transform the way patient well-being assessments are accomplished."

During the first week of the study, patients wore their Apple Watches for an average of 9.3 hours a day, took 3,760 mean steps a day, exercised 8.3 minutes a day, were sedentary for 224.9 minutes a day, and burned 115.8 kilocalories a day.

The researchers observed significant associations between standard patient-reported outcome measures and activity data. The strongest correlation was between steps per day and the Patient-Reported Outcomes Measurement Information System physical function scoring system. In addition, researchers found that patients' emoji responses were significantly associated with standard patient-reported outcomes.

"While further research is needed to validate the use of wearable activity monitors in cancer care, we believe this technology has the potential to improve the way we care for patients," Dr. Thompson said. "In the future, it may be possible to monitor patient symptoms and communicate with patients between appointments via wearable technology."