KSS AHSN supported the Royal Surrey NHS Foundation Trust (RSFT) to develop a new app with Piota for people living with metastatic cancer

The challenge

Enhanced Supportive Care (ESC) is a fresh and modern approach to supporting people through cancer treatment. It focuses on providing better access to expertise in managing the adverse effects of cancer and cancer treatments.

The Royal Surrey NHS Foundation Trust’s​ ESC service was set up in September 2019 and started seeing patients from January 2020. It aims to support all patients with recently diagnosed locally advanced or metastatic cancer who are receiving anti-cancer treatment at St Luke’s Cancer Centre, Royal Surrey NHS Foundation Trust (RSFT).

As the coronavirus (COVID-19) pandemic started in 2020, the ESC team at Royal Surrey NHS Foundation Trust wanted to find an innovative solution to help them to support patients with newly diagnosed metastatic cancer. In particular, the team was looking to remotely signpost patients to trusted sources of information and wanted to explore ways to digitally capture patient-reported symptoms.

Our approach

Kent Surrey Sussex Academic Health Science Network (KSS AHSN) supported the Royal Surrey NHS Foundation Trust Enhanced Supportive care (ESC) department to find a suitable application (app) solution. Based on the potential app partners researched and presented by KSS AHSN, the ESC team selected a company called Piota (Put It On The App) to support them to co-design an app.

The ESC department specifically wanted to develop a digital app that could enable patients with metastatic cancer to complete a pre-consultant symptom assessment questionnaire using their own digital devices. In addition, the team wanted the app to provide updates and notifications along with condition-specific guidance material to help to support ESC patients remotely alongside their appointments.

The app that Royal Surrey NHS Foundation Trust ESC and Piota created focuses on reducing the amount of time spent in appointments completing the symptom assessment questionnaire, so clinicians can focus on what matters most to the patient. The app enables clinicians to review answers before their consultations; and allows them to signpost patients to other trusted information or websites.

The use of an app to remotely obtain patient reported outcomes was completely new to the ESC team and a departure from traditional working practices. It was crucial therefore for the Piota and KSS AHSN teams to support the hospital team to adopt and use this technology as part of their offer.

Unity Insights supported KSS AHSN to conduct a real-world evaluation and budget impact model to review the use of the app and any benefits seen by both patients and clinicians, as well as the wider benefits to the Trust as a whole (e.g., clinician time saved).

Technology to improve our communication and way of working is one of the key ESC principles and as a team we were keen to embrace this from the start using a bespoke digital platform. Given that we had limited app experience, KSS AHSN were invaluable in helping us to impartially source and review providers that suited our needs. We chose Piota due to their track record with other NHS hospitals, the simple set-up process, ease of use for patients and clinicians and cost-effectiveness. After two years, the app is embedded in our service, and we can see potential to expand its use moving forward.

Emma Dillsworth

ESG Project Manager , Royal Surrey NHS Foundation Trust

About Piota

Founded in 2014, Piota (‘Put It On The App’) was founded in 2014 to create high-quality apps at affordable prices. The company creates applications (apps) to simplify communication and effectively engage with the range of stakeholders.

Piota has developed a digital health app for healthcare settings that represents a quickly customised two-way communication portal, allowing clinical units and services to directly communicate with a range of stakeholders through a single channel.

We are pleased that the ESC service found the app easy to implement and popular with the patients who used it. It is notable that patients using the app completed 3.1 forms per person compared to 1.3 forms per person using paper. In the next phase when app use is extended to all newly referred patients, if these results are maintained significant cost and time savings will accrue to the ESC service.

James Dickson


Impact and outcomes

The real-world evaluation and budget impact model was conducted by Unity Insights between 1 Jan 2021 – 28 February 2022 (14 months). The evaluation included patient satisfaction scores and patient and staff user feedback. 155 ESC patients were included in the analysis.

Patient satisfaction scores from self-reported surveys showed both app users and non-app users were largely very satisfied with the ESC service across the six questions.

General feeling from clinicians is the app should be better integrated into the usual pathway to increase uptake.

One clinician said: “[the app] allows us to focus on what is important to the patient from the start of the consultation.”

The analysis has enabled the ESC team to set future goals around the use of the app and the results could be used on a wider, national scale to help inform other NHS ESC services. To produce a more robust model of the cost of the intervention, a larger sample size is recommended.

We’re delighted to have helped the RSCH clinical team articulate their need, find a well-evidenced solution that matched this need, support a pilot and help them evaluate it over the last 2 years such they can continue to procure and use it to best help their patients.

Dr Charlotte Roberts

Associate Director , KSS AHSN

How the app is being used

  • All newly referred outpatients are offered the ESC app at their first appointment as standard
  • All patients who have shown an interest in using the app to be routinely contacted by ESC project manager to help with any queries
  • Royal Surrey NHS Foundation Trust ESC recognises that not all patients want to or are not able to use digital solutions. Patients do not have to use the app and paper-based symptom trackers and information leaflets are still available for patients.
  • Highly specialised Occupational Therapist continues to upload a new wealth of material to help with difficult to manage symptoms
  • The team continue to collect app activity data to learn and improve the app on an ongoing basis.