Like having a personal healthcare coach in your pocket

Cancer patients who undergo stem cell transplantation face a long recovery, requiring medications with debilitating side effects and support around the clock. It’s a difficult experience, with studies showing that more than 70 percent of patients don’t adhere to drug regimens.  

Statistician Susan Murphy spends her days trying to help people suffering from such challenging maladies. The Mallinckrodt Professor of Statistics and Computer Science and associate faculty at the Kempner Institute and her team address healthcare needs not through medicine, but by mobile apps. 

Murphy’s lab specializes in creating sophisticated computational instructions known as reinforcement learning algorithms, which form the technical backbone of next-generation programs to help people stick to a medication protocol, for instance, or regular tooth brushing, or reducing cannabis use.

And if this sounds like one of those ubiquitous apps that tracks steps or counts calories, think again. 

“If you’ve ever downloaded a health app, those tend to be pretty dumb,” Murphy said. “For example, you’ll get a physical activity app, you’ll sprain your ankle, and it’ll continue to tell you to go for a walk.” 

Using advancements in artificial intelligence and sensing technologies to move beyond one-size-fits-all interventions, the lab’s apps are capable of real-time personalization, meting out psychological rewards, and in some cases, leveraging social networks to help users stick to goals.

This approach is called “just-in-time adaptive intervention” because it aims to provide support at just the right time by registering changing needs and contexts. 

Currently the Murphy lab is working with software engineers, cancer clinicians, and behavioral scientists to develop an app for stem-cell transplant patients and their primary caregivers, usually parents. 

Health management, especially for the sickest, typically requires involvement of others. For instance, up to 73 percent of family-care partners have primary responsibility for managing cancer-related medications. 

The researchers are in the early stages of developing the algorithm, to be deployed in a first-round clinical trial this year by collaborators at the University of Michigan and Northwestern University. The trial, called ADAPTS HCT, will focus on adolescent and young adult patients who’ve had stem-cell transplants in the 14 weeks post-surgery.

The algorithm will inform sequential decisions, including when and whether to send motivational prompts to the patient, and whether to send messages and reminders to both patient and caregiver. The application includes a word-guessing game that fosters social support and collaboration between patient and caregiver. 

“We hypothesize that in improving the relationship between patients and their caregivers, patients can function and manage their medications better,” said Harvard postdoctoral fellow Ziping Xu, who is leading the ADAPTS HCT algorithm development.

The app will employ reinforcement machine learning, in which the software will “learn” from previous interactions. For example, rather than simply sending preset reminders about medications, the algorithm will tailor timing and content according to when they have been most useful to patients. That way there is less chance the notifications will be deemed irrelevant or ill-timed and eventually habitually ignored.

“We use the algorithm to learn what is the best way to interact with each patient,” Xu said. 

The Murphy lab is deploying its algorithmic expertise across other domains. With their University of Michigan collaborators, they’ve recently pilot-tested a program called MiWaves aimed at young adults who are abusing cannabis. 

Like the ADAPTS HCT app, MiWaves continually learns and adapts from interactions with each patient to improve its decision rules, with the goal of helping them reduce their daily intake.

The lab is also several years into a project called Oralytics, which recently wrapped up a 10-week randomized trial to help refine the delivery of push notifications to help patients adhere to a tooth-brushing protocol: two sessions of two-minute duration daily, covering all four mouth quadrants. 

The first Oralytics clinical trial included some 70 participants who all received the mobile app with a wireless-enabled toothbrush that sent data to the team’s collaborators at Proctor and Gamble. 

Graduate student Anna Li Trella, who led the Oralytics project through the first trial, said the recently collected data will help the team develop methods to better handle messy problems like missing data and software errors. 

“There are many constraints to running an algorithm in real life,” Trella said. “Now that we’ve conducted the first trial, we can make improvements to help the algorithm collect better data and learn better.”

Murphy thinks of her lab as creating practical pocket coaches who can help people get where they want to go. 

“Very, very few people can afford a human coach. And in fact, some people may not want such intensive human interaction,” Murphy said. “That’s where the idea for these digital supports comes in.”