![]() Both relaxation and distraction apps each shared an endpoint of a lifting of tension, soothing of anxiety, and restoration to a sense of peace. A distraction app was defined by the study team as one that included a passive receptivity to sound/visual diversion or recreation. A relaxation app was one that involved active entrance into a focused state of calm such as participatory mindfulness, engaged visualization, or body scan. Our study team differentiated between relaxation and distraction in terms of the level of participant engagement/activity required. In considering the role of technology in a pediatric clinical setting, our study team considered the roles of both relaxation and distraction ( Table 1). With the widespread ownership and access to technology, our pediatric palliative care team wondered whether we may consider leveraging current technology use to include apps for calming, relaxation, and mindfulness rather than strictly gaming apps. Smartphones are near universal among younger adults, with >90% of adolescent and young adults owning a smartphone. Approximately three-quarters (77%) of Americans now own a smartphone and half own a tablet computer. Technology represents an entertainment presence for culture this anecdotally is recognized in the increased presence of audiovisual material use as a distraction technique by parents in waiting rooms and hospital rooms. Provision of mobile apps resource summary has the potential to foster pediatric palliative care providers’ knowledge of app functionality and applicability as part of ongoing patient care. Mood and sleep patterns were the main symptoms targeted by apps. Apps featured a relaxation approach (12/16), soothing images (8/16), and breathing techniques (8/16). All were available in English with four available in Spanish. The apps operated on either iOS or Android platforms. Sixteen of the 22 apps identified were included in the final analysis. Reviewer discussion resulted in consensus. Apps were then characterized by infant, child, adolescent, and adult caregiver group categories. Validated Mobile Application Rating Scale (MARS) scores were determined by two blinded reviewers. Apps were reviewed using a systematic data extraction tool. The pediatric palliative care study team searched smartphone application platforms for apps relevant to calming, relaxation, and mindfulness for pediatric and adolescent patients. Patients and families increasingly use mobile apps as a relaxation and distraction intervention for children with complex, chronic medical conditions in the waiting room setting or during inpatient hospitalizations and yet, there is limited data on app quality assessment or review of these apps for level of engagement, functionality, aesthetics, or applicability for palliative pediatric patients.
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