老九品茶

When Dom Raban鈥檚 daughter was diagnosed with a rare type of cancer, he saw first-hand how daunting the treatment journey can be for children.

Issy was just 13 when she was diagnosed with Ewing鈥檚 sarcoma, a cancerous tumour that grows within bones and the surrounding soft tissue. Seven years on and cancer-free, she is helping her father鈥檚 vision of supporting others faced with the same terrifying scenario.

鈥淚t鈥檚 weird to still be talking about children with cancer every day 鈥� but it鈥檚 really cathartic,鈥� Raban, founder of digital agency Corporation Pop, reflects in an interview with 老九品茶Cloud.

While he acknowledges that information was made available through books and leaflets, the designer and entrepreneur saw an opportunity to rethink the process. Raban first revealed the existence of the resulting side-project to 老九品茶Cloud in 2016 鈥� and last year Xploro, as it would later be known, became his full-time focus.

Among the app鈥檚 team of developers is none other than Issy, now 20. 鈥淚t鈥檚 incredibly rewarding to see young children, who are going through similar treatments to my daughter, being helped by Xploro,鈥� Raban says.

Like many games for children, the Xploro app centres on a user鈥檚 customised 3D avatar. This cheerful, personalised virtual friend doubles up as an all-knowing guide full of information about upcoming treatments.

The character can explain in simple terms what the child should expect from his or her next appointment 鈥� and even take them through a CAT scan to highlight how the procedure doesn鈥檛 hurt despite the scary chamber and loud noises. Its design is inspired by lifestyle simulator The Sims while the language could be straight from a Super Mario game.

鈥淣intendo鈥檚 language style is non-patronising to younger children, but simple enough for younger people to understand. We鈥檝e mimicked that approach,鈥� says Raban.

However the character is a great deal more than a prewritten proxy: children can chat to and confide in their new guide through the app like they would a friend, have them appear on their bed or the ward through augmented reality, and be reminded of upcoming appointments.

All this seemingly simple functionality requires a powerful back end of tools. Xploro鈥檚 custom-built AI is the 鈥榖rains鈥� of the character and can answer questions, understand sentiment and even tell jokes. It has also been built to interpret misspellings you鈥檇 expect from a child who might 鈥� for example 鈥� want to know about chemotherapy without necessarily being able to spell the word.

A mood diary and calendar of events to help children are also included to give the users control of their day. This part of the app can be managed via the parent or guardian, who also have a space to keep a journal. A clinician鈥檚 management system allows for the customisation of some content, including the addition of those events, and detailed analytics for monitoring patient feedback.

And when children get tired of talking, there are also games modelled on how the treatments are working to battle the cancer.

A trial of the app among children aged six to 16 was held at cancer care specialist hospital The Christie (see Emmie boxout, opposite page), which has since become Xploro鈥檚 first paying customer. A research team at Edge Hill University 鈥� led by Lucy Gray, a Professor in Child Health Literacy and leading figure on the information needs of children going into hospital 鈥� determined that the app improves clinical results. The evaluation of 80 children, half of which had access to Xploro, found that access to it showed a statistically significant reduction in procedural anxiety.

鈥淭hat鈥檚 really important, because there鈥檚 lots of research evidence that says that if you can reduce anxiety, then you can improve clinical outcomes,鈥� says Raban, who also highlights the anecdotal feedback received by the Xploro team.

When the mother of a nine-year-old girl being treated for the removal of a benign brain tumour got in touch, they readily provided her with access to the app. Within a few days the daughter was markedly less afraid and openly talking about going to hospital. 鈥淪he was internalising all of her fears but, through familiarisation, she went from being terrified to actually talking about the experience.

鈥淭hat sums up what we鈥檙e trying to achieve. It鈥檚 what success looks like.鈥�

The aim is for the app to be used by 鈥渁 dozen or so NHS trusts鈥�. 鈥淲e鈥檒l then use that as a reputational door opener for the European and US markets,鈥� Raban adds.

The key to the UK market, he says, is for clinicians to become aware of Xploro and make a case for it to the hospital鈥檚 own charity, rather than seeking NHS funds. 鈥淔inding the money to pay for the software can become quite a protracted process,鈥� he qualifies.

The firm plans to broaden its content to include people coming into hospital for basic procedures. Over the next year to 18 months, it will work with clinical partners to develop content for diabetes, respiratory illness and mental health: 鈥淥nce we鈥檝e done that, we want to develop versions for other age groups. Developing that content for adults is actually quite simple, in terms of the differences we鈥檇 need to make. It鈥檚 more of a change to the user interface than the whole structure of the app.鈥�

Around 25 million people in the UK reported high levels of anxiety during March due to the COVID-19 pandemic, according to the Office for National Statistics. Should another coronavirus wave sweep the planet, the app would be well-placed to help reduce this.

鈥淭here鈥檚 definitely a role for Xploro to play in explaining 鈥榳hat is a virus?鈥� and 鈥榟ow do you treat it?鈥欌�� says Raban. 鈥淲e haven鈥檛 got that content, but were something like this to happen again in future, I could see Xploro playing an important part in reducing anxiety.鈥�

Raban has also had conversations with eager users who want the app to work for treatments outside of hospital, for example at home or in school.

鈥淭he long-term goal is any age, any condition, anywhere in the world.鈥�

Meet Emmie, 11 鈥� an Xploro expert

Emmie is part of Xploro鈥檚 Expert Advisor group, which tests the app at The Christie.

Emmie has been lending her experience of hospitals and treatments to the company for two years.

鈥淚t is very scary,鈥� she tells 老九品茶Cloud of entering hospital as a young patient. 鈥淚 didn鈥檛 know what was going on, so for other children the app can help you see what is going to happen with different machinery. There were different procedures I didn鈥檛 know, which I know now because of the app.鈥�

Emmie is a gamer and keen user of Roblox, an online platform where people can design their own games and play those created by others. She says Xploro is better than her other games because the content is all free to use. 鈥淭here are some games that use coins, but Xploro is free so you can customise the characters however you want.鈥�

Mum Eve says her daughter enjoyed making a character which didn鈥檛 look exactly like her, and that the design choices of the character were a good way to strike up a conversation with new friends in the same hospital bay. 鈥淵ou can use the app to become friends with new people in your bay, because they are all playing the same game,鈥� Eve says.

Emmie adds: 鈥淚f you have a favourite nurse you can put in their name and customise [the character] to look like them.鈥�

She says her friends can also use the app to get a better idea of what she has been through. That ability to communicate the experience in new ways extends to Emmie and Eve鈥檚 relationship too.

鈥淎s a parent, the app gives lots of opportunity to talk with Emmie about what might be happening at the hospital,鈥� she says. And when Emmie wants questions answered privately, the chatbot is there as a safe space accessible only to her.

The diary and mood journal, while a useful space to express feelings, also keeps a record of her progress. 鈥淪he might feel quite unwell one day, but by the time we鈥檇 gone to see the consultant, she鈥檇 feel fine,鈥� says Eve, who explains that the consultant can use that mood journal data to build a better picture of her progress.

Emmie is still on the advisory group, and is brimming with ideas for new features 鈥� including adding VR and being able to take on the role of a doctor or nurse in the simulation.

Xploro鈥檚 international challenge

A Spanish-language version of the app is being tested in Barcelona 鈥� but the end-goal is to penetrate the US market

The challenge facing Xploro if it is to achieve global success is to weed out the cultural differences around healthcare.

The firm is currently working with Hospital Sant Joan de D茅u in Barcelona, a teaching hospital specialising in the fields of paediatrics, gynaecology and 聽obstetrics, to develop and test the Spanish-language version.

Raban is working to get new patient user groups to evaluate the app. 鈥淟ast year we were successful in getting some European money to help us produce a Spanish language version of Xploro,鈥� he says. 鈥淥ne of the things we noticed is that they don鈥檛 really have wards. Most patients are treated in their own rooms.鈥�

This means that the current 3D model of a ward in Xploro鈥檚 app (left) was confusing to its Spanish users. 鈥淭hat鈥檚 just one minor example of the cultural differences which need to change.鈥�

Raban, who acknowledges the ambition of attempting to get into multiple countries at once, says the US 鈥� a market where 13 per cent of people speak Spanish as a first language 鈥� is the biggest fish it is looking to catch. 鈥淭he States has always been a really important market to us. We spent quite a lot of time reworking the software last year so that it can be localised easily,鈥� he says.

A planned trip to the US, curtailed by coronavirus, formed part of the firm鈥檚 conversations with the US National Cancer Institute. Together they are detailing potential work with a number of US hospitals.

Raban admits that COVID-19 has left 鈥渆verything up in the air at the moment鈥� but sees the first year鈥檚 sales coming from the UK, followed by 60% of sales coming from the US in 2021.

The sales process, he says, is entirely different to that of the UK. 鈥淧eople tend to think of the NHS as a single body. In fact, each NHS trust operates completely differently from the next. One thing which unites them is a really complex digital procurement system.

鈥淩ightly or wrongly 鈥� and emotionally I think wrongly, but as business person rightly 鈥� selling in the UK is quite difficult, whereas in the States you鈥檙e dealing with hospitals that are operating more like conventional businesses.鈥�