## 4 Discussion
### Future Directions  
This study has provided valuable insights into the potential and challenges of implementing the PERSIST platform for cancer survivor care. To maximize its impact and facilitate wider adoption, future research and development should prioritize several key areas. Firstly, enhancing usability and accessibility is paramount. The high attrition rate due to technical challenges underscores the need for rigorous device testing, careful selection, and user-friendly interfaces. Detailed analysis of patient feedback and usability testing with target users are essential to identify and address specific usability issues. Future iterations should focus on simplifying the interface, allowing personalized customization, and providing enhanced technical support and training. To further improve accessibility, future developments should prioritize simplified user interfaces, multimedia educational resources, and personalized technical support, particularly for individuals with varying health literacy and technological skills. Secondly, integrating personalized and holistic care is crucial. Future PERSIST app development should incorporate features addressing psychological factors like stress and motivation, including stress management tools, personalized goal-setting, and resilience resources. AI-driven personalized feedback, adapting to mental states, warrants exploration. Furthermore, to enhance the platform's ability to deliver tailored and adaptable support, future developments should focus on leveraging its existing capabilities for patient feedback integration, vital parameter tracking, and risk factor identification. Dynamic, adaptive algorithms can be implemented to tailor alerts and interventions based on individual patient profiles, real-time data, and evolving health conditions. Additionally, the CDSS should be refined to provide personalized risk predictions, while the MRAST framework can provide insights into patient emotional states. AI can analyze the diverse data collected through the mHealth (version 1.0) and mClinician (version 1.0) applications to personalize interventions and provide real-time alerts and feedback. Integrating AI-powered chatbots or virtual assistants can further enhance patient support. Thirdly, fostering long-term engagement and trust is essential for sustained platform use. To enhance long-term patient motivation and engagement, future iterations should focus on improving real-time feedback and patient progress tracking and incorporating gamification and social support features. Methods such as personalized goal setting, community support, and regular content updates should be introduced. Integrating the platform with existing healthcare services and incorporating gamification can further enhance engagement. Personalized reminders, data portability, and continued technical support are also crucial. To build patient trust, improvements in data privacy and security are essential, including transparent data handling policies, robust encryption, and granular data access control. Fourthly, optimizing clinical integration and collaboration is vital for seamless adoption. To better integrate clinician input and align the intervention with standard cancer care practices, future development should prioritize early and continuous clinician engagement, including design workshops, customizable dashboards, and EHR integration. Regular feedback loops and comprehensive training are also essential. Finally, addressing demographic variations and potential negative effects is necessary to ensure equitable access and patient well-being. Future research should examine variations in self-efficacy and patient activation outcomes across diverse demographic groups, adapting the intervention with culturally tailored content, language accessibility,and age-appropriate design. The study revealed unexpected negative effects, including heightened anxiety and frustration among some participants, particularly related to technical difficulties.