Effects of an Internet Support System to Assist Cancer Patients in Reducing Symptom Distress: A Randomized Controlled Trial

Background: Cancer patients experience many physical and psychosocial problems for which they need support. WebChoice is an Internet-based, interactive health communication application that allows cancer patients to monitor their symptoms and problems, provides individually tailored information and self-management support, e-communication with expert cancer nurses, and an e-forum for group discussion with other patients. Objective: The objective of this study was to examine the effects of WebChoice on symptom distress (primary outcome), depression, self-efficacy, health-related quality of life, and social support (secondary outcomes). Methods: In this 1-year repeated-measures randomized controlled trial, 325 breast and prostate cancer patients were randomized into 1 experimental group with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites. Results: Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale (slope estimate, −0.052 [95% confidence interval, −0.101 to −0.004]; t = 4.42; P = .037). There were no significant group differences on secondary outcomes. Additional analyses showed significant within-group improvements in depression in the experimental group only. In the control group, self-efficacy and health-related quality of life deteriorated significantly over time. Conclusion: This randomized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms. Although only 1 hypothesis was partially supported, the combined results show a clear trend toward better scores in the intervention group on most outcome measures. Implications for Practice: If findings can be supported with additional research, WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness.

[1]  K. Siebens,et al.  Cardiovascular nursing in Belgium: at the crossroad. , 2007, Progress in cardiovascular nursing.

[2]  N. Suksomboon,et al.  Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. , 2009, Diabetes technology & therapeutics.

[3]  S. Woolf.  The meaning of translational research and why it matters. , 2008, JAMA.

[4]  Jennifer N Stinson,et al.  An Internet-based Self-management Program with Telephone Support for Adolescents with Arthritis: A Pilot Randomized Controlled Trial , 2010, The Journal of Rheumatology.

[5]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[6]  L. Williams,et al.  Patient-Centered Communication in Cancer Care: The Role of the NCI’s Cancer Information Service , 2011, Journal of Cancer Education.

[7]  Linda Teri,et al.  6/Use of the Center for Epidemiological Studies-Depression Scale with Older Adults , 1986 .

[8]  L. Derogatis,et al.  The prevalence of psychiatric disorders among cancer patients. , 1983, JAMA.

[9]  H. Thaler,et al.  The Memorial Symptom Assessment Scale Short Form (MSAS‐SF) , 2000, Cancer.

[10]  Cornelia M. Ruland,et al.  Cancer Patients' Questions and Concerns Expressed in an Online Nurse-delivered Mail Service: Preliminary Results , 2009, Nursing Informatics.

[11]  P. Butow,et al.  Oncologists' reactions to cancer patients' verbal cues , 2002, Psycho-oncology.

[12]  Vimla L. Patel,et al.  Web-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled trial , 2002, AMIA.

[13]  Shirley Moore,et al.  Designing Tailored Internet Support to Assist Cancer Patients in Illness Management , 2007, AMIA.

[14]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[15]  S. Horn,et al.  Practice-Based Evidence Study Design for Comparative Effectiveness Research , 2007, Medical care.

[16]  M. Feuerman,et al.  Symptom and quality of life survey of medical oncology patients at a Veterans Affairs medical center , 2000, Cancer.

[17]  R Zeller,et al.  Strengthening experimental design by balancing potentially confounding variables across treatment groups. , 1997, Nursing research.

[18]  H. Christensen,et al.  The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials , 2010, The Medical journal of Australia.

[19]  Sallie Newell,et al.  How well do Medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? , 1998, Cancer.

[20]  D. Wantland,et al.  The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes , 2004, Journal of medical Internet research.

[21]  P. Maguire,et al.  The relationship between patients' concerns and psychological distress in a hospice setting , 1998, Psycho-oncology.

[22]  Cornelia M. Ruland,et al.  Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients' need for symptom management support: a randomized clinical trial , 2010, J. Am. Medical Informatics Assoc..

[23]  P. Maguire,et al.  Predictors of Psychiatric Morbidity in Cancer Patients , 1994, British Journal of Psychiatry.

[24]  P Maguire,et al.  Maladaptive coping and affective disorders among cancer patients , 1996, Psychological Medicine.

[25]  P. Macdonald.  Heart failure with preserved ejection fraction — coming to terms with an oxymoron , 2010, The Medical journal of Australia.

[26]  P. Diggle.  Analysis of Longitudinal Data , 1995 .

[27]  D. Gustafson,et al.  Effect of computer support on younger women with breast cancer , 2001, Journal of General Internal Medicine.

[28]  Todd H Wagner,et al.  Computerized health information and the demand for medical care. , 2003, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[29]  N. Laird,et al.  Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. , 1997, Statistics in medicine.

[30]  Richard L. Street,et al.  Patient-centered communication in cancer care: Promoting healing and reducing suffering , 2007 .

[31]  T. Merluzzi,et al.  Self‐efficacy for coping with cancer: revision of the Cancer Behavior Inventory (version 2.0) , 2001, Psycho-oncology.

[32]  R. Epstein,et al.  Why the nation needs a policy push on patient-centered health care. , 2010, Health affairs.

[33]  Eric A. Finkelstein,et al.  Cost Effectiveness of Internet Interventions: Review and Recommendations , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[34]  H. Scher,et al.  The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. , 1994, European journal of cancer.

[35]  S. Moore,et al.  Designing and Testing Telehealth Interventions to Improve Outcomes for Cardiovascular Patients , 2007, The Journal of cardiovascular nursing.

[36]  Matthew W Kreuter,et al.  Tailored and targeted health communication: strategies for enhancing information relevance. , 2003, American journal of health behavior.

[37]  Brian T. Austin,et al.  Improving chronic illness care: translating evidence into action. , 2001, Health affairs.

[38]  A. J. van der Beek,et al.  Effectiveness of Web-based Interventions on Patient Empowerment: A Systematic Review and Meta-analysis , 2010, Journal of medical Internet research.

[39]  H. de Vries,et al.  Efficacy of two tailored interventions promoting physical activity in older adults. , 2009, American journal of preventive medicine.

[40]  Robert P. Hawkins,et al.  CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved , 2002, Int. J. Medical Informatics.

[41]  James J. Cimino,et al.  Research Paper: A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study , 2009, J. Am. Medical Informatics Assoc..

[42]  Howard Cabral,et al.  Weight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study , 2008, Journal of medical Internet research.

[43]  Elizabeth Murray,et al.  Interactive Health Communication Applications for people with chronic disease. , 2005, The Cochrane database of systematic reviews.

[44]  Valarie Blue Bird Jernigan,et al.  Online Diabetes Self-Management Program , 2010, Diabetes Care.

[45]  Kathleen M Griffiths,et al.  Systematic Review on Internet Support Groups (ISGs) and Depression (1): Do ISGs Reduce Depressive Symptoms? , 2009, Journal of medical Internet research.

[46]  Cornelia M Ruland,et al.  Left Hanging in the Air: Experiences of Living With Cancer as Expressed Through E-mail Communications With Oncology Nurses , 2011, Cancer nursing.

[47]  Seung-Kwon Myung,et al.  Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. , 2009, Archives of internal medicine.

[48]  H. Sintonen.  The 15D instrument of health-related quality of life: properties and applications , 2001, Annals of medicine.

[49]  Peter J Sterk,et al.  Internet-Based Self-management Plus Education Compared With Usual Care in Asthma , 2009, Annals of Internal Medicine.