Web-based symptom management for women with recurrent ovarian cancer: a pilot randomized controlled trial of the WRITE Symptoms intervention.

CONTEXT Little research has focused on symptom management among women with ovarian cancer. Written Representational Intervention To Ease Symptoms (WRITE Symptoms) is an educational intervention delivered through asynchronous web-based message boards between a study participant and a nurse. OBJECTIVES We evaluated WRITE Symptoms for 1) feasibility of conducting the study via message boards, 2) system usability, 3) participant satisfaction, and 4) initial efficacy. METHODS Participants were 65 women (mean age, 56.5; SD = 9.23) with recurrent ovarian cancer randomized using minimization with race/ethnicity (non-Hispanic white vs. minority) as the stratification factor. Measures were obtained at baseline and two and six weeks after intervention. Outcomes were feasibility of conducting the study, system usability, participant satisfaction, and efficacy (symptom severity, distress, consequences, and controllability). RESULTS Fifty-six (87.5%) participants were retained, and the mean usability score (range 1-7) was 6.18 (SD = 1.29). All satisfaction items were scored at 5 (of 7) or higher. There were significant between-group effects at T2 for symptom distress, with those in the WRITE Symptoms group reporting lower distress than those in the control group [t(88.4) = -2.57; P = 0.012], with a similar trend for symptom severity [t(40.4) = -1.95; P = 0.058]. Repeated measures analysis also supported a group effect, with those in the WRITE Symptoms group reporting lower symptom distress than those in the control condition [F(1, 56.7) = 4.59; P = 0.037]. CONCLUSION Participants found the intervention and assessment system easy to use and had high levels of satisfaction. Initial efficacy was supported by decreases in symptom severity and distress.

[1]  E A Balas,et al.  Clinical trials of interactive computerized patient education: implications for family practice. , 1997, The Journal of family practice.

[2]  M. Goodman,et al.  Cancer Symptom Management , 2001 .

[3]  H. Christensen,et al.  Adherence in Internet Interventions for Anxiety and Depression: Systematic Review , 2009, Journal of medical Internet research.

[4]  D. Tripathy,et al.  Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  P. Sherwood,et al.  Computer-mediated patient education: opportunities and challenges for supporting women with ovarian cancer. , 2009, The Nursing clinics of North America.

[6]  Clarann Weinert,et al.  Health knowledge acquisition by rural women with chronic health conditions: a tale of two Web approaches. , 2008, The Australian journal of rural health.

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

[8]  Alla Sikorskii,et al.  Symptom management for cancer patients: a trial comparing two multimodal interventions. , 2007, Journal of pain and symptom management.

[9]  H. Leventhal,et al.  I can tell when my blood pressure is up, can't I?". , 1985 .

[10]  R. Croyle,et al.  Mental Representation in Health and Illness , 2011 .

[11]  Cornelia M. Ruland,et al.  Effects of an Internet Support System to Assist Cancer Patients in Reducing Symptom Distress: A Randomized Controlled Trial , 2013, Cancer nursing.

[12]  B. Piraino,et al.  Randomized controlled trial of SPIRIT: an effective approach to preparing African-American dialysis patients and families for end of life. , 2009, Research in nursing & health.

[13]  N. Kearney,et al.  Evaluation of a mobile phone-based, advanced symptom management system (ASyMS©) in the management of chemotherapy-related toxicity , 2009, Supportive Care in Cancer.

[14]  R. Serlin,et al.  Evaluation of the Symptom Representation Questionnaire (SRQ) for assessing cancer-related symptoms. , 2008, Journal of pain and symptom management.

[15]  Elizabeth Ercolano,et al.  Self‐management: Enabling and empowering patients living with cancer as a chronic illness , 2011, CA: a cancer journal for clinicians.

[16]  B. Given,et al.  Pain and fatigue management: results of a nursing randomized clinical trial. , 2002, Oncology nursing forum.

[17]  Kim Wagler-Ziner,et al.  A cognitive behavioral intervention for symptom management in patients with advanced cancer. , 2005, Oncology nursing forum.

[18]  Roger L. Brown,et al.  An individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors: three pilot studies. , 2009, Oncology nursing forum.

[19]  J. Douglas,et al.  A Randomized, Controlled Trial to Improve Advance Care Planning Among Patients Undergoing Cardiac Surgery , 2005, Medical care.

[20]  H. Donovan,et al.  Nonspecific Effects in Psychoeducational Intervention Research , 2009, Western journal of nursing research.

[21]  R. Burger,et al.  Intraperitoneal cisplatin and paclitaxel in ovarian cancer. , 2006, The New England journal of medicine.

[22]  H. Donovan,et al.  A representational approach to patient education. , 2001, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[23]  E. Venkatraman,et al.  Topotecan and liposomal doxorubicin in recurrent ovarian cancer: is sequence important? , 2005, International Journal of Gynecologic Cancer.

[24]  James R. Lewis,et al.  Psychometric Evaluation of the PSSUQ Using Data from Five Years of Usability Studies , 2002, Int. J. Hum. Comput. Interact..

[25]  D H Gustafson,et al.  Access to health information and support: a public highway or a private road? , 1998, JAMA.

[26]  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..

[27]  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.

[28]  R. Ozols,et al.  The management of recurrent ovarian cancer. , 2007, Seminars in oncology.

[29]  S. Rachman.  Contributions to medical psychology , 1980 .

[30]  R. Serlin,et al.  A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain). , 2008, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[31]  M. Diefenbach,et al.  The Active Side of Illness Cognition , 1991 .

[32]  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.

[33]  B. Monk,et al.  Salvage bevacizumab (rhuMAB VEGF)-based therapy after multiple prior cytotoxic regimens in advanced refractory epithelial ovarian cancer , 2006 .

[34]  H. Donovan,et al.  Representations of fatigue in women receiving chemotherapy for gynecologic cancers. , 2005, Oncology nursing forum.

[35]  N. Douglas,et al.  Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[36]  H. Thaler,et al.  Symptom prevalence, characteristics and distress in a cancer population , 1994, Quality of Life Research.

[37]  D. Cella,et al.  Patient-related barriers to fatigue communication: initial validation of the fatigue management barriers questionnaire. , 2002, Journal of pain and symptom management.

[38]  B. Monk,et al.  A comparison of quality-of-life domains and clinical factors in ovarian cancer patients: a Gynecologic Oncology Group study. , 2010, Journal of pain and symptom management.

[39]  R. Serlin,et al.  A randomized trial of a representational intervention for cancer pain: does targeting the dyad make a difference? , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[40]  B. Monk,et al.  Assessment of factors that contribute to decreased quality of life in Gynecologic Oncology Group ovarian cancer trials , 2009, Cancer.

[41]  S. Pignata,et al.  Treatment of recurrent epithelial ovarian cancer , 2009, Therapeutics and clinical risk management.

[42]  A. Barsevick,et al.  Efficacy of an intervention for fatigue and sleep disturbance during cancer chemotherapy. , 2010, Journal of pain and symptom management.

[43]  R. Muñoz,et al.  Internet interventions for improving psychological well‐being in psycho‐oncology: review and recommendations , 2012, Psycho-oncology.

[44]  E. Kohn,et al.  A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study. , 2011, Gynecologic oncology.

[45]  D. Bodurka,et al.  Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer , 2005, Supportive Care in Cancer.

[46]  H. Donovan,et al.  An update on the representational approach to patient education. , 2007, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[47]  Justin Starren,et al.  Research Paper: A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus , 2006, J. Am. Medical Informatics Assoc..

[48]  H. Donovan,et al.  Patient-provider communication and perceived control for women experiencing multiple symptoms associated with ovarian cancer. , 2005, Gynecologic oncology.

[49]  Wanzhu Tu,et al.  Effect of telecare management on pain and depression in patients with cancer: a randomized trial. , 2010, JAMA.