Comparing Effects in Regular Practice of E-Communication and Web-Based Self-Management Support Among Breast Cancer Patients: Preliminary Results From a Randomized Controlled Trial

Abstract

BackgroundWhile Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness, few studies have examined the relative contribution of different Web-based components to improve outcomes. Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care.ObjectiveOur aim was to compare in regular care the effects of (1) an Internet-based patient provider communication service (IPPC), (2) WebChoice, a Web-based illness management system for breast cancer patients (IPPC included), and (3) usual care on symptom distress, anxiety, depression, (primary outcomes), and self-efficacy (secondary outcome). This study reports preliminary findings from 6 months’ follow-up data in a 12-month trial.MethodsWe recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals. The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated. In addition to the IPPC, WebChoice contains components for symptom monitoring, tailored information and self-management support, a diary, and communication with other patients. A total of 20 care providers (11 nurses, 6 physicians, and 3 social workers) were trained to answer questions from patients. Outcomes were measured with questionnaires at study entry and at study months 2, 4, and 6. Linear mixed models for repeated measures were fitted to compare effects on outcomes over time.ResultsPatients were randomly assigned to the WebChoice group (n=64), the IPPC group (n=45), or the usual care group (n=58). Response rates to questionnaires were 73.7% (123/167) at 2 months, 65.9 (110/167) at 4 months, and 62.3% (104/167) at 6 months. Attrition was similar in all study groups. Among those with access to WebChoice, 64% (41/64) logged on more than once and 39% (25/64) sent e-messages to care providers. In the IPPC group, 40% (18/45) sent e-messages. Linear mixed models analyses revealed that the WebChoice group reported significantly lower symptom distress (mean difference 0.16, 95% CI 0.06-0.25, P=.001), anxiety (mean difference 0.79, 95% CI 0.09-1.49, P=.03), and depression (mean difference 0.79, 95% CI 0.09-1.49, P=.03) compared with the usual care group. The IPPC group reported significant lower depression scores compared with the usual care group (mean difference 0.69, 95% CI 0.05-1.32, P=.03), but no differences were observed for symptom distress or anxiety. No significant differences in self-efficacy were found among the study groups.ConclusionsIn spite of practice variations and moderate use of the interventions, our results suggest that offering Web support as part of regular care can be a powerful tool to help patients manage their illness. Our finding that a nurse-administered IPPC alone can significantly reduce depression is particularly promising. However, the multicomponent intervention WebChoice had additional positive effects.Trial RegistrationC...

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…Evaluative research in this area has found a mixed picture in terms of the impact of patient monitoring on self-management and patient outcomes. 313,318,[372][373][374][375] Mixed-methods research is needed to explore the contexts in which and mechanisms through which these interventions achieve their intended outcomes.…”

Randomized Trial of a Social Networking Intervention for Cancer-Related Distress

“…Borosund et al (29) and Ruland et al (30) demonstrated that an internet-based messaging system to provide breast cancer patients with the ability to send questions to care providers and receive responses, a discussion forum for communicating with other patients, and a blogging tool resulted in significant, but quite small, improvements with respect to anxiety, depression, and symptom distress relative to a usual care control group. Use of the social tools, such as the discussion forum and blogs was limited, such that the median number of posts per participant was zero in both the discussion forum and the blogs and an average of 1 advice message was sent, although participants did spend time reading what others had posted.…”

The challenge of involving elderly patients in primary care by using an electronic communication tool with their professionals: a mixed methods study

“…Third, professional characteristics influence the use of the tools. For instance, healthcare providers beliefs (is the tool useful for professionals and patient);22 – 24 the fact that general practitioner adoption of e-mail remains low even though it is easily available26 and professionals do not give equal priority to e-communication (nurses are more conscientious than physicians);22 low computer literacy, insufficient basic formal training in health IT applications, physicians’ concerns about more work; workflow issues; problems related to new system implementation, including concerns about confidentiality of patient information; depersonalization; incompatibility with current health care practices; lack of standardization and problems with reimbursement 20. Fourth, barriers to implementation can also be found at the institutional level.…”

“…Fourth, barriers to implementation can also be found at the institutional level. There are concerns about confidentiality and security25 unclarity in the implementation process concerning decisions about roles, sufficient time and sufficient competence of professionals 22 , 24…”