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Exposure to a patient-centered, Web-based intervention for managing cancer symptom and quality of life issues: impact on symptom distress.

Berry DL, Blonquist TM, Patel RA, Halpenny B, McReynolds J - J. Med. Internet Res. (2015)

Bottom Line: Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions.The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group.Clinical and personal demographics influenced voluntary use.

View Article: PubMed Central - HTML - PubMed

Affiliation: Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, United States. donna_berry@dfci.harvard.edu.

ABSTRACT

Background: Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions. Even though usage statistics are easily logged in most eHealth interventions, usage or exposure has rarely been reported in trials, let alone studied in relationship to effectiveness.

Objective: The intent of the study was to evaluate use of a fully automated, Web-based program, the Electronic Self Report Assessment-Cancer (ESRA-C), and how delivery and total use of the intervention may have affected cancer symptom distress.

Methods: Patients at two cancer centers used ESRA-C to self-report symptom and quality of life (SxQOL) issues during therapy. Participants were randomized to ESRA-C assessment only (control) or the ESRA-C intervention delivered via the Internet to patients' homes or to a tablet at the clinic. The intervention enabled participants to self-monitor SxQOL and receive self-care education and customized coaching on how to report concerns to clinicians. Overall and voluntary intervention use were defined as having ≥2 exposures, and one non-prompted exposure to the intervention, respectively. Factors associated with intervention use were explored with Fisher's exact test. Propensity score matching was used to select a sample of control participants similar to intervention participants who used the intervention. Analysis of covariance (ANCOVA) was used to compare change in Symptom Distress Scale (SDS-15) scores from pre-treatment to end-of-study by groups in the matched sample.

Results: Radiation oncology participants used the intervention, overall and voluntarily, more than medical oncology and transplant participants. Participants who were working and had more than a high school education voluntarily used the intervention more. The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group.

Conclusions: The intended effects of a Web-based, patient-centered intervention on cancer symptom distress were modified by intervention use frequency. Clinical and personal demographics influenced voluntary use.

Trial registration: Clinicaltrials.gov NCT00852852; http://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/6YwAfwWl7).

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Related in: MedlinePlus

Sample selection for the propensity score analysis.Note: EOS=end of study; SDS=Symptom Distress Scale; Demo=demographics.
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figure4: Sample selection for the propensity score analysis.Note: EOS=end of study; SDS=Symptom Distress Scale; Demo=demographics.

Mentions: Figure 4 outlines the sample selection from the parent trial for the propensity score analysis. Of the 262 participants randomized to the intervention group with a baseline and end-of-study SDS-15 score, 188 (71.8%) used the intervention. Complete demographic data were available for 167 (88.8%) of the 188 who used the intervention and 218 (83.5%) of the 261 control participants with baseline and end-of-study SDS-15 score. Using the propensity score and nearest neighbor matching, 167 control participants were selected from the possible 218 as the matched control group. Covariates were confirmed to be balanced (data not shown). Participants who used the intervention had lower symptom distress; mean change in the SDS-15 score was 1.07 (SD 6.55) in the matched control group (higher distress) and −0.57 (SD 5.68) in the intervention group (lower distress). In the ANCOVA analysis, SDS-15 score was reduced by an estimated 1.53 points (95% CI 0.32-2.75; P=.01) in the intervention group compared to the matched control group. The sensitivity analysis that balanced the missingness within the work status and minority status factors produced similar results as the complete data analysis (data not shown).


Exposure to a patient-centered, Web-based intervention for managing cancer symptom and quality of life issues: impact on symptom distress.

Berry DL, Blonquist TM, Patel RA, Halpenny B, McReynolds J - J. Med. Internet Res. (2015)

Sample selection for the propensity score analysis.Note: EOS=end of study; SDS=Symptom Distress Scale; Demo=demographics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526904&req=5

figure4: Sample selection for the propensity score analysis.Note: EOS=end of study; SDS=Symptom Distress Scale; Demo=demographics.
Mentions: Figure 4 outlines the sample selection from the parent trial for the propensity score analysis. Of the 262 participants randomized to the intervention group with a baseline and end-of-study SDS-15 score, 188 (71.8%) used the intervention. Complete demographic data were available for 167 (88.8%) of the 188 who used the intervention and 218 (83.5%) of the 261 control participants with baseline and end-of-study SDS-15 score. Using the propensity score and nearest neighbor matching, 167 control participants were selected from the possible 218 as the matched control group. Covariates were confirmed to be balanced (data not shown). Participants who used the intervention had lower symptom distress; mean change in the SDS-15 score was 1.07 (SD 6.55) in the matched control group (higher distress) and −0.57 (SD 5.68) in the intervention group (lower distress). In the ANCOVA analysis, SDS-15 score was reduced by an estimated 1.53 points (95% CI 0.32-2.75; P=.01) in the intervention group compared to the matched control group. The sensitivity analysis that balanced the missingness within the work status and minority status factors produced similar results as the complete data analysis (data not shown).

Bottom Line: Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions.The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group.Clinical and personal demographics influenced voluntary use.

View Article: PubMed Central - HTML - PubMed

Affiliation: Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, United States. donna_berry@dfci.harvard.edu.

ABSTRACT

Background: Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions. Even though usage statistics are easily logged in most eHealth interventions, usage or exposure has rarely been reported in trials, let alone studied in relationship to effectiveness.

Objective: The intent of the study was to evaluate use of a fully automated, Web-based program, the Electronic Self Report Assessment-Cancer (ESRA-C), and how delivery and total use of the intervention may have affected cancer symptom distress.

Methods: Patients at two cancer centers used ESRA-C to self-report symptom and quality of life (SxQOL) issues during therapy. Participants were randomized to ESRA-C assessment only (control) or the ESRA-C intervention delivered via the Internet to patients' homes or to a tablet at the clinic. The intervention enabled participants to self-monitor SxQOL and receive self-care education and customized coaching on how to report concerns to clinicians. Overall and voluntary intervention use were defined as having ≥2 exposures, and one non-prompted exposure to the intervention, respectively. Factors associated with intervention use were explored with Fisher's exact test. Propensity score matching was used to select a sample of control participants similar to intervention participants who used the intervention. Analysis of covariance (ANCOVA) was used to compare change in Symptom Distress Scale (SDS-15) scores from pre-treatment to end-of-study by groups in the matched sample.

Results: Radiation oncology participants used the intervention, overall and voluntarily, more than medical oncology and transplant participants. Participants who were working and had more than a high school education voluntarily used the intervention more. The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group.

Conclusions: The intended effects of a Web-based, patient-centered intervention on cancer symptom distress were modified by intervention use frequency. Clinical and personal demographics influenced voluntary use.

Trial registration: Clinicaltrials.gov NCT00852852; http://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/6YwAfwWl7).

Show MeSH
Related in: MedlinePlus