Efficacy of Mobile Instant Messaging-Delivered Brief Motivational Interviewing for Parents to Promote Physical Activity in Pediatric Cancer Survivors: A Randomized Clinical Trial

Understanding the effectiveness and design of parent-oriented mobile health interventions: a systematic review and narrative synthesis

BACKGROUND

Parents of children with a health condition experience high levels of distress which can have long-term impact on the child and parent. Dyadic interventions have the potential to decrease this distress, however several barriers to access including time constraints have been reported. Mobile health (mHealth) interventions can address several of these barriers.

GOAL

The goal of this systematic review was to review and synthesize the literature examining the effects of parent-oriented mHealth interventions and their content and design.

METHODS

We searched PubMed/MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central databases from January 2013 to 2023 using a search strategy based on telemedicine and parents/caregivers. Included studies were randomized controlled trials assessing the effect of parent-oriented mHealth interventions on child and parent health. The Cochrane risk-of-bias tool was used to assess for bias in studies. Trial details and design and content features of interventions were extracted. Outcomes were organized using the Van Houtven's Framework for Informal Caregiver Interventions. Results are presented narratively.

RESULTS

Fifty papers pertaining to 49 unique studies met our inclusion criteria. More than half of the studies scored high-risk for bias. Interventions targeted a wide range of pediatric conditions. Intervention type included texting (n = 17) and investigator-developed mobile applications (n = 16). Interventions significantly improved parent psychological health and child health outcomes. Key intervention features and design included the use/application of codesign and a theory-driven intervention.

CONCLUSION

Parent-oriented mHealth interventions identified in this review significantly improved both parent and child health outcomes. Therefore, these interventions have the potential to support parents outside of a clinical setting.

Effects of digital health on symptoms and health-related quality of life in children and adolescent cancer survivors: a meta-analysis and systematic review

OBJECTIVES

To assess the effectiveness of digital health on symptoms and health-related quality of life in children and adolescent cancer survivors.

METHODS

We searched PubMed, Embase, Web of Science, Cochrane Library, and CINAHL databases on July 11, 2024, to identify randomized controlled trials of the impact of digital health on children and adolescent cancer survivors aged 0-19 years. The Cochrane Risk of Bias Tool version 1.0 was used to evaluate the quality of randomized controlled trials. It was registered in PROSPERO with the number CRD42024526347.

RESULTS

A total of 23 randomized controlled trials were included, of which 18 were meta-analyzed. Compared with usual care, digital health interventions can significantly improve pain (SMD = -0.86, 95% CI: -1.21 to -0.51, P < 0.001), nausea and vomiting (SMD = -0.49, 95% CI: -0.97 to -0.02, P = 0.04), anxiety (SMD = -1.05, 95% CI: -1.60 to -0.50, P = 0.0002), distress (SMD = -0.74, 95% CI: -1.07 to -0.41, P < 0.001), fear (MD = -0.91, 95% CI: -1.40 to -0.42, P = 0.0003), and health-related quality of life (SMD = 1.41, 95% CI: 1.11 to 1.70, P < 0.001) in children and adolescent cancer survivors. However, improvements in fatigue and anger were not significant.

CONCLUSIONS

Our systematic review provides evidence that digital health interventions have great potential to improve the symptoms and health-related quality of life of children and adolescent cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Digital technologies to improve symptoms and health-related quality of life in children and adolescent cancer survivors deserve wider application.

Nursing interventions for improving quality of life among parents with major Thalassemic children: a scoping review

INTRODUCTION

Thalassemia major is a chronic genetic disease requiring long-term treatment, significantly impacting the quality of life of affected children and their parents. Parents often experience emotional, social, and economic burdens in caring for children with thalassemia. Nursing interventions play a crucial role in improving their quality of life by providing holistic support. This scoping review aims to explore nursing interventions that enhance the quality of life of parents with children diagnosed with thalassemia major.

METHODS

A scoping review methodology was applied. Literature searches were conducted in CINAHL, PubMed, and Scopus, as well as Google Scholar. The primary keywords included "nursing intervention," "quality of life," "thalassemia," "parents," and "family support." Inclusion criteria comprised full-text, original research articles published in English from 2015 to 2024. Data extraction was performed manually, and qualitative descriptive analysis was used.

RESULTS

Nine studies met the inclusion criteria, discussing various nursing interventions to improve parental quality of life. Effective interventions included positive thinking therapy, family empowerment, counseling, and education, which enhanced parental knowledge, coping skills, emotional well-being, and overall quality of life. Key factors supporting intervention success included active parental participation, continuous healthcare support, and the availability of accessible educational resources.

CONCLUSION

This study highlights the essential role of nurses in supporting parents of children with thalassemia. A holistic nursing approach is crucial in addressing the multifaceted needs of these parents. Further research should explore the long-term effectiveness of these interventions and their adaptation to individual family circumstances.

Individualized Physical Activity Prescriptions for Children and Adolescents With Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

For improved health outcomes, children and adolescents with cancer must maintain physical activity. Individualized physical activity prescription is an effective way to promote physical activity in this group.

OBJECTIVE

We reviewed and meta-analyzed evidence on the effectiveness of individualized physical activity prescriptions for improving physical activity and other health outcomes among children and adolescents with cancer.

METHODS

Seven databases were searched from inception up to January 2024 for randomized controlled trials. Two researchers independently extracted data and assessed the quality of studies using the Risk-of-Bias tool. Data were pooled into Review Manager 5.3 for data synthesis and subgroup analyses.

RESULTS

Seventeen randomized controlled trials were included. The systematic review summarized the characteristics of recent interventions. Meta-analyses showed that although individualized physical activity prescriptions had no overall effect on physical activity (n = 8 studies), anthropometry and body composition (n = 5), functional capacity (n = 3), quality of life (n = 8), fatigue (n = 3), and self-efficacy (n = 5), they improved cardiovascular fitness (n = 8, P = .02) and muscle strength (n = 8, P = .04). Subgroup analyses showed that studies providing 6-month interventions (P = .003) or such interventions combined with motivational interviewing (P = .002) reported significantly increased physical activity in patients.

CONCLUSIONS

Individualized physical activity prescriptions appear to improve cardiovascular fitness and muscle strength in children and adolescents with cancer.

IMPLICATIONS FOR PRACTICE

High-quality studies providing long-duration interventions and motivational interviewing are needed for optimal physical activity programs for children and adolescents with cancer. The application of electronic devices should increase the types of physical activities for this group to further improve health outcomes.

The prognostic role of WeChat-based instant doctor-patient communication in patients with advanced pancreatic cancer

BACKGROUND

Patients with advanced pancreatic ductal adenocarcinoma (PDAC) need timely medical assistance since the emergence of complications due to the disease and antitumor treatment. Studies have confirmed that instant messaging can improve the quality of life and compliance of cancer patients. However, the prognostic role of instant doctor-patient communication based on instant messaging applications in PDAC has not been studied.

METHODS

Patients with PDAC who received first-line chemotherapy at Peking Union Medical College Hospital between January 2015 and October 2022 were reviewed. We categorized patients into two groups according to whether they received WeChat-based instant doctor-patient communication, and the prognosis and toxicity data between the two groups were compared.

RESULTS

A total of 431 PDAC patients were enrolled, of whom 163 had long-term instant communication with their doctors based on WeChat, and 268 did not receive WeChat-based instant communication. There was no significant correlation between WeChat-based communication and first-line chemotherapy overall response rate (14.1% vs. 8.6%, p = 0.074), incidence of grade ≥ 3 adverse events (66.9% vs. 65.7%, p = 0.814) or overall survival (14.7 vs. 13.9 months, p = 0.170) in all enrolled patients. However, patients who received WeChat-based instant communication had a higher completion rate of first-line chemotherapy (42.0% vs. 30.7%, p = 0.023). Consistently, in the patients who developed grade ≥ 3 adverse events (n = 231), those who received WeChat-based instant communication had significantly longer overall survival (17.3 vs. 15.3 months, p = 0.018), even after adjustment for biases.

CONCLUSIONS

WeChat-based instant doctor-patient communication demonstrated no superiority in improving the efficacy of chemotherapy or preventing chemotherapy toxicity in PDAC patients, but it may contribute to improving the completion rate of chemotherapy and the prognosis in patients who experienced severe adverse events.

IMPLICATIONS FOR CANCER SURVIVORS

Instant doctor‒patient communication may help to timely and appropriately deal with adverse events and prolong the survival time of patients with PDAC, supporting the promotion of mobile technology in clinical practice.

Impact of Technology on Physical Activity Levels of Childhood Cancer Survivors: A Systematic Review

OBJECTIVES

Childhood cancer survivors often experience long-term health challenges like muscle weakness and obesity. Physical activity is essential for alleviating these effects, and technological interventions are being recommended to promote physical activity. This systematic review aimed to evaluate technological interventions' impact on childhood cancer survivors' PA levels.

METHODS

The systematic review followed PRISMA guidelines and included studies published until May 2024 from various databases. The Joanna Briggs Institute critical appraisal tools were used to assess study quality. The study was registered in PROSPERO under registration number CRD42024564857.

RESULTS

A total of nine studies were included in the review: four were randomized controlled trials (RCT), three were feasibility studies, and two were pilot studies. These studies, involving a total of 417 childhood cancer survivors, utilized a wide range of technological interventions. Six of the studies were of good quality, while three were of fair quality. Three studies used mobile apps, two used web-based platforms, two utilized m-health solutions, one incorporated a video game, and one employed a telehealth application. The results revealed that two-thirds of the mobile applications were ineffective in enhancing physical activity. In contrast, one of the m-health applications proved to be effective. Additionally, web-based platforms, telehealth applications, and video games demonstrated effectiveness in increasing physical activity.

CONCLUSIONS

Technological interventions show promise for improving physical activity among childhood cancer survivors, with six studies demonstrating significant benefits. More research is needed to identify effective strategies and optimize intervention designs, focusing on long-term outcomes.

IMPLICATIONS FOR NURSING PRACTICE

This systematic review assesses technology-based interventions aimed at promoting physical activity in childhood cancer survivors. The findings emphasize the potential and variability of digital tools, underscoring the necessity for additional research to refine intervention strategies and facilitate long-term physical activity among this group.

The development of an augmented reality application for exercise prescription within paediatric oncology: App design and protocol of a pilot study

Background: Children and young people with cancer face barriers when engaging with exercise, such as treatment-related side effects, psychosocial burdens and lack of individualised provisions. Digital health tools, such as smartphone applications, have emerged as a promising driver to support healthcare provisions in exercise prescription among patients. It is vital to explore how such technologies can be developed more effectively in order to strengthen the evidence supporting their use and for more appropriate implementation within healthcare. This study aims to explore user experiences, preferences and suggested improvements from healthy children and young people aged 9-21 years. Methods: An augmented reality (AR) application was specifically developed for children and young people aged 9-21 years undergoing cancer treatment and a protocol for a pilot study was designed. The target sample of this pilot study is 90 healthy children and young people aged 9-21 years. Practical 30-min workshops will be conducted encouraging participants to engage with the smartphone app. Focus groups will explore participant experiences, preferences, and suggested improvements. Data will be analysed deductively with apriori themes derived from the semi-structured interviews. Discussion: Obtaining user experiences, preferences and suggested improvements is especially important for the development of novel apps, such as those prescribing exercise and using algorithms and augmented reality software. Results from this study will directly influence the development of an augmented reality application, which will also be applied within a long-term trial in paediatric oncology.

Design and methods of the StepByStep randomized trial of a mobile health and social media physical activity intervention among adolescent and young adult survivors of childhood cancer: A report from the Children's Oncology Group

BACKGROUND

Interventions to increase physical activity are needed in adolescent and young adult survivors of childhood cancer who are largely inactive but at lifelong elevated risk of multiple chronic conditions improved by physical activity. The goals of the StepByStep study are to evaluate the effects of a 48-week distance-based, multi-component mobile health and social media behavioral intervention on physical activity, biomarkers of cardiometabolic health, and health-related quality of life.

METHODS

This ongoing study is a two-arm, prospective, multi-site randomized controlled trial. 384 childhood cancer survivors age ≥ 15 years and < 21 years who were 3-36 months off therapy and not meeting physical activity guidelines were enrolled. The trial will test the efficacy of a 24-week intensive multi-component physical activity intervention combining a wearable physical activity tracker, social media peer support group, and individualized goal setting followed by a 24-week maintenance phase of the intervention to improve outcomes. The control group receives the wearable physical activity tracker only.

CONCLUSION

There is a growing need for novel, developmentally appropriate interventions to increase physical activity and improve the health trajectory of adolescent and young adult survivors of childhood cancer. If efficacious, this portable and scalable intervention would be a much-needed tool to reduce the morbidity from cancer treatment and improve quality of life among survivors after treatment ends.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04089358; COG Identifier: ALTE2031.

Prevention of cardiotoxicity in childhood cancer survivors: In physical exercise, we trust

In recent years, the mean survival rate of children after a cancer diagnosis has significantly improved. At the same time, a growing interest in short and long-term cardiovascular (CV) complications of cancer therapy, as well as long-term CV risk in childhood cancer survivors (CCS) developed, along with proposals of protocols for the diagnosis, management, and prevention of cancer therapy-related CV toxicity (CTR-CVT) in this population. Many clinical and individual risk factors for CTR-CVT have been identified, and a non-negligible prevalence of traditional CV risk factors has been described in this population, potentially associated with a further worsening in both CTR-CVT and long-term CV risk. Physical exercise (PE) represents a promising, free-of-cost and free-of-complications, helpful therapy for primary and secondary prevention of CTR-CVT in CCS. The present narrative review aims to summarize the most critical evidence available about CTR-CVT in CCS, focusing on the role of PE in this clinical scenario.

Factors impacting physical activity among post-treatment pediatric cancer survivors with overweight and obesity

BACKGROUND

Pediatric cancer survivors (PCS) with overweight and obesity are at risk for various secondary chronic diseases. Although previous research has found physical activity (PA) as beneficial after treatment, the PA levels are low among PCS, highlighting the need for lifestyle interventions targeting PA.

METHODS

A secondary analysis of preliminary baseline data from a multi-site trial, NOURISH-T + , a healthy lifestyle intervention for PCS with overweight and obesity, and their caregivers, was conducted to assess factors related to PCS PA (i.e., moderate to vigorous intensity PA, MVPA). Kendall's Tau-b was used to assess correlations between PCS MVPA, health and treatment-related factors, and caregivers' sedentary behavior and MVPA. Wilcoxon Signed Ranks Test was used to assess the differences between PCS and caregiver sedentary behavior and MVPA. A multiple linear regression analysis was performed to determine predictors of PCS MVPA.

RESULTS

Seventy-three PCS-caregiver dyads were included in this analysis (N = 146). Many of the PCS were female, diagnosed with Acute Lymphoblastic Leukemia, stage 1, with a mean body mass index (BMI) percentile of 94.4 ± 4.7. Caregivers were female and parents to the PCS. Significant correlations were found between PCS MVPA, time since treatment, PCS weight change since COVID, caregiver sedentary behavior and MVPA. Significant differences were observed between PCS and caregiver sedentary behavior and MVPA. Household income, radiation treatment, and caregiver MVPA were significant predictors of PCS MVPA.   Conclusions: Demographics, cancer treatment type, and caregiver role modeling are important factors to consider when developing future lifestyle interventions for PCS. (NCT04656496, registered 12-07-2020).

WHAT IS KNOWN

• Parents/caregivers are presumed to be a potential influence on their children's physical activity What is new: • Parents/caregivers' moderate-to-vigorous physical activity is the strongest predictor of their children's (pediatric cancer survivors') physical activity.

The evolution of motivational interviewing

This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies.

Associations between older adults' social media use behaviors and psychosocial well-being

BACKGROUND

Research examining associations between social media use behaviors and psychosocial well-being among older adults are limited.

AIMS

To explore associations between older adults' social media (social networking services and instant messaging applications) use behaviors and psychosocial well-being.

METHODS

This was a secondary data analysis. All data were retrieved from the Taiwan Communication Survey database, an annual survey that examines trends in Taiwanese residents' communication behaviors and social media use. The original investigation was conducted in Taiwan from September to December 2019. Data from 647 older adults aged over 60 years were extracted for the analyses. Social media use behaviors (users/non-users and time spent using), positive psychosocial outcomes (life satisfaction, self-determination, subjective well-being, and happiness), negative psychosocial outcomes (loneliness, depression, and anxiety), and demographic variables were included.

RESULTS

Social media users had significantly higher levels of subjective well-being and lower levels of depression, anxiety, and loneliness compared with non-users. Time spent on social networking services was significantly and positively correlated with negative psychosocial outcomes (β = 0.103, p = 0.044, f2 = 0.011), and it was significantly and inversely correlated with positive psychosocial outcomes (β = - 0.063, p = 0.049, f2 = 0.004). Time spent using an instant messaging application was significantly positively associated with positive psychosocial outcomes (β = 0.068, p = 0.031, f2 = 0.005). The proposed path model had an acceptable model fit.

DISCUSSION

Study results indicated that older adults' social media use behaviors were associated with their psychosocial well-being.

CONCLUSIONS

Older adults are recommended to use social media for appropriate time periods as an important way to promote social engagement for their psychosocial well-being.

Motivational interviewing-an evidence-based, collaborative, goal-oriented communication approach in lifestyle medicine: A comprehensive review of the literature

The global threat of noncommunicable diseases (NCDs) is alarmingly increasing. The health and economic burden of improper lifestyle choices is immense. Reducing modifiable risk factors has been demonstrated to significantly prevent chronic diseases. At this crucial time, lifestyle medicine (LM) has been recognized as an evidence-based medical domain applicable to NCDs. Among the tools used in LM, motivational interviewing (MI) is a patient-centered, collaborative counseling approach. In this evidence-based review article, we discuss recent literature on the application of MI in the six LM pillars defined by the British Society of LM (BSLM): healthy eating, mental wellbeing, healthy relationships, physical activity, minimizing harmful substances, and sleep. MI helps strengthen patients' motivation to ameliorate behaviorally influenced health problems, improve treatment adherence, and optimize medical interventions. Technically correct, theoretically congruent, and psychometrically sound MI interventions yield satisfactory outcomes and help improve patient quality of life. Lifestyle change is often a gradual process involving multiple efforts and setbacks. MI is based on the idea that change is a process rather than an event. Extensive literature evidence supports the benefits of MI treatment, and interest in research on MI application is increasing across all BSLM pillars. MI helps people alter their thoughts and feelings about making changes by recognizing obstacles to change. Even interventions of short duration have been reported to yield better outcomes. Healthcare professionals must understand the relevance and importance of MI in clinical practice.

Cancer-related fatigue in childhood cancer survivors: A systematic scoping review on contributors of fatigue and how they are targeted by non-pharmacological interventions

OBJECTIVES

We aimed to identify contributors to cancer-related fatigue (CRF), explore non-pharmacological interventions addressing CRF, and highlight which contributors were targeted by these interventions in childhood cancer survivors.

METHODS

We performed a search in various databases and used the PRISMA-ScR checklist. Findings were synthesized in various different tables and figures in accordance with our objectives.

RESULTS

We included 49 articles in this systematic scoping review. We identified 59 significant contributors. Depression and physical activity level were some of the most studied significant contributors. Ten interventional studies were identified (e.g., yoga, physical activity intervention) that addressed 6 contributors (e.g., physical activity level).

DISCUSSION

This review is the first to describe and relate contributors and non-pharmacological interventions targeting CRF in childhood cancer survivors. Important clinical implications could be derived from the variety of factors explaining CRF and how it is currently addressed.