A qualitative exploration of barriers and facilitatorsto adherence to an online self-help intervention for cancer-related distress

"One Size Doesn't Fit All": Nutrition Care Needs in Esophageal and Gastric Cancer Survivors-A Qualitative Study

Background/Objectives: Nutritional complications are highly prevalent in esophageal and gastric cancer survivors and can negatively impact their quality of life. Gaining insight into survivors' experiences with nutrition care can inform the development of tailored nutrition care programs for this population. The present study investigated esophageal and gastric cancer survivors' nutritional challenges and complications. It also explored survivors' and their carers' perceived unmet nutrition care needs. Methods: Esophageal and gastric cancer survivors and their caregivers were invited to participate in a semi-structured interview. Participants were asked about their nutritional challenges and experiences with existing dietetic services in meeting their nutrition care needs. Data were analyzed using Braun and Clarke's six-stage approach to thematic analysis. Results: Twelve individual interviews were completed and analyzed, and three themes emerged: nutrition-related challenges and complications, experiences with dietetic services, and coping strategies. Persistent gastrointestinal symptoms were reported as the main nutritional challenges impacting survivors' daily and social lives. While participants reported good access to dietetic services, they emphasized the need for additional support during early post-surgery stages and long-term survivorship. Key unmet needs included access to personalized dietary advice for symptom management and timely information on nutritional challenges and post-treatment complications. Conclusions: The present study underscores the need for increased dietitian support throughout the esophageal and gastric cancer journey to provide timely, personalized, and practical dietary information for survivors and their caregivers. These insights should be considered for developing tailored nutrition care programs for esophageal and gastric cancer survivors.

Development of an evidence-informed implementation strategy for a digital supportive care platform for brain tumour patients, their carers and healthcare professionals

Background

Implementation challenges of digital health solutions (DHSs) comprise complexities of behavioural change, resource limitation, inertia in existing systems, and failure to include consumer preferences. Understanding the factors which contribute to successful implementation of DHS is essential. We report the development of an implementation strategy for Brain Tumours Online (BT Online), a digital supportive care platform for patients with brain tumours, their carers and healthcare professionals.

Aim

To develop an evidence-informed implementation strategy for BT Online, considering the specific barriers and facilitators to implementing DHS for adults with a brain tumour and their carers and healthcare professionals.

Methods

A rapid review methodology was used to summarise factors relevant to implementation of DHS for people affected by cancer. Themes from the review were supported by implementation guidelines for DHS and the combined evidence informed the implementation strategy. Each theme was matched with specific steps for implementing BT Online.

Results

The rapid review identified 10 themes, namely, awareness of the new digital platform; institutional integration and support; data security, the quality, usability and accessibility of the platform; belief in the benefit of the platform; the need for holistic and tailored features; the timing of introducing the platform; engagement of healthcare professionals; and the re-definition of roles and workload. The themes were matched with 51 concrete implementation steps.

Discussion

The purpose of the strategy was to minimise risk of implementation failure, consider the specific context of care and generate a reference framework to evaluate BT Online prior to upscaling to use outside the research context. Our method contributes a novel approach of developing an evidence-informed rigorous implementation strategy if existing implementation frameworks do not apply.

DigiTRAC: Qualitative insights from knowledge users to inform the development of a Digital Toolkit for enhancing resilience among multiple sclerosis caregivers

BACKGROUND

Resilience-promoting resources are critically needed to support positive caregiving experiences for multiple sclerosis (MS) caregivers. A digital toolkit offers a flexible way to access and use evidence-based resources that align with MS caregivers' interests and needs over time.

OBJECTIVE

We explored the perspectives of key knowledge users regarding content areas, features, and other considerations to inform an MS caregiver resilience digital toolkit.

METHODS

Twenty-two individuals completed a demographic survey as part of this study: 11 MS family caregivers, 7 representatives of organizations providing support services for people with MS and/or caregivers, and 4 clinicians. We conducted nine semi-structured individual interviews and two focus groups. Data were analyzed using content analysis.

RESULTS

Participants recommended that a digital toolkit should include content focused on promoting MS caregivers' understanding of the disease, its trajectory and available management options, and enhancing caregiving skills and caregivers' ability to initiate and maintain behaviours to promote their own well-being. Features that allow for tracking and documenting care recipients' and caregivers' experiences, customization of engagement, and connectivity with other sources of support were also recommended. Participants suggested a digital toolkit should be delivered through an app with web browser capabilities accessible on smartphones, tablets, or laptops. They also acknowledged the need to consider how users' previous technology experiences and issues related to accessibility, usability, privacy and security could influence toolkit usage.

CONCLUSION

These findings will guide future toolkit development and evaluation. More broadly, this study joins the chorus of voices calling for critical attention to the well-being of MS family caregivers.

Dropout or Drop-In Experiences in an Internet-Delivered Intervention to Prevent Depression and Enhance Subjective Well-Being During the Perinatal Period: Qualitative Study

Background

The perinatal period is a vulnerable time when women are at increased risk of depression. "Mamma Mia" is a universal preventive internet-delivered intervention offered to pregnant women, with the primary goals of preventing the onset or worsening of depression and enhancing subjective well-being during the perinatal period. However, treatment dropout from internet-delivered interventions is often reported.

Objective

The study aim was to acquire an understanding of the different experiences among participants who dropped out of the Mamma Mia intervention during pregnancy, compared to participants who dropped out during the postpartum follow-up phase.

Methods

A total of 16 women from a larger randomized controlled trial (Mamma Mia) participated in individual semistructured interviews following a strengths, weaknesses, opportunities, and threats format. Of the 16 participants included, 8 (50%) women dropped out early from the intervention during pregnancy (pregnancy group), whereas 8 (50%) women dropped out later, after giving birth (postpartum follow-up group). Data were analyzed using the framework approach.

Results

The results showed that there were differences between the groups. In general, more participants in the postpartum follow-up group reported that the program was user-friendly. They became more aware of their own thoughts and feelings and perceived that the program had provided them with more new knowledge and practical information than participants in the pregnancy group. Participants in both groups suggested several opportunities for improving the program.

Conclusions

There were differences between women who dropped out of the intervention during pregnancy and the postpartum follow-up phase. The reported differences between groups should be further examined.

Supporting cancer patients to self-manage: Extent of use and perceptions of "trusted" online self-management resources

OBJECTIVES

Online resources can support patient self-management practices, but are not systematically used in routine clinical practice. We evaluated cancer patients' satisfaction with, and use of, tailored online resources.

METHODS

Patients completed monthly validated electronic patient reported outcome measures (ePROMs) of distress, unmet needs and symptoms. Patients with ePROM scores above pre-determined thresholds received an email directing them to relevant online self-management resources. Perceptions and experiences with these resources were evaluated via an online survey 3, 6 and 9 months after their initial monthly ePRO; and a subset of patients was also interviewed. Webpage use was monitored through Google Analytics and ClickMeter.

RESULTS

Overall, 221 patients completed evaluation surveys and 31 completed interviews. Patients spent 0-10 min on average accessing resources, with 93% indicating they would reuse them. The most viewed page was physical wellbeing (n = 680); exercise and nutrition resources were most popular; and 69% of patients were satisfied with information content, reporting resources were easy to understand and navigate.

CONCLUSIONS

Online resources are perceived as acceptable and useful. Design and delivery recommendations can improve their support of self-management.

PRACTICE IMPLICATIONS

Incorporating automated online self-management resources into routine clinical workflows is a viable model to support routine follow up care.

Effectiveness of internet-based support interventions on patients with breast cancer: a systematic review and narrative synthesis

OBJECTIVE

To identify the elements of internet-based support interventions and assess their effectiveness at reducing psychological distress, anxiety and/or depression, physical variables (prevalence, severity and distress from physical symptoms) and improving quality of life, social support and self-efficacy among patients with breast cancer.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

Web of Science, Cochrane Library, PubMed, MEDLINE, PsycINFO, CINAHL, CNKI, Wanfang and VIP from over the past 5 years of each database to June 2021.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Included were randomised controlled trials (RCTs) or quasi-experimental (QE) studies focusing on internet-based support interventions in patients with breast cancer.

DATA EXTRACTION AND SYNTHESIS

Reviewers independently screened, extracted data and assessed risk of bias (Cochrane Collaboration' risk of bias tool, Joanna Briggs Institute reviewer's manual). Narrative synthesis included the effect and elements of internet-based support interventions for women with breast cancer.

RESULTS

Out of 2842 articles, 136 qualified articles were preliminarily identified. After further reading the full text, 35 references were included, including 30 RCTs and five QE studies. Internet-based support interventions have demonstrated positive effects on women's quality of life and physical variables, but inconsistent effectiveness has been found on psychological distress, symptoms of anxiety and/or depression, social support and self-efficacy.

CONCLUSIONS

Internet-based support interventions are increasingly being used as clinically promising interventions to promote the health outcomes of patients with breast cancer. Future research needs to implement more rigorous experimental design and include sufficient sample size to clarify the effectiveness of this internet-based intervention.

PROSPERO REGISTRATION NUMBER

CRD42021271380.

Qualitative studies conducted alongside randomized controlled trials in oncology: A scoping review of use and rigour of reporting

BACKGROUND

Randomized controlled trials (RCTs) are the gold standard for generating evidence to inform clinical oncology practice. Knowledge gained through qualitative research methodologies can be complementary to that gained through RCTs. How qualitative research has been combined with RCTs in oncology has not been previously characterized.

OBJECTIVE

This scoping review was conducted to summarize how qualitative research associated with RCTs in the oncology setting has been conducted and examine the quality of reporting.

ELIGIBILITY CRITERIA

Manuscripts reporting on qualitative research linked with RCTs in the cancer context that involved patients (both adult and pediatric) and/or informal caregiver (friends/family) were included.

SOURCES OF EVIDENCE

Peer-reviewed manuscripts indexed in MEDLINE (OVID) and CINAHL, published in English between 2008 and January 2019.

CHARTING METHODS

Formal scoping review methods were followed. A data extraction tool informed by the research questions as well as the COnsolidated criteria for REporting Qualitative research (COREQ) was utilized. Extraction was conducted independently by two authors, with disagreements resolved by a third.

RESULTS

Fifty-four articles were included. Assessing information sharing, diet/exercise, and psychotherapeutic interventions were the most common focuses of the RCTs. The most common focus of the qualitative component was on gaining insight into the experience of receiving the intervention or participating in RCT procedures. How the intervention impacted the cancer experience was not a common focus of the qualitative components. Some reports provided insufficient information to understand how the qualitative components aligned with the RCT components. The results of the qualitative and RCT components were not integrated to draw meaningful conclusions about the efficacy of the intervention under study in most cases. Reports focusing on only qualitative methods had higher median (Mdn) reporting of COREQ items compared to reports that included both the qualitative and RCT components (Mdn = 18 vs. Mdn = 14, respectively; p <0.001).

CONCLUSIONS

This review identified that qualitative research has been combined with RCTs in the cancer context in a number of ways, most commonly to understand the experience of receiving study interventions or participating in trial procedures. Exploring how interventions impact other aspects of the cancer experience is an approach that should be considered in future work. Formalized guidelines for the design and reporting of investigations that combine qualitative and RCT approaches in the cancer context are expected to be of value.

TWEETABLE ABSTRACT

Combining qualitative research with randomized controlled trials in oncology: an impornt opportunity for discovery.

Acceptability and Feasibility of a Guided Biopsychosocial Online Intervention for Cancer Patients Undergoing Chemotherapy

Chemotherapy is a physically and psychologically highly demanding treatment, and specific Internet-based interventions for cancer patients addressing both physical side effects and emotional distress during chemotherapy are scarce. This study examined the feasibility and acceptability of a guided biopsychosocial online intervention for cancer patients undergoing chemotherapy (OPaCT). A pre-post, within-participant comparison, mixed-methods research design was followed. Patients starting chemotherapy at the outpatient clinic of the National Center for Tumor Diseases in Heidelberg, Germany, were enrolled. Feasibility and acceptability were evaluated through intervention uptake, attrition, adherence and participant satisfaction. As secondary outcomes, PHQ-9, GAD-7, SCNS-SF34-G and CBI-B-D were administered. A total of N = 46 patients participated in the study (female 76.1%). The age of participants ranged from 29 to 70 years (M = 49.3, SD = 11.3). The most prevalent tumour diseases were breast (45.7%), pancreatic (19.6%), ovarian (13.1%) and prostate cancer (10.8%). A total of N = 37 patients (80.4%) completed the OPaCT intervention. Qualitative and quantitative data showed a high degree of participant satisfaction. Significant improvements in the SCNS-SF34 subscale 'psychological needs' were found. Study results demonstrate the feasibility and acceptability of the intervention. The results show that OPaCT can be implemented well, both in the treatment process and in participants' everyday lives. Although it is premature to make any determination regarding the efficacy of the intervention tested in this feasibility study, these results suggest that OPaCT has the potential to reduce unmet psychological care needs of patients undergoing chemotherapy.

The engagement of tertiary students with an online mental health intervention during the coronavirus disease 2019 pandemic: A feasibility study

Background

We discuss the feasibility of a brief, online mental health promotion programme for tertiary students and establish recommendations for future programmes.

Methods

The programme ‘Student Elevenses’ was delivered at a tertiary education institution. ‘Student Elevenses’ aimed to promote student wellbeing during the coronavirus disease 2019 crisis, comprised of 10–15-min daily online micro-interventions targeting six lifestyle areas for wellbeing, and was delivered via video conference. Upon programme completion, all students were invited to complete barriers to engagement survey, irrespective of whether they had attended or heard of the programme. Descriptive statistics were calculated for demographics, as well as feasibility and acceptability outcomes including recruitment rates, attendance rates and reported barriers to attendance. Open-ended questions were coded for themes.

Results

Less than 1% of those who consented to participate actually attended the programme, with attendance ranging from 2 to 17 participants. Participants were predominantly female (68%), domestic students (81%) and had a mean age of 29.5 years. The barriers students reported included fixed time, online format, a belief programme would not be helpful, preference for existing supports and perceived impacts of coronavirus disease 2019. Students recommended embedding support within policies/teaching, offering a range of supports and involving students in design.

Conclusion

Barriers to mental health promotion via telehealth should be considered to promote accessibility and acceptability for tertiary students. Future programmes should consider reaching students through mandatory activities (e.g. lectures, tutorials) and should include student consultation and co-design to support the development of programmes that meet student needs and preferences.

Creating a Digital Toolkit to Reduce Fatigue and Promote Quality of Life in Multiple Sclerosis: Participatory Design and Usability Study

Background

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS.

Objective

The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages.

Methods

Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality.

Results

The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle.

Conclusions

This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue.

Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study

BACKGROUND

Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient.

OBJECTIVE

The aim of this study is to perform a qualitative analysis of patients' experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout.

METHODS

A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach.

RESULTS

The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period.

CONCLUSIONS

Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated.

Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation

Background: The UK's Improving Access to Psychological Therapies (IAPT) program is a stepped-care model treating individuals with depression and anxiety disorders. Internet-delivered cognitive behavioral therapy (iCBT) is routinely offered to individuals with mild to moderate symptoms, but its applicability to individuals with severe clinical symptoms and requiring a high-intensity intervention is relatively unknown. The current study sought to investigate the potential impacts of using iCBT as a prequel for patients requiring high-intensity treatment (HIT; face-to-face) for depression and anxiety in IAPT. Methods: The study utilized an open study design. One hundred and twenty-four participants who were on a waiting list for high-intensity, face-to-face psychological treatment were offered iCBT. Psychometric data on symptoms of depression, anxiety, and functioning were collected from participants before starting and on finishing iCBT and at the point of service exit. Therapeutic alliance data were collected from patients and clinicians during treatment. Patient pathway data, such as number of treatment sessions and time in treatment, was also collected and incorporated into the analysis. Results: Significant reductions across primary outcome measures of depression and anxiety, as well as improved functioning, were observed from baseline to iCBT treatment exit, and from iCBT exit to service exit. Analysis of the therapeutic alliance data for patients and clinicians illustrated differences in outcome for those who dropped out and those who completed treatment. Discussion: This study illustrates the potential for using iCBT as a prequel to high-intensity therapy for depression and anxiety disorders and is the first of its kind to do so within IAPT stepped care. The results show that iCBT is a valuable option reducing waiting times and enhancing clinical efficiency. The study contributes to the well-established evidence on online psychological treatments worldwide, but further clinical and service development research is necessary to scale these treatments appropriately.

Finding My Way: results of a multicentre RCT evaluating a web-based self-guided psychosocial intervention for newly diagnosed cancer survivors

PURPOSE

This multicentre randomised controlled trial examined the efficacy of Finding My Way (FMW), a 6-week/6-module online self-guided psychotherapeutic intervention for newly diagnosed curatively treated cancer survivors, in reducing cancer-related distress and improving quality of life compared to an online attention control.

METHODS

Participants were randomised on a 1:1 ratio using a gender-stratified block design to intervention (n = 94) or attention control (n = 97), and were blinded to condition. Assessments were completed at baseline (T0), post-intervention (T1), 3 months (T2), and 6 months (T3) post-intervention. Mixed model repeated measures analyses examined differences between groups for cancer-specific distress (primary outcome) and general distress, quality of life (QoL), coping, and health service utilisation (secondary outcomes).

RESULTS

While both groups reported reduced cancer-specific and general distress over time, between-group differences were not significant. Intervention participants reported lower total health service utilisation and supportive care utilisation post-intervention than controls (total HS use: between-group mean difference = - 1.07 (- 1.85 to - 0.28); supportive care use: between-group mean difference = - 0.64 (- 1.21 to - 0.06)) and significantly higher emotional functioning at 3 months (between-group mean difference = 7.04 (0.15 to 13.9)). At 6 months, the supportive care utilisation finding reversed (between-group mean difference = 0.78 points (0.19 to 1.37). Across remaining QoL and coping outcomes, no significant group differences emerged.

CONCLUSIONS

While both groups experienced reductions in distress, between-group differences were not significant. This contrasts with the significantly improved emotional functioning observed in FMW participants at 3 months and the short-term reductions in health service utilisation. Long-term increases in supportive care service utilisation suggest FMW only met needs while being actively used.

TRIAL REGISTRATION

ACTRN12613000001796;  http://www.ANZCTR.org.au/ACTRN12613000001796.aspx.

Psychological support for patients with cancer: evidence review and suggestions for future directions

PURPOSE OF REVIEW

Psychological distress and mental health comorbidity are common in cancer. Various therapeutic frameworks have been used for interventions to improve psychological wellbeing and quality of life in cancer patients with mixed results. This article reviews contributions to that literature published since January 2017.

RECENT FINDINGS

The majority of new psychological intervention research in cancer has used cognitive behavioural therapy (CBT) or mindfulness-based interventions. CBT has been considered a gold-standard intervention and recent evidence justifies continuation of this. Recent reviews call into question the validity of evidence for mindfulness-based interventions. A smaller number of trials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged, and whereas findings are promising, additional fully powered trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions.

SUMMARY

Efficacious, timely and acceptable psychological interventions are a necessary component of comprehensive cancer care. There is some way to go before the evidence conclusively points towards which interventions work for which cancer groups and for which specific outcomes. Methodological limitations must be addressed in future trials; at the forefront remains the need for fully powered, head-to-head comparison trials.

Towards a framework for reporting self-guided interventions for people with cancer

PURPOSE OF REVIEW

The purpose of this article is to provide an updated review exploring the recent developments in the field of self-guided interventions and describe the state of knowledge. This article builds on a previous systematic review on self-guided interventions, finding that the recent literature demonstrates that evidence for these interventions is mixed. The field is limited by descriptions of these interventions, and it is not possible to ascertain what aspects of interventions are more successful.

RECENT FINDINGS

Development of a reporting framework whereby self-guided interventions could be clearly presented, would be a substantial contribution to understanding the evidence for these studies. Recent findings also support the need to understand patient adherence and engagement, which could be achieved within a reporting framework. Additionally, ensuring patient safety is paramount and all studies should develop strategies to ensure patients can engage with these studies in a way that allows them to access more help and support if required.

SUMMARY

Self-guided interventions have potential for implementation and further translation because of being cost-effective and requiring few resources; and a reporting framework has the capacity to lead to clearer definitions and descriptions; and significantly improve the quality of evidence for these studies.

Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews

BACKGROUND

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS-a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)-developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery.

OBJECTIVE

The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS.

METHODS

Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS.

RESULTS

Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management.

CONCLUSIONS

A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution.

Does access to an information-based, breast cancer specific website help to reduce distress in young women with breast cancer? Results from a randomised trial

To assess the effectiveness of a purpose-built information-based website to reduce distress among young women with breast cancer. A total of 337 participants (Intervention Group [IG] n = 202; Usual Care Group [UCG] n = 177) returned the completed baseline questionnaires (T1). Details regarding accessing the website were provided to IG participants. Follow-up questionnaires were completed: (a) 3 months (T2) and (b) 6 months after baseline (T3). Outcomes included anxiety and depression (primary outcomes), quality of life (QoL) and unmet information needs. About 70% of the IG accessed the website, typically only once (median: 1, range 1-15), spending a median of 19 min (range: 1-315) on the site. Mean levels of anxiety and depression did not differ between the two groups at T1, T2 or T3. While improvement in total QoL was greater in the IG than UCG between T1 and T2, QoL scores did not differ between groups at T3. The number of unmet needs did not differ between the two groups at T3. The intervention was not effective in reducing anxiety, or depression in this group of women. As a high number of unmet needs were identified, other strategies for addressing these needs of young women with breast cancer are needed.