Attitudes toward Technology-Based Cancer Support Programs Among Korean American Breast Cancer Survivors

Multiple dimensions of the quality of life among Asian American breast cancer survivors: The impact of a technology-based program

OBJECTIVE

The purpose of this study was to examine if a technology-based information and coaching/support program could improve the quality of life of Asian American breast cancer survivors and determine the factors that influenced the changes in the women's quality of life by the technology-based program.

METHODS

This was a randomized controlled trial with 199 Asian American breast cancer survivors (104 in the intervention group and 95 in the control group). Multiple instruments including the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B) were used to assess background factors, disease factors, and the quality of life. The data were analyzed using intent-to-treat general linear models.

RESULTS

The FACT-B total and subscale scores of the intervention group increased from pre-test (T0) to post 3-months (T2), while those of the control group decreased. Significant interaction between time and group were found only in physical well-being (β = 0.84, p = .025) from T0 to T1 (post 1-month) and social well-being (β = 1.05, p = .006) from T0 to T2 within the mixed-effect model with AR1. The PRQ scores mediated the effect of the technology-based intervention on the Breast Cancer Subscale scores (p < .05) over one month (T0 to T1).

CONCLUSION

The technology-based program improved physical and social well-being among Asian American breast cancer survivors. Social support mediated the impact of the program on the quality of life. Future studies are needed on different dimensions of the quality of life with diverse groups of survivors. NCT02803593.

Interventions, programmes and resources that address culturally and linguistically diverse consumer and carers' cancer information needs: a mixed methods systematic review

BACKGROUND

Culturally and linguistically diverse (CaLD) consumers and carers have been identified as experiencing high levels of unmet needs relating to information and support across the cancer journey. This review identified and evaluated the effectiveness of strategies to meet the cancer information needs of consumers and carers from CaLD backgrounds.

METHODS

This review followed Joanna Briggs Institute (JBI) methodology for systematic reviews. Databases searched included MEDLINE, CINAHL Ultimate, PsycINFO and AMED, ProQuest Dissertations and Theses, and GreyNet. Published and unpublished studies between 2013 - May 2024 on interventions, programmes or resources developed for adults (aged 18 years and over) from CaLD communities in relation to cancer prevention, cancer treatment or life after cancer were reviewed for inclusion. The review protocol was registered in PROSPERO (CRD42023451557).

RESULTS

One hundred and twenty papers were included in the review. The majority were quasi-experimental studies (n = 52), followed by randomised controlled trials (n = 38) and qualitative studies (n = 25). The populations represented in the review included Latino (n = 47), Chinese (n = 28), Asian (n = 19), Korean (n = 16), and Vietnamese communities (n = 7). Most studies focused on prevention activities (n = 89) with a smaller number focused on active treatment (n = 6) and life after cancer (n = 20). Most studies focused on breast cancer (n = 37), followed by cervical cancer (n = 21). Engagement with community members was identified as an important requirement to develop and adapt interventions that were culturally acceptable, feasible and relevant to meet the communities' needs. The majority of interventions demonstrated a positive impact on the primary outcome measured. No studies reported on the experiences of consumers and carers from CaLD backgrounds in the development of interventions, programmes and resources to address their cancer information needs.

CONCLUSIONS

This review supports a tailored approach to develop information, resources and interventions that leverage community resources and expertise to ensure that they are accessible and relevant to CaLD communities. The onus for researchers and clinicians is the creation of information, resources and interventions that are both accessible in terms of language and comprehension and are culturally relevant.

Connected and supported: a scoping review of how online communities provide social support for breast cancer survivors

PURPOSE

To (i) assess how and to what extent online communities are used among breast cancer survivors (BCS) as a source of social support, (ii) describe the kind of support BCS access through online communities, and (iii) explore how these communities foster social support for BCS that promotes well-being and reduces the challenges of survivorship.

METHODS

We conducted a scoping review. A professional librarian performed a comprehensive search in multiple databases from January 2010 to May 2023. The review process adhered to the Johana Briggs Institute's method guidelines and the PRISMA-ScR reporting system.

RESULTS

Fifteen studies were included. Participants used social media, cancer support communities, message boards, or websites for information and emotional support. Qualitative findings resulted in four themes: to reassure; to empower; to promote equity, diversity, and inclusion; and to demonstrate for BCS the drawbacks of online support.

CONCLUSIONS

We underscore that a variety of internet websites and social media platforms are valuable for and appreciated by BCS, especially as a source of social support and human connectedness. Our study raises the existing gap in cultural/ethnic representation in this field and shows that institutional and organizational efforts are needed to address gaps in information regarding access to social support for multiethnic BCS women.

IMPLICATIONS FOR CANCER SURVIVORS

This data synthesis will empower the BCS community by sharing how they can strengthen and support their peers and community via their participation in online communities that connect and support cancer survivors in healthcare spaces.

A randomized controlled trial testing a virtual program for Asian American women breast cancer survivors

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1.

Breast Cancer Survivors' Attitudes toward eMental Health: A Cross-Sectional Study

BACKGROUND

Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables.

METHODS

A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ2, and multiple regression analyses were computed to explore associations between attitudes and collected variables.

RESULTS

BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH.

CONCLUSIONS

eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.

Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review

BACKGROUND

Health care systems have become increasingly more reliant on patients' ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations.

OBJECTIVE

This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people.

METHODS

A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool.

RESULTS

Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants' views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others.

CONCLUSIONS

This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health.

A Decision Tree Analysis on the Impact of a Technology-Based Program on Symptom Distress: Asian American Breast Cancer Survivors

Using a decision tree analysis, this study aimed to identify the characteristics of the groups within Asian American breast cancer survivors whose symptom distress scores were effectively improved by a technology-based program. This was a secondary analysis of the data from an ongoing randomized controlled trial among 115 Asian American breast cancer survivors. The instruments were questions on background factors; the Memorial Symptom Assessment Scale-Short Form; the Cancer Behavior Inventory; the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using chi-square tests, t tests, repeated measurement analyses, and decision tree analyses. The decrease in the global distress index scores was the largest (1.253 points) among those with high psychological support needs. The decrease in the physical symptom distress scale scores was the largest (1.133 points) among those with high physical and daily living support needs who had a short US residence period and who were young. The decrease in the psychological symptom distress scores was the largest (1.511) among those with high psychological support needs. The findings suggest several characteristics of the groups within Asian American breast cancer survivors whose symptom distress could be highly improved by a technology-based intervention.