Experiences of Internet-Based Stepped Care in Individuals With Cancer and Concurrent Symptoms of Anxiety and Depression: Qualitative Exploration Conducted Alongside the U-CARE AdultCan Randomized Controlled Trial

Application of stepped care model in cancer patients: a scoping review

PURPOSE

To clarify the implementation steps, characteristics, effects, acceptability, and feasibility of the stepped care model (SCM) while also offering a resource for pertinent interventions in cancer care.

METHODS

We searched the PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and PsycINFO databases from inception to October 22, 2023. Two key concepts were used: cancer and stepped care model. Two reviewers independently screened the articles and extracted data by repeatedly reading the abstracts and full texts. The included literature was analyzed according to the updated framework for scoping reviews proposed by the Joanna Briggs Institute (JBI).

RESULTS

A total of 14 studies were included. Most of the reviewed SCMs comprised two steps: self-management interventions in the first step and cognitive-behavior interventions in the second step. Most often, interventions were delivered electronically. The main applications of SCM included providing psychological support, treating insomnia and relieving cancer-related fatigue. SCM was effective in improving multiple outcomes for cancer patients with feasibility and acceptability.

CONCLUSIONS

SCM has a promising future and is applicable to oncology care. Further research on facilitators and barriers to the application of this model in cancer care is needed to enhance patients' quality of life.

Addressing cancer survivors' information needs and satisfaction: a systematic review of potential intervention components for survivors with a rare cancer type

OBJECTIVE

Providing current, evidence-based information to cancer survivors is critical for informed decision making. People diagnosed with a rare cancer report higher unmet information needs compared to common cancer survivors. However, interventions providing informational support for rare cancers are limited. Therefore, the aims of this systematic review were to identify and synthesise interventions decreasing survivors' information needs and/or improving satisfaction with information, and to explore potential components to be included in an intervention for rare cancer survivors.

METHODS

Searches were conducted in PubMed, CINAHL, Embase, PsycINFO and the Cochrane Library. Studies reporting an intervention targeting information needs and/or patient satisfaction with information in survivors of any cancer type were included. Data were extracted, a quality assessment performed and findings were synthesised.

RESULTS

A total of 7012 studies were identified and 34 were included in the review. Five studies targeted patients with a rare cancer type; the remaining studies included common cancer survivors. Interventions varied in relation to the mode of information provision, timing of intervention delivery, and the intervention provider. The most promising interventions included face-to-face communication and written material and were delivered by a nurse. All rare cancer studies were designed around a web-based program, but none of them improved outcomes.

CONCLUSIONS

Interventions targeting information needs and/or patient satisfaction with information in rare cancer survivors are lacking. Future studies should focus on this underserved group, and successful aspects of interventions for common cancer survivors should be considered for inclusion when designing an intervention for rare cancer survivors.

Perceptions of adult patients with cancer towards telemedicine: A qualitative meta-synthesis

Objective

This study aims to systematically identify, evaluate, and synthesize published qualitative research on the views and attitudes of adult cancer patients toward telemedicine and, consequently to better inform the future development of telemedicine technology and interventions.

Methods

A meta-synthesis review was conducted to identify qualitative studies that reported adult cancer patients' perceptions toward telemedicine applications using nine electronic databases, including PubMed, MEDLINE, Web of Science, the Cochrane Library, PsycINFO, CINAHL, Wan Fang, VIP, and CNKI, from inception to November 2022. Quality appraisal was guided by the Joanna Briggs Institute's (JBI) Critical Appraisal Checklist for Qualitative Research. Data were synthesized using "thematic synthesis" to identify themes and concepts.

Results

A total of 3518 articles were retrieved, of which 23 met the inclusion and exclusion criteria. These studies identified three key meta-themes and 11 key sub-themes: (1) Benefits of telemedicine: obtaining information and social support, maintaining the continuity of treatment, receiving professional assistance, having greater flexibility, and promoting physical and mental health; (2) Limitations of telemedicine: interference with normal life, privacy and security issues, auxiliary function issues, and increased psychological burden; (3) Expectations for future telemedicine: more personalized intervention, more specific and diverse information.

Conclusions

The study showed that the benefits and limitations coexisted in the process of telemedicine application among adult cancer patients. It is necessary to develop personalized applications that are better suited to the needs and characteristics of adult cancer patients. Future telemedicine interventions should focus on information diversification and provide patients with more diverse and effective information.

Systematic review registration

PROSPERO, CRD42022324528.

Experience of life quality from patients with aplastic anemia: a descriptive qualitative study

BACKGROUND

Despite the increasing incidence of aplastic anemia in China, few studies have explored its effect on the patients' quality of life from the perspective of these patients. In fact, patients with aplastic disorder live with the disease for a long time, and need to face a variety of difficult realities, including multiple disease symptoms and drug side effects, heavy burden of medical costs, difficulties in social reintegration, and negative emotional distress. Therefore, this study used descriptive qualitative research to explore the direct and rich quality-of-life experiences of patients with aplastic anemia.

METHODS

A total of 19 patients with aplastic anemia were recruited in this study using purposive sampling combined with maximum variation strategy. 5 of the patients with AA were from northern China, and the others were from southern China. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method.

RESULTS

This study yielded important information about the experiences of patients with aplastic anemia in China. The content analysis method finally identified 3 themes and 9 sub-themes, including: physical symptoms (declining physical capacity, treatment-related symptoms, changes in body image), psychological symptoms (mood changes related to the stage of the disease, change in self-image, growth resulting from the disease experience), social burden (decline in career development, perceived burden to the family, social stigma). Patients with AA from different regions didn't show much difference in quality of life.

CONCLUSIONS

Aplastic anemia affects the physical, psychological, and social aspects of patients' lives. Therefore, health care providers need to consider the patients' physical response and psychological feelings to provide relevant medical guidance and multi-channel social support that would improve their confidence and quality of life.

CLINICAL TRIAL REGISTRATION

Name: Development and preliminary application of Quality of Life Scale for Patients with Aplastic Anemia. Number: ChiCTR2100047575. URL: http://www.chictr.org.cn/login.aspx?referurl=%2flistbycreater.aspx .

Long-term effects on depression and anxiety of an internet-based stepped care intervention for patients with cancer and symptoms of depression and anxiety. The U-CARE AdultCan trial

Background

Cancer is a serious disease that commonly causes significant psychological distress. The internet-based intervention (iCAN-DO), utilizing a stepped care approach for the treatment of anxiety and depression in individuals with cancer, has been shown to have favorable results for symptoms of depression at the primary endpoint, 10 months after randomization compared to standard care (SC). The aim of the present study was to evaluate the long-term effects of the intervention 18 and 24 months after randomization.

Methods

Patients with breast, colorectal, or prostate cancer and a score > 7 on either of the Hospital Anxiety and Depression Scale (HADS) subscales (n = 245) were recruited to the study in conjunction with a regular hospital visit. They were randomized to access to the stepwise iCAN-DO intervention for 24 months or to SC. Step 1 of the intervention comprised psycho-educative online material. In Step 2, internet-based cognitive-behavioral therapy with individual online support from a therapist was added. Step 2 was offered to those who reported persistent anxiety or depression symptoms (>7 on HADS), also at 1, 4, and/or 7 months after randomization. Missing data were imputed using the last rank carried forward method and used for the main analyses according to the intention-to-treat approach. Effects sizes (Cohen's d), and minimally clinically important difference (MCID) were calculated. Linear mixed models were used to analyze intervention effects over time.

Results

Symptoms of depression decreased significantly (p < 0.05) in the iCAN-DO group compared with the SC group from baseline to 18 months (d = 0.29), but not to 24 months (d = 0.27). Even though the average iCAN-DO group participant surpassed a MCID in symptoms of anxiety (>2 p) at both long-term follow-ups, the differences did not reach statistical significance, either at 18 months (p = 0.10) or 24 months (p = 0.09). Positive effects of iCAN-DO compared with the SC were also shown for some secondary HRQoL-outcomes; social functioning at 18 months (p = 0.02) and 24 months (p = 0.001), and sleep problems at 24 months (p = 0.01).

Conclusion

A stepped-care internet-based intervention that has previously shown positive results for symptoms of depression at 10 months did show similar positive long-term effects also at 18 months. For symptoms of anxiety, no effect could be shown. The internet may provide an effective format for interventions to reduce symptoms of depression after cancer at patients' own choice of time, regardless of distance to a psycho-oncology clinic.

Experiences of Women With Breast Cancer Using Telehealth: A Qualitative Systematic Review

Breast cancer is the most prevalent malignant neoplasm among women. Its treatment comprises different strategies. Telehealth can ensure continuity of care in distant locations. This study aimed to synthesize qualitative evidence of women's experiences with telehealth during the treatment and follow-up of breast cancer. We performed a qualitative systematic review and meta-synthesis. The databases included in the search were: Pubmed, EMBASE, CINAHAL, and Web of Science. The search combined the terms: breast cancer, telemedicine, telehealth, and qualitative study. The studies included were: qualitative design and mixed methods studies with qualitative components. The COREQ Checklist assisted in assessing the quality of included studies and an adaptation of thematic analysis for the qualitative meta-synthesis. We included twelve articles in the review. In the meta-synthesis, 3 themes emerged. (1) Structure: simple design and space to obtain information but in need of adjustments. (2) Usability: about the benefits and limitations of telehealth. (3) Interaction with health professionals. Telehealth is an accepted strategy for the clinical care of women with breast cancer. Patients identified the need for improvements in structure, usability, and interaction. PROTOCOL REGISTRATION: PROSPERO registration number CRD42021228326, registered 06/02/2021.

Impact of connected health interventions on psychological wellbeing and quality of life in patients with cancer: A systematic review and meta-analysis

OBJECTIVE

Connected health technologies have the potential to improve access to cancer care and support and reduce costs. We aimed to assess the impacts of interventions delivered using connected health technologies on psychological and quality of life (QoL) outcomes in people living with and beyond cancer.

METHODS

PUBMED, PsycINFO, Web of Science, and EMBASE were searched using terms relating to (i) cancer, (ii) connected health, and (iii) QoL/psychological wellbeing. Studies were included if they evaluated interventions using connected health technologies and assessed psychological and/or QoL outcomes for adults at any stage of cancer treatment or survivorship.

RESULTS

Thirty-seven studies met the inclusion criteria with a total of 8956 participants. Connected health technologies included web-based applications (n = 24), smart applications (n = 12), and wearable devices (n = 1). Studies were heterogeneous in terms of intervention components. We identified five clusters: (i) Psychosocial support and rehabilitation, (ii) psychoeducation and information support, (iii) symptom monitoring, reporting and self-management, (iv) peer and social support, and (v) health coaching and physical activity training. Due to heterogeneity of outcome measures, the meta-analysis included only seven RCTs; pooled mean estimates showed connected health interventions were moderately effective in reducing symptoms of depression (SMD: -0.226, 95% CI -0.303/-0.149) and anxiety (SMD: -0.188, 95% CI: 0.279/-0.0963) compared with usual care.

CONCLUSION

While the considerable heterogeneity observed highlights the need for more rigorous studies to improve reproducibility and efficiency, results suggest that connected health interventions have the potential to improve psychological wellbeing and QoL outcomes in people living with and beyond cancer.

Orem's Theory with Educational Telephone Follow-ups: A Randomized Controlled Trial

The authors of this study examined the effect of Orem's Self-Care Deficit Theory (OSCDT) based education and telephone follow-ups on the self-care agency, anxiety, loneliness, and well-being of patients with colorectal cancer chemotherapy. In this study, data of 47 patients with colorectal cancer (randomly assigned into the intervention or control group) were collected between April 2016 and March 2017 from a university hospital's daytime chemotherapy unit in Turkey. Before chemotherapy, the intervention group was given individualized education based on the OSCDT and an educational booklet. After chemotherapy treatments, these patients received a telephone follow-up call. The control group received only routine nursing care. The self-care agency and general well-being, and its sub-dimensions, of the intervention group increased, and its state-trait anxiety and loneliness levels decreased, when compared with the control group. Nurses must play a more active role in education and follow-ups, and telephone follow-ups should be included in nursing care in chemotherapy units.

Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review

BACKGROUND

Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored.

OBJECTIVE

This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions.

METHODS

A scoping review of the literature was conducted using the Arksey and O'Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research.

RESULTS

Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI.

CONCLUSIONS

As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research.

Effects of a WeChat-based multimodal psychoeducational intervention on psychological well-being and quality of life in acute leukaemia patients in China: a randomised controlled trial

PURPOSE

The treatment and side effects of chemotherapy for acute leukaemia (AL) may cause both physical and psychological symptoms in patients. This study evaluated the effects of a WeChat-based multimodal psychoeducational intervention (ICARE programme) on fatigue, distress, anxiety, depression, and quality of life (QoL) among adult AL patients.

METHODS

In total, 72 participants were randomly assigned either to an intervention or control group (n = 36), respectively, from two large tertiary hospitals in Fuzhou, China (from April to December 2019). Data were collected at baseline, post-intervention, and after a 4-week follow-up using the Brief Fatigue Inventory, Distress Thermometer, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-leukaemia. Descriptive statistics was used to summarise the sociodemographic and clinical characteristics of the participants and a linear mixed model was used to analyse the score changes.

RESULTS

Between the two groups, there were statistically significant improvements in fatigue, distress, anxiety, depression, physical well-being, social/family well-being, emotional well-being, functional well-being (all p < 0.001), and leukaemia-specific subscale (p = 0.001). The difference over time was significant for leukaemia-specific subscale and fatigue, both (p < 0.001), anxiety (p = 0.001), and social/family well-being (p = 0.005). The interaction effects were significant for fatigue, distress, anxiety, physical well-being, social/family well-being, and emotional well-being, all (p < 0.001), depression (p = 0.019), leukaemia-specific subscale (p = 0.008), and total QoL score (p = 0.004).

CONCLUSION

WeChat-based multimodal psychoeducational intervention demonstrated a significant effect in reducing fatigue, distress, anxiety, depression, and QoL in AL patients. This ICARE programme contributed to continuing care to support AL patients.

IMPLICATIONS FOR CANCER SURVIVORS

The ICARE programme can improve the mental health and QoL of AL patients. The application of WeChat-based psychoeducational interventions have significant potential to benefit cancer patients due to their reach and can be an added value to routine care.

People with cancer and their family caregivers' personal experience of using supportive eHealth technology: A narrative review

PURPOSE

To synthesise existing qualitative evidence regarding the experiences of people living with cancer and their family caregivers using eHealth technology in their home setting.

METHOD

A narrative review using a systematic approach was utilised. Five databases (PubMed, CINAHL, EMBASE, PsycINFO and the Cochrane Library) were searched using a tailored search strategy to identify primary research articles published between January 2005 and May 2021. Studies were quality appraised using the Critical Appraisal Skills Programme's Qualitative Studies Checklist and the Mixed Method Appraisal Tool, where relevant. Identified studies were appraised by three reviewers and data were extracted for analysis. Key themes were identified and agreed upon by the authors.

RESULTS

28 empirical studies were included in the review. Five major themes emerged: (i) understanding of cancer and its care (ii) alignment and integration of eHealth technology into daily life (iii) connection and collaboration with healthcare professionals, family and peers (iii) reassurance and sense of safety (iv) and the psychosocial impact on the self during the cancer experience.

CONCLUSIONS

eHealth technology can have positive role in the lives of people with cancer and their family caregivers, beyond the intended health outcomes of the intervention. Individual preferences amongst people with cancer and their family caregivers using eHealth technology must be considered, especially regarding cancer information delivery, content and support methods. This review underlines a critical need for further in-depth evidence on the personal meaning and relationships people with cancer and their family caregivers develop with eHealth technology in an ambulatory care setting.

Cocreated internet-based stepped care for individuals with cancer and concurrent symptoms of anxiety and depression: Results from the U-CARE AdultCan randomized controlled trial

Objective

The aim was to evaluate the effects of cocreated internet‐based stepped care (iCAN‐DO) on anxiety, depression, posttraumatic stress, and health‐related quality of life (HRQoL) in individuals with cancer and self‐reported anxiety and/or depression symptoms, compared with standard care.

Methods

Clinically recruited individuals with breast, colorectal, or prostate cancer underwent online screening with the Hospital Anxiety and Depression Scale (HADS). Those with anxiety and/or depression symptoms (>7 on any of the HADS subscales) were randomized to iCAN‐DO or standard care. iCAN‐DO comprised psychoeducation and self‐care strategies (step 1) and internet‐based cognitive behavioral therapy (iCBT, step 2). Data were collected before randomization and at 1, 4, 7, and 10 months and analyzed with intention‐to‐treat regression analysis and randomization tests.

Results

Online screening identified 245 (27%) of 909 individuals who reported anxiety and/or depression symptoms. They were randomized to iCAN‐DO (n  = 124) or standard care (n = 121). Of them 49% completed the 10‐month assessment, and in the iCAN‐DO group 85% accessed step 1 and 13% underwent iCBT. iCAN‐DO decreased the levels of symptoms of depression (−0.54, 95% confidence interval: −1.08 to −0.01, P < .05) and the proportion of individuals with symptoms of depression (P < .01) at 10 months, compared with standard care, according to HADS. There were no significant effects on anxiety, posttraumatic stress, or HRQoL.

Conclusion

Internet‐based stepped care improves symptoms of depression in individuals with cancer. Further studies are needed to gain knowledge on how to optimize and implement internet‐based support in oncology care.