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Lyons KD, Wechsler SB, Ejem DB, Stevens CJ, Azuero A, Khalidi S, Hegel MT, dos Anjos SM, Codini ME, Chamberlin MD, Morency JL, Coffee-Dunning J, Thorp KE, Cloyd DZ, Goedeken S, Newman R, Muse C, Rocque G, Keene K, Pisu M, Echols J, Bakitas MA. Telephone-Based Rehabilitation Intervention to Optimize Activity Participation After Breast Cancer: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e242478. [PMID: 38517442 PMCID: PMC10960198 DOI: 10.1001/jamanetworkopen.2024.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 03/23/2024] Open
Abstract
Importance Following treatment, breast cancer survivors face challenges participating in valued activities. Objective To determine whether a telephone-based coaching rehabilitation intervention enhances activity participation in the year following breast cancer treatment. Design, Setting, and Participants In this multisite, single-blind randomized clinical trial (Optimizing Functional Recovery of Breast Cancer Survivors), recruitment occurred between August 28, 2019, and April 30, 2022. Data collection was completed by April 1, 2023. Participants were recruited from 2 cancer centers (Dartmouth College and the University of Alabama at Birmingham) and via social media advertisements. Women aged 18 years or older who had completed primary treatment for stage I to III breast cancer within 1 year and reported participation restrictions were eligible to participate. Randomization was stratified by site, treatment, and time since treatment. Interventions The intervention, delivered via telephone over 9 sessions, used behavioral activation and problem-solving principles to promote activity participation. The education-based attention control condition was delivered via telephone at matched intervals. Main Outcomes and Measures The primary outcome was participation, assessed using 5 measures, including Patient-Reported Outcomes Measurement Information System (PROMIS) social participation-satisfaction measure. One individualized outcome allowed participants to specify activities for which they wanted to foster recovery. Outcomes were collected by telephone by blinded coordinators at baseline and at 8, 20, and 44 weeks. The individualized outcome was assessed at the first and last intervention and control session. Results Among 1996 patients identified, 303 were eligible and enrolled. Of these, 284 women (94%; mean [SD] age, 56.1 [10.2] years) completed baseline assessments and were randomized, and 81% or more of each group completed the final assessment with no adverse events. Of those who completed the final assessment, 118 of 114 (82%) were in the intervention group, and 113 of 140 (81%) were attention control participants. Between-group differences were not statistically significant for the main measures of PROMIS satisfaction (week 20: Cohen d, 0.1 [95% CI, -0.09 to 0.29] and week 44: Cohen d, -0.08 [95% CI, -0.27 to 0.11]) and ability (week 20: Cohen d, 0.15 [95% CI, -0.06 to 0.37] and week 44: Cohen d, -0.08 [95% CI, -0.27 to 0.11]). On the individualized outcome, intervention participants reported significantly greater improvements in activity satisfaction (Cohen d, 0.76 [95% CI, 0.48-1.02]) and performance (Cohen d, 0.60 [95% CI, 0.32-0.87]). Conclusions and Relevance In this randomized clinical trial, the intervention catalyzed greater improvements in self-selected activity participation and goal disengagement but did not otherwise accelerate recovery compared with the control condition. Future research should determine what intervention features may lead to the greatest reductions in participation restrictions and other measures that may detect functional recovery. Trial Registration ClinicalTrials.gov Identifier: NCT03915548.
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Affiliation(s)
- Kathleen Doyle Lyons
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston
| | - Stephen B. Wechsler
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston
| | - Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Courtney J. Stevens
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Mark T. Hegel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Sarah M. dos Anjos
- School of Health Professions, Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham
| | - Megan E. Codini
- Department of Rehabilitation, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Mary D. Chamberlin
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jamme L. Morency
- Rehabilitation Medicine, Dartmouth Health, Lebanon, New Hampshire
| | | | - Karen E. Thorp
- Rehabilitation Medicine, Dartmouth Health, Lebanon, New Hampshire
| | | | - Susan Goedeken
- Department of Neurology, Mass General Brigham, Boston, Massachusetts
| | - Robin Newman
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | - Colleen Muse
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston
| | - Gabrielle Rocque
- Department of Medicine, Division of Hematology and Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham
| | - Kimberly Keene
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Maria Pisu
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham
- Center for Palliative and Supportive Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
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Ejem DB, Wechsler S, Gallups S, Khalidi S, Coffee-Dunning J, Montgomery AP, Stevens CJ, Keene K, Rocque GB, Chamberlin M, Hegel MT, Azuero A, Pisu M, Ellis D, Ingram SA, Lawhon VM, Gilbert T, Morrissette K, Morency J, Thorp K, Codini M, Newman R, Echols J, Cloyd D, dos Anjos S, Muse C, Goedeken S, Laws KE, Herbert J, Bakitas M, Lyons KD. Enhancing Efficiency and Reach Using Facebook to Recruit Breast Cancer Survivors for a Telephone-Based Supportive Care Randomized Trial During the COVID-19 Pandemic. JCO Oncol Pract 2023; 19:1020-1030. [PMID: 37733975 PMCID: PMC10667016 DOI: 10.1200/op.23.00117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 08/03/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE Evidence supporting social media-based recruitment of cancer survivors is limited. This paper describes how we used Facebook during the COVID-19 pandemic to augment our recruitment of breast cancer survivors for our two-site telephone-based randomized clinical trial (RCT) at Dartmouth-Hitchcock Medical Center and the University of Alabama at Birmingham. METHODS Originally a two-site RCT of a telephone-delivered breast cancer survivorship intervention, we extended our clinic-based recruitment to Facebook. Participant characteristics, geographic reach, and baseline outcomes were compared across recruitment sources (ie, two clinics and Facebook) using descriptive statistics and effect sizes. RESULTS Enrollment rates (20%-29%) were comparable across recruitment sources. The 21-month Facebook marketing campaign accounted for 59% (n = 179/303) of our total sample and had the greatest geographic reach, recruiting women from 24 states. The Facebook campaign reached a total of 51,787 unique individuals and cost $88.44 in US dollars (USD) per enrolled participant. Clinic samples had a greater proportion of women who were widowed (8% v 1%; P = .03) and Facebook had a higher proportion of women with a household income over $40,000 USD (83% v 71%; P = .02). There were no statistically significant differences between Facebook and the two clinics on baseline survey scores. CONCLUSION Augmenting traditional recruitment with Facebook increased our RCT's geographic and sociodemographic reach and supported meeting recruitment goals in a timely way. In the wake of the COVID-19 pandemic, cancer survivorship researchers should consider using social media as a recruitment strategy while weighing the advantages and potential biases introduced through such strategies.
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Affiliation(s)
- Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen Wechsler
- School of Health and Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Sarah Gallups
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | | | - Aoyjay P. Montgomery
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Al
| | | | - Kimberly Keene
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gabrielle B. Rocque
- Division of Geriatrics, Gerontology, and Palliative Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Divisions of Hematology & Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mary Chamberlin
- Department of Hematology/Oncology, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Mark T. Hegel
- Department of Psychiatry, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Maria Pisu
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Daphne Ellis
- Department of Psychiatry, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Stacey A. Ingram
- Divisions of Hematology & Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Valerie M. Lawhon
- Divisions of Hematology & Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Tiffany Gilbert
- Department of Psychiatry, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Kali Morrissette
- Department of Psychiatry, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Jamme Morency
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Karen Thorp
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Megan Codini
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Robin Newman
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Danielle Cloyd
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah dos Anjos
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Colleen Muse
- School of Health and Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Susan Goedeken
- Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA
| | - Kristen Elizabeth Laws
- School of Health and Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Jennae Herbert
- School of Health and Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
- Division of Geriatrics, Gerontology, and Palliative Care, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kathleen D. Lyons
- School of Health and Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA
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Stevens CJ, Wechsler S, Ejem DB, Khalidi S, Coffee-Dunning J, Morency JL, Thorp KE, Codini ME, Newman RM, Echols J, Cloyd DZ, dos Anjos S, Muse C, Gallups S, Goedeken SC, Flannery K, Bakitas MA, Hegel MT, Lyons KD. A Process Evaluation of Intervention Delivery for a Cancer Survivorship Rehabilitation Clinical Trial Conducted during the COVID-19 Pandemic. Curr Oncol 2023; 30:9141-9155. [PMID: 37887560 PMCID: PMC10605104 DOI: 10.3390/curroncol30100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
The purpose of the present study was to conduct a process evaluation of intervention delivery for a randomized controlled trial (RCT) conducted during the COVID-19 pandemic (NCT03915548). The RCT tested the effects of a telephone-delivered behavioral intervention on changes in breast cancer survivors' satisfaction with social roles and activities, as compared to an attention control condition. This process evaluation examined (a) fidelity monitoring scores; (b) participants' perceived benefit ratings for gaining confidence, reducing distress, adjusting habits and routines, setting goals, and increasing exercise; and (c) field notes, email communications, and transcripts of coach supervision and debriefing sessions. The behavioral and attention control conditions were delivered with a high degree of fidelity (global quality rating score for the BA/PS condition was M = 4.6 (SD = 0.6) and M = 4.9 (SD = 0.3) for the attention control condition, where "5" is the highest rating). The behavioral intervention participants perceived greater benefits than the control participants pertaining to goal setting, t(248) = 5.73, p = <0.0001, adjusting habits and routines, t(248) = 2.94, p = 0.0036, and increasing exercise, t(248) = 4.66, p = <0.0001. Moreover, coaches' perceptions regarding the behavioral intervention's therapeutic aspects aligned with the study's a priori conceptual model including the use of a structured process to set small, observable goals and facilitate the independent use of problem-solving skills. However, coaches also noted that aspects of the attention control condition, including the perceived relevance of the educational content and opportunities for social support, may have made it more therapeutically potent than intended. The pandemic may have affected the activity goals behavioral intervention participants could set as well as augmented the relevancy of social support provided in both conditions.
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Affiliation(s)
- Courtney J. Stevens
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Stephen Wechsler
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Jamme L. Morency
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Karen E. Thorp
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Megan E. Codini
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Robin M. Newman
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Danielle Z. Cloyd
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah dos Anjos
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Colleen Muse
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Sarah Gallups
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Susan C. Goedeken
- Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kaitlin Flannery
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mark T. Hegel
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
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