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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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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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Morency JL, Caldon KL, Root L, Hayes CA, Brighton S, Lyons KD. Feasibility study of a wellness intervention for caregivers of patients undergoing hematopoietic stem cell transplantation: The Ready to CARE Intervention. Br J Occup Ther 2020. [DOI: 10.1177/0308022620950980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Caregivers of patients undergoing hematopoietic stem cell transplantation need encouragement to maintain their own wellbeing. This feasibility study explored a six-session wellness intervention for caregivers entitled Ready to CARE (Connect, Actively Relax, and Exercise). Method This study used a single-arm pre–post design to explore the feasibility and acceptability of the intervention and study procedures. The individual, participant-directed intervention was initiated at hospitalization for stem cell reinfusion. Caregivers completed telephone surveys on four occasions and engaged in one semi-structured interview to share their perceptions of the intervention. Results Twenty participants enrolled and completed the baseline survey, with 50%, 90%, and 80% completing the subsequent three surveys, respectively. Seventy-four percent completed all six sessions of the intervention. Caregivers most often used the sessions to set goals related to physical activity (36%), stress management (14%), sleep (13%), and caregiving tasks (11%). Caregivers reported appreciation of the intervention’s focus on supporting caregivers, taking action with goal-setting, and allowing caregivers to determine the focus of the goals. Scheduling the sessions was the most problematic aspect of the intervention. Conclusion While caregivers were open to a wellness intervention, a high degree of flexibility and tailoring is needed to engage and support busy caregivers. Clinical Trial Registration: NCT03210727
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Affiliation(s)
- Jamme L Morency
- Department of Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kate L Caldon
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Lynn Root
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christi A Hayes
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine, Hanover, NH, USA
| | - Susan Brighton
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kathleen Doyle Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Stevens CJ, Hegel MT, Bakitas MA, Bruce M, Azuero A, Pisu M, Chamberlin M, Keene K, Rocque G, Ellis D, Gilbert T, Morency JL, Newman RM, Codini ME, Thorp KE, Dos Anjos SM, Cloyd DZ, Echols J, Milford AN, Ingram SA, Davis J, Lyons KD. Study protocol for a multisite randomised controlled trial of a rehabilitation intervention to reduce participation restrictions among female breast cancer survivors. BMJ Open 2020; 10:e036864. [PMID: 32060166 PMCID: PMC7044873 DOI: 10.1136/bmjopen-2020-036864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Many breast cancer survivors report an inability to fully participate in activities of daily living after completing cancer treatment. Reduced activity participation is linked to negative consequences for individuals (eg, depression, reduced quality of life) and society (reduced workforce participation). There is currently a lack of evidence-based interventions that directly foster cancer survivors' optimal participation in life roles and activities. Pilot study data suggest rehabilitation interventions based on behavioural activation (BA) and problem-solving treatment (PST) can facilitate post-treatment role resumption among breast cancer survivors. METHODS AND ANALYSIS This protocol describes a multisite randomised controlled trial comparing a 4-month long, nine-session BA and PST-informed rehabilitation intervention (BA/PS) against a time-matched, attention control condition. The overall objective is to assess the efficacy of BA/PS for enhancing breast cancer survivors' activity participation and quality of life over time. A total of 300 breast cancer survivors reporting participation restrictions after completing curative treatment for stage 1-3 breast cancer within the past year will be recruited across two sites (Dartmouth-Hitchcock Medical Center and University of Alabama at Birmingham). Assessments are collected on enrolment (T1) and 8 (T2), 20 (T3) and 44 (T4) weeks later. ETHICS AND DISSEMINATION Study procedures are approved by the Committee for the Protection of Human Subjects at Dartmouth College, acting as the single Institutional Review Board of record for both study sites (STUDY 00031380). Results of the study will be presented at national meetings and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03915548; Pre-results.
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Affiliation(s)
- Courtney J Stevens
- Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Mark T Hegel
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie Anne Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martha Bruce
- Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary Chamberlin
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kimberly Keene
- Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabrielle Rocque
- Medicine, Divisions of Hematology and Oncology, and Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daphne Ellis
- Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tiffany Gilbert
- Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jamme L Morency
- Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robin M Newman
- Occupational Therapy, Boston University College of Health and Rehabilitation Sciences Sargent College, Boston, Massachusetts, USA
| | - Megan E Codini
- Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Karen E Thorp
- Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah M Dos Anjos
- Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Danielle Z Cloyd
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashley N Milford
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stacey A Ingram
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasmine Davis
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathleen Doyle Lyons
- Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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