Demographic characteristics, call details and psychosocial support needs of the family/friends of someone diagnosed with cancer who access Australian Cancer Council telephone information and support services

What is the economic and social return on investment for telephone cancer information and support services in Australia? An evaluative social return on investment study protocol

INTRODUCTION

Over 50% of people affected by cancer report unmet support needs. To address unmet information and psychological needs, non-government organisations such as Cancer Councils (Australia) have developed state-based telephone cancer information and support services. Due to competing demands, evidence of the value of these services is needed to ensure that future investment makes the best use of scarce resources. This research aims to determine the costs and broader economic and social value of a telephone support service, to inform future funding and service provision.

METHODS AND ANALYSIS

A codesigned, evaluative social return on investment analysis (SROI) will be conducted to estimate and compare the costs and monetised benefits of Cancer Council Victoria's (CCV) telephone support line, 13 11 20, over 1-year and 3-year benefit periods. Nine studies will empirically estimate the parameters to inform the SROI and calculate the ratio (economic and social value to value invested): step 1 mapping outcomes (in-depth analysis of CCV's 13 11 20 recorded call data; focus groups and interviews); step 2 providing evidence of outcomes (comparative survey of people affected by cancer who do and do not call CCV's 13 11 20; general public survey); step 3 valuing the outcomes (financial proxies, value games); step 4 establishing the impact (Delphi); step 5 calculating the net benefit and step 6 service improvement (discrete choice experiment (DCE), 'what if' analysis). Qualitative (focus groups, interviews) and quantitative studies (natural language processing, cross-sectional studies, Delphi) and economic techniques (willingness-to-pay, financial proxies, value games, DCE) will be applied.

ETHICS AND DISSEMINATION

Ethics approval for each of the studies will be sought independently as the project progresses. So far, ethics approval has been granted for the first two studies. As each study analysis is completed, results will be disseminated through presentation, conferences, publications and reports to the partner organisations.

Greek Caregivers of Chronically Ill Patients Struggling in Everyday Life

BACKGROUND

Caregivers of chronically ill geriatric patients face several problems throughout the disease progression of the patients under their care. This is a prospective crosssectional study conducted from September 2017 to September 2018, including 130 caregivers of geriatric patients from Attica, Greece.

OBJECTIVES

This study investigates caregivers' anxiety, perception of changes in their lives, and quality of life.

METHODS

The questionnaires administered were the revised Bakas Caregiving Outcomes Scale (rBCOS), the State-Trait Anxiety Inventory (STAI), and the Linear Analogue Scale Assessment (LASA).

RESULTS

Influencing factors associated with rBCOS, STAI and LASA were care timespan and energy levels. Only the State Anxiety Scale and the Patient-caregiver Relationship rBCOS questionnaire seemed to be affected by a cancer diagnosis.

CONCLUSION

Our findings revealed that anxiety, low quality of life, and perception of changes in the lives of caregivers are the underlying factors. Significant factors were time spent caring for the patient, the status of their relationship, the diagnosis, especially in life-threatening and life-limiting diseases, and the caregivers' energy levels. These results are important in order to comprehend the lives of caregivers and assess by what means could the healthcare system and society further assist them.

The male perspective: A mixed methods study of the impact, unmet needs and challenges of caring for women with breast cancer

OBJECTIVES

As a formative investigation toward the development of a supportive care intervention for male caregivers, this study explored the emotional impact, unmet needs and challenges experienced by men when caring for a woman with breast cancer.

DESIGN

A cross-sectional mixed methods study, with an online survey and interviews.

SAMPLE

A total of 89 participants completed the survey, of whom 13 completed interviews. The majority (93%) of participants were husbands of care recipients; of the care recipients, 75% had early stage breast cancer and 45% were diagnosed over 5 years ago.

METHOD

Participants completed questionnaires assessing their emotional wellbeing, unmet needs and biopsychosocial challenges, with a sub-sample participating in subsequent interviews to elaborate on survey responses.

FINDINGS

Emotional difficulty was reported by <25% of the sample, and 83% reported experiencing at least one unmet need (M = 81.5, SD = 33.2). Of the 39 biopsychosocial challenges presented, 100%, 86% and 73% reported "ever experiencing," "currently experiencing," and "ever needing help," respectively. Interviewed participants echoed the most reported needs and challenges as changes to sex life, fear of recurrence and lack of practical information.

CONCLUSIONS

Male cancer caregivers experience diverse challenges and require psychological support and practical information using both online and offline approaches to support their caregiving responsibilities.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Healthcare professionals can support male caregivers by: being aware of their information and psycho-social needs; directing caregivers to online interventions for additional information; and facilitating the provision of online psycho-sexual and FCR support.

Non-use of cancer information services among people experiencing cancer in Ireland

PURPOSE

The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer.

METHOD

This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis.

RESULTS

The key themes to emerge from the date were 'living in the here and now' and 'awareness of the Cancer Society'. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society.

CONCLUSIONS

Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies' services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement.

Are cancer helplines effective in supporting caregivers? A systematic review

PURPOSE

The aims of this systematic review were to summarize the profile of caregivers accessing cancer helplines, to evaluate caregiver satisfaction with the helpline service, and to review the evidence base of intervention studies testing the efficacy of community-based cancer helplines in improving caregiver health and well-being.

METHODS

Four electronic databases (Medline, CINAHL, PsychINFO, and EMBASE) were systematically searched to identify relevant literature, including all articles published in English until May 2018. Reference lists of accepted papers were reviewed for the inclusion of additional potentially relevant articles, gray literature was excluded.

RESULTS

Forty-five publications met the inclusion criteria for this review. Forty-one papers reported on the proportion of caregivers accessing cancer helplines. Twenty-six studies described demographic and clinical characteristics of caregivers and eight reported on call characteristics. Reasons for contacting the service were stated in 21 studies and caregiver satisfaction with the helpline service was assessed in 12 articles. Fourteen studies investigated specific topics of interest (e.g., prevalence of sleep problems, distress screening, or clinical trial participation). Two randomized controlled trials examined the efficacy of cancer helplines in improving caregiver outcomes, with findings showing interventions to be effective in reducing distress and unmet needs, and in increasing positive adjustment.

CONCLUSIONS

There is limited scientific evidence regarding the efficacy of cancer helplines to improve caregivers' health and well-being. More intervention studies are needed to examine the benefits of cancer helplines to this study population to ensure structured referral pathways can be established.

A scoping review of consumer needs for cancer information

OBJECTIVE

This study was a scoping review of research on cancer-related health information seeking and needs of patients, survivor, non-patients, and caregivers.

METHODS

This study used the COSI model to search for articles published from 2007 to 2017.

RESULTS

In total, 117 articles with titles and abstracts including the following terms were selected: cancer, health, information, seeking. Non-patients obtained information from the Internet, doctors, and media, whereas patients obtained information from doctors, the Internet, and media. Information needs were the highest for treatment, prognosis, and psychosocial support. Patients had the highest need for information on prognosis and treatment, whereas non-patients had the highest need for general cancer information, prevention, and cancer examination. Caregivers sought information about treatment, psychosocial support, and prevention.

CONCLUSION

This study revealed an increase in the number of research articles identifying cancer patients' information needs. Cancer patients rely on health professionals for information; thus, relevant materials are needed. Furthermore, not only medical but also psychosocial support information is needed.

PRACTICE IMPLICATIONS

There is a need for cancer information from health professionals, and thus for patient-centered training materials. Furthermore, a survey system to evaluate consumers' cancer information needs should be developed.

Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings

Background

There are few support systems available to informal carers who provide care to cancer patients. Smartphone apps have the capacity to reach large audiences and can provide information and support at a time convenient to carers.

Objective

The aim of this study was to design a smartphone app prototype for carers of adults with cancer.

Methods

A multiple-method design was used to develop a smartphone app. Current and past carers of people with any type of cancer were recruited from a public hospital, a private hospital, and a carer organization, who participated in either a focus group or phone interview. Carers answered questions about items to include in an app to address supportive care needs identified. Using carers’ feedback, a smartphone app was designed and tested.

Beta testing was conducted using a convenience sample of participants who completed scenarios to inform the app’s design, functionality, and usability. Scenarios were timed and marked as complete or incomplete. Participants completed a questionnaire about the usability of the app. Beta testing occurred in 2 stages—a paper-based version of the app and an app-based test using the participants’ preferred device. Alpha testing was completed internally to ensure the functionality of the app. Data were collected between May 2016 and August 2017.

Results

A total of 33 carers participated in phone interviews and 12 in focus groups; their average age was 55 (SD 14) years, and 60% (27/45) were female. The majority of carers (76%, 25/33) had a positive attitude toward using smartphone apps. Carers noted that smartphone technology might improve their ability to seek information and support in managing their own health as well as the care needs of the person with cancer. Carers requested a variety of information and resources to be included in the app. Paper-based testing included the following: participants (N=10) were aged above 30 years (30%, 3/10), 30 to 49 years (30%, 3/10), and 50 years or above (40%, 4/10), and 60% (6/10) were male. Participants found the app user-friendly and pleasing in appearance.

App-based testing included the following: participants (N=10) were aged above 30 years (20%, 2/10), 30 to 49 years (30%, 3/10), and 50 years or above (50%, 5/10), and 50% (5/10) were male. Participants reported the app to be user-friendly and easy to navigate. The majority (60%, 6/10) of participants were unable to create a shortcut icon to add the app to the home screen of their phone.

Conclusions

Carers highlighted the needed information and support to assist them during the caring period; they also reported having a positive attitude toward smartphone apps. The Carer Guide App is currently undergoing a pilot study to further test usability among carers of people with 1 cancer type.

Demographic and cancer-related differences between self-seeking patients and supported patients: Analysis of cancer information-service data

OBJECTIVE

Surrogate information seeking is quite common, and several studies have presented data on caregivers, family members, and friends who seek health information on the Internet or from a cancer-information service (CIS) on behalf of cancer patients. However, these studies provide little information about the patients who are supported by surrogate seekers. Therefore, this study analyzed demographic and cancer-related differences, including diverse informational needs, between self-seeking patients and patients who benefited from surrogate seekers (ie, caregivers, family, or friends) requesting information on their behalf.

METHODS

We conducted a retrospective audit of phone and e-mail inquiries to a German CIS between January and December 2016 from self-seeking patients (n = 13 723) and surrogate information seekers, as well as the corresponding supported patients (n = 6696).

RESULTS

Supported patients were more likely to be males (P < 0.001), older than self-seeking patients (P < 0.001), and older than the corresponding surrogate seekers (P < 0.001). They were also more likely to be in the diagnostic or palliative stage (P < 0.001) and were less likely to suffer from breast cancer or prostate cancer (P < 0.001) than self-seeking patients. There were significant differences in the CIS requests of self-seekers and surrogate seekers.

CONCLUSIONS

The results point to different support needs of self-seekers and surrogate seekers. Thus, surrogate seekers and their corresponding supported patients should be seen as a separate target group to self-seeking patients, with the former requiring informational and emotional support on diverging topics and at different disease stages.

Feasibility, useability and acceptability of technology-based interventions for informal cancer carers: a systematic review

BACKGROUND

Carers looking after someone with cancer often experience negative impacts on their own health. M-health interventions have been designed to provide information and support to patients and their carers. However, the effectiveness of technology-based interventions for carers is less well understood. The objectives were to assess the feasibility, useability and acceptability of technology-based interventions among carers of people living with cancer.

METHODS

A systematic search of the CINAHL, MEDLINE and PSYCINFO databases was performed using terms related to web-based interventions and smartphone applications, carers and cancer. Studies were included if a randomised controlled trial or pilot study was conducted, focused on adult carers looking after another adult with cancer and were published between January 2007-June 2017. Articles were excluded if they reported qualitative results only or were evaluating existing websites and applications. Feasibility was measured by attrition, recruitment rates and frequency of intervention use; useability was measured by the ease of intervention use and the role of features to minimise errors in use. Acceptability was measured by carers' perception of the appropriateness of the content and their ability to incorporate the intervention into their daily routines.

RESULTS

Of the 729 articles, six articles met the inclusion criteria. Attrition ranged from 14% - 77%, recruitment rates from 20% - 66% and intervention useability varied across studies. Half of the studies implemented measures to improve useability. Overall, carers rated the content of the interventions as appropriate and reported improved knowledge and communication. Acceptability was further demonstrated as carers preferred the flexibility available with web-based interventions.

CONCLUSIONS

Technology-based interventions are suitable for use among carers of people with cancer. Further research is required to fully assess the impact of technology as an information and support mechanism for carers.