The role of Internet cancer information for older adults with cancer: Perspectives of older adults and healthcare professionals

Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence

PURPOSE

Approximately 50% of cancer survivors experience moderate-severe fear of cancer recurrence (FCR). Self-guided digital interventions have potential to address the high level of FCR-related unmet needs at scale, but existing digital interventions have demonstrated variable engagement and efficacy. This study aimed to evaluate the feasibility and preliminary efficacy of iConquerFear, a five-module self-guided digital FCR intervention.

METHODS

Eligible curatively treated breast cancer survivors were recruited. Participants reporting clinically significant FCR (≥ 13 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were given access to iConquerFear. Feasibility was indicated by > 50% of eligible participants enrolling in iConquerFear and recording moderate (≥ 120 min) or greater usage. Preliminary efficacy was evaluated via changes in self-reported FCR severity, anxiety, depression, intrusions and metacognitions from baseline to immediately and 3 months post-intervention.

RESULTS

Fifty-four (83%) of 65 eligible participants enrolled in iConquerFear; six subsequently withdrew. Thirty-nine (83%) participants recorded moderate (n = 24; 120-599 min) or high (n = 15; ≥ 600 min) usage. Engagement levels increased with participant age (p = 0.043), but were lower in participants with higher baseline FCR (p = 0.028). Qualitative feedback indicated engagement was sometimes limited by difficulties with navigation and relating to featured survivors. Participants reported significantly improved FCR (mean reduction (95%CI): baseline to post-intervention - 3.44 (- 5.18, - 1.71), baseline to 3-month follow-up - 4.52 (- 6.25, - 2.78), p =  < 0.001).

CONCLUSION

iConquerFear is a feasible and potentially efficacious intervention for reducing FCR in breast cancer survivors. Easier navigation and more relatable examples may enhance engagement.

IMPLICATIONS FOR CANCER SURVIVORS

iConquerFear may help address moderate but burdensome FCR levels in cancer survivors.

Caring for older adults with cancer in Canada: Views from healthcare providers and cancer care allies in the community

BACKGROUND

Cancer is common and disproportionately impacts older adults. Moreover, cancer care of older adults is complex, and the current Canadian cancer care system struggles to address all of the dimensions. In this project, our goal was to understand the barriers and facilitators to caring for older adults with cancer from perspectives of healthcare professionals and cancer care allies, which included community groups, seniors' centers, and other community-based supports.

METHODS

In collaboration with a patient advisory board, we conducted focus groups and interviews with multiple local healthcare professionals and cancer care allies in British Columbia, Canada. We used a descriptive qualitative approach and conducted a thematic analysis using NVivo software.

RESULTS

A total of 71 participants of various disciplines and cancer care allies participated. They identified both individual and system-level barriers. Priority system-level barriers for older adults included space and staffing constraints and disconnections within healthcare systems, and between healthcare practitioners and cancer care allies. Individual-level barriers relate to the complex health states of older adults, caregiver/support person needs, and the needs of an increasingly diverse population where English may not be a first or preferable language.

CONCLUSIONS

This study identified key barriers and facilitators that demonstrate aligned priorities among a diverse group of healthcare practitioners and cancer care allies. In conjunction with perspectives from patients and caregivers, these findings will inform future improvements in cancer care. Namely, we emphasize the importance of connections among health systems and community networks, given the outpatient nature of cancer care and the needs of older adults.

Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the effectiveness of digital and face-to-face interventions in reducing fear of cancer recurrence (FCR) among individuals with cancer.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for evaluating the efficacy of psychological interventions for FCR published between July 2018 and December 2021. We searched for research papers using PubMed, Embase, and Cochrane and assessed their quality using the Revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Of the 2113 identified studies, we analyzed 17 samples (N = 1482) from 14 studies, of which 13 were RCTs. The overall sample showed a moderate effect size (Hedges' g = 0.607; 0.356 to 0.858; p < 0.001; I2  = 81.29%) in FCR reduction. The overall effect size was 0.621 (95% CI, 0.276 to 0.966; p < 0.001; I2  = 81.78%) for face-to-face interventions and 0.517 (95% CI, 0.093 to 0.941; p = 0.017; I2  = 83.19%) for digital interventions. The difference between the two effect sizes was not statistically significant.

CONCLUSION

Our meta-analysis suggests that digital interventions are moderately effective in reducing FCR, similar to face-to-face interventions. However, given the high degree of heterogeneity, this conclusion should be interpreted with caution. Further studies are required to identify the most effective digital interventions and the populations that may benefit from them.

Scoping review of the preferences of older adults for patient education materials

OBJECTIVE

To provide an overview of studies that describe the preferred mode and format of delivery of patient education materials to older adults.

METHODS

A scoping review was used to identify relevant literature published between January 2010 and June 2021, with specific attention given to studies conducted in high income countries with similar health systems.

RESULTS

A total of 3245 titles were identified, and 20 met the inclusion criteria and were included in this scoping review. Older adults preferred written information that could be accessed via health professionals or downloaded online. Other key features were identified including logical layout, signposted information, larger text size, labelled visual aids, and use of images appropriate and relevant to the target group were preferred. Audio visual resources were also considered valuable when well designed. Formats for patient education such as apps, group classes and online courses were less popular with older adults.

CONCLUSIONS

Patient education materials for older adults should be carefully designed, with attention to layout and content. Older adults indicated a preference for hard copy handouts or in a format that can be downloaded.

PRACTICE IMPLICATIONS

Regular engagement with older consumers about their preferences is important as technology for delivery of patient education materials evolve. Key features for specific attention during the design process include a logical layout (tested with consumers), signposted information, text size, labelled visual aids and appropriate images. The perspectives of other key groups of older adults such as those from minority populations or other disadvantaged groups are largely unexplored.

Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review

Objective: Disparities in cancer care contribute to higher rates of cancer mortality. Online health information would be a resource for cancer patients to obtain knowledge and make health decisions. However, factors that hinder or facilitate online searching behaviours among patients remain unexplored. The current systematic review aims to identify and synthesise evidence of cancer patients' barriers to and facilitators of online health information-seeking behaviours. Methods: Electronic databases (PubMed, EMBASE, Scopus) were systematically searched, and a total of 123 full-text studies were reviewed of which 24 met the inclusion criteria. Results: Thematic analysis was performed to identify barriers and facilitators of online health information-seeking behaviours. Seven key themes were identified: (1) socio-demographic characteristics (age, gender, education, income, ethnicity and language), (2) psychosocial aspects (psychological wellbeing, need for a face to face contact, motivation, support), (3) accessibility (Internet access, residence), (4) quality and quantity of information (amount, reliability), (5) cancer stage and symptoms (time since diagnosis, experiencing symptoms), (6) aspects related to healthcare professionals (relationship with the patients and opinions on online health information) and (7) digital literacy (computer skills and literacy). Conclusions: Findings underscore the significance of recognising the multifaceted nature of barriers and facilitators affecting cancer patients' online health information-seeking behaviours. A strong link between these factors and cancer patients' ability to make informed decisions and cope effectively with their diagnosis emerged. Consequently, addressing these barriers and leveraging the identified facilitators could lead to improvements in patient-centred care, ultimately contributing to better healthcare services and informed decision-making for cancer patients. Future research should prioritise exploring strategies for enhancing cancer care accessibility across all stakeholders involved.

Registration

CRD42023408091.

Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women

Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI95%: 0.336-0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.

Impact of Internet Use on Mental Health among Elderly Individuals: A Difference-in-Differences Study Based on 2016-2018 CFPS Data

The number of elderly Internet users has increased significantly in the past few years. However, the impact of Internet use on mental health remains unclear. In this study, we performed a difference-in-differences analysis using data from the 2016 and 2018 waves of the China Family Panel Studies (CFPS) to evaluate the impact of Internet usage on mental health among elderly individuals. A total of 5031 validated respondents were included to explore the relationship between Internet use and reduced levels of depression as well as improved life satisfaction among elderly individuals. The results showed that Internet use significantly reduced depression levels. Unexpectedly, Internet use was not found to improve life satisfaction. Moreover, discontinuing Internet use was not significantly associated with improvements in depression or life satisfaction. More research is needed to fully elucidate the relationship between Internet use and depression levels, as well as life satisfaction among elderly individuals.

Exploring Perceptions of Technology Use to Support Self-Management Among Older Adults with Cancer and Multimorbidities

OBJECTIVES

Our objective was to explore and describe how older adults engage with technology to support cancer self-management behaviors, particularly as they live with multimorbidity.

DATA SOURCES

We used a qualitative descriptive approach and semi-structured interviews with older adults with cancer who had at least one other chronic condition. Two authors analyzed the data using a descriptive thematic analysis approach using NVivo 12 software.

CONCLUSION

We found that older adults are interested in, if not already, engaging with technology and internet searching to manage their cancer diagnosis and treatment. Data were grouped into three themes: (1) Using technology to take control; (2) Confidence in technology supports competence in self-management; and (3) Desired features for future interventions. Participants felt they might need extra support learning how to craft a search, filter facts, and digest information from the internet to manage their cancer. Those who reported using technology to keep records about their health made more statements reflecting confidence in their technology usage.

IMPLICATION FOR NURSING PRACTICE

Older adults are interested in engaging technology to support self-management. The specific implications that arise from this study are that (1) older adults' interest in engaging with technology has a unique potential to support foundations for self-management behaviors and activities and (2) empowering self-management behaviors and attitudes through technology may result in better treatment outcomes, as evidenced by increased capabilities in the six core self-management skills.

Coping during COVID-19: a mixed methods study of older cancer survivors

PURPOSE

Older cancer survivors are among the most vulnerable to the negative effects of COVID-19 and may need specific survivorship supports that are unavailable/restricted during the pandemic. The objective of this study was to explore how older adults (≥ 60 years) who were recently (≤ 12 months) discharged from the care of their cancer team were coping during the pandemic.

METHODS

We used a convergent mixed method design (QUAL+quan). Quantitative data were collected using the Brief-COPE questionnaire. Qualitative data were collected using telephone interviews to explore experiences and strategies for coping with cancer-related concerns.

RESULTS

The mean sample age (n = 30) was 72.1 years (SD 5.8, range 63-83) of whom 57% identified as female. Participants' Brief-COPE responses indicated that they commonly used acceptance (n = 29, 96.7%), self-distraction (n = 28, 93.3%), and taking action (n = 28, 93.3%) coping strategies. Through our descriptive thematic analysis, we identified three themes: (1) drawing on lived experiences, (2) redeploying coping strategies, and (3) complications of cancer survivorship in a pandemic. Participants' coping strategies were rooted in experiences with cancer, other illnesses, life, and work. Using these strategies during the pandemic was not new-they were redeployed and repurposed-although using them during the pandemic was sometimes complicated. These data were converged to maximize interpretation of the findings.

CONCLUSIONS

Study findings may inform the development or enhancement of cancer and non-cancer resources to support coping, particularly using remote delivery methods within and beyond the pandemic. Clinicians can engage a strengths-based approach to support older cancer survivors as they draw from their experiences, which contain a repository of potential coping skills.

The Effects of Social Participation Restriction on Psychological Distress among Older Adults with Chronic Illness

This study examined how restricted social participation mediates the relationship between chronic illness and psychological distress among community-dwelling older adults. Additionally, the use of the Internet for health care was tested as a moderator to examine whether the relationship between limited social participation and psychological distress differs. Using the multiple-group path analysis approach, 16,032 community-dwelling older adults (65+) from the National Health Interview Survey were analyzed. The findings show that 32.2% suffered from chronic illnesses that limited their daily activities, and 26% reported social participation restrictions to some degree. While having chronic illnesses was associated with greater psychological distress, the association was also through increased social participation restriction (mediation). Furthermore, differences in mediation were found between health information technology users and nonusers (moderated mediation). In contrast to the hypothesis, the adverse relationship between limited social participation and psychological distress was stronger among users, although chronic conditions were associated with greater social participation restrictions among nonusers. The findings suggest that with proper accommodations and interventions that aim to increase the social participation of community-dwelling older adults, the disadvantageous effects of chronic conditions on psychological distress could be ameliorated. Moreover, the importance of such interventions is greater among health information technology users.

Internet health information education for older adults: A pilot study

This study aimed to develop internet health information education program, and to explore the program's feasibility and preliminary effects. We made use of an intervention mapping approach and adopted as conceptual framework the information-motivation-behavioral skills model to develop the program. We evaluated the feasibility and the impact of the education program using a single-group pretest-posttest design using generalized equation estimation. Eleven older adults participated in the classes from January 25 to February 22, 2019. Each outcome of the behavioral theory-based components of the program-computer/Web knowledge (p < .001), attitude toward internet-based health information (p = .002), eHealth literacy score (p < .001), searching performance scores (p < .001), and level of understanding of internet-based health information (p = .002)-showed significant improvement immediately after the intervention. This pilot study reveals that a behavior theory-based education program for utilizing internet-based health information is an effective way to increase older adults' eHealth literacy.