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Leenen JPL, Scherrenberg M, Bruins W, Boyne J, Vranken J, Brunner la Rocca HP, Dendale P, van der Velde AE. Usability of a digital health platform to support home hospitalization in heart failure patients: a multicentre feasibility study among healthcare professionals. Eur J Cardiovasc Nurs 2024; 23:188-196. [PMID: 37294588 DOI: 10.1093/eurjcn/zvad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
AIMS Heart failure (HF) is a common cause of mortality and (re)hospitalizations. The NWE-Chance project explored the feasibility of providing hospitalizations at home (HH) supported by a newly developed digital health platform. The aim of this study was to explore the perceived usability by healthcare professionals (HCPs) of a digital platform in addition to HH for HF patients. METHODS AND RESULTS A prospective, international, multicentre, single-arm interventional study was conducted. Sixty-three patients and 22 HCPs participated. The HH consisted of daily home visits by the nurse and use of the platform, consisting of a portable blood pressure device, weight scale, pulse oximeter, a wearable chest patch to measure vital signs (heart rate, respiratory rate, activity level, and posture), and an eCoach for the patient. Primary outcome was usability of the platform measured by the System Usability Scale halfway and at the end of the study. Overall usability was rated as sufficient (mean score 72.1 ± 8.9) and did not differ between the measurements moments (P = 0.690). The HCPs reported positive experiences (n = 7), negative experiences (n = 13), and recommendations (n = 6) for the future. Actual use of the platform was 79% of the HH days. CONCLUSION A digital health platform to support HH was considered usable by HCPs, although actual use of the platform was limited. Therefore, several improvements in the integration of the digital platform into clinical workflows and in defining the precise role of the digital platform and its use are needed to add value before full implementation. REGISTRATION clinicaltrials.gov NCT04084964.
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Affiliation(s)
- Jobbe P L Leenen
- Connected Care Centre, Isala Hospital, Dr. van Heesweg 2, Zwolle, AB 8025, The Netherlands
- Isala Academy, Isala Hospital, Dr. van Heesweg 2, Zwolle, AB 8025, The Netherlands
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Salvatorstraat 20, Hasselt 3500, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, Hasselt 3500, Belgium
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Wendy Bruins
- Isala Heart Centre, Isala Hospital, Dr. van Heesweg 2, Zwolle, AB 8025, The Netherlands
| | - Josiane Boyne
- Cardiology Department, Maastricht University Medical Centre, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands
| | - Julie Vranken
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, Hasselt 3500, Belgium
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Hans-Peter Brunner la Rocca
- Cardiology Department, Maastricht University Medical Centre, Minderbroedersberg 4-6, Maastricht, 6211 LK, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Salvatorstraat 20, Hasselt 3500, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Martelarenlaan 42, Hasselt 3500, Belgium
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
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Gingele AJ, Brandts L, Vossen K, Knackstedt C, Boyne J, Brunner-La Rocca HP. Prognostic value of signs and symptoms in heart failure patients using remote telemonitoring. J Telemed Telecare 2024; 30:180-185. [PMID: 34516318 DOI: 10.1177/1357633x211039404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Heart failure is a serious burden on health care systems due to frequent hospital admissions. Early recognition of outpatients at risk for clinical deterioration could prevent hospitalization. Still, the role of signs and symptoms in monitoring heart failure patients is not clear. The heart failure coach is a web-based telemonitoring application consisting of a 9-item questionnaire assessment of heart failure signs and symptoms and developed to identify outpatients at risk for clinical deterioration. If deterioration was suspected, patients were contacted by a heart failure nurse for further evaluation. METHODS Heart failure coach questionnaires completed between 2015 and 2018 were collected from 287 patients, completing 18,176 questionnaires. Adverse events were defined as all-cause mortality, heart failure- or cardiac-related hospital admission or emergency cardiac care visits within 30 days after completion of each questionnaire. Multilevel logistic regression analyses were performed to assess the association between the heart failure coach questionnaire items and the odds of an adverse event. RESULTS No association between dyspnea and adverse events was observed (odds ratio 1.02, 95% confidence interval 0.79-1.30). Peripheral edema (odds ratio 2.21, 95% confidence interval 1.58-3.11), persistent chest pain (odds 2.06, 95% confidence interval 1.19-3.58), anxiety about heart failure (odds ratio 2.12, 95% confidence interval 1.44-3.13), and extensive struggle to perform daily activities (odds ratio 2.23, 95% confidence interval 1.38-3.62) were significantly associated with adverse outcome. DISCUSSION Regular assessment of more than the classical signs and symptoms may be helpful to identify heart failure patients at risk for clinical deterioration and should be an integrated part of heart failure telemonitoring programs.
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Affiliation(s)
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, the Netherlands
| | - Kjeld Vossen
- Department of Cardiology, Maastricht University Medical Centre, the Netherlands
| | | | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, the Netherlands
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Lee KCS, Breznen B, Ukhova A, Martin SS, Koehler F. Virtual healthcare solutions in heart failure: a literature review. Front Cardiovasc Med 2023; 10:1231000. [PMID: 37745104 PMCID: PMC10513031 DOI: 10.3389/fcvm.2023.1231000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.
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Affiliation(s)
| | - Boris Breznen
- Evidence Synthesis, Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | | | - Seth Shay Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Friedrich Koehler
- Deutsches Herzzentrum der Charité (DHZC), Centre for Cardiovascular Telemedicine, Campus Charité Mitte, Berlin, Germany
- Division of Cardiology and Angiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Stremmel C, Breitschwerdt R. Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review. JMIR Cardio 2023; 7:e44983. [PMID: 37647103 PMCID: PMC10500361 DOI: 10.2196/44983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. OBJECTIVE After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). METHODS We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. RESULTS Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. CONCLUSIONS Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.
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Kuan PX, Chan WK, Fern Ying DK, Rahman MAA, Peariasamy KM, Lai NM, Mills NL, Anand A. Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis. Lancet Digit Health 2022; 4:e676-e691. [PMID: 36028290 PMCID: PMC9398212 DOI: 10.1016/s2589-7500(22)00124-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 10/29/2022]
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Al-Saadi J, Grönholdt Klein M, Ilicki JJ, Djarv T. Comparison of Physical and Digital Treatment and Documentation of Uncomplicated Cystitis. Cureus 2021; 13:e17342. [PMID: 34567883 PMCID: PMC8450688 DOI: 10.7759/cureus.17342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Symptomatic criteria have a diagnostic specificity of approximately 90% for uncomplicated cystitis. Today there are triage bots that can collect patient history and document simultaneously. Acute uncomplicated cystitis could potentially be managed digitally, due to the symptom-based approach to diagnosis, but no studies have yet validated this approach. Aim We determined the extent of criteria documentation and evaluated adherence to antibiotic recommendations in order to compare physical and digital patient consultations for uncomplicated cystitis. Materials and methods This cross-sectional study recruited sixteen 50-year-old women who presented with urinary symptoms to digital healthcare or to three primary physical healthcare facilities. The primary endpoint was the proportion of patients who had two or more documented criteria and received correct antibiotic treatment. Results In total, 307 patient visits were included in the study (278 in the digital arm and 40 in the physical arm). The proportion of patients who had two or more documented diagnostic criteria and correct treatment was significantly higher in the digital arm (96 vs 81.6 %, p < 0.001). The total proportion of patients who had fully documented diagnostic criteria did not differ significantly between the arms, however, the proportion with two or more documented criteria was significantly higher in the digital arm (95 vs 77.5%, p < 0.001). The proportion of treated patients who had documented exclusion of diagnostic complicating factors was higher in the digital arm (85.5 vs 0%, p < 0.001). Conclusions More patients with urinary tract infection (UTI) now seek digital healthcare providers who have similar or better adherence to antibiotic treatment recommendations and documentation.
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Affiliation(s)
- Jonathan Al-Saadi
- Clinical Neuroscience, Karolinska University Hosptal, Stockholm, SWE
| | | | | | - Therese Djarv
- Emergency Medicine, Karolinska Institute, Stockholm, SWE
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Scherrenberg M, Storms V, van der Velde AE, Boyne J, Bruins W, Vranken J, Leenen JPL, Brunner-La Rocca HP, De Kluiver EP, Dendale P. A Home Hospitalisation Strategy for Patients with an Acute Episode of Heart Failure Using a Digital Health-Supported Platform: A Multicentre Feasibility Study - A Rationale and Study Design. Cardiology 2021; 146:793-800. [PMID: 34438396 DOI: 10.1159/000519085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heart failure (HF) is a common cause of hospitalisation and mortality in elderly. The frequent rehospitalisations put a serious burden on patients, health-care budgets, and health-care capacity. Frequent hospital admissions are also associated with a substantial additional hazard for serious complications and reduced quality of life. The NWE-Chance project will explore the feasibility and scalability of providing home hospitalisation supported by a newly developed digital health-supported platform and daily visits of specialised nurses. METHODS/DESIGN Hundred patients with chronic HF will be recruited over a 1-year period. The digital health-supported home hospitalisation strategy will be tested in 3 hospitals with different experience in delivering home hospitalisation: Isala Zwolle, Maastricht UMC+, both in The Netherlands, and Jessa Hospital, Hasselt in Belgium. The home hospitalisation intervention will have a maximal duration of 14 days. Feasibility will be measured with acceptability, satisfaction, and usability questionnaires for patients, nurses, and physicians. Furthermore, safety and costs will be assessed for 30 days after the start of the home hospitalisation intervention. DISCUSSION The NWE-Chance project will be one of the first studies to examine the feasibility of a digital health-supported home hospitalisation platform for HF patients. It has the potential to augment current standard HF care and quality of life of HF patients and to innovate the standard HF care to potentially lower the hospitalisation-related complications, the burden of HF on health-care systems, and to potentially implement more patient-centred care strategies.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium, .,UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium, .,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium,
| | - Valerie Storms
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Josiane Boyne
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Julie Vranken
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jobbe P L Leenen
- Isala Heart Centre, Zwolle, The Netherlands.,Connected Care Center, Isala, Zwolle, The Netherlands
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Thomas EE, Taylor ML, Banbury A, Snoswell CL, Haydon HM, Gallegos Rejas VM, Smith AC, Caffery LJ. Factors influencing the effectiveness of remote patient monitoring interventions: a realist review. BMJ Open 2021; 11:e051844. [PMID: 34433611 PMCID: PMC8388293 DOI: 10.1136/bmjopen-2021-051844] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions. DESIGN Realist review-a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015-2020 and used RPM to monitor an individual's biometric data (eg, heart rate, blood pressure) from a distance. PRIMARY AND SECONDARY OUTCOME MEASURES Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations). RESULTS Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care. CONCLUSION While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Victor M Gallegos Rejas
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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Yun YH, Lim CI, Lee ES, Kim YT, Shin KH, Kim YW, Park KJ, Jeong SY, Ryu KW, Han W, Jung KH, Park SC, Kim MS, Kim S, Shim YM, Oh JH, Lee JM, Ryoo SB, Woo J, Noh DY, Park JW, In Moon B, Kim HJ, Nam SJ, Lee DH, Zo JI, Park SM, Kang E, Rhee Y, Jung JY, Sim JA, Lee J, Shin A. Efficacy of health coaching and a web-based program on physical activity, weight, and distress management among cancer survivors: A multi-centered randomised controlled trial. Psychooncology 2020; 29:1105-1114. [PMID: 32307828 DOI: 10.1002/pon.5394] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate the efficacy of health coaching and a web-based program on survivor physical activity (PA), weight, and distress management among stomach, colon, lung and breast cancer patients. METHODS This randomised, controlled, 1-year trial conducted in five hospitals recruited cancer survivors within 2 months of completing primary cancer treatment who had not met ≥1 of these behavioural goals: (i) conducting moderate PA for at least 150 minutes/week or strenuous exercise for over 75 minutes per week or, in the case of lung cancer patients, low or moderate intensity exercise for over 12.5 MET per week, (ii) maintaining normal weight, and (iii) attaining a score >72 in the Post Traumatic Growth Inventory (PTGI). Participants were randomly assigned to one of three groups: the control group, a web-only group, or a health coaching + web group. The primary endpoint was based on a composite of PA, weight, and PTGI score at 12 months. RESULTS Patients in the health coaching + web group (difference = 6.6%, P = .010) and the web-only group (difference = 5.9%, P = .031) had greater overall improvements across the three-outcome composite than the control group. The health coaching + web group had greater overall improvement in PTGI (difference = 12.6%; P < .001) than the control group, but not in PA and weight. CONCLUSION The web-based program, with or without health coaching, may improve health behaviours including PA, weight, and distress management among cancer survivors within 2 months of completing primary cancer treatment. The web-based program with health coaching was mainly effective for reducing psychological distress.
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Affiliation(s)
- Young Ho Yun
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Il Lim
- Department of Education, Seoul National University College of Education, Seoul, South Korea
| | - Eun Sook Lee
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Young Tae Kim
- Department of Cardiovascular and Thoracic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Woo Kim
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun Won Ryu
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Hae Jung
- Department of Oncology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Chan Park
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Moon Soo Kim
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Kim
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Cardiovascular and Thoracic Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hwan Oh
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jong Mog Lee
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Joohyun Woo
- Department of Oncology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung In Moon
- Department of Oncology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seok Jin Nam
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Ho Lee
- Department of Oncology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Il Zo
- Department of Cardiovascular and Thoracic Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - EunKyo Kang
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - YeEun Rhee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ju Youn Jung
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Ah Sim
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Joonki Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
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