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Tuckey N, Agteren JV, Chur-Hansen A, Ali K, Fassnacht DB, Beatty L, Bareham M, Wardill H, Iasiello M. Implementing a group-based online mental well-being program for women living with and beyond breast cancer - A mixed methods study. Asia Pac J Clin Oncol 2024. [PMID: 38558488 DOI: 10.1111/ajco.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE There is a gap in available mental well-being services in Australia for women diagnosed with breast cancer. This pilot mixed-methods uncontrolled study aimed to assess the feasibility of an online mental health and well-being intervention, the Be Well Plan (BWP), which enables participants to create a personalized, flexible well-being strategy. METHODS Women diagnosed with stages I-IV breast cancer were recruited into 4 asynchronous groups to participate in the BWP, a 5-week facilitator-led group-based mental health and well-being program. Psychological measures used at baseline and post-intervention included: the Warwick Edinburgh Mental Well-Being Scale, Brief Resilience Scale, Self-compassion Scale, 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder scale, and EORC QLQ-C30. Multivariate analysis of variance and effect sizes were calculated on pre- and post-psychological measures, followed by qualitative content analysis on post-completion interviews with participants. RESULTS Nineteen women (mean age 45.7, standard deviation = 7.74) were included in the study. Large effect sizes were reported for mental well-being, depressive symptoms, and anxiety (partial ω2 = 0.28, 0.21, and 0.20, respectively). Self-compassion, resilience, and quality of life results were not statistically significant. Qualitative content analysis provided insight into experiences with Program Delivery Experience, Application of the BWP, Mental Health Improvements, Supporter Involvement, Adopted Interventions, and Recruitment. Participants reported benefits in mindfulness, grounding techniques, and physical activities. CONCLUSION The BWP has the potential to be an effective intervention to support the mental health and well-being of breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS This study highlights flexible interventions that accommodate the diverse needs of breast cancer survivors to improve mental well-being and alleviate psychological distress.
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Affiliation(s)
- Natalie Tuckey
- Mental Health and Well-being Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Joep van Agteren
- Mental Health and Well-being Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathina Ali
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Daniel B Fassnacht
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Lisa Beatty
- Flinders University Institute of Mental Health & Well-being, College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Monique Bareham
- Patient Advocate and Cancer Survivor - SA 2022 Local Hero, Adelaide, Australia
| | - Hannah Wardill
- Supportive Oncology Research Group, Precision Medicine Theme (Cancer Program), The South Australian Health and Medical Research Institute, Adelaide, Australia
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Matthew Iasiello
- Mental Health and Well-being Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Hughes L, Taylor RM, Beckett AE, Lindner OC, Martin A, McCulloch J, Morgan S, Soanes L, Uddin R, Stark DP. The Emotional Impact of a Cancer Diagnosis: A Qualitative Study of Adolescent and Young Adult Experience. Cancers (Basel) 2024; 16:1332. [PMID: 38611010 PMCID: PMC11010824 DOI: 10.3390/cancers16071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The biographical disruption that occurs in adolescents and young adults following a cancer diagnosis can affect various important psychosocial domains including relationships with family and friends, sexual development, vocational and educational trajectories, and physical and emotional wellbeing. While there is evidence of the physical impact of cancer during this period, less is known about the impact on emotional wellbeing and especially on the barriers for young people accessing help and support. We aimed to obtain a more in-depth understanding of young people's experiences of their diagnosis, treatment, psychological impact, and range of resources they could or wanted to access for their mental health. We conducted an in-depth qualitative study using semi-structured interviews with 43 young people who had developed cancer aged 16 to 39 years and were either within 6 months of diagnosis or 3-5 years after treatment had ended. Framework analysis identified three themes: the emotional impact of cancer (expressed through anxiety, anger, and fear of recurrence); personal barriers to support through avoidance; and support to improve mental health through mental health services or adolescent and young adult treatment teams. We showed the barriers young people have to access care, particularly participant avoidance of support. Interrupting this process to better support young people and provide them with flexible, adaptable, consistent, long-term psychological support has the potential to improve their quality of life and wellbeing.
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Affiliation(s)
- Luke Hughes
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Rachel M. Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
- Department of Targeted Intervention, University College London, London WC1E 6BT, UK
| | - Angharad E. Beckett
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, UK; (A.E.B.); (J.M.)
| | - Oana C. Lindner
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK;
| | - Joanne McCulloch
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, UK; (A.E.B.); (J.M.)
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Leeds Teaching Hospitals NHS Foundation Trust, Leeds LS9 7TF, UK;
| | | | - Rizwana Uddin
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
| | - Dan P. Stark
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
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Yen KY, Cheng JY, Li JQ, Toh ZA, He HG. The effectiveness of digital psychosocial interventions on psychological distress, depression, anxiety, and health-related quality of life in patients with gynaecological cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:240. [PMID: 38512538 DOI: 10.1007/s00520-024-08415-4] [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] [Received: 08/28/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Patients with gynaecological cancer often experience psychological issues due to multiple stressors. Psychological disturbances have debilitating effects on patients with gynaecological cancer. In recent decades, digital psychosocial interventions have rapidly advanced and been incorporated into mental health interventions. Digital psychosocial interventions could provide patients with several benefits over traditional in-person interventions, including convenience, anonymity, flexible scheduling, and geographic mobility. The aim of this systematic review was to synthesize the effectiveness of digital psychosocial intervention in reducing psychological distress, depression, and anxiety and improving health-related quality of life in patients with gynaecological cancer. METHODS Three-step extensive search was performed on 22 December 2022 from nine bibliographic databases, trial registries and grey literature. Experimental studies involving patients with gynaecological cancer utilizing digital psychosocial interventions for the improvement of mental health outcomes were included. Meta-analysis was conducted using RevMan 5.4 software. Heterogeneity was analysed by Cochran's Q test and I2. Subgroup analyses were attempted to evaluate relative effect sizes of subgroup features. RESULTS Meta-analysis of nine studies revealed small effect size in reduction of depression post-intervention (d = 0.24, 95% CI - 0.46 to - 0.02) and medium effect size in reduction of psychological distress post-intervention (d = 0.51, 95% CI - 0.81 to - 0.21) and follow-up (d = 0.65, 95% CI - 1.25 to - 0.05) compared to the control group. The effects of digital psychosocial interventions on anxiety and health-related quality of life were not statistically significant. CONCLUSIONS Digital psychosocial interventions probably reduced psychological distress and slightly reduced depression amongst patients with gynaecological cancer compared to the control group, which can be integrated into clinical practice. Additional trials with rigorous methodology and bigger sample sizes are needed to validate findings. TRIAL REGISTRATION PROSPERO (CRD42023389502).
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Affiliation(s)
- Kai Yoong Yen
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Jing Ying Cheng
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Jin-Qiu Li
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- Department of Nursing, Zhuhai Campus, Zunyi Medical University, Zhuhai, Guangdong, China
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- Division of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore.
- National University Health System, Singapore, Singapore.
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Walsh EA, Safren SA, Penedo FJ, Antoni MH. If we build it, will they come? A scoping review of objective engagement metrics in asynchronous psychosocial telehealth interventions for breast cancer survivors. Clin Psychol Rev 2024; 107:102374. [PMID: 38171138 DOI: 10.1016/j.cpr.2023.102374] [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] [Received: 02/14/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
Burgeoning technologies and the COVID-19 pandemic resulted in a boom of telehealth for immunocompromised patients, such as those with cancer. Telehealth modalities overcome barriers and promote accessibility to care. Currently, efficacious psychosocial interventions exist to address negative aftereffects of a cancer diagnosis and treatment. Many of these interventions often incorporate asynchronous telehealth (e.g., web-based, smartphone mobile app) features. However, asynchronous platforms are limited by suboptimal engagement. Subjective indicators of perceived engagement in the forms of acceptability, feasibility, and adherence are often captured, yet prior research has found discrepancies between perceived and actual engagement. The FITT (frequency, intensity, time/duration, type of engagement) model, originally developed for use to quantify engagement within exercise trials, provides a framework to assess objective engagement of psychosocial interventions for breast cancer. Using 14 keywords and searching six databases through 11/2023, 56 studies that used asynchronous telehealth interventions in breast cancer were identified. All FITT domains were reported at least once across studies with intensity metrics most commonly reported. Nine metrics were described across FITT domains. Human-centered design principles to guide telehealth development and privacy considerations are discussed. Findings offer suggestions for how to represent and optimize objective engagement in asynchronous telehealth cancer care.
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Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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Akdemir A, Smith AB, Wu VS, Rincones O, Russell H, Lyhne JD, Kemp E, David M, Bamgboje-Ayodele A. Guided versus non-guided digital psychological interventions for cancer patients: A systematic review and meta-analysis of engagement and efficacy. Psychooncology 2024; 33:e6290. [PMID: 38282223 DOI: 10.1002/pon.6290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To evaluate engagement with and efficacy of guided versus non-guided digital interventions targeting psychological symptoms of cancer via a systematic review of current evidence. METHODS PubMed, Scopus, PsychINFO, MEDLINE, and CINAHL databases were searched. Eligible publications were randomised controlled trials of guided or non-guided digital psychological interventions used in cancer settings reporting intervention efficacy and/or engagement. Study methodological quality was assessed using the Cochrane risk of bias (RoB) tool. Random effects meta-analyses were performed on outcomes with sufficient data, with sub-group analyses of intervention type and follow-up period. RESULTS Forty-three studies were included. Studies varied by level of guidance, type of technology used, duration, and outcomes assessed. Most studies had a high overall RoB. Meta-analysis indicated that guided interventions significantly reduced distress, anxiety, and fatigue, while non-guided did not. For depression and quality of life, both guided and non-guided interventions produced significant improvements. Guided interventions reported higher levels of intervention engagement than non-guided. CONCLUSIONS Guided digital psychological interventions were likely to be more effective than non-guided ones for cancer patients, particularly in reducing distress, anxiety, and fatigue. Whilst both types were found to improve depression and life quality, guided interventions were associated with higher patient engagement. These findings suggest digital interventions could supplement traditional cancer care, warranting further research concerning long-term effects and cost-efficiency.
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Affiliation(s)
- Aleyna Akdemir
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Verena Shuwen Wu
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
| | - Hayley Russell
- Ovarian Cancer Australia, Melbourne, Victoria, Australia
| | - Johanne Dam Lyhne
- Department of Clinical Oncology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Emma Kemp
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Adeola Bamgboje-Ayodele
- Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, New South Wales, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Fridriksdottir N, Ingadottir B, Skuladottir K, Zoëga S, Gunnarsdottir S. Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study. JMIR Form Res 2023; 7:e50550. [PMID: 38015268 PMCID: PMC10770793 DOI: 10.2196/50550] [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: 07/04/2023] [Revised: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. OBJECTIVE This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. METHODS This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. RESULTS The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=-.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=-.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. CONCLUSIONS This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.
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Affiliation(s)
- Nanna Fridriksdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Kristin Skuladottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigridur Zoëga
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Sigridur Gunnarsdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- Cancer Registry, The Icelandic Cancer Society, Reykjavik, Iceland
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Atashi V, Hashemi M, Haghighat S, Sadegh R, Sami R, Bahadori M. Mobile Phone App-Based or Face-to-Face Pulmonary Rehabilitation in COVID-19 Survivors. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:699-706. [PMID: 38205421 PMCID: PMC10775877 DOI: 10.4103/ijnmr.ijnmr_337_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/17/2023] [Accepted: 07/25/2023] [Indexed: 01/12/2024]
Abstract
Background Pulmonary Rehabilitation (PR) is recommended as a standard, effective, and important treatment for COVID-19 survivors who remain symptomatic after the acute phase. Therefore, we aimed to compare the effect of mobile phone-based PR application with face-to-face PR on the quality of life, anxiety, depression, and daily life activities of COVID-19 survivors. Materials and Methods A quasi-experimental was conducted on 65 COVID-19 survivors during 2022. Convenient sampling was done based on the inclusion criteria. The intervention group (n = 31) received PR through a mobile phone application, and the control group (n = 34) received face-to-face PR. Data were collected before and after the intervention in both groups using a demographic information questionnaire, SF-12, the hospital anxiety and depression scale, and Barthel scale. For all tests, a maximum error of 5% was considered. Results The two studied groups had no statistically significant difference with respect to all the investigated variables at baseline (p > 0.05). After the intervention, the mean anxiety and depression score of the patients in the control group was significantly lower than the intervention group (t = -3.46, f = 63, p = 0.01). After our intervention, there was no statistically significant difference in the mean quality of life and daily life activity scores between the two groups (t = -0.68, f = 63, p > 0.05). Conclusions The application of PR does not show a statistically significant difference in terms of improving the quality of life and daily activities compared with the face-to-face method; we suggest that the PR application be used as a cost-effective method when face-to-face PR is not possible.
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Affiliation(s)
- Vajihe Atashi
- Nursing and Midwifery Care Research Center, Adult Health Nursing Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Hashemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shila Haghighat
- Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Sadegh
- Department of Community and Prevention Medicine, Medical Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mobina Bahadori
- Adult Health Nursing Department, School of Nursing and Midwifery, Qom University of Medical Science, Qom, Iran
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Abdulai M, Owiredu D, Boadu I, Tabong PTN, Sarfo B, Bonful HA, Addo- Lartey A, Akuffo KO, Danso-Appiah A. Psychosocial interventions and their effectiveness on quality of life among elderly persons living with HIV in Africa South of the Sahara: Systematic review and meta -analysis protocol. PLoS One 2023; 18:e0291781. [PMID: 37729324 PMCID: PMC10511069 DOI: 10.1371/journal.pone.0291781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The number of elderly people living with HIV (EPLHIV) has increased significantly as a result of antiretroviral treatment (ART) and this has brought about a variety of psychosocial challenges that have an impact on their quality of life (QoL). Various psychosocial interventions have been tried or implemented in Sub-Saharan Africa (SSA) to improve QoL of EPLHIV. However, there is paucity of data on the types and effectiveness of these interventions. This systematic review, therefore, aims to explore available psychosocial interventions in SSA and their effectiveness in improving the QoL of EPLHIV. METHODS We will search PubMed, PsycINFO, LILACS, Cochrane Library, Google Scholar, HINARI, Africa Journals Online, Scopus and Web of Science to retrieve publications on psychosocial interventions implemented to improve QoL of EPLHIV from inception of the identified databases to 31st December 2023 without language restrictions. Also, supplementary sources such as conference proceedings, preprint repositories, databases of dissertations, as well as WHO and governmental databases can be explored for additional studies. For unpublished studies, trial registries and experts would be contacted, and reference lists of retrieved papers will be manually searched. Retrieved studies will be deduplicated using Mendeley and exported to Rayyan. At least two reviewers will independently select studies, extract data and assess the quality of the included studies using validated tools. Dichotomous outcomes data will be assessed and reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference (MD) will be used; all reported with their 95% confidence interval (CI). Heterogeneity will be explored graphically by inspecting the overlapping of CIs and assessed quantitatively using the I2 statistic. EXPECTED OUTCOMES This systematic review will be the first to rigorously identify psychosocial intervention on QoL of EPLHIV in SSA and assess their effectiveness with the aim to provide regional and country- specific data that will inform the selection and implementation of appropriate and socially acceptable policies across countries in SSA. Key findings of the review are expected to contribute critical evidence on availability, types and effectiveness of psychosocial interventions for improving quality of life of vulnerable elderly persons in SSA living with HIV. Furthermore, the review will explore any variation and possible correlates of psychosocial interventions by age, sex, CD4 count (if available), setting and geographic location within SSA that will provide healthcare professionals with reliable evidence, with the ultimate goal of inspiring countries in SSA to adopt innovative interventions to improve HIV care. TRIAL REGISTRATION Systematic review registration: The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42021278218.
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Affiliation(s)
- Marijanatu Abdulai
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- National AIDS/STI Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Isaac Boadu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Science, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Adolphina Addo- Lartey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Walsh EA, Popok PJ, Ream M, Bainter S, Perdomo D, Taub C, Saez-Clarke E, Kesmodel S, Blomberg BB, Antoni MH. Predictors of initial engagement with an asynchronous cognitive behavioral stress management website among older women with nonmetastatic breast cancer. Support Care Cancer 2023; 31:466. [PMID: 37452882 PMCID: PMC11051687 DOI: 10.1007/s00520-023-07939-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Digital interventions, like websites, offer greater access to psychosocial treatments; however, engagement is often suboptimal. Initial use may be a target to "hook" participants. Few studies examine engagement with cognitive behavioral stress management (CBSM). We tested predictors of engagement in the first week of using a CBSM website among women with breast cancer (BC). METHODS Older women (≥ 50 years) with nonmetastatic BC enrolled in an on-going trial (8/2016-4/2022, #NCT03955991) and were randomized to receive 10 synchronous, virtual CBSM group sessions immediately (n = 41) or after a 6-month waitlist (n = 34). All received simultaneous access to an asynchronous website, where supplemental videos and resources were released weekly. Engagement was tracked via breadth (features used) and depth (clicks within content). Multilevel modeling tested predictors of engagement (i.e., time, condition, age, daily stress, depression, race, ethnicity, disease stage). RESULTS Breadth decreased over the first week of CBSM (b = -0.93, p < .01), and women with more advanced stage disease engaged with more breadth (b = 0.52, p < .01) and depth (b = 14.06, p < .01) than women with earlier stage disease. Non-Hispanic (b = -0.59, p = .03) and White (b = -0.97, p < .01) women engaged with more features. Cancer stage and intervention timing interacted. Women with more advanced cancer stage who received CBSM later engaged with the most depth (b = -11.73, p = .04). All other characteristics did not predict engagement. CONCLUSIONS Disease stage, race, ethnicity, and intervention timing predicted engagement with a CBSM website in older BC patients. IMPLICATIONS FOR CANCER SURVIVORS Delivering CBSM later in cancer treatment may mitigate competing demands. Fostering greater engagement in racial/ethnic minorities is needed.
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Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA.
| | - Paula J Popok
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA
| | - Molly Ream
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA
| | - Sierra Bainter
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA
| | - Dolores Perdomo
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Chloe Taub
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Estefany Saez-Clarke
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Susan Kesmodel
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bonnie B Blomberg
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Department of Microbiology/Immunology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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10
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Igelström H, Carlsson M, Hauffman A, von Essen L, Grönqvist H, Johansson B, Olsson EM. Long-term effects on depression and anxiety of an internet-based stepped care intervention for patients with cancer and symptoms of depression and anxiety. The U-CARE AdultCan trial. Internet Interv 2023; 32:100625. [PMID: 37273929 PMCID: PMC10235429 DOI: 10.1016/j.invent.2023.100625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023] Open
Abstract
Background Cancer is a serious disease that commonly causes significant psychological distress. The internet-based intervention (iCAN-DO), utilizing a stepped care approach for the treatment of anxiety and depression in individuals with cancer, has been shown to have favorable results for symptoms of depression at the primary endpoint, 10 months after randomization compared to standard care (SC). The aim of the present study was to evaluate the long-term effects of the intervention 18 and 24 months after randomization. Methods Patients with breast, colorectal, or prostate cancer and a score > 7 on either of the Hospital Anxiety and Depression Scale (HADS) subscales (n = 245) were recruited to the study in conjunction with a regular hospital visit. They were randomized to access to the stepwise iCAN-DO intervention for 24 months or to SC. Step 1 of the intervention comprised psycho-educative online material. In Step 2, internet-based cognitive-behavioral therapy with individual online support from a therapist was added. Step 2 was offered to those who reported persistent anxiety or depression symptoms (>7 on HADS), also at 1, 4, and/or 7 months after randomization. Missing data were imputed using the last rank carried forward method and used for the main analyses according to the intention-to-treat approach. Effects sizes (Cohen's d), and minimally clinically important difference (MCID) were calculated. Linear mixed models were used to analyze intervention effects over time. Results Symptoms of depression decreased significantly (p < 0.05) in the iCAN-DO group compared with the SC group from baseline to 18 months (d = 0.29), but not to 24 months (d = 0.27). Even though the average iCAN-DO group participant surpassed a MCID in symptoms of anxiety (>2 p) at both long-term follow-ups, the differences did not reach statistical significance, either at 18 months (p = 0.10) or 24 months (p = 0.09). Positive effects of iCAN-DO compared with the SC were also shown for some secondary HRQoL-outcomes; social functioning at 18 months (p = 0.02) and 24 months (p = 0.001), and sleep problems at 24 months (p = 0.01). Conclusion A stepped-care internet-based intervention that has previously shown positive results for symptoms of depression at 10 months did show similar positive long-term effects also at 18 months. For symptoms of anxiety, no effect could be shown. The internet may provide an effective format for interventions to reduce symptoms of depression after cancer at patients' own choice of time, regardless of distance to a psycho-oncology clinic.
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Affiliation(s)
- Helena Igelström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden
| | - Maria Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
| | - Anna Hauffman
- Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Entrance 78, 1st floor, 751 85 Uppsala, Sweden
| | - Louise von Essen
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden
| | - Helena Grönqvist
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Rudbecklaboratoriet, 75185 Uppsala, Sweden
| | - Erik M.G. Olsson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden
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11
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Eysenbach G, García-Muñoz C, Ortiz-Álvarez J, Saigí-Rubió F, Conejo-Mir J, Pereyra-Rodriguez JJ. Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression. J Med Internet Res 2022; 24:e42397. [PMID: 36485027 PMCID: PMC9789500 DOI: 10.2196/42397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Digital strategies are innovative approaches to the prevention of skin cancer, but the attrition following this kind of intervention needs to be analyzed. OBJECTIVE The aim of this paper is to assess the dropouts from studies focused on digital strategies for the prevention of skin cancer. METHODS We conducted this systematic review with meta-analyses and metaregression according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statements. Search terms for skin cancer, digital strategies, and prevention were combined to search PubMed, Scopus, Web of Science, CINAHL, and Cochrane Library from inception until July 2022. Randomized clinical trials that reported dropouts of participants and compared digital strategies with other interventions to prevent skin cancer in healthy or disease-free participants were included. Two independent reviewers extracted data for analysis. The Revised Cochrane Collaboration Bias tool was employed. We calculated the pooled dropout rate of participants through a meta-analysis of proportions and examined whether dropout was more or less frequent in digital interventions against comparators via an odds ratio (OR) meta-analysis. Data were pooled using a random-effects model. Subgroup meta-analyses were conducted in a meta-analysis of proportions and OR meta-analysis to assess the dropout events when data were sorted by digital interventions or control comparator. A univariate metaregression based on a random-effects model assessed possible moderators of dropout. Participants' dropout rates as pooled proportions were calculated for all groups combined, and the digital and comparator groups separately. OR>1 indicated higher dropouts for digital-based interventions. Metaregressions were performed for age, sex, length of intervention, and sample size. RESULTS A total of 17 studies were included. The overall pooled dropout rate was 9.5% (95% CI 5.0-17.5). The subgroup meta-analysis of proportions revealed a dropout rate of 11.6% for digital strategies (95% CI 6.8-19.0) and 10.0% for comparators (95% CI 5.5-17.7). A trend of higher dropout rates for digital strategies was observed in the overall (OR 1.16, 95% CI 0.98-1.36) and subgroup OR meta-analysis, but no significant differences were found between the groups. None of the covariates moderated the effect size in the univariate metaregression. CONCLUSIONS Digital strategies had a higher dropout rate compared to other prevention interventions, but the difference was not significant. Standardization is needed regarding reporting the number of and reasons for dropouts. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329669; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329669.
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Affiliation(s)
| | | | - Juan Ortiz-Álvarez
- Department of Dermatology, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Julián Conejo-Mir
- Department of Dermatology, Virgen del Rocío University Hospital, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - Jose-Juan Pereyra-Rodriguez
- Department of Dermatology, Virgen del Rocío University Hospital, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
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