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Background
A fully automated computer-tailored Web-based self-management intervention, Kanker Nazorg Wijzer (KNW [Cancer Aftercare Guide]), was developed to support early cancer survivors to adequately cope with psychosocial complaints and to promote a healthy lifestyle. The KNW self-management training modules target the following topics: return t...
Context in source publication
Context 1
... section describes the details of the MRA that was based on personal scores from the baseline questionnaire and that can refer to the seven self-management modules of the KNW (see Figure 2). The classification criteria for green, orange, and red MRA are summarized in Table 1 [36][37][38][39][40][41][42][43][44][45]. A green MRA signifies that the respondent reported no complaints, or minor complaints or needs, concerning the specific topic. ...
Similar publications
Background
Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychoso...
Citations
... While some research has explored participants' module choices in multi-behavior interventions [14,15,[26][27][28][29][30][31], there is limited understanding of the underlying choice mechanisms, such as which personal characteristics are related to choice. Investigating this is crucial, as diverse subgroups may utilize interventions differently, and some may not use it as recommended, e.g., not choosing the recommended module(s). ...
... These studies have shown that certain modules are preferred over others, for example, physical activity over diet [14,15,26]. There is also consistency that health promoting-behaviors such as physical activity and diet are preferred over substance-related modules [14,15,[26][27][28][29][30][31]. Two studies among vocational students reported on choice preferences within multiple addictive behavior interventions. ...
... Providing feedback or recommending modules may enhance the alignment between participants' module choice and their prevention needs [30]. Studies show that people are more inclined to choose modules that were recommended to them, based on their demonstrated risk profile [8,17,29]. Consequently, most previous studies utilized feedback or recommendations to guide module choice [8, 14-17, 26, 29, 32], with only a few exceptions [27,28,30,33]. ...
BACKGROUND
Vocational school students exhibit a high prevalence of addictive behaviors. Digital prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tailoring intervention content to participants’ preferences, such as allowing them to choose behavior modules, may increase engagement and efficacy. However, there is limited understanding of how personal characteristics relate to module choices and their alignment with prevention needs.
OBJECTIVE
This paper examines the prevention needs of German vocational school students as well as their prevention preferences through self-determined module choice in the multi-behavior app-based addiction prevention program "ready4life".
METHODS
A two-arm cluster-randomized trial recruited German vocational students aged 16+ years. Among 376 classes from 35 schools, "ready4life" was introduced during a school lesson. Students were invited to download the "ready4life" app, and completed an anonymous screening with individualized risk and competence feedback in form of a traffic light system. Informed consent was given by 2568 students. Intervention classes received individual app-based coaching, with weekly chat contacts with a virtual coach over four months. They could choose two out of six modules: alcohol, tobacco, cannabis, social media/gaming, stress and social competencies. Module choice was self-determined. Control group classes received a link to health behavior information and could access coaching after 12 months.
RESULTS
Prevention need was high. For 86% two or more risks were reported according to a yellow or red traffic light feedback. Within the intervention group, stress (818/1236, 66.2%) and social media/gaming (625/1236, 50.6%) were the most chosen topics, followed by alcohol (360/1236, 29.1%), social competencies (306/1236, 24.8%), tobacco (232/1236, 18.8%), and cannabis (131/1236, 10.6%). Module choices closely aligned with received traffic light feedback, particularly among those with one or two risks. Multilevel regression models showed females were significantly more likely to choose the stress module (P<.001; OR 2.38, 95% CI 1.69-3.33), while males preferred social media/gaming (P<.001; OR 0.52, 95% CI 0.40-0.69), alcohol (P<.001; OR 0.50, 95% CI 0.37-0.67) and cannabis (P<.001; OR 0.37, 95% CI 0.21-0.63), when holding age, education track and prevention need for the respective behavior constant. Younger students were significantly more likely to choose the cannabis module (P<.001; OR 0.81, 95% CI 0.74-0.90). Educational track also influenced module choice, e.g., health, social affairs, teaching and education tracks had the highest likelihood of choosing the stress module. Students’ prevention needs significantly influenced choice of the corresponding module, e.g., higher alcohol consumption increased the likelihood of choosing the alcohol module (P<.001; OR 1.31, 95% CI 1.20-1.43).
CONCLUSIONS
Our study confirms vocational students' high prevention needs regarding addictive behaviors. A key finding was the high congruence between students' module choices and their demonstrated needs, with most students being interested in the stress module. Module choice also differed by age, gender, and educational track.
CLINICALTRIAL
German Clinical Trials Register (DRKS): DRKS00022328
INTERNATIONAL REGISTERED REPORT
RR2-https://doi.org/10.1024/0939-5911/a000811
... Self-management eHealth interventions (SMeHIs) for psychological adjustment have been shown to improve health-related quality of life (HRQoL) 1,2 and provide appropriate strategies to assist cancer survivors (CSs) in identifying ways to deal with associated disease problems and concerns. 1,3 ...
... All studies were published between 2016 to 2021, with the majority (n = 5) being conducted in the Netherlands. 3,15,34,36,37 The remaining three were conducted in the US, 8 Australia, 14 and Norway. 27 All eight studies were RCTs comparing the control group with usual care or waiting list. ...
... Participants' ages ranged from 52 to 69.6 years (SD = 4.8-14.1). In addition, five studies 3,8,14,15,27 included participants who had been diagnosed with other cancers, while three included participants diagnosed with prostate or breast cancer. Regarding the time frame of treatment in one study, 8 participants reported that they had completed their preliminary program of cancer treatment within the previous seven years. ...
eHealth interventions support psychological adjustment to life-threatening crises such as cancer survival and improving health-related quality of life. This review synthesizes existing knowledge on the effectiveness of self-management eHealth interventions and summarizes the best evidence on psychological adjustment for health-related quality of life among cancer survivors. Five electronic databases were searched for articles reporting self-management eHealth interventions for the psychological adjustment of cancer survivors from February 2011 to March 2022. Articles were included if they were published in English or Thai journals; peer-reviewed; evaluated self-management through technology to support psychological adjustment for quality of life; and concerned adult cancer survivors. Data were extracted from all included articles using online data imported into the Joanna Briggs Institute SUMARI program to increase the consistency of data extraction, with a quantitative summary and analysis by two reviewers.Eight articles met the inclusion criteria, integrating self-management eHealth interventions and demonstrating a statistically significant improvement of psychological adjustment for the participants’ health-related quality of life. This review identified that self-management eHealth interventions might assist with the development of mechanisms/strategies which may effectively support cancer survivors’ psychological adjustment for their health-related quality of life. However, supportive cancer care via eHealth interventions may subordinate additional behavioral change techniques and information resources to assist and develop an individual’s coping mechanisms. The information gained may help healthcare providers with the development and enhancement of practice-related clinical guidelines that assist with implementing self-management eHealth interventions for cancer survivors.
... quality of life, evidence supporting effective interventions with minimal side effects and long-term benefits is needed for cancer survivors with anxiety and depression. Evidence from RCTs has indicated that several behavioral approaches, such as mindfulness-based approaches, hypnosis, and self-management strategies, are effective in improving anxiety and depression in cancer survivors [56][57][58] . However, most studies have been conducted in breast cancer survivors; thus, these interventions need to be further tested in different groups of survivors. ...
This study aimed to investigate the effects of cognitive behavioral therapy (CBT) on anxiety and depression in cancer survivors. The PubMed, Embase, PsycINFO, and Cochrane Library databases were searched. Randomized controlled trials that evaluated the effects of CBT in cancer survivors were included. The standardized mean difference (SMD) was used as an effect size indicator. Fifteen studies were included. For the depression score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, SMD (95% confidence interval [CI]) = 0.88 (0.46, 1.29), P < 0.001; pre-treatment versus 3-month follow-up, 0.83 (0.09, 1.76), P = 0.08; pre-treatment versus 6-month follow-up, 0.92 (0.27, 1.58), P = 0.006; and pre-treatment versus 12-month follow-up, 0.21 (− 0.28, 0.70), P = 0.40. For the anxiety score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, 0.97 (0.58, 1.36), P < 0.001; pre-treatment versus 3-month follow-up, 1.45 (− 0.82, 3.72), P = 0.21; and pre-treatment versus 6-month follow-up, 1.00 (0.17, 1.83), P = 0.02). The pooled result of the fixed effects model for the comparison between pre-treatment and the 12-month follow-up was 0.10 (− 0.16, 0.35; P = 0.45). The subgroup analysis revealed that the geographical location, treatment time and treatment form were not sources of significant heterogeneity. CBT significantly improved the depression and anxiety scores of the cancer survivors; such improvement was maintained until the 6-month follow-up. These findings support recommendations for the use of CBT in survivors of cancer.
... Previously published studies have already demonstrated the effectiveness of CBT on psychosocial symptoms including depression, anxiety, and mood disturbance in cancer patients [28][29][30]. Other published studies have also indicated that virtual or Internet-based modes of delivery are effective and appealing options for psychosocial interventions, especially in terms of accessibility and convenience [31][32][33][34]. Therefore, it is important to note that the current study was not focused on evaluating intervention effectiveness, but, instead, on exploring the impact of virtual CBT-based support on psychosocial symptoms in cancer survivors. ...
Background
Depression, anxiety, and fear of recurrence (FOR) are prevalent among cancer survivors, and it is recommended that they have access to supportive services and resources to address psychosocial needs during follow-up care. This study examined the impact of a virtual cognitive behavioral therapy (CBT)-based telephone coaching program (BounceBack®) on depression, anxiety, and FOR.
Method
Through the After Cancer Treatment Transition (ACTT) clinic at the Women’s College Hospital (Toronto, Canada), eligible participants were identified, consented, and referred to the BounceBack® program. Program participation involved completion of self-selected online workbooks and support from trained telephone coaches. Measures of depression (PHQ-9), anxiety (GAD-7), and FOR (fear of cancer recurrence inventory, FCRI) were collected at pre-intervention (baseline) and post-intervention (6-month and 12-month time points). For each psychosocial measure, paired t-tests compared mean scores between study time points. Participant experiences and perceptions were collected through a survey.
Results
Measures of depression and anxiety significantly improved among participants from pre-intervention to post-intervention. Scores for PHQ-9 and GAD-7 decreased from moderate to mild levels. Measure of FOR also significantly improved, while FCRI sub-scale scores significantly improved for 5 of the 7 factors that characterize FOR (triggers, severity, psychological distress, functional impairment, insight). Participants rated the intervention a mean score of 7 (out of 10), indicating a moderate level of satisfaction and usefulness.
Conclusion
This study suggested that a virtual CBT-based telephone coaching program can be an effective approach to managing depression, anxiety, and fear of recurrence in cancer survivors.
... Overall, Nuts & Bolts was considered relevant, user-friendly, and acceptable by most participants. These findings are consistent with previous studies, which reported high levels of patient satisfaction with web-based and mobile-based psychosocial interventions [48][49][50][51][52][53][54][55], particularly those encouraging patient empowerment [56], such as Nuts & Bolts. This is significant for survivors of testicular cancer, given the barriers to engagement that this unique cohort faces over and above other populations with cancer [26][27][28][29][30][31]. ...
Background:
Distress is common immediately after diagnosis of testicular cancer. It has historically been difficult to engage people in care models to alleviate distress because of complex factors, including differential coping strategies and influences of social gender norms. Existing support specifically focuses on long-term survivors of testicular cancer, leaving an unmet need for age-appropriate and sex-sensitized support for individuals with distress shortly after diagnosis.
Objective:
We evaluated a web-based intervention, Nuts & Bolts, designed to provide support and alleviate distress after diagnosis of testicular cancer.
Methods:
Using a mixed methods design to evaluate the acceptability, feasibility, and impact of Nuts & Bolts on distress, we randomly assigned participants with recently diagnosed testicular cancer (1:1) access to Nuts & Bolts at the time of consent (early) or alternatively, 1 week later (day 8; delayed). Participants completed serial questionnaires across a 4- to 5-week period to evaluate levels of distress (measured by the National Comprehensive Cancer Network Distress Thermometer [DT]; scored 0-10), anxiety, and depression (Hospital Anxiety and Depression Score [HADS]-Anxiety and HADS-Depression; each scored 0-21). The primary end point was change in distress between consent and day 8. Secondary end points of distress, anxiety, and depression were assessed at defined intervals during follow-up. Optional, semistructured interviews occurring after completion of quantitative assessments were thematically analyzed.
Results:
Overall, 39 participants were enrolled in this study. The median time from orchidectomy to study consent was 14.8 (range 3-62) days. Moderate or high levels of distress evaluated using DT were reported in 58% (23/39) of participants at consent and reduced to 13% (5/38) after 1 week of observation. Early intervention with Nuts & Bolts did not significantly decrease the mean DT score by day 8 compared with delayed intervention (early: 4.56-2.74 vs delayed: 4.47-2.74; P=.85), who did not yet have access to the website. A higher baseline DT score was significantly predictive of reduction in DT score during this period (P<.001). Median DT, HADS-Anxiety, and HADS-Depression scores reduced between orchidectomy and 3 weeks postoperatively and then remained stable throughout the observation period. Thematic analysis of 16 semistructured interviews revealed 4 key themes, "Nuts & Bolts is a helpful tool," "Maximizing benefits of the website," "Whirlwind of diagnosis and readiness for treatment," and "Primary stressors and worries," as well as multiple subthemes.
Conclusions:
Distress is common following the diagnosis of testicular cancer; however, it decreases over time. Nuts & Bolts was considered useful, acceptable, and relevant by individuals diagnosed with testicular cancer, with strong support for the intervention rendered by thematic analyses of semistructured interviews. The best time to introduce support, such as Nuts & Bolts, is yet to be determined; however, it may be most beneficial as soon as testicular cancer is strongly suspected or diagnosed.
... This has been previously suggested in other work. For example, many studies have demonstrated the effectiveness of tailoring interventions specifically for cancer survivors for improving various health outcomes and behaviors, including cancer-related fatigue, sleep disturbance, quality of life, social and emotionally functioning, and dietary habits (Kanera et al., 2016;Kim et al., 2018;Spees et al., 2019;Willems et al., 2017). Similarly, tailoring interventions to meet the needs of rural residents and address rural health disparities has also received growing attention, with researchers suggesting that interventions developed in nonrural areas may not be effective when translated into rural settings due to a lack of appropriate tailoring for rural populations (Heckman & Carlson, 2007;Kurti et al., 2015). ...
We examined the prevalence of psychological outcomes (i.e., symptoms of depression and anxiety) by age and age-varying associations between physical activity and psychological outcomes among rural cancer survivors. Participants (N = 219; ages 22–93) completed sociodemographic, psychological, and physical activity questionnaires. Time-varying effect models estimated the prevalence of psychological outcomes and assessed associations between physical activity and psychological outcomes as a flexible function of age. Depression and anxiety symptoms decreased with age among cancer survivors aged 22–40 years and were relatively stable across age among those > 40 years. Positive associations between vigorous physical activity and psychological outcomes in those aged 22–40 years were identified. In those > 70–80 years, there were negative associations between vigorous physical activity and psychological outcomes. Results suggest there is variation across age in the associations between physical activity and psychological outcomes among rural survivors. Future research should further explore these age-varying relationships to identify important intervention targets.
... We assumed that feedback messages in the CT intervention will be of higher personal relevance for smokers than for nonsmokers, because non-smokers are usually not personally involved in the topic of smoking cessation. Past research has shown that perceived personal relevance significantly predicted higher appreciation of a CT digital health intervention (Kanera et al., 2016). ...
Computer-tailored (CT) digital health interventions have shown to be effective in obtaining behaviour change. Yet, user perceptions of these interventions are often unsatisfactory. Traditional CT interventions rely mostly on text-based feedback messages. A way of presenting feedback messages in a more engaging manner may be the use of narrated animations instead of text. The goal of this study was to assess the effect of manipulating the mode of delivery (animation vs. text) in a smoking cessation intervention on user perceptions among smokers and non-smokers. Smokers and non-smokers (N = 181) were randomized into either the animation or text condition. Participants in the animation condition assessed the intervention as more effective (ηp2 = .035), more trustworthy (ηp2 = .048), more enjoyable (ηp2 = .022), more aesthetic (ηp2 = .233), and more engaging (ηp2 = .043) compared to participants in the text condition. Participants that received animations compared to text messages also reported to actively trust the intervention more (ηp2 = .039) and graded the intervention better (ηp2 = .056). These findings suggest that animation-based interventions are superior to text-based interventions with respect to user perceptions.
... Although the population of patients with cancer is growing owing to the aging population and improved cancer care, complaints, needs, and preferences of patients with cancer can vary individually over different subjects and time [10], placing health care budgets under increasing strain. As a result, health authorities are seeking to lessen the burden by using technology to support a move toward self-care and outpatient long-term monitoring. ...
Background
Digital self-management support tools (DSMSTs)—electronic devices or monitoring systems to monitor or improve health status—have become increasingly important in cancer care.
Objective
The aim of this review is to analyze published randomized clinical trials to assess the effectiveness of DSMSTs on physical and psychosocial symptoms or other supportive care needs in adult patients with cancer.
Methods
Five databases were searched from January 2013 to January 2020. English or Dutch language randomized controlled trials comparing DSMSTs with no intervention, usual care, alternative interventions, or a combination and including patients aged ≥18 years with pathologically proven cancer in the active treatment or survivorship phases were included. The results were summarized qualitatively.
Results
A total of 19 publications describing 3 types of DSMSTs were included. Although the content, duration, and frequency of interventions varied considerably across studies, the commonly used elements included an assessment component, tailored symptom self-management support, an information section, a communication section, and a diary. Significant positive effects were observed on quality of life in 6 (out of 10) studies, on anxiety in 1 (out of 5) study and depression in 2 (out of 8) studies, on symptom distress in 5 (out of 7) studies, on physical activity in 4 (out of 6) studies, on dietary behavior in 1 (out of 4) study, and on fatigue in 2 (out of 5) studies. Moreover, significant negative effects were observed on anxiety in 1 (out of 5) study and depression in 1 (out of 8) study. Most interventions were web-based interventions; 2 studies used mobile apps, and 1 study used a game as a DSMST. The overall quality of the studies was found to be good, with 13 out of 19 studies classified as high quality.
Conclusions
This review suggests that DSMSTs have a beneficial effect on the quality of life. For effects on other patient outcomes (eg, anxiety and depression, symptom distress, physical activity, dietary behavior, and fatigue), the evidence is inconsistent and limited or no effect is suggested. Future research should focus on specific tumor types, study different types of interventions separately, and assess the effects of specific interventions at different stages of disease progression.
... respectively). Screening of frequently prescribed anxiolytics and antidepressants was investigated, revealing that for the most part, SSRIs were prescribed, but as low as 15.5% of depressed and anxious patients received the required treatment (Waraich et al., 2004;Brothers et al., 2011;Findley et al., 2012;Li et al., 2012;Baltenberger et al., 2014;Nakash et al., 2014;Jassim et al., 2015;van den Berg et al., 2015;Kanera et al., 2016;Lengacher et al., 2016;Reich et al., 2017;Ahmed, 2019). Our research employed two validated tools (GAD-7 and HADS) to assess the prevalence of anxiety among cancer patients in the inpatient setting, and both of them were reliable and showed a significant correlation (correlation coefficient: 0.812) in terms of the prevalence of anxiety (37.6% versus 35.6% in the inpatient setting). ...
Objectives
Depression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among cancer patients in the inpatient and outpatient settings.
Materials and Methods
A total of 1,011 patients (399 inpatients and 612 outpatients) formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.
Results
The prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized (37.1%) compared with patients in the outpatient setting (14.5%) (p < 0.001). Similarly, anxious symptomatology was more prevalent in the inpatient setting (p < 0.001). In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.
Conclusion
Our study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required.
... respectively). Screening of frequently prescribed anxiolytics and antidepressants was investigated, revealing that for the most part, SSRIs were prescribed, but as low as 15.5% of depressed and anxious patients received the required treatment (Waraich et al., 2004;Brothers et al., 2011;Findley et al., 2012;Li et al., 2012;Baltenberger et al., 2014;Nakash et al., 2014;Jassim et al., 2015;van den Berg et al., 2015;Kanera et al., 2016;Lengacher et al., 2016;Reich et al., 2017;Ahmed, 2019). Our research employed two validated tools (GAD-7 and HADS) to assess the prevalence of anxiety among cancer patients in the inpatient setting, and both of them were reliable and showed a significant correlation (correlation coefficient: 0.812) in terms of the prevalence of anxiety (37.6% versus 35.6% in the inpatient setting). ...
Objectives: Depression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among cancer patients in the inpatient and outpatient settings.
Materials and Methods: A total of 1,011 patients (399 inpatients and 612 outpatients) formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.
Results: The prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized (37.1%) compared with patients in the outpatient setting (14.5%) (p < 0.001). Similarly, anxious symptomatology was more prevalent in the inpatient setting (p < 0.001). In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.
Conclusion: Our study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required.
