title: Comparing effects in regular practice of e-communication and Web-based self-management support among breast cancer patients: preliminary results from a randomized controlled trial.
abstract: BACKGROUND
  While Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness, few studies have examined the relative contribution of different Web-based components to improve outcomes. Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care.
  
  
  OBJECTIVE
  Our aim was to compare in regular care the effects of (1) an Internet-based patient provider communication service (IPPC), (2) WebChoice, a Web-based illness management system for breast cancer patients (IPPC included), and (3) usual care on symptom distress, anxiety, depression, (primary outcomes), and self-efficacy (secondary outcome). This study reports preliminary findings from 6 months' follow-up data in a 12-month trial.
  
  
  METHODS
  We recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals. The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated. In addition to the IPPC, WebChoice contains components for symptom monitoring, tailored information and self-management support, a diary, and communication with other patients. A total of 20 care providers (11 nurses, 6 physicians, and 3 social workers) were trained to answer questions from patients. Outcomes were measured with questionnaires at study entry and at study months 2, 4, and 6. Linear mixed models for repeated measures were fitted to compare effects on outcomes over time.
  
  
  RESULTS
  Patients were randomly assigned to the WebChoice group (n=64), the IPPC group (n=45), or the usual care group (n=58). Response rates to questionnaires were 73.7% (123/167) at 2 months, 65.9 (110/167) at 4 months, and 62.3% (104/167) at 6 months. Attrition was similar in all study groups. Among those with access to WebChoice, 64% (41/64) logged on more than once and 39% (25/64) sent e-messages to care providers. In the IPPC group, 40% (18/45) sent e-messages. Linear mixed models analyses revealed that the WebChoice group reported significantly lower symptom distress (mean difference 0.16, 95% CI 0.06-0.25, P=.001), anxiety (mean difference 0.79, 95% CI 0.09-1.49, P=.03), and depression (mean difference 0.79, 95% CI 0.09-1.49, P=.03) compared with the usual care group. The IPPC group reported significant lower depression scores compared with the usual care group (mean difference 0.69, 95% CI 0.05-1.32, P=.03), but no differences were observed for symptom distress or anxiety. No significant differences in self-efficacy were found among the study groups.
  
  
  CONCLUSIONS
  In spite of practice variations and moderate use of the interventions, our results suggest that offering Web support as part of regular care can be a powerful tool to help patients manage their illness. Our finding that a nurse-administered IPPC alone can significantly reduce depression is particularly promising. However, the multicomponent intervention WebChoice had additional positive effects.
  
  
  BACKGROUND
  Clinicaltrials.gov:NCT00971009; http://clinicaltrials.gov/show/NCT00971009 (Archived by WebCite at http://www.webcitation.org/6USKezP0Y).
authors.affiliation: Centre for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Elin
authors.identifier: http://orcid.org/0000-0003-3897-7055
authors.initials: E
authors.lastname: Børøsund
authors.forename: Milada
authors.identifier: http://orcid.org/0000-0001-8947-8649
authors.initials: M
authors.lastname: Cvancarova
authors.forename: Shirley M
authors.identifier: http://orcid.org/0000-0003-2712-6896
authors.initials: SM
authors.lastname: Moore
authors.forename: Mirjam
authors.identifier: http://orcid.org/0000-0002-4108-391X
authors.initials: M
authors.lastname: Ekstedt
authors.forename: Cornelia M
authors.identifier: http://orcid.org/0000-0001-6521-4884
authors.initials: CM
authors.lastname: Ruland
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D003142:Communication; D019468:Disease Management; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
keywords: Internet; Web-based intervention; cancer; eHealth; electronic mail; patient-centered care; professional-patient relations; randomized controlled trial; symptom management