title: Exposure to a patient-centered, Web-based intervention for managing cancer symptom and quality of life issues: impact on symptom distress.
abstract: BACKGROUND
  Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions. Even though usage statistics are easily logged in most eHealth interventions, usage or exposure has rarely been reported in trials, let alone studied in relationship to effectiveness.
  
  
  OBJECTIVE
  The intent of the study was to evaluate use of a fully automated, Web-based program, the Electronic Self Report Assessment-Cancer (ESRA-C), and how delivery and total use of the intervention may have affected cancer symptom distress.
  
  
  METHODS
  Patients at two cancer centers used ESRA-C to self-report symptom and quality of life (SxQOL) issues during therapy. Participants were randomized to ESRA-C assessment only (control) or the ESRA-C intervention delivered via the Internet to patients' homes or to a tablet at the clinic. The intervention enabled participants to self-monitor SxQOL and receive self-care education and customized coaching on how to report concerns to clinicians. Overall and voluntary intervention use were defined as having ≥2 exposures, and one non-prompted exposure to the intervention, respectively. Factors associated with intervention use were explored with Fisher's exact test. Propensity score matching was used to select a sample of control participants similar to intervention participants who used the intervention. Analysis of covariance (ANCOVA) was used to compare change in Symptom Distress Scale (SDS-15) scores from pre-treatment to end-of-study by groups in the matched sample.
  
  
  RESULTS
  Radiation oncology participants used the intervention, overall and voluntarily, more than medical oncology and transplant participants. Participants who were working and had more than a high school education voluntarily used the intervention more. The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group.
  
  
  CONCLUSIONS
  The intended effects of a Web-based, patient-centered intervention on cancer symptom distress were modified by intervention use frequency. Clinical and personal demographics influenced voluntary use.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00852852; http://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/6YwAfwWl7).
authors.affiliation: Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, United States. donna_berry@dfci.harvard.edu.
authors.forename: Donna L
authors.identifier: http://orcid.org/0000-0001-7935-2807
authors.initials: DL
authors.lastname: Berry
authors.forename: Traci M
authors.identifier: http://orcid.org/0000-0003-1346-988X
authors.initials: TM
authors.lastname: Blonquist
authors.forename: Rupa A
authors.identifier: http://orcid.org/0000-0001-5015-3134
authors.initials: RA
authors.lastname: Patel
authors.forename: Barbara
authors.identifier: http://orcid.org/0000-0001-6273-8674
authors.initials: B
authors.lastname: Halpenny
authors.forename: Justin
authors.identifier: http://orcid.org/0000-0001-6150-3523
authors.initials: J
authors.lastname: McReynolds
mesh_terms: D003695:Delivery of Health Care; D019468:Disease Management; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods*; D018802:Patient-Centered Care / Q000379:methods; D011788:Quality of Life / Q000523:psychology; D018787:Radiation Oncology; D012107:Research Design; D012648:Self Care; D057566:Self Report; D012647:Self-Assessment; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine / Q000379:methods; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data
keywords: Internet; cancer; eHealth; patient-centered technology; quality of life; symptoms