J. Med. Internet Res. - 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.

Tópicos

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Resumo

CKGROUND: 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.TRIAL REGISTRATION: Clinicaltrials.gov:NCT00971009; http://clinicaltrials.gov/show/NCT00971009 (Archived by WebCite at http://www.webcitation.org/6USKezP0Y).

Resumo Limpo

ckground webbas intervent shown assist wide rang patient success manag ill studi examin relat contribut differ webbas compon improv outcom efficaci trial need test effect web support offer part routin careobject aim compar regular care effect internetbas patient provid communic servic ippc webchoic webbas ill manag system breast cancer patient ippc includ usual care symptom distress anxieti depress primari outcom selfefficaci secondari outcom studi report preliminari find month followup data month trialmethod recruit patient recent diagnos breast cancer undergo treatment three norwegian hospit nurseadminist ippc allow patient send secur emessag receiv emessag health care personnel hospit treat addit ippc webchoic contain compon symptom monitor tailor inform selfmanag support diari communic patient total care provid nurs physician social worker train answer question patient outcom measur questionnair studi entri studi month linear mix model repeat measur fit compar effect outcom timeresult patient random assign webchoic group n ippc group n usual care group n respons rate questionnair month month month attrit similar studi group among access webchoic log sent emessag care provid ippc group sent emessag linear mix model analys reveal webchoic group report signific lower symptom distress mean differ ci p anxieti mean differ ci p depress mean differ ci p compar usual care group ippc group report signific lower depress score compar usual care group mean differ ci p differ observ symptom distress anxieti signific differ selfefficaci found among studi groupsconclus spite practic variat moder use intervent result suggest offer web support part regular care can power tool help patient manag ill find nurseadminist ippc alon can signific reduc depress particular promis howev multicompon intervent webchoic addit posit effectstri registr clinicaltrialsgovnct httpclinicaltrialsgovshownct archiv webcit httpwwwwebcitationorguskezpi

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