uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Experiences of Internet-Based Stepped Care in Individuals With Cancer and Concurrent Symptoms of Anxiety and Depression: Qualitative Exploration Conducted Alongside the U-CARE AdultCan Randomized Controlled Trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.ORCID iD: 0000-0003-3845-6209
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden; Stockholm Hlth Care Serv, Stockholm, Sweden.ORCID iD: 0000-0003-4570-5891
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.ORCID iD: 0000-0002-6421-2227
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.ORCID iD: 0000-0001-6226-6849
2020 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 22, no 3, article id e16547Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Individuals with newly diagnosed cancer may experience impaired health in several aspects and often have a large need for information and support. About 30% will experience symptoms of anxiety and depression, with varying needs of knowledge and support. Despite this, many of these patients lack appropriate support. Internet-based support programs may offer a supplement to standard care services, but must be carefully explored from a user perspective.

OBJECTIVE: The purpose of this study was to explore the participants' perceptions of the relevance and benefits of an internet-based stepped care program (iCAN-DO) targeting individuals with cancer and concurrent symptoms of anxiety and depression.

METHODS: We performed a qualitative study with an inductive approach, in which we used semistructured questions to interview 15 individuals using iCAN-DO. We analyzed the interviews using content analysis.

RESULTS: The analysis found 17 subcategories regarding the stepped care intervention, resulting in 4 categories. Participants described the need for information as large and looked upon finding information almost as a survival strategy when receiving the cancer diagnosis. iCAN-DO was seen as a useful, reliable source of information and support. It was used as a complement to standard care and as a means to inform next of kin. Increased knowledge was a foundation for continued processing of participants' own feelings. The optimal time to gain access to iCAN-DO would have been when being informed of the diagnosis. The most common denominator was feeling acknowledged and supported, but with a desire for further adaptation of the system to each individual's own situation and needs.

CONCLUSIONS: Users saw the internet-based stepped care program as safe and reliable and used it as a complement to standard care. Similar interventions may gain from more personalized contents, being integrated into standard care, or using symptom tracking to adjust the contents. Offering this type of program close to diagnosis may provide benefits to users.

TRIAL REGISTRATION: ClincalTrials.gov NCT-01630681; https://clinicaltrials.gov/ct2/show/NCT01630681.

Place, publisher, year, edition, pages
2020. Vol. 22, no 3, article id e16547
Keywords [en]
internet-based interactive health communication application, internet-based intervention, internet-based stepped care, oncology nursing, patient portals, psychoeducation, self care, telemedicine
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-408798DOI: 10.2196/16547ISI: 000522157700001PubMedID: 32224483OAI: oai:DiVA.org:uu-408798DiVA, id: diva2:1423231
Funder
Swedish Cancer SocietyForte, Swedish Research Council for Health, Working Life and WelfareAvailable from: 2020-04-14 Created: 2020-04-14 Last updated: 2020-04-27Bibliographically approved
In thesis
1. Internet-based Psychosocial Support: Design, Effects and User Experience in the Cancer Setting
Open this publication in new window or tab >>Internet-based Psychosocial Support: Design, Effects and User Experience in the Cancer Setting
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and Aim Being diagnosed with cancer is often described as a major loss of control leading to severe psychological distress and symptoms of anxiety and depression can continue to affect the individual in the long term. The cancer and its treatment may influence all dimensions of health, thus the psychosocial support provided needs to be multifaceted and easy accessed. Internet-based interventions may be one way to provide such support, but evidence is limited. This thesis aimed to investigate the design, effects, and experiences of internet-based psychosocial support in cancer.

Methods and Results Study 1 encompassed a co-creation development process resulting in the interactive support provided as the first step in an internet-based stepped care intervention (iCAN-DO). The effects of iCAN-DO were investigated in a randomised controlled trial, targeting individuals newly diagnosed with cancer and concurrent self-reported symptoms of anxiety and depression (according to the Hospital Anxiety and Depression Scale). Step 1 had a psycho-educative content involving self-care strategies and was available to the intervention group during the ten-month study period. Step 2 comprised a guided internet-based cognitive behavior therapy (iCBT) program and was offered those without improvement in anxiety and depression after using Step 1. The results showed that iCAN-DO improved symptoms of depression compared with standard care, while symptoms of anxiety were largely unaffected. Most participants used Step 1, while only a few used Step 2.

In Study 2, aspects of usefulness, relevance, and usability in iCAN-DO were explored through qualitative interviews, analysed using content analysis. Results showed that standard healthcare did not meet the individuals' needs and iCAN-DO was used as complement, providing access to relevant, trustworthy information and support. Usability was affected by the perceived usefulness and ease of use of the intervention, as well as by the user´s circumstances in life and consequences of the cancer. The co-creation process in the development of Step 1 added relevance, but both steps 1 and 2 would have gained from being provided earlier, integrated into standard healthcare and more adaptable to the individual.

Conclusion The thesis concluded that the internet-based intervention had positive effects on symptoms of depression in individuals newly diagnosed with cancer. Individuals with cancer experience several unmet needs in standard healthcare and since psycho-educative support including self-care advice seems feasible in this group, efforts are needed to incorporate internet-based support in regular oncology care. Since the intervention did not target all symptoms (i.e. anxiety) further research is needed on how to enhance efficacy and how to make iCBT more feasible for this group.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 101
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1667
Keywords
Internet, eHealth, Nursing, Oncology, Cancer, Anxiety, Depression, Psychosocial Intervention, Technology-Based Interventions, Stepped Care
National Category
Medical and Health Sciences Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-408909 (URN)978-91-513-0950-7 (ISBN)
Public defence
2020-06-12, H:son Holmdahlsalen, Uppsala Akademiska Sjukhus, ing 100, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-05-20 Created: 2020-04-16 Last updated: 2020-05-20

Open Access in DiVA

fulltext(116 kB)14 downloads
File information
File name FULLTEXT01.pdfFile size 116 kBChecksum SHA-512
fefbd7edeb9ac3a870aed8a952744fb19b1a3be7045f106fc2b3ef6995e23c5dd22ffdfba0ec58cef7eecdfcba4490c780c9d5a7dbe5c580bf96934b4845c989
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Hauffman, AnnaAlfonsson, SvenIgelström, HelenaJohansson, Birgitta

Search in DiVA

By author/editor
Hauffman, AnnaAlfonsson, SvenIgelström, HelenaJohansson, Birgitta
By organisation
Experimental and Clinical OncologyClinical Psychology in HealthcareÅsenlöf: Physiotheraphy
In the same journal
Journal of Medical Internet Research
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 14 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 20 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf