Australian researchers are at the forefront of developing high-quality, e-interventions for a range of psychological conditions, including several in psycho-oncology.
The e-Psychology session provided a forum for discussion of four different approaches to the use of technology; three were evaluations of e-interventions addressing either cancer related distress, depression and anxiety, or sexual concerns. The fourth is the very ambitious and forward-thinking PROMPT-Care system, an ehealth decision-support system that uses real-time collection of patient reported outcomes in self-management and clinical care.
The Rekindle study, run in partnership between University of Sydney and Cancer Council NSW, is an online biopsychoeducational intervention aimed at reducing the intimacy and sexual concerns of cancer survivors and/or their partners. The study, funded by ARC, has completed recruitment and is now awaiting the maturation of the phase II feasibility results. With 105 subjects recruited in the last year, there is a need for support in the area of sexual health post-cancer.
iCanADAPT is an internet-based cognitive behavioural therapy program aimed at early cancer patients experiencing depression and/or anxiety. It is a novel randomized controlled trial assessing the efficacy of this approach in a cancer population. The program forms part of the larger program of work, ADAPT, undertaken by the Psycho-Oncology Cooperative Research Group to implement a clinical pathway to support routine distress screening in cancer care. iCanADAPT is showing promise and we eagerly await the full results of this trial.
Finding My Way is a web-based psychosocial intervention or cancer related distress, run by Dr Lisa Beatty from Flinders Centre for Innovation in Cancer. The results of this study showed reduction in distress across both the intervention and control group. There are some interesting data regarding dose and usage patterns that will inform future directions of this intervention development. But a key take away message was the importance of ensuring your control group was a true attention control rather than a lower dose of the intervention.
Within the PROMPT-Care system, the team have negotiated the complexities of collecting data direct from patients, implementing a flagging process for symptoms of concern, and feedback either direct to patients and to clinical staff supporting their care. This is a mammoth achievement, integrating responses with the MOSAIC electronic medical record system. The next step is the ability to feed information into other electronic medical record systems.
Despite our ongoing concerns about accessibility and computer literacy of the cancer population, these four independent projects demonstrate high penetration of computers and internet access into the Australian population, with estimates of 83-86% of homes having internet access.
Making e-interventions available may overcome some concerns about accessibility of psychosocial services, in particular for sensitive topics like sexual concerns. Developing e-interventions is expensive and time-consuming and all speakers agreed that a major challenge is how we integrate the content.
It is likely modular development is the future, enabling individuals to tailor interventions to their needs and ensure the sustainability of the programs. With a number of the groups working with international partners, these technologies are likely to develop globally and be supported in multiple languages, a benefit for our increasingly global population.
[hr] Dr Haryana Dhillon is a Senior Research Fellow, School of Psychology, University of Sydney. She co-leads the Survivorship Research Group within the Centre for Medical Psychology and Evidence-based decision-making. Haryana sits on the COSA Council and Board, and is Chair of the COSA Survivorship group.