Northouse, L., Schafenacker, A., Barr, K.L., Katapodi, M., Yoon, H., Brittain, K., . . . An, L. (2014). A tailored web-based psychoeducational intervention for cancer patients and their family caregivers. Cancer Nursing, 37, 321–330

To test the effects and feasibility of a tailored web-based, nurse-delivered psychoeducational intervention on patient and caregiver outcomes

Patients and caregivers were given unique access to web-based questionnaires and completed these separately. The web-based program consisted of three sessions two weeks apart to provide education sequentially, including cancer effects on family, family strength and value of teamwork, family concerns, addressing problems, communication tips, types of support, finding meaning in illness, and looking to the future. Dyads completed sessions together and were offered choices of tailored activities to promote interaction between web sessions. Dyads also received tailored messages according to baseline score in areas such as communication, support, and self-efficacy. Follow-up email session reviews were done after each web session. The study was conducted over eight weeks. Study measures were obtained at baseline and week 8.

• N = 38 dyads  
• MEAN AGE = 54.8 years for patients, 50.6 years for partners
• MALES: 39.5% of caregivers, FEMALES: 60.5% of caregivers
• KEY DISEASE CHARACTERISTICS: Breast, colorectal, lung, and prostate cancers; 47.4% had stage I or II disease, and the rest had stage II or IV.  
• OTHER KEY SAMPLE CHARACTERISTICS: 5.3% were African American, and 2.6% were Asian—the rest were Caucasian. More than 80% had at least some college education, and  more than 60% had annual incomes of $50,000 or more.

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: United States

• Quasi-experimental

• FACT- G version 4 for quality of life
• Satisfaction with the program 
• Benefits of illness scale
• Lewis Mutuality and Interpersonal Sensitivity Scale 
• Social Support Scale 
• Lewis Cancer Self-Efficacy Scale

Dyads had decreased overall emotional distress (p < .05), anger-hostility (p < .01), and fatigue-inertia (p < .05), and improvement in overall quality of life (p < .05), physical quality of life (p < .05), functional quality of life (p < .01), and perceived benefits of illness or caregiving (p < .01). Effect sizes for caregivers were medium for self-efficacy (d = .40) and social support (d = .33), although changes from baseline were not statistically significant. Small effect sizes were seen for emotional and fatigue outcomes. Significant change over time was seen for total emotional distress, anger-hostility, fatigue inertia, and total quality of life for dyads together. Patients improved in the areas of physical quality of life, and caregivers improved in the area of self-efficacy. The web-based program had an 86% retention rate.

Findings show that this type of web-based program is feasible and may benefit patients and caregivers.

• Small sample (less than 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias(sample characteristics)
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: The sample was generally well educated and had a higher-level income, so findings may not be generalizable to other groups. The intervention would only apply to those with internet access and some level of comfort with computer use. What phase of care all patients were in, or if any were receiving treatment, is not clear. If participants had any other supportive services involved in their care is not clear.

Findings suggest that provision of a tailored, web-based psychoeducational and messaging intervention is feasible and may improve some patient and caregiver outcomes. A web-based approach for this type of intervention can provide a practical alternative for patients with ability to use the internet. Additional well-designed studies in more diverse patient groups will be helpful to further demonstrate efficacy and usability.