Steel, J.L., Geller, D.A., Kim, K.H., Butterfield, L.H., Spring, M., Grady, J., . . . Tsung, A. (2016). Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting. Cancer, 122, 1270–1282. 

To examine the effects of a collaborative care intervention for reducing depression, pain, and fatigue in patients and stress and depression in caregivers

Patients and their caregivers were randomized to receive a web-based stepped intervention or enhanced usual care. The web-based intervention included access to a psychoeducational web site and a care coordinator who contacted participants by telephone every two weeks and in-person during clinic or hospital visits about every two months. The care coordinator communicated with the medical team or primary care physician for recommended interventions. In addition to the psychoeducation, the website provided an area where patients could record and monitor their own symptoms, a library of relaxation and educational videos, a participant chat room, and a general resource library. Care coordinators were trained in cognitive behavioral therapy and used an intervention manual. Weekly supervision of care coordinator adherence to the study protocol was provided. In the enhanced usual care group, if a patient had high depression or pain scores, he or she was contacted by a care coordinator and was provided with education and referrals for symptom management interventions as needed.

• N = 188   
• MEAN AGE = 61 years (SD = 11)
• MALES: 73%, FEMALES: 27%
• KEY DISEASE CHARACTERISTICS: Hepatic cancer or cancers with liver metastases

• SITE: Single site   
• SETTING TYPE: Home    
• LOCATION: Pittsburgh

PHASE OF CARE: Late effects and survivorship

Randomized, controlled trial

• Caregivers: Center for Epidemiological Studies Depression Scale (CES-D), Caregiver Quality of Life Index-Cancer (CQLI-C) scale
• Patients: CES-D, Brief Pain Inventory (BPI), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), FACT-General (FACT-G), FACT-Hepatobiliary (FACT-Hep)

There were 84 page views by caregivers. Most frequently viewed areas were living with cancer, diagnosis and treatment, and managing symptoms. For patients, no differences existed between groups in fatigue or pain. An effect size of 0.748 for caregiver stress was seen at the six-month follow-up. An effect size of 0.372 was seen for caregiver depression.

The web-based psychoeducational intervention did not show significant benefit for patient symptoms compared to enhanced usual care. This intervention aimed at patients but may have had some benefit for caregivers of those patients with significant symptoms.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Unintended interventions or applicable interventions not described that would influence results
• The number of caregivers involved in the analysis of impact on stress, etc., was not stated, and no statistical analysis of differences between caregiver groups was provided.  
• The enhanced usual care group had many of the same features as the experimental group—the main difference was the website use.  
• There may not have been enough difference between interventions to show significant effects.

This study looked at the effects of a web-based system for psychoeducation and support of patients on patient symptoms and associated caregiver stress and depression scores. No significant difference in patient symptoms compared to the usual care study group was seen. This intervention, aimed at management of patient symptoms, may have had some positive benefit for caregivers.