A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol

Abstract

BackgroundInternet-delivered interventions can provide remarkable opportunities in addressing breast cancer survivors' unmet support care needs, as they present an effective strategy to improve care coordination and provide access to efficacious, cost-efficient and convenient survivorship care. Nevertheless, research focusing on improving survivors' psychosocial needs using internet-based tools is scarce and its practical implementation is limited.ObjectivesTo study the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, a 10 weeks guided internet-delivered individually-tailored Acceptance and Commitment Therapy (ACT)-influenced cognitive behavioural (CBT) intervention developed to improve mild to moderate anxiety and depression in Breast cancer survivors when compared to treatment as usual (TAU) in a waiting list control group (WLC).MethodsA two-arm, parallel, open label, multicentre, waiting list randomized controlled trial will be conducted to investigate the efficacy and cost-effectiveness of INNOVBC. The primary outcomes in this research will be anxiety and depression. Secondary outcomes will include psychological flexibility, fatigue, insomnia, sexual dysfunction and Health Related Quality of Life (HRQoL).Ethical approvalThis study has been reviewed and approved by Comissão Nacional de Proteção de Dados; Instituto Português de Oncologia do Porto Francisco Gentil; Unidade Local de Saúde de Matosinhos, EPE; Centro Hospitalar de São João and Ordem dos Psicólogos ethical committees.Expected resultsIt is anticipated that iNNOVBC will show to be an efficacious and cost-effective program in improving the outcomes of interest in this study, as opposed to a WLC under TAU. The results of this research will be published in accordance with CONSORT-EHEALTH guidelines.ConclusionsThis study will inform on the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, in improving psychosocial outcomes in breast cancer survivors when compared to TAU in a WLC. Its conclusions will contribute to understand the idiosyncrasies of designing and implementing internet-delivered interventions in breast cancer survivors.Trial Registration code: INNOVBC (NCT03275727).

Mitigating COVID-19 Impact on the Portuguese Population Mental Health: The Opportunity That Lies in Digital Mental Health

“…The equitable implementation of self-guided, guided, or blended approaches, possibly following a stepped care model, would facilitate psychoeducation delivery, contribute to citizens' empowerment, and ease the burden over healthcare providers, allowing them to focus on patients with severe conditions, ultimately contributing to the resilience of the healthcare system. However, only a handful of such programs were under development or ongoing in Portugal [e.g., (96)(97)(98)(99)] prior to the COVID-19 crisis, and, to the best of our knowledge, very few internet-delivered initiatives were developed/adapted to address COVID-19 specific constraints in the meantime (e.g., internet-delivered multimodal pre-habilitation program for confined cancer patients) (100), suggesting that well-known implementation barriers, namely clinicians' attitudes and lack of knowledge, training, and experience, persist (68). Such barriers are probably compromising the development, adaptation, and implementation of internet interventions during this crisis in Portugal.…”

“…However, only a handful of such programs were under development or ongoing in Portugal [e.g., ( 96 – 99 )] prior to the COVID-19 crisis, and, to the best of our knowledge, very few internet-delivered initiatives were developed/adapted to address COVID-19 specific constraints in the meantime (e.g., internet-delivered multimodal pre-habilitation program for confined cancer patients) ( 100 ), suggesting that well-known implementation barriers, namely clinicians' attitudes and lack of knowledge, training, and experience, persist ( 68 ). Such barriers are probably compromising the development, adaptation, and implementation of internet interventions during this crisis in Portugal.…”

Mitigating COVID-19 impact on the Portuguese population mental health: the opportunity that lies in Digital Mental Health (Preprint)

“…However, only a handful of such programs were under development or ongoing in Portugal [e.g., (96)(97)(98)(99)] prior to the COVID-19 crisis, and, to the best of our knowledge, very few internet-delivered initiatives were developed/adapted to address COVID-19 specific constraints in the meantime (e.g., internet-delivered multimodal pre-habilitation program for confined cancer patients) (100), suggesting that well-known implementation barriers, namely clinicians' attitudes and lack of knowledge, training, and experience, persist (68). Such barriers are probably compromising the development, adaptation, and implementation of internet interventions during this crisis in Portugal.…”

Virtual care models for cancer survivorship

“…The pilot study reported high levels of engagement in all aspects of the intervention, as well as general improvements in weight, fruit and vegetable intake, and physical activity 30 . Two additional studies evaluated the effectiveness of technology-supported cognitive behavioral therapy in mitigating anxiety, depression 31 , and fatigue 32 amongst breast cancer survivors. In the latter of the two studies, the intervention group reported improved fatigue scores, functional impairment, psychological distress, and quality of life when compared to a control group 32 .…”