An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial

Abstract

BackgroundPain is a challenge for patients following hematopoietic stem cell transplantation (HCT).ObjectiveThis study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients.MethodsParticipants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected.ResultsParticipants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants’ experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group.ConclusionsUsing focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficia...

Effectiveness of e‐health based self‐management to improve cancer‐related fatigue, self‐efficacy and quality of life in cancer patients: Systematic review and meta‐analysis

“…The trials were published between 2005–2018. Trials were undertaken in the USA (Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ), Netherlands (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Golsteijn et al, ; Willems et al, ), UK (Foster et al, ), Canada (Vallerand et al, ), China (Zhang et al, ; Zhu et al, ), and South Korea (Lee et al, ).…”

“…Participants in four trials were patients with any cancer (Foster et al, ; Bantum et al, ; Somers et al, ; Willems et al, ). The other eleven trials focused on specific cancers: breast cancer (Admiraal et al, ; van den Berg et al, ; Lee et al, ; Owen et al, ; Smith et al, ; Zhu et al, ), glioma (Boele et al, ), haematological cancer (Syrjala et al, ; Vallerand et al, ), rectal cancer (Zhang et al, ), and both colorectal cancer and prostate cancer (Golsteijn et al, ).…”

“…The other eleven trials focused on specific cancers: breast cancer (Admiraal et al, ; van den Berg et al, ; Lee et al, ; Owen et al, ; Smith et al, ; Zhu et al, ), glioma (Boele et al, ), haematological cancer (Syrjala et al, ; Vallerand et al, ), rectal cancer (Zhang et al, ), and both colorectal cancer and prostate cancer (Golsteijn et al, ). Nine trials reported participants who completed primary treatment (Admiraal et al, ; van der Berg et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhang et al, ); the time since treatment completion was 4 weeks to 18 years. One trial included participants undergoing treatment (Zhu et al, ), while another one included both undergoing treatment and primary treatment completed (Golsteijn et al, ).…”

“…Interventions in trials focused on behaviour change (Golsteijn et al, ; Lee et al, ; Bantum et al, ; Vallerand et al, ), medical management (Foster et al, ; Smith et al, ; Somers et al, ; Zhang et al, ; Zhu et al, ), and psychological management (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Owen et al, ; Syrjala et al, ) while one trial focused on both behaviour and psychological management (Willems et al, ). Most studies were web‐based (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Foster et al, ; Golsteijn et al, ; Lee et al, ; Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ) and two trial was telephone‐based (Vallerand et al, ; Zhang et al, ), and one was APP‐based (Zhu et al, ). The intervention duration lasted for 4 weeks to 6 months.…”

“…The intervention duration lasted for 4 weeks to 6 months. Interventions were implemented according to a regular schedule by week (Boele et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Vallerand et al, ; Zhang et al, ) or by month (Golsteijn et al, ), while other interventions were accessible at any time study completion (Admiraal et al, ; van der Berg et al, ; Owen et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhu et al, ).…”