Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer

Abstract

Background Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (http://clinicaltrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data. Methods HealthScore is a six‐month, theory‐based, multicomponent intervention delivered through participant‐driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit‐wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient‐Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function. Results From May 2020 to March 2022, 50 participants completed the single‐arm pilot. Feasibility was high: 66% enrolled and 71% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE = 1.1) from baseline to 3 months, and 4.3 (SE = 1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self‐efficacy. Discussion HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.

A qualitative study of stakeholders' experiences with and acceptability of a technology‐supported health coaching intervention (SHARE‐S) delivered in coordination with cancer survivorship care

“…Other health coaching interventions for cancer survivors have been longer in duration and included more sessions (e.g., 11 calls over 6 months; weekly for 6 months). 37 , 38 While this relatively low‐dose intervention (involving just three remotely delivered sessions with a health coach) produced promising effects, future research could expand the number of sessions, while still considering how technology may support scalability. Referring clinicians and patients reported informational needs during the referral and enrollment process; both groups noted they would benefit from more information about what to expect from the program and its specific components at its outset, suggesting that more provider training and supportive materials may be beneficial.…”

“…Specifically, both coaches and patients wanted more sessions to build rapport and enhance accountability and self‐management skills. Other health coaching interventions for cancer survivors have been longer in duration and included more sessions (e.g., 11 calls over 6 months; weekly for 6 months) 37,38 . While this relatively low‐dose intervention (involving just three remotely delivered sessions with a health coach) produced promising effects, future research could expand the number of sessions, while still considering how technology may support scalability.…”

Digital engagement and telehealth coaching intervention provides physical and mental health improvements for cancer patients: Results from a PROMIS-10 evaluation

“…These digital health programs can improve global, physical, and mental health while providing support in an ambulatory setting for people with cancer in managing their disease, by enhancing patients' selfe cacy, as well as helping providers track and respond to patient-reported outcomes [6]. Further, digital cancer health coaching programs have also been found to improve physical and mental health scores ( [9], [10], [11].…”