Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study

Abstract

Background One in three cancer patients experience high psychological distress. Mindfulness-based interventions are effective in reducing psychological distress in this patient group. However, these interventions lack availability and flexibility, which may compromise participation in the intervention for cancer patients experiencing late symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. However, little is known about the usage of these online mindfulness-based interventions. Objective The aim of this study was to (1) predict uptake of and adherence to online mindfulness-based cognitive therapy (eMBCT) using baseline patient characteristics (demographic, cancer-related, personality, and psychological variables) and (2) examine the relations between adherence and treatment outcomes in eMBCT for cancer patients. Methods A total of 125 cancer patients were assigned to eMBCT in a parent randomized controlled trial comparing MBCT and eMBCT with treatment as usual in distressed cancer patients. Various usage measures of eMBCT were automatically tracked within the online program. Based on activity of use, participants were classified as nonusers, minimal users, low users, and intended users. Questionnaires were used to assess baseline characteristics (preintervention) and outcomes (pre- and postintervention). To answer the research questions, data were analyzed with t tests, χ2 tests, and linear regression models. Results Based on weekly activity, participants were classified as nonusers (n=17, 13.6%), who completed no exercises in MBCT; minimal users (n=31, 24.8%), who completed at least one exercise of one to three sessions; low users (n=12, 9.6%), who completed at least one exercise of four to seven sessions; and intended users (n=65, 52.0%), who completed at least one exercise of eight to nine sessions. Nonusers had more fear of cancer recurrence at baseline than users (uptake), and intended users were more conscientious than minimal and low users (adherence). Intended users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. Conclusions This study showed that adherence was related to improved patient outcomes. Patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.

The influence of education level on sleep-related outcomes and sleep management strategies in prostate cancer patients

“…Our findings also indicated that education level does not predict the use of other sleep management strategies that we asked (sleep medication, CBT, mindfulness, hypnosis, acupuncture). These results are similar to the findings from studies in other cancer populations, for example on the use of mindfulness [37,38] and acupuncture [39] in cancer care. However, our data on sleep medication use differs from the findings in the general population, where sleep medication users are more likely to be of lower education than non-users [40,41].…”

Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis

“…Of these, nine reported a positive association between engagement and mental health outcomes (33, 34, 36, 39-41, 43, 47, 49) while eight did not find a significant association (35,37,38,42,(44)(45)(46)48). Fourteen studies examined DMHIs that were guided (20,(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62). Among these studies, six reported a positive association between engagement and mental health outcomes (50-52, 54, 55, 57) while eight did not find a significant association (20,53,56,(58)(59)(60)(61)(62).…”

Data_Sheet_1.DOCX

“…In the remaining 23 studies, participants were not formally diagnosed with a mental health condition but were screened for symptoms indicative of mental disorders. Of these studies, 12 reported a positive association between engagement and the primary mental health outcome (33,36,40,41,43,47,49,50,52,57,63,65) while the other 11 did not find a significant association (37, 38, 42, 44-46, 48, 58, 59, 62, 64).…”

“…Nine studies (35,36,42,44,46,50,52,59,64) investigated the relationship between engagement and psychological distress or psychological recovery. Of these, three reported a positive association between engagement and post-intervention symptoms (36, 50, 52) while six did not find any significant association (35,42,44,46,59,64).…”

“…Of the 25 studies included in the meta-analysis, 20 studies (20, 33-35, 37, 40, 41, 43, 47, 48, 51, 54-57, 59, 61, 63-65) employed correlational designs to investigate the association between engagement and mental health outcomes. The other five studies (36,38,50,52,66) used between-group mixed model comparisons to identify any differences in post-intervention outcomes between users who exhibited higher vs. lower levels of engagement. To maximize comparability across studies, the number of modules (also referred to as activities or sessions) completed was used as our primary measure of engagement, owing to its common use among the included studies.…”