Abstract
Among existing telehealth interventions, cognitive behavioral stress management (CBSM) offers particular benefit for reducing psychosocial suffering and promoting disease adaptation, particularly among patients with cancer. Among patients with breast cancer, CBSM has been adapted and tested in person, and while efficacious, many barriers stand in the way of in-person treatments for cancer survivorship. CBSM has been tested via telehealth for patients with breast and prostate cancer, which may offer an alternative and accessible method for intervention delivery.
This trial delivered synchronous, 10-week videoconferenced CBSM plus access to an asynchronous website to women with nonmetastatic breast cancer. In the current dissertation, three studies were conducted to examine predictors and outcomes of engagement.
The first study tested patient-level characteristics, including sociodemographic, medical, geographic, and psychosocial characteristics on program engagement with CBSM. No patient-level predictors impacted program-level engagement. The second study determined the effects of therapist adherence and competence in videoconferenced sessions on weekly participant engagement. Few patient-level covariates, including receipt of adjuvant treatment, predicted engagement over and above other predictors. Lastly, no effects of therapist behaviors, patient engagement, or the combination of these effects on patient post-intervention outcomes (i.e., negative and positive affect, fatigue, pain, depressive and intrusive symptoms, and sleep disturbance) emerged. Patient-level factors, including days since surgery and pre-CBSM outcome values predicted post-CBSM outcomes over therapist behaviors and engagement.
Overall, findings point to the potential for treatment-related factors to impact engagement and uptake of asynchronous digital interventions. Future directions include expansion of engagement measurement modeling and modifications of asynchronous interventions to encourage engagement through human centered design.