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Journal of General Internal Medicine

, Volume 16, Issue 7, pp 435–445 | Cite as

Effect of computer support on younger women with breast cancer

  • David H. Gustafson
  • Robert Hawkins
  • Suzanne Pingree
  • Fiona McTavish
  • Neeraj K. Arora
  • John Mendenhall
  • David F. Cella
  • Ronald C. Serlin
  • Funmi M. Apantaku
  • James Stewart
  • Andrew Salner
Original Articles

Abstract

OBJECTIVE: Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved.

DESIGN: Randomized controlled trial conducted between 1995 and 1998.

SETTING: Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago, Ill), and a cancer resource center (Indianapolis, Ind). The latter three sites treat many underserved patients.

PARTICIPANTS: Newly diagnosed breast cancer patients (N=246) under age 60.

INTERVENTIONS: Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support.

MEASUREMENTS AND MAIN RESULTS: Pretest and two posttest surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group.

CONCLUSIONS: Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations.

Key Words

breast cancer quality of life patient participation computer patient education disadvantaged Digital Divide 

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References

  1. 1.
    Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin. 1999;49(1):8–31.PubMedGoogle Scholar
  2. 2.
    Meyerowitz BE. Psychosocial correlates of breast cancer and its treatments. Psychol Bull. 1980;87(1):108–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Vinokur AD, Threatt BA, Caplan RD, et al. Physical and psychosocial functioning and adjustment to breast cancer: long-term follow-up of a screening population. Cancer. 1989;63:394–405.PubMedCrossRefGoogle Scholar
  4. 4.
    Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16:501–14.PubMedGoogle Scholar
  5. 5.
    Nayfield SG, Ganz PA, Moinpour CM, Cella DF, Hailey BJ. Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials. Qual Life Res. 1992;1:203–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Aaronson NK, Meyerowitz BE, Bard M, et al. Quality of life research in oncology: past achievements and future priorities. Cancer. 1991;67(3):839–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Chevarley F, White E. Recent trends in breast cancer mortality among white and black U.S. women. Am J Public Health. 1997;87(5):775–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Health Services Research Group. Development of the Index of Medical Underservice. Health Services Research. Summer, 1975, 168–80.Google Scholar
  9. 9.
    Marino C, Gerlach KK. An analysis of breast cancer coverage in selected women’s magazines, 1987–1995. Am J Health Promot. 1999;13(3):163–70.PubMedGoogle Scholar
  10. 10.
    Scroggins TG Jr, Bartley TK. Enhancing cancer control: assessing cancer knowledge; attitudes and beliefs in disadvantaged communities. J La State Med Soc. 1999;151(4):202–4.PubMedGoogle Scholar
  11. 11.
    Nelles WB, McCaffrey RJ, Blanchard CG, Ruckdeschel JC. Social support and breast cancer: a review. J Psychosoc Oncol. 1991;9(2):21–34.CrossRefGoogle Scholar
  12. 12.
    Street RL, Voigt B. Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Making. 1997;17:298–306.PubMedCrossRefGoogle Scholar
  13. 13.
    Bilodeau BA, Degner LF. Information needs, sources of information, and decisional roles in women with breast cancer. Oncol Nurs Forum. 1996;23(4):691–6.PubMedGoogle Scholar
  14. 14.
    Gustafson DH, Hawkins RP, Boberg E, et al. Impact of a patient-centered, computer-based health information/support system. Am J Prev Med. 1999;16(1):1–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Smaglik P, Hawkins R, Pingree S, Gustafson D. The quality of interactive computer use among HIV infected individuals. J Health Communication. 1998;3:53–68.CrossRefGoogle Scholar
  16. 16.
    Boberg E, Gustafson D, Hawkins R, et al. Development, acceptance and use patterns of a computer based education and social support system for people living with AIDS/HIV infection. Comp Hum Behav. 1995;11(2):289–311.CrossRefGoogle Scholar
  17. 17.
    Pingree S, Hawkins RP, Gustafson D, et al. Will the disadvantaged ride the information highway? Hopeful answers from a computer-based health crisis system. J Broadcasting Electronic Media. 1996;40(3):331–53.Google Scholar
  18. 18.
    Gustafson D, Wise M, McTavish F, et al. Development and pilot evaluation of a computer-based support system for women with breast cancer. J Psychosoc Oncol. 1993;11(4):69–93.CrossRefGoogle Scholar
  19. 19.
    McTavish FM, Gustafson DH, Owens BH, et al. CHESS: an interactive computer system for women with breast cancer piloted with an under-served population. In: Ozbolt JG, ed. Transforming Information, Changing Health Care; Proceedings of the Eighteenth Annual Symposium on Computer Applications in Medical Care. Philadelphia: Hanley & Belfus; 1994.Google Scholar
  20. 20.
    Gustafson DH, Taylor JO, Thompson S, Chesney P. Assessing the needs of breast cancer patients and their families. Qual Manage Healthcare. 1993;2(1):6–17.Google Scholar
  21. 21.
    Love S, Lindsey K. Dr. Susan Love’s Breast Book. Reading, Mass: Addison-Wesley Publishing Company; 1995.Google Scholar
  22. 22.
    Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM, ed. Evaluation of Chemotherapeutic Agents. New York: Columbia University Press; 1949:199–205.Google Scholar
  23. 23.
    Schag CC, Heinrich RL, Ganz PA. Karnofsky Performance Status revisited: reliability, validity, and guidelines. J Clin Oncol. 1984;2:187–93.PubMedGoogle Scholar
  24. 24.
    Darlington RB. Regression and Linear Models. New York: McGraw Hill; 1990:263–6.Google Scholar
  25. 25.
    Ende-Murphy K. The relationship of self-directed learning, self-efficacy, and health value in young women with cancer using a computer health education program. Madison, Wis: University of Wisconsin; 1996. Unpublished Ph.D. Thesis.Google Scholar
  26. 26.
    Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 1997:974–86.Google Scholar
  27. 27.
    Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.PubMedGoogle Scholar
  28. 28.
    Fairclough DL, Cella DF. Functional Assessment of Cancer Therapy (FACT-G): non-response to individual questions. Qual Life Res. 1996;5:321–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Cella DF, Bonomi AE, Lloyd SR, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Lung (FACT-L) quality of life instrument. Lung Cancer. 1995;12:199–220.PubMedCrossRefGoogle Scholar
  30. 30.
    Moinpour CM, Feigl P, Metch B, Hayden KA, Meyskens FL Jr, Crowley J. Quality of life end points in cancer trials: review and recommendations. J Natl Cancer Inst. 1989;81(7):485–95.PubMedCrossRefGoogle Scholar
  31. 31.
    Hardy MA. Regression with Dummy Variables. Newbury Park, Calif: Sage Publications Inc; 1993; Sage University Paper Series: Quantitative Applications in the Social Sciences, Series No. 07-093.Google Scholar
  32. 32.
    Cohen J, Cohen P. Applied multiple regression/correlation analysis for the behavioral sciences. 2nd Ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1983.Google Scholar
  33. 33.
    Seaman MA, Levin JR, Serlin RC. New developments in pairwise multiple comparisons: some powerful and practicable procedures. Psychol Bull. 1991;110:577–86.CrossRefGoogle Scholar
  34. 34.
    Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.Google Scholar
  35. 35.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd Ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1988.Google Scholar
  36. 36.
    Demetri GD, Kris M, Wade J, Degos L, Cella D. Quality of life benefit in chemotherapy patients treated with Epoetin Alfa is independent of disease response or tumor type: results from a prospective community oncology study. J Clin Oncol. 1998;16(10):3412–25.PubMedGoogle Scholar
  37. 37.
    Bonomi P, Kim K, Fairclough D, et al. Comparison of survival and quality of life in advanced non-small-cell lung cancer patients treated with pacilitaxel-cisplatin vs. etoposide-cisplatin: results of an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2000;18(3):623–31.PubMedGoogle Scholar
  38. 38.
    U.S. Bureau of the Census. United States Population Estimates by Age, Sex, Race and Hispanic Origin, 1990–1997. Washington, DC: Population Division, U.S. Bureau of the Census; 1998:20233.Google Scholar
  39. 39.
    Gustafson D, McTavish F, Hawkins R, et al. Computer support for elderly women with breast cancer: results of a population-based intervention. (Letter) JAMA. 1998;280(15).Google Scholar
  40. 40.
    CommerceNet/Nielsen. Electronic commerce on the rise according to CommerceNet /Nielsen Media Research Survey. Jan. 7, 1998; http://www.commerce.net/news/press/121 197.html.Google Scholar
  41. 41.
    Eng T, Maxfield A, Patrick K, Deering M, Ratzan S, Gustafson D. Access to health information and support: a public highway or a private road? JAMA. 1998;280(15):1371–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Robinson T, Eng T, Patrick K, Gustafson D. An evidence-based approach to interactive health communication: a challenge to medicine in the information age. JAMA. 1998;280(14):1264–9.PubMedCrossRefGoogle Scholar

Copyright information

© Blackwell Science Inc 2001

Authors and Affiliations

  • David H. Gustafson
    • 1
  • Robert Hawkins
    • 2
  • Suzanne Pingree
    • 3
  • Fiona McTavish
    • 4
  • Neeraj K. Arora
    • 9
  • John Mendenhall
    • 10
  • David F. Cella
    • 7
    • 11
  • Ronald C. Serlin
    • 5
  • Funmi M. Apantaku
    • 12
  • James Stewart
    • 6
  • Andrew Salner
    • 8
    • 13
  1. 1.Received from the Departments of Industrial Engineering and Preventive Medicinethe University of Wisconsin-MadisonMadison
  2. 2.the School of Journalism and Mass Communicationthe University of Wisconsin-MadisonMadison
  3. 3.the Department of Life Sciences Communicationthe University of Wisconsin-MadisonMadison
  4. 4.the Center for Health Systems Research and Analysisthe University of Wisconsin-MadisonMadison
  5. 5.the Department of Educational Psychologythe University of Wisconsin-MadisonMadison
  6. 6.the Department of Clinical Oncologythe University of Wisconsin-MadisonMadison
  7. 7.the Department of Psychiatry and Behavioral Sciencethe University of Wisconsin-MadisonMadison
  8. 8.the Department of Radiation Oncology and The Cancer Programthe University of Wisconsin-MadisonMadison
  9. 9.Division of Cancer Control and Population SciencesNational Cancer InstituteBethesda
  10. 10.SBC Technology Resources, Inc.Austin
  11. 11.Evanston Northwestern HealthcareEvanston
  12. 12.National Black Leadership Initiative on CancerUniversity of Illinois at ChicagoChicago
  13. 13.Hartford HospitalHartford

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