The feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game for women with advanced breast or gynecologic cancer.


Journal

Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236

Informations de publication

Date de publication:
01 10 2023
Historique:
revised: 13 04 2023
received: 21 02 2023
accepted: 05 05 2023
medline: 23 10 2023
pubmed: 27 5 2023
entrez: 27 5 2023
Statut: ppublish

Résumé

Cancer clinicians and systems aim to provide patient-centered care, but not all patients have the self-advocacy skills necessary to ensure their care reflects their needs and priorities. This study examines the feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game (an educational video game) intervention in women with advanced breast or gynecologic cancer. Women with recently diagnosed (<3 months) metastatic breast or advanced gynecologic cancer were randomized 2:1 to receive a tablet-based serious game (Strong Together) (n = 52) or enhanced care as usual (n = 26). Feasibility was based on recruitment, retention, data completion, and intervention engagement. Acceptability was assessed via a postintervention questionnaire and exit interview. Preliminary efficacy was assessed on the basis of change scores from baseline to 3 and 6 months in self-advocacy (Female Self-Advocacy in Cancer Survivorship Scale) using intention-to-treat analysis. Seventy-eight women (55.1% with breast cancer; 44.9% with gynecologic cancer) were enrolled. Feasibility was demonstrated by satisfactory recruitment (69% approach-to-consent rate; 93% enroll-to-randomize rate), retention (90% and 86% at 3 and 6 months, respectively; 85% data completion), and intervention engagement (84% completed ≥75% of the game). Participants endorsed the intervention's (75%) and trial's (87%) acceptability. Participants in the intervention group experienced significant improvements in self-advocacy at 3 and 6 months compared to participants in the control group. Strong Together is feasible and acceptable among women with advanced breast or gynecologic cancer. This intervention demonstrates promising evidence of clinical efficacy. A future confirmatory trial is warranted to test the efficacy of the intervention for patient and health system outcomes.

Sections du résumé

BACKGROUND
Cancer clinicians and systems aim to provide patient-centered care, but not all patients have the self-advocacy skills necessary to ensure their care reflects their needs and priorities. This study examines the feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game (an educational video game) intervention in women with advanced breast or gynecologic cancer.
METHODS
Women with recently diagnosed (<3 months) metastatic breast or advanced gynecologic cancer were randomized 2:1 to receive a tablet-based serious game (Strong Together) (n = 52) or enhanced care as usual (n = 26). Feasibility was based on recruitment, retention, data completion, and intervention engagement. Acceptability was assessed via a postintervention questionnaire and exit interview. Preliminary efficacy was assessed on the basis of change scores from baseline to 3 and 6 months in self-advocacy (Female Self-Advocacy in Cancer Survivorship Scale) using intention-to-treat analysis.
RESULTS
Seventy-eight women (55.1% with breast cancer; 44.9% with gynecologic cancer) were enrolled. Feasibility was demonstrated by satisfactory recruitment (69% approach-to-consent rate; 93% enroll-to-randomize rate), retention (90% and 86% at 3 and 6 months, respectively; 85% data completion), and intervention engagement (84% completed ≥75% of the game). Participants endorsed the intervention's (75%) and trial's (87%) acceptability. Participants in the intervention group experienced significant improvements in self-advocacy at 3 and 6 months compared to participants in the control group.
CONCLUSIONS
Strong Together is feasible and acceptable among women with advanced breast or gynecologic cancer. This intervention demonstrates promising evidence of clinical efficacy. A future confirmatory trial is warranted to test the efficacy of the intervention for patient and health system outcomes.

Identifiants

pubmed: 37243943
doi: 10.1002/cncr.34887
doi:

Types de publication

Randomized Controlled Trial Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

3034-3043

Subventions

Organisme : NIA NIH HHS
ID : K24 AG070285
Pays : United States

Informations de copyright

© 2023 American Cancer Society.

Références

Epstein RM, Fiscella K, Lesser CS, Stange KC. Why the nation needs a policy push on patient-centered health care. Health Aff. 2010;29(8):1489-1495. doi:10.1377/hlthaff.2009.0888
Thomas TH, Donovan HS, Rosenzweig MQ, Bender CM, Schenker Y. A conceptual framework of self-advocacy in women with cancer. ANS Adv Nurs Sci. 2021;44(1):E1-E13. doi:10.1097/ANS.0000000000000342
Walsh-Burke K, Marcusen C. Self-advocacy training for cancer survivors: the Cancer Survival Toolbox. Cancer Pract. 1999;7(6):297-301. doi:10.1046/j.1523-5394.1999.76008.x
Self-Advocacy: A Cancer Survivor’s Handbook. National Coalition for Cancer Survivorship. Published online 2009. https://www.canceradvocacy.org/wp-content/uploads/2013/01/Self_Advocacy.pdf
Epstein RM, Duberstein PR, Fenton JJ, et al. Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA Oncol. 2017;1(5):92-100. doi:10.1001/jamaoncol.2016.4373
Hagan TL, Cohen SM, Rosenzweig MQ, Zorn K, Stone CA, Donovan HS. The Female Self-Advocacy in Cancer Survivorship Scale: a validation study. J Adv Nurs. 2018;74(4):976-987. doi:10.1111/jan.13498
Hagan TL, Donovan HS. Ovarian cancer survivors’ experiences of self-advocacy: a focus group study. Oncol Nurs Forum. 2013;40(2):140-147. Accessed May 23, 2023. doi:10.1188/13.ONF.A12-A19
Li B, Mah K, Swami N, et al. Symptom assessment in patients with advanced cancer: are the most severe symptoms the most bothersome? J Palliat Med. 2019;22(10):1252-1259. doi:10.1089/jpm.2018.0622
Dong ST, Butow PN, Tong A, et al. Patients’ experiences and perspectives of multiple concurrent symptoms in advanced cancer: a semi-structured interview study. Support Care Cancer. 2016;24(3):1373-1386. doi:10.1007/s00520-015-2913-4
Wang T, Molassiotis A, Chung BPM, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(1):96. doi:10.1186/s12904-018-0346-9
Miller AS, Cafazzo JA, Seto E. A game plan: gamification design principles in mHealth applications for chronic disease management. Health Inf J. 2016;22(2):184-193. doi:10.1177/1460458214537511
McGonigal J. Reality Is Broken: Why Games Make Us Better and How They Can Change the World. Penguin Press; 2011.
Loerzel VW, Clochesy JM, Geddie PI. Using serious games to increase prevention and self-management of chemotherapy-induced nausea and vomiting in older adults with cancer. Oncol Nurs Forum. 2020;47(5):576. doi:10.1188/20.ONF.567-576
Kim HJ, Kim SM, Shin H, Jang JS, Kim YI, Han DH. A mobile game for patients with breast cancer for chemotherapy self-management and quality-of-life improvement: randomized controlled trial. J Med Internet Res. 2018;20(10):e273. doi:10.2196/JMIR.9559
Thomas TH, Sivakumar V, Babichenko D, Grieve VLB, Klem ML. Mapping behavioral health serious game interventions for adults with chronic illness: scoping review. JMIR Serious Games. 2020;8(3):e18687. doi:10.2196/18687
Thomas TH, McLaughlin M, Hayden M, et al. Teaching patients with advanced cancer to self-advocate: development and acceptability of the Strong TogetherTM serious game. Games Health J. 2019;8(1):55-63. doi:10.1089/g4h.2018.0021
Moore CG, Carter RE, Nietert PJ, Stewart PW. Recommendations for planning pilot studies in clinical and translational research. Clin Transl Sci. 2011;4(5):332-337. doi:10.1111/j.1752-8062.2011.00347.x
Sim J, Lewis M. The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2012;65(3):301-308. doi:10.1016/j.jclinepi.2011.07.011
Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008;31(2):180-191. doi:10.1002/nur.20247
Kraemer HC, Mintz J, Noda A, Tinklenberg J, Yesavage JA. Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiatr. 2006;63(5):484-489. doi:10.1001/archpsyc.63.5.484
Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626-629. doi:10.1016/j.jpsychires.2010.10.008
Healy P, You KL, Xu A, Thomas TH, Babichenko D. A narrative serious game to teach self-advocacy skills in advanced cancer. Procedia Comput Sci. 2022;206(C):162-172. doi:10.1016/j.procs.2022.09.095
Schenker Y, White D, Rosenzweig M, et al. Care management by oncology nurses to address palliative care needs: a pilot trial to assess feasibility, acceptability, and perceived effectiveness of the CONNECT intervention. J Palliat Med. 2015;18(3):232-240. doi:10.1089/jpm.2014.0325
Greer JA, Macdonald JJ, Vaughn J, et al. Pilot study of a brief behavioral intervention for dyspnea in patients with advanced lung cancer. J Pain Symptom Manag. 2015;50(6):854-860. doi:10.1016/j.jpainsymman.2015.06.010
Kamal AH, Wolf S, Nicolla JM, et al. Usability of PCforMe in patients with advanced cancer referred to outpatient palliative care: results of a randomized, active-controlled pilot trial. J Pain Symptom Manag. 2019;58(3):382-389. doi:10.1016/j.jpainsymman.2019.05.007
Lewis JR. Psychometric evaluation of the PSSUQ using data from five years of usability studies. Int J Hum Comput Interact. 2002;14(3-4):463-488. doi:10.1080/10447318.2002.9669130
Thomas TH, Murray PJ, Rosenzweig M, et al. “I was never one of those people who just jumped right in for me”: patient perspectives on self-advocacy training for women with advanced cancer. Support Care Cancer. 2023;31(1):96. doi:10.1007/S00520-022-07531-3/TABLES/4
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):570-579. doi:10.1200/JCO.1993.11.3.570
Webster K, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcome. 2003;1:79. doi:10.1186/1477-7525-1-79
Cleeland C, Mendoza T, Wang X, et al. Assessing symptom distress in cancer patients: the M. D. Anderson Symptom Inventory. Cancer. 2000;89(7):1634-1646. doi:10.1002/1097-0142(20001001)89:7<1634::aid-cncr29>3.0.co;2-v
Cleeland CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr. 2007;37:16-21. doi:10.1093/JNCIMONOGRAPHS/LGM005
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69-77. doi:10.1016/S0022-3999(01)00296-3
Sereika S, Engberg S. Development of standardized sociodemographic and co-morbidity questionnaires. In: The 17th International Nursing Research Congress Focusing on Evidence-Based Practice, July 19-22, 2006. Accessed July 17, 2020. https://stti.confex.com/stti/congrs06/techprogram/paper_30321.htm
Dickman Portz J, Ford K, Bekelman DB, et al. “We’re taking something so human and trying to digitize”: provider recommendations for mHealth in palliative care. J Palliat Med. 2020;23(2):240-247. doi:10.1089/JPM.2019.0216
Vogel RI, Niendorf K, Petzel S, et al. A patient-centered mobile health application to motivate use of genetic counseling among women with ovarian cancer: a pilot randomized controlled trial. Gynecol Oncol. 2019;153(1):100-107. doi:10.1016/J.YGYNO.2019.01.019
Kubo A, Kurtovich E, McGinnis MA, et al. Pilot pragmatic randomized trial of mHealth mindfulness-based intervention for advanced cancer patients and their informal caregivers. Psychooncology. 2020:pon.5557. doi:10.1002/PON.5557
Shiely F, Foley J, Stone A, et al. Managing clinical trials during COVID-19: experience from a clinical research facility. Trials. 2021;22(1):62. doi:10.1186/S13063-020-05004-8
Johnson D, Deterding S, Kuhn KA, Staneva A, Stoyanov S, Hides L. Gamification for health and wellbeing: a systematic review of the literature. Internet Interv. 2016;6:89-106. doi:10.1016/j.invent.2016.10.002
van der Lubbe LM, Gerritsen C, Klein MCA, Hindriks KV. Empowering vulnerable target groups with serious games and gamification. Entertain Comput. 2021;38:100402. doi:10.1016/J.ENTCOM.2020.100402
Epstein AS, O’Reilly EM, Shuk E, et al. A randomized trial of acceptability and effects of values-based advance care planning in outpatient oncology: Person-Centered Oncologic Care and Choices. J Pain Symptom Manag. 2018;56(2):169-177.e1. doi:10.1016/j.jpainsymman.2018.04.009
Agarwal R, Shuk E, Romano D, et al. A mixed methods analysis of patients’ advance care planning values in outpatient oncology: Person-Centered Oncologic Care and Choices (P-COCC). Support Care Cancer. 2020;28(3):1109-1119. doi:10.1007/s00520-019-04910-1

Auteurs

Teresa Hagan Thomas (TH)

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Catherine Bender (C)

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Heidi S Donovan (HS)

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.

Patty Jo Murray (PJ)

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Sarah Taylor (S)

University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.
Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Margaret Rosenzweig (M)

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.

Susan M Sereika (SM)

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Adam Brufsky (A)

University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.
Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Yael Schenker (Y)

Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

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