Shinn E H, Jensen K, McLaughlin J, Garden A S, Fellman B M, Liang Li, Peterson S K
Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, United States of America.
Texas Health Care- Head and Neck Cancer Center of Texas, THC-PLLC, United States of America.
Internet Interv. 2019 Oct 28;18:100289. doi: 10.1016/j.invent.2019.100289. eCollection 2019 Dec.
Pharyngeal and laryngeal cancers are highly curable; however survivors are at high risk for long-term dysphagia after radiation. To address lack of access to preventive care in community settings, we developed a responsive web-based application to help patients adhere to preventive swallowing exercises and cope with radiation side effects. We conducted an interim study analysis to determine website usage characteristics and to examine the effect size for future trials.
Pharyngeal and laryngeal cancer patients were recruited for enrollment by speech language pathologists before primary radiation and introduced to the interactive website. The program (English and Spanish) features tracking logs for preventive exercises, instructional videos, patient stories and search features. Patients' self-reported swallowing function was assessed with the MD Anderson Dysphagia Inventory (MDADI) at baseline and at 6 months. Adherence to preventive exercises was assessed during the 10 week intervention. Number of unique website visits, total duration of website exposure, and rankings of the most popular webpages were calculated. Preliminary regression models were run using adherence and MDADI as outcomes.
Of the 160 enrolled, 96 had 10-week adherence data and 61 had 6-month MDADI data. The average age was 63 (SD = 12.26), 49.4% were from rural counties, 44% had a high school education or lower, and 42% reported annual income of $30,000 or less. The average number of visits was 5.49 (SD = 9.96) and the average total time spent with the website was 41.09 min (SD =88.48). Preliminary analyses indicated that number of unique visits to the website was independently associated with increased adherence to preventive exercises (p = .001-.008).
Our website showed significant effects in promoting adherence to swallowing exercises. However, our return visit rate showed that the platform needs improvement in navigability and usability for this older population undergoing challenging treatment in community settings with low resources.
咽喉癌具有较高的治愈率；然而，放疗后的幸存者长期吞咽困难的风险很高。为了解决社区环境中缺乏预防保健服务的问题，我们开发了一个基于网络的响应式应用程序，以帮助患者坚持进行吞咽预防练习并应对放疗副作用。我们进行了一项中期研究分析，以确定网站使用特征，并为未来试验检验效应大小。
言语病理学家在初次放疗前招募咽喉癌患者入组，并向他们介绍交互式网站。该程序（英语和西班牙语）具有预防练习跟踪日志、教学视频、患者故事和搜索功能。在基线和6个月时，使用MD安德森吞咽困难量表（MDADI）评估患者自我报告的吞咽功能。在为期10周的干预期间评估对预防练习的依从性。计算了网站的独立访问次数、网站浏览总时长以及最受欢迎网页的排名。使用依从性和MDADI作为结果运行初步回归模型。
在160名入组患者中，96名有10周的依从性数据，61名有6个月的MDADI数据。平均年龄为63岁（标准差=12.26），49.4%来自农村县，44%的人接受过高中或以下教育，42%的人报告年收入为3万美元或以下。平均访问次数为5.49次（标准差=9.96），在网站上花费的平均总时长为41.09分钟（标准差=88.48）。初步分析表明，网站的独立访问次数与预防练习依从性的提高独立相关（p=0.001-0.008）。
我们的网站在促进吞咽练习依从性方面显示出显著效果。然而，回访率表明，对于在资源匮乏的社区环境中接受具有挑战性治疗的老年人群体，该平台在可导航性和可用性方面需要改进。
