Børøsund Elin, Meland Anders, Eriksen Hege R, Rygg Christine M, Ursin Giske, Solberg Nes Lise
Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
JMIR Form Res. 2023 Sep 19;7:e48719. doi: 10.2196/48719.
Psychosocial stress-management interventions can reduce stress and distress and improve the quality of life for survivors of cancer. As these in-person interventions are not always offered or accessible, evidence-informed digital stress-management interventions may have the potential to improve outreach of psychosocial support for survivors of cancer. Few such digital interventions exist so far, few if any have been developed specifically for survivors of breast cancer, and few if any have attempted to explore more than 1 distinct type of intervention framework.
This study aimed to develop 2 digital psychosocial stress-management interventions for survivors of breast cancer; 1 cognitive behavioral therapy-based intervention (CBI), and 1 mindfulness-based intervention (MBI).
The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for survivors of cancer, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multidisciplinary design approach and were iteratively conducted in close collaboration between key stakeholders, including experts within psychosocial oncology, cancer epidemiology, stress-management, and eHealth as well as survivors of breast cancer and health care providers. Core psychosocial oncology stress-management and cancer epidemiology experts first conducted a series of workshops to identify cognitive behavioral and mindfulness specific StressProffen content, overlapping psychoeducational content, and areas where development and incorporation of new material were needed. Following the program content adaptation and development phase, phases related to user testing of new content and technical, privacy, security, and ethical aspects and adjustments ensued. Intervention content for the distinct CBI and MBI interventions was refined in iterative user-centered design processes and adjusted to electronic format through stakeholder-centered iterations.
For the CBI version, the mindfulness-based content of the original StressProffen was removed, and for the MBI version, cognitive behavioral content was removed. Varying degrees of new content were created for both versions, using a similar layout as for the original StressProffen program. New content and new exercises in particular were tested by survivors of breast cancer and a project-related editorial team, resulting in subsequent user centered adjustments, including ensuring auditory versions and adequate explanations before less intuitive sections. Other improvements included implementing a standard closing sentence to round off every exercise, and allowing participants to choose the length of some of the mindfulness exercises. A legal disclaimer and a description of data collection, user rights and study contact information were included to meet ethical, privacy, and security requirements.
This study shows how theory specific (ie, CBI and MBI) digital stress-management interventions for survivors of breast cancer can be developed through extensive collaborations between key stakeholders, including scientists, health care providers, and survivors of breast cancer. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for outreach and impact of psychosocial interventions for survivors of cancer.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/47195.
心理社会压力管理干预措施可以减轻压力和痛苦，提高癌症幸存者的生活质量。由于这些面对面的干预措施并非总是能够提供或获得，基于证据的数字压力管理干预措施可能有潜力改善对癌症幸存者的心理社会支持服务范围。到目前为止，这类数字干预措施很少，几乎没有专门为乳腺癌幸存者开发的，也很少有尝试探索超过一种不同类型的干预框架的。
本研究旨在为乳腺癌幸存者开发两种数字心理社会压力管理干预措施；一种基于认知行为疗法的干预措施（CBI）和一种基于正念的干预措施（MBI）。
CBI和MBI干预措施的开发源自现有的StressProffen项目，这是一个针对癌症幸存者的数字压力管理干预项目，主要基于认知行为治疗理念。开发过程采用多学科设计方法，在关键利益相关者之间密切合作下反复进行，这些利益相关者包括心理肿瘤学、癌症流行病学、压力管理和电子健康领域的专家，以及乳腺癌幸存者和医疗服务提供者。心理肿瘤学压力管理和癌症流行病学核心专家首先举办了一系列研讨会，以确定认知行为和正念特定的StressProffen内容、重叠的心理教育内容，以及需要开发和纳入新材料的领域。在项目内容改编和开发阶段之后，进行了与新内容的用户测试以及技术、隐私、安全和伦理方面相关的阶段，并随之进行了调整。不同的CBI和MBI干预措施的内容在以用户为中心的迭代设计过程中得到完善，并通过以利益相关者为中心的迭代调整为电子格式。
对于CBI版本，删除了原始StressProffen中基于正念的内容，对于MBI版本，删除了认知行为内容。两个版本都创建了不同程度的新内容，采用了与原始StressProffen项目类似的布局。特别是新内容和新练习由乳腺癌幸存者和与项目相关的编辑团队进行了测试，随后进行了以用户为中心的调整，包括确保有听觉版本，并在不太直观的部分之前提供充分的解释。其他改进包括实施标准的结束语来结束每个练习，并允许参与者选择一些正念练习的时长。包含了法律免责声明以及数据收集、用户权利和研究联系信息的描述，以满足伦理、隐私和安全要求。
本研究展示了如何通过包括科学家、医疗服务提供者和乳腺癌幸存者在内的关键利益相关者之间的广泛合作，为乳腺癌幸存者开发特定理论（即CBI和MBI）的数字压力管理干预措施。提供各种基于证据的压力管理方法可能会增加对癌症幸存者心理社会干预措施的服务范围和影响的兴趣。
国际注册报告识别号（IRRID）：RR2-10.2196/47195。
