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Table 1 Findings for the feasibility, useability and acceptability of technology-based interventions for cancer carers

From: Feasibility, useability and acceptability of technology-based interventions for informal cancer carers: a systematic review

  Sample characteristics Methodology Results
Reference Cancer type Country N= Mean age Female (%) Design Study arms Intervention Study primary outcomes Feasibility Useability Acceptability Limitations
Chih, DuBenske [42] Advanced: breast, prostate and lung USA 217 56 64.2 • RCT
• 6 and 12-month follow-ups
2) CHESS with clinician report (CR). CR sends reports to the clinician for timely management of symptoms
• Both groups completed a check-in every seven days and provided information about their needs and patients’ symptoms.
• Both groups had access to CHESS: information, communication and training services
• CR created a report that was made available to clinicians to review patient symptoms
1) Caregiver preparedness
 No significant effect.
2) Physical burden
 No significant effect
3) Negative mood
 Carers in the CHESS with CR group had less negative mood than those in the CHESS only group at 6 months (p = 0.009) and at 12 months (p = 0.004).
• Recruitment rate 25%
• Attrition rate 39% at 6 months.
• Attrition rate 52% at 12 months.
• 26% of people in CHESS + CR and 21% of people in CHESS did not use Check in
• Telephone or face-to-face training
• Distribution of computer and system manuals
• Available technical support line
• CR alone could not be assessed because it was integrated in CHESS.
• Carers with fewer needs may have been more likely to complete the 12-month follow-up.
• The sample was most well educated, Caucasians.
DuBenske, Gustafson [43] Advanced lung USA 246 55 68.3 • RCT
• 24 -month intervention
• 2 monthly follow-ups.
• 6-month data reported on
3) Internet access with a list of recommended websites
• Participants in the CHESS groups had access to information, communication and training.
• Participants were encouraged to log in weekly, but natural useage was observed.
1) Disruptiveness
 No significant effect.
2) Burden
 At 6 months carers in the CHESS + CR group had lower burden than carers in the Internet only group (P = 0.021).
3) Negative mood
 At 6 months carers in the CHESS + CR group had lower negative mood than carers in the Internet only group (p = 0.006).
• Recruitment rate 62%
• Attrition rate 31% at 6 months.
• Nearly 50% did not return 6-month follow-up surveys
• 73% of users logged into CHESS at least once
• Carers logged in on average 14.6 times, viewed 293 pages and used the system for 50 min each month
• 27% of users in Group 1 used the system minimally or not at all
• Computers and laptops provided
• Internet use paid for
• Distribution of computer and user manuals
• Telephone training offered for all participants, 59% completed training
• Low recruitment and the removal of the CHESS only arm (Group 2).
• Providing carers with Internet access may have been sufficient to address some carers’ needs, decreasing any effects of CHESS.
Namkoong, DuBenske [44] Advanced lung USA 285 55 68% • RCT
• 24-month intervention
• 2-monthly follow-ups
• 6-month data reported on
2) Internet only
• Carers in the CHESS group had access to information, communication and training services.
• Participants were encouraged to log in regularly, but natural useage was observed.
1) Caregiver bonding
 At 6 months a positive effect (p = 0.05) was seen in carers bonding with one-another in the CHESS group compared to the Internet only group.
2) Association between CHESS use and coping strategies
 No significant effect
3) Association between caregiver bonding and coping strategies.
 Positively associated with active behaviour (p = 0.05), positive reframing (p = 0.05) and instrumental support (P = 0.01)
• Recruitment rate 43%
• Attrition rate 63.5%
• Only 104 carers completed to 6 month follow up
Northouse, Schafenacker [36] Advanced lung, colorectal, breast and prostate USA 44 50 60.5% • Single arm feasibility study
• 6-week intervention
• Pre and Post surveys
  • Carer/patient dyads completed three modules each two weeks apart.
• Intervention content was tailored depending on information provided in baseline questionnaires.
• Content included the impact on cancer on the family, addressing concerns and finding support and future planning.
1) Emotional distress
 Small reduction in distress (d = 0.28).
2) QOL
 Small improvement in QOL (d = 0.20).
3) Social support
 Small improvement in social support (d = 0.33).
4) Self-efficacy
 Small improvement in self-efficacy (d = 0.40).
• Recruitment rate 51%
• Attrition rate 14%
• A help button was available for carers if they require assistance. Few carers utilised this, and only when they required help with passwords
• The program was reported highly as easy to use
• The intervention was accepted as it could be completed at home and at a time convenient to the participants
• Some participants requested more information about symptom management and coping
• Unable to assess the efficacy of the intervention as there was no control group
Scott and Beatty [37] Breast, colorectal, prostate, thyroid, ovarian, testicular and angio-sarcoma. Australia 13 48 67% • Case study
• 6 module cognitive behavioural therapy course
• Baseline, 1-week post intervention and 3 months post intervention follow-up
  • A cognitive behaviour therapy programme including education, worksheets and survivor stories.
• Modules released each week.
• Program designed for patients, carers asked to take patient perspective for aspects that did not directly apply to them.
1) Negative affect
 Large reduction in negative affect (d = 0.88)
2) Cancer specific distress
 Small reduction in distress (d = 0.37).
3) OQL role functioning
 Small increase in role functioning (d = 0.34).
4) QOL emotional functioning
 Moderate increase in emotional functioning (d = 0.62).
• Recruitment rate 20%
• 31% attrition to the end of the intervention
• 77% attrition to the follow-up questionnaire
• Five participants completed the program
• Four participants completed 2-5 modules
• Four participants completed one or none of the program
• 78% stated the program was helpful
• 33% stated the intervention needed a stronger focus on carers
• Qualitative findings showed mixed results for the acceptability of the intervention, some preferring the convenience of web-based interventions and some finding them impersonal
• Dropouts were more likely to have better psychological outcomes at baseline
• Carers who completed the intervention were more likely to be in the post-treatment phase
• No control group
Song, Rini [38] Prostate USA 25 59 100% • Feasibility study.
• Eight-week intervention
• Pre and post surveys
• Qualitative post-intervention assessments
  • Dyads completed seven education modules: two mandatory and five optional.
• Modules included information, links to videos for skills training and assignments.
• Each module took 10-20 min to complete.
• Assignments required extra time to complete
• Dyads had access to resource centre with online resources and links to organisations.
1) QOL
 Small increase in social quality of life (d = 0.25).
2) Couple communication
 No effect
3) Perception of patients’ symptoms
 Small increase in effect size from d = 0.18 pre intervention to d = 0.51 post intervention.
• Recruitment rate 51%
• Attrition rate 15%
• On average carers spent 43.99 min on the intervention (patients’ 41.99 min)
• The intervention was rated as easy to use, concise, easy to understand and engaging with different formats of information (text and videos)
• There were no issues with Internet connectivity
• The intervention was accepted for improving knowledge, symptom management and communication Carers valued that they were able to tailor the modules to their own needs • Inclusion of patients and carers with relatively low symptoms/ needs (19 months post diagnosis)
• Exclusion of non-partnered patients/carers
  1. Note: A dash has been used in cells where information was not reported on. CR refers to clinician report and QOL refers to quality of life
  2. p = statistical significance < 0.05
  3. d represents effect sizes where 0.2 is small, 0.5 moderate and 0.8 large effect