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Objectives To determine whether an online support tool can impact anxiety in women experiencing an abnormal mammogram. Materials and methods We developed an online support system using the Comprehensive Health Enhancement Support System (CHESS) designed for women experiencing an abnormal mammogram as a model. Our trial randomized 130 of these women to online support (the intervention group) or to a list of five commonly used Internet sites (the comparison group). Surveys assessed anxiety and breast cancer worry, and patient satisfaction at three important clinical time points: when women were notified of their abnormal mammogram, at the time of diagnostic imaging, and at the time of biopsy (if biopsy was recommended). Results Study participants in the intervention group showed a significant decrease in anxiety at the time of biopsy compared to the comparison group ( p = 0.017). However, there was no significant difference in anxiety between the intervention group and the comparison group at the time of diagnostic work-up. We discontinued assessment of patient satisfaction after finding that many women had substantial difficulty answering the questions that referenced their physician, because they did not understand who their physician was for this process of care. Conclusion The combination of the inability to identify the physician providing care during the mammography work-up and anxiety effects seen only after an interaction with the breast imaging team may indicate that online support only decreases the anxiety of women in concert with direct interpersonal support from the healthcare team. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The Internet offers a potential medium for delivering smoking cessation treatment to adolescents. However, few Internet-based cessation programs for adolescents have been evaluated. We describe adolescent use of a home-based Internet intervention to stop smoking (Stomp Out Smokes [SOS]) and explore baseline characteristics associated with SOS use. Methods: Participants were 70 adolescent smokers aged 12–18 years (50% female, 90% Caucasian) randomized to receive the SOS intervention for 24 weeks as part of a larger clinical trial. SOS comprised 40 components, of which eight were primarily interactive (e.g., discussion support group, ask an expert, quit plan) and 32 were primarily informational (e.g., managing withdrawal, medications to stop smoking). SOS use data were captured electronically, including total logins to the site, and type of SOS components used defined by page hits on the interactive and information components. Results: A total of 7,708 SOS website pages (6825 interactive and 883 informational) were accessed over the 24 weeks. The highest proportion of page hits was for the discussion support group (35%) and quit plan (30%). Interactive pages were significantly more likely to be used than informational pages (median 65 vs. 6, p < .001). Males accessed fewer interactive pages compared with females (p = .04). No other baseline characteristics were univariately associated with total logins or use of informational or interactive pages. Conclusions: Adolescent smokers most often used a discussion support group and other interactive Internet-based cessation components. Future studies designed to increase adolescent use, and efficacy of, Internet-based cessation programs are warranted. [Copyright &y& Elsevier]

Abstract: The Network for the Improvement of Addiction Treatment (NIATx) teaches participating treatment centers to use process improvement strategies. A cross-site evaluation monitored impacts on days between first contact and first treatment and percent of patients who started treatment and completed two, three and four units of care (i.e., one outpatient session, 1 day of intensive outpatient care, and 1 week of residential treatment). The analysis included 13 agencies that began participation in August 2003, submitted 10–15 months of data, and attempted improvements in outpatient (n =7), intensive outpatient (n =4) or residential treatment services (n =4) (two agencies provided data for two levels of care). Days to treatment declined 37% (from 19.6 to 12.4 days) across levels of care; the change was significant overall and for outpatient and intensive outpatient services. Significant overall improvement in retention in care was observed for the second unit of care (72–85%; 18% increase) and the third unit of care (62–73%; 17% increase); when level of care was assessed, a significant gain was found only for intensive outpatient services. Small incremental changes in treatment processes can lead to significant reductions in days to treatment and consistent gains in retention. [Copyright &y& Elsevier]

This study identified the key Unmet Needs of men with localized prostate cancer. A series of Nominal Groups were used to identify needs, from which a 135-item survey was developed to assess both the Importance and Unmet Need of each item. An Importance-Weighted Unmet Need score was calculated for each item, incorporating both the Importance and the degree to which the need was unmet. Surveys (n=500) were distributed in four geographically distinct areas, with a response rate of 46%. Respondents were 90% Caucasian, 80% married, with a mean age of 66 years, and mean education of 14 years. Care delivery needs were most important and least unmet, while Support needs were least important and most unmet. However, when degree to which needs were unmet was weighted by Importance, information needs had the highest Importance-Weighted Unmet Need scores. The greatest Unmet Needs for information were in knowledge of recurrence issues and in side effects of the illness and its treatment. [Copyright &y& Elsevier]

This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review places particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups. [ABSTRACT FROM AUTHOR]

Background: A key component of relapse prevention is to self-monitor the internal (feelings or cravings) and external (people, places, activities) factors associated with relapse. Smartphones can deliver ecological momentary assessments (EMA) to help individuals self-monitor. The purpose of this exploratory study was to develop a model for predicting an individual's risk of future substance use after each EMA and validate it using a multi-level model controlling for repeated measures on persons.Methods: Data are from 21,897 observations from 43 adults following their initial episode of substance use treatment in Chicago from 2015 to 2016. Participants were provided smartphones for six months and asked to complete two to three minute EMAs at five random times per day (81% completion). In any given EMA, 2.7% reported substance use and 8% reported any use in the next five completed EMA. Chi-square Automatic Interaction Detector (CHAID) was used to classify EMAs into six levels of risk and then validated with a hierarchical linear model (HLM).Results: The major predictors of substance use in the next five completed EMAs were substance use pattern over the current and prior five EMAs (no recent/current use, either recent or current use [but not both], continued use [both recent and current]), negative affect (feelings), and craving (rating). Negative affect was important for EMAs with no current or recent use reported; craving was important for EMAs with either recent or current use; and neither mattered for EMAs with continued use. The CHAID gradated EMA risk from 0.7% to 36.6% of the next five completed EMAs with substance use reported. It also gradated risk of "any" use in the next five completed EMAs from 3% to 82%.Conclusions: This study demonstrated the potential of using smartphone-based EMAs to monitor and provide feedback for relapse prevention in future studies. [ABSTRACT FROM AUTHOR]

Background: A key component of relapse prevention is to self-monitor the internal (feelings or cravings) and external (people, places, activities) factors associated with relapse. Smartphones can deliver ecological momentary assessments (EMA) to help individuals self-monitor. The purpose of this exploratory study was to develop a model for predicting an individual's risk of future substance use after each EMA and validate it using a multi-level model controlling for repeated measures on persons.Methods: Data are from 21,897 observations from 43 adults following their initial episode of substance use treatment in Chicago from 2015 to 2016. Participants were provided smartphones for six months and asked to complete two to three minute EMAs at five random times per day (81% completion). In any given EMA, 2.7% reported substance use and 8% reported any use in the next five completed EMA. Chi-square Automatic Interaction Detector (CHAID) was used to classify EMAs into six levels of risk and then validated with a hierarchical linear model (HLM).Results: The major predictors of substance use in the next five completed EMAs were substance use pattern over the current and prior five EMAs (no recent/current use, either recent or current use [but not both], continued use [both recent and current]), negative affect (feelings), and craving (rating). Negative affect was important for EMAs with no current or recent use reported; craving was important for EMAs with either recent or current use; and neither mattered for EMAs with continued use. The CHAID gradated EMA risk from 0.7% to 36.6% of the next five completed EMAs with substance use reported. It also gradated risk of "any" use in the next five completed EMAs from 3% to 82%.Conclusions: This study demonstrated the potential of using smartphone-based EMAs to monitor and provide feedback for relapse prevention in future studies. [ABSTRACT FROM AUTHOR]

Background: We estimated the efficacy of the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction and examined the extent to which this use of services mediated the effects of A-CHESS on risky drinking days and abstinence from drinking.Methods: We conducted secondary data analyses of the A-CHESS randomized controlled trial. Recruitment occurred in five residential treatment programs operated by two addiction treatment organizations. Participants were 349 adults with alcohol use disorders recruited two weeks before discharge from residential treatment. We provided intervention arm participants with a smartphone, the A-CHESS application, and an 8-month service plan. Control arm participants received treatment as usual. Telephone interviews at 4, 8, and 12-month follow-ups assessed past-month risky drinking days, past-month abstinence, and post-discharge service utilization (past-month outpatient addiction treatment and past-week mutual help including Alcoholics Anonymous and Narcotics Anonymous). Using mixed effects latent variable models, we estimated the indirect effects of A-CHESS on drinking outcomes, as mediated by post-discharge service utilization.Results: Approximately 50.5% of participants reported outpatient addiction treatment and 75.5% reported mutual help at any follow-up interview in the year following randomization. Assignment to the A-CHESS intervention was associated with an increased odds of outpatient addiction treatment across follow-ups, but not mutual help. This use of outpatient addiction treatment mediated the effect of A-CHESS on risky drinking days, but not abstinence. The effect of A-CHESS through outpatient addiction treatment appeared to reduce the expected number of risky drinking days across follow-ups by 11%.Conclusions: The mobile health (mHealth) intervention promoted the use of outpatient addiction treatment, which appeared to contribute to its efficacy in reducing risky drinking. Future research should investigate how mHealth interventions could link patients to needed treatment services and promote the sustained use of these services. [ABSTRACT FROM AUTHOR]

Context: Palliation in patient care is under-utilized in part because many patients have insufficient knowledge about this management option. Information technology can improve awareness by providing access to numerous sources of trustworthy information. Evidence acquisition: To estimate what a patient interested in palliation might find online, online resources were searched in July 2010, using terms relevant to palliation. PubMed was searched for publications relevant to discussed topics. Evidence synthesis: Search engines returned vast numbers of hits, and identifying trustworthy sites was difficult. Products judged as trustworthy were classified as information, decision tool, or extended interaction tool. Sites with useful educational material were relatively plentiful; decision guides or interactive tools were much rarer. Available consumer informatics did not address some terminal illnesses very well, and some subpopulations such as children, nor was there sufficient attention to literacy levels or principles of instructional design. Online or published information about usage numbers, effectiveness, and cost/benefit considerations was scant. Many sectors, including commercial, government, healthcare, research, and wellness/advocacy groups, have created consumer informatics for palliation. Conclusions: Online information about palliation is available, although identifying trustworthy sources can be problematic. General information sites are relatively plentiful, but more tools for decision making, and interaction would increase value of web resources. More attention to literacy levels, instructional principles, and needs of special populations would improve products. Research to measure usage of such tools, ability to influence behavior, and cost/benefit issues is needed. [ABSTRACT FROM AUTHOR]

Objective: In 1996, 2001, and 2010, the Consolidated Standards of Reporting Trials (CONSORT) group released criteria for reporting critical information about randomized clinical trials . These criteria were intended to improve the quality and completeness of reporting of RCTs in health care research. This paper discusses the relevance of the CONSORT recommendations for the reporting and design of eHealth research. Methods: We reviewed the CONSORT recommendations and discussed their particular relevance to eHealth (electronic information, support and/or communication resources designed to promote health) research. This review focuses on such issues as recruitment and screening of participants, description of treatment elements, and reporting of outcome data and adverse events. Results: eHealth research presents special challenges regarding the comprehensive and effective reporting of research information. However, the strategic application of CONSORT recommendations holds great promise for improving the quality and informativeness of eHealth research. Conclusion: Investigators need to consider CONSORT recommendations at all stages of the research enterprise, including planning, execution and reporting in order to increase the informativeness of their research efforts. Practice implications: The recommendations contained in this paper have the potential to enhance the public health and scientific value of eHealth research. [Copyright &y& Elsevier]

Abstract: Purpose: To examine how psychosocial variables predicted use of an online health consultation service among low-income breast cancer patients and in turn how using this service affected these same psychosocial outcomes. Method: This retrospective study included 231 recently diagnosed, low-income (at or below 250% of the federal poverty level) breast cancer patients provided a free computer with 16 weeks of access to the Internet-based ‘Ask an Expert’ service offered as part of the Comprehensive Health Enhancement Support System (CHESS) “Living with Breast Cancer” program. The use activity included a total of 502 messages submitted to the online health consultation service. The data included five psychosocial variables: information seeking, social support, health self efficacy, participation in health care, and doctor–patient relationship, were collected at both the pre-test and 16-week post-test after using the service. Correlation tests were conducted to examine the relationship between pre- and post-test, and use activity. A multiple regression model was formed for each of five psychosocial variables to examine how use activity of the consultation service was associated with various psychosocial measurements. Results: In total, 865 distinct consulting queries from 502 messages were identified as measurement of patients’ use activities (3.74 consulting queries per participant). Use activity had significant negative relationships with pre-test scores across all five psychosocial variables. The regression models found significant positive main effects (use activity) associated with three of these psychosocial variables: health self efficacy, participation in health care and doctor–patient relationship. Use activity of the online consultation service did not have significant relationships with the dependent variables of information seeking and perceived social support. Conclusion: Low-income breast cancer patients sought out information from an online cancer information expert. Patients with more negative perceptions at pre-test tended to use the service more. Greater use of the service was associated with improvement in patients’ perception of health self-efficacy, participation in health care and doctor–patient relationship. Moreover, use of online health consultation appears to level the differences, narrowing the gaps between those who were worse and better off at pre-test. These findings suggest that online health consultation can serve as an effective complement to other resources, which help low-income, breast cancer patients feel more confident to participate more actively in their health care, become more actively involved in making decisions about their treatments and enhance the relationship with their doctors. [Copyright &y& Elsevier]

This study examined the relationship between breast cancer patients’ experience of barriers to accessing health information and their psychosocial health outcomes and explored the extent to which this relationship was mediated by patient perceptions of competence in dealing with health-related issues. Study sample consisted of 225 women surveyed within 6 months of diagnosis. Regression analyses suggested that patients who reported greater difficulty in accessing needed information experienced lower emotional (P=0.05), functional (P<0.05), and social/family (P<0.05) well-being as well as lower perceptions of health competence (P<0.001). Also, patient perceptions of health competence mediated the relationship between barriers to accessing information and patient outcomes (emotional well-being, P<0.05; functional well-being. P<0.01; social/family well-being, P=0.01). Breast cancer patients often report dissatisfaction with the extent to which their information needs are addressed by their health care providers. Our findings underscore the need for designing and implementing interventions that would aid providers in better meeting the information needs of their patients. [Copyright &y& Elsevier]

This study examined how giving and receiving emotional support in a smartphone-based alcoholism support group changed over time, and what factors predicted the changing patterns. Data were collected as part of a randomized clinical trial of testing a smartphone-based relapse prevention system for alcoholics. Findings suggested that giving and receiving emotional support in a smartphone-based alcoholism support group tended to decline over time. The initial value and growth rate of giving and receiving emotional support varied depending on the group participants' characteristics. These features should be considered in building strategies for the design and implementation of smartphone-based addiction support groups. [ABSTRACT FROM AUTHOR]

Highlights: [•] Emotional communication competence moderates the benefits of emotional support. [•] Expressing support improves mental well-being for patients with high competence. [•] Expressing support decreases mental well-being for patients with low competence. [•] Receiving support reduces cancer-related concern for patients with high competence. [•] Receiving support increases cancer-related concern for patients with low competence. [Copyright &y& Elsevier]

Abstract: The chronically relapsing nature of alcoholism leads to substantial personal, family, and societal costs. Addiction-comprehensive health enhancement support system (A-CHESS) is a smartphone application that aims to reduce relapse. To offer targeted support to patients who are at risk of lapses within the coming week, a Bayesian network model to predict such events was constructed using responses on 2,934 weekly surveys (called the Weekly Check-in) from 152 alcohol-dependent individuals who recently completed residential treatment. The Weekly Check-in is a self-monitoring service, provided in A-CHESS, to track patients' recovery progress. The model showed good predictability, with the area under receiver operating characteristic curve of 0.829 in the 10-fold cross-validation and 0.912 in the external validation. The sensitivity/specificity table assists the tradeoff decisions necessary to apply the model in practice. This study moves us closer to the goal of providing lapse prediction so that patients might receive more targeted and timely support. [Copyright &y& Elsevier]

Abstract: Objectives: To explore how the expression of emotional support in an online breast cancer support group changes over time, and what factors predict this pattern of change. Methods: We conducted growth curve modeling with data collected from 192 participants in an online breast cancer support group within the Comprehensive Health Enhancement Support System (CHESS) during a 24-week intervention period. Results: Individual expression of emotional support tends to increase over time for the first 12 weeks of the intervention, but then decrease slightly with time after that. In addition, we found that age, living situation, comfort level with computer and the Internet, coping strategies were important factors in predicting the changing pattern of expressing emotional support. Conclusions: Expressing emotional support changed in a quadratic trajectory, with a range of factors predicting the changing pattern of expression. Practical implications: These results can provide important information for e-health researchers and physicians in determining the benefits individuals can gain from participation in should CMSS groups as the purpose of cancer treatment. [Copyright &y& Elsevier]

Objective: Caregivers maintain critical roles in cancer patient care. Understanding cancer-related information effects both caregiver involvement and ability to have needs met. This study examines the mediating role caregiver's clinic visit involvement has on the relationships between caregiver's information competence and their need fulfillment and clinic visit satisfaction.Methods: Secondary analysis of 112 advanced lung, breast, and prostate cancer caregivers participating in a large clinical trial. Caregiver information competence was assessed at pretest. Involvement, need fulfillment, and visit satisfaction were assessed immediately following the clinic appointment.Results: Involvement correlated with information competence (r=.21, p<.05), need fulfillment (r=.48, p<.001), and satisfaction (r=.35, p<.001). The correlation between information competence and need fulfillment (r=.26, p<.01) decreased when controlling for involvement (r=.19, p=.049), demonstrating mediation, and accounted for 24.4% of the variance in need fulfillment. The correlation between information competence and satisfaction (r=.21, p=.04), decreased and was non-significant when controlling for involvement (r=.15, p=.11), demonstrating mediation, and accounted for 13% of variance in visit satisfaction.Conclusion: Caregiver's clinic visit involvement mediates the relationships between their information competence and their need fulfillment and visit satisfaction.Practice Implications: Efforts to improve the caregiving experience, and potentially patient outcomes, should focus on system-wide approaches to facilitating caregivers' involvement and assertiveness in clinical encounters. [ABSTRACT FROM AUTHOR]

Abstract: The Network for the Improvement of Addiction Treatment (NIATx) applies process improvement strategies to enhance the quality of care for the treatment of alcohol and drug disorders. A prior analysis reported significant reductions in days to treatment and significant increases in retention in care [McCarty, D., Gustafson, D. H., Wisdom, J. P., Ford, J., Choi, D., Molfenter, T., Capoccia, V., Cotter, F. 2007. The Network for the Improvement of Addiction Treatment (NIATx): enhancing access and retention. Drug Alcohol Depend. 88, 138–145]. A second cohort of outpatient (n =10) and intensive outpatient (n =4) treatment centers tested the replicability of the NIATx model. An additional 20 months of data from the original cohort (7 outpatient, 4 intensive outpatient, and 4 residential treatment centers) assessed long-term sustainability. The replication analysis found a 38% reduction in days to treatment (30.7 to 19.4 days) during an 18-month intervention. Retention in care improved 13% from the first to second session of care (from 75.4% to 85.0%), 12% between the first and third session of care (69.2–77.7%), and 18% between the first and fourth session of care (57.1–67.5%). The sustainability analysis suggested that treatment centers maintained the reductions in days to treatment and the enhanced retention in care. Replication of the NIATx improvements in a second cohort of treatment centers increases confidence in the application of process improvements to treatment for alcohol and drug disorders. The ability to sustain the gains after project awards were exhausted suggests that participating programs institutionalized the organizational changes that led to the enhanced performance. [Copyright &y& Elsevier]

Objectives: To determine the effects of online narrative and didactic information on breast cancer patients' healthcare participation and the interaction effects of race.Methods: Sample: 353 breast cancer patients (111 African Americans) using an eHealth program with narratives (audiovisual and text) and didactic information (text only).Measures: healthcare participation scale (0, 4 months), online information use.Analyses: hierarchical regression.Results: Narrative (beta=0.123, p<0.01) and didactic (beta=0.104, p<0.05) information use had independent and positive effects on healthcare participation. Effects of both were significantly greater for African Americans.Conclusions: Findings are consistent with and advance prior research on online learning processes and outcomes for breast cancer patients: (1) benefits accrue with using a variety of online learning tools; (2) African Americans use and benefit more from online narrative and didactic information than do Caucasians.Practice Implications: eHealth programs should provide both didactic and narrative information-especially for African Americans and might consider making greater use of interactive and audiovisual formats. As patients increasingly use of the web for cancer information, clinicians should provide lists of web high quality resources that provide both narrative and didactic information. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine how the pre-existing doctor–patient relationship predicts conceptually distinct service use within an Interactive Cancer Communication System (ICCS) for underserved women with breast cancer and in turn how service utilization influences the doctor–patient relationship. Methods: Study sample included 231 recently diagnosed, lower income breast cancer patients. Participants were provided a free computer, Internet access and training in how to use an ICCS called the Comprehensive Health Enhancement Support System (CHESS) “Living with Breast Cancer” program. Survey data was collected at pre-test and 4-months after using the system, and use data about how women used the system was also collected. Results: The only statistically significant predictor of service use was that patients with a more negative appraisal about the doctor–patient relationship used the Ask an Expert service more frequently, and there were trends toward a more negative appraisal of the doctor–patient relationship being associated with higher use of Information and Interactive services. Conversely, there was a trend toward a more positive appraisal predicting higher use of the Discussion Group service. In terms of statistically significant effects, more frequent utilization of Information services was associated with a more positive appraisal of the doctor relationship. Conclusion: While a more negative perception of the doctor–patient relationships at pre-test was associated with higher use of most of the conceptually distinct services within this ICCS, use of the Information services was associated with having a more positive appraisal of the doctor–patient relationship at post-test suggesting that high-quality information on the Internet can serve to improve patients’ satisfaction with their doctor. [Copyright &y& Elsevier]

Abstract: Objective: Evaluation of novel treatment delivery methods, such as the Internet are notably absent from the adolescent smoking treatment literature. Methods: Adolescent smokers ages 11–18 years were randomized to a clinic-based, brief office intervention (BOI; N =69) consisting of four individual counseling sessions; or to Stomp Out Smokes (SOS), an Internet, home-based intervention (N =70). Adolescents in SOS had access to the SOS site for 24 weeks. Results: The 30-day, point-prevalence smoking abstinence rates for BOI and SOS were 12% versus 6% at week 24 and 13% versus 6% at week 36, with no significant treatment differences. Among participants who continued to smoke, SOS was associated with a significantly greater reduction in average number of days smoked than BOI (P =0.006). The BOI was found to be feasible with high session attendance rates. SOS participants accessed the site a mean±S.D. of 6.8±7.1 days. SOS use dropped to less than one-third of participants by week 3. Conclusion: Additional research is needed to tap the potential capabilities of the Internet for adolescent smoking cessation using proactive, personalized, patient-education components. Practice implications: Augmenting the SOS type of intervention with more structured, personal and proactive patient-education components delivered in-person or by telephone or electronic mail is recommended. [Copyright &y& Elsevier]

Objectives: To examine the effects of exchanging treatment information within computer-mediated breast cancer support groups on emotional well-being, and to explore whether this relationship is moderated by health self-efficacy. Methods: Sample: 177 breast cancer patients using an electronic Health (eHealth) program with discussion group. Measure: expression and reception of treatment information; emotional well-being scale (0, 4 months). Analyses: hierarchical regression. Results: Effects of expression and reception of treatment information on emotional well-being were significantly greater for those who have higher health self-efficacy. Conclusions: Results conditionally support prior research finding positive effects of treatment information exchanges among breast cancer patients. Such exchanges had a positive impact on emotional well-being for those with higher health self-efficacy, but they had a negative influence for those with lower health self-efficacy. Practice implications: Given that the association between emotional well-being and exchanging treatment information was moderated by health self-efficacy, clinicians should explain the role of health self-efficacy before encouraging patients to use eHealth systems for treatment exchanges. [Copyright &y& Elsevier]