Mobile Apps to Reduce Distress in Breast Cancer Survivors Using an Adaptive Design

September 28, 2023 updated by: Philip Chow, Ph.D., University of Virginia

Evaluating a Mobile Application to Reduce Distress in Breast Cancer Survivors Using an Adaptive Design

The overarching goals of this project are to provide the first rigorous test of a scalable and publicly accessible mobile health intervention (IntelliCare) to address emotional distress in women with breast cancer, and to test the impact of human coaching as a way to increase engagement with digital health interventions to improve outcomes. To achieve these goals, an innovative experimental study design, known as a Sequential, Multiple Assignment, Randomized Trial (SMART), will be used to test the effects of the IntelliCare apps on symptoms of depression and anxiety, as well as the added value of human support to improve participant engagement. 313 breast cancer survivors diagnosed within the past 5 years and who screen positive for elevated symptoms of depression and/or anxiety will be recruited. Participants will initially be randomized to receive the IntelliCare apps or app-delivered patient education (control) for 8 weeks, and the impact of the IntelliCare apps on reducing symptoms of depression and anxiety in breast cancer survivors relative to control will be tested (Aim 1). We will monitor the app usage data of participants who receive the IntelliCare apps. Those who are high-engagers will continue to use the apps with no change. Those who are low-to-moderate engagers will be rerandomized after 1 week to either receive added coaching vs. not (i.e., no change) in addition to the apps. The hypothesis is that added coaching to address barriers to app usage will lead to greater engagement with the apps (Aim 2), for low-to-moderate engagers. Finally, semi-structured exit interviews will be conducted with participants that receive the IntelliCare apps and coaching. Interviews will capture survivors' perceptions about the extent to which, and how, tailoring the apps and coaching specifically for breast cancer survivors may improve intervention outcomes and engagement (Aim 3).

Study Overview

Study Type

Interventional

Enrollment (Actual)

314

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

    • Virginia
      • Charlottesville, Virginia, United States, 22904
        • University of Virginia

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. age ≥ 18 years (age 19 if in Nebraska, given age of consent);
  2. 0-5 years post-diagnosis of Stage I, II, or III female breast cancer;
  3. elevated symptoms of depression as measured by the Patient Health Questionnaire-8 (PHQ-8) score ≥ 10 and/or symptoms of anxiety as measured by the Generalized Anxiety Disorder-7 (GAD-7) score ≥ 8.

Exclusion Criteria:

  1. Taking antidepressant medication and have had an appointment to adjust the dosage over the past 2 weeks;
  2. mental health condition deemed to interfere with study procedures or put the participant at undue risk based on self-reported history of psychosis or bipolar disorder, or active suicidal ideation that necessitates more intense care;
  3. do not have an app-compatible phone (i.e., iOS 10.3 or later or Android 4.0.3 or later);
  4. cannot read and speak English (current intervention only available in English).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Factorial Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: IntelliCare
IntelliCare is a self-guided, fully automated suite of apps designed for brief, frequent check-ins to promote skill acquisition. IntelliCare has been shown in both general deployment and human-supported trials to be efficacious in reducing symptoms of depression and anxiety.
IntelliCare is a self-guided, fully automated suite of 6 apps designed for brief, frequent check-ins to promote skill acquisition. IntelliCare has been shown in both general deployment and human-supported trials to be efficacious in reducing symptoms of depression and anxiety.
The randomization of added coaching vs. no added coaching after 1 week will only be carried out in the IntelliCare group. Coaching is a human supported approach to optimizing the use and benefit of the IntelliCare apps.
Active Comparator: Patient Education
The patient education app will contain psychoeducational information about distress prevalence and distress management. It will serve as an active control condition to compare with the IntelliCare apps.
The Patient Education app will contain content relevant for general distress management. This includes information about thoughts/worries, prevalence of mood symptoms, CBT strategies for coping with negative affect, and other information typical of education-based mental health apps. The structure of this app will closely mirror patient education websites and apps which mimic the form and structure of apps that target cancer survivors and that primarily provide educational information about cancer and related symptoms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient Health Questionnaire-8
Time Frame: Baseline
8 item scale that measures depression symptoms on a continuous scale. Scores range from 0-24, with a higher score indicating greater severity of symptoms of depression.
Baseline
Patient Health Questionnaire-8
Time Frame: 8 weeks
8 item scale that measures depression symptoms on a continuous scale. Scores range from 0-24, with a higher score indicating greater severity of symptoms of depression.
8 weeks
Patient Health Questionnaire-8
Time Frame: 6 months
9 item scale that measures depression symptoms on a continuous scale. Scores range from 0-24, with a higher score indicating greater severity of symptoms of depression.
6 months
Patient Health Questionnaire-8
Time Frame: 12 months
8 item scale that measures depression symptoms on a continuous scale. Scores range from 0-24, with a higher score indicating greater severity of symptoms of depression.
12 months
Generalized Anxiety Disorder-7
Time Frame: Baseline
7 item scale that measures anxiety symptoms on a continuous scale. Scores range from 0-21, with a higher score indicating greater severity of symptoms of anxiety.
Baseline
Generalized Anxiety Disorder-7
Time Frame: 8 weeks
7 item scale that measures anxiety symptoms on a continuous scale. Scores range from 0-21, with a higher score indicating greater severity of symptoms of anxiety.
8 weeks
Generalized Anxiety Disorder-7
Time Frame: 6 months
7 item scale that measures anxiety symptoms on a continuous scale. Scores range from 0-21, with a higher score indicating greater severity of symptoms of anxiety.
6 months
Generalized Anxiety Disorder-7
Time Frame: 12 months
7 item scale that measures anxiety symptoms on a continuous scale. Scores range from 0-21, with a higher score indicating greater severity of symptoms of anxiety.
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
App Engagement from App Sessions
Time Frame: Frequency of unique app sessions from Baseline through 8 weeks
Number of app sessions
Frequency of unique app sessions from Baseline through 8 weeks
App Engagement from App Session Duration
Time Frame: Duration in seconds of app sessions from Baseline through 8 weeks
App session duration
Duration in seconds of app sessions from Baseline through 8 weeks
App Engagement from App Downloads
Time Frame: Number of apps downloaded from Baseline through 8 weeks
App downloads
Number of apps downloaded from Baseline through 8 weeks
36-Item Short Form Survey
Time Frame: Baseline
The SF-36 is a 36 item scale that is composed of 2 summary scores that measure health status related to both physical and mental health. Scores for each domain range from 0-100, with higher scores indicating better health status.
Baseline
36-Item Short Form Survey
Time Frame: 8 weeks
The SF-36 is a 36 item scale that is composed of 2 summary scores that measure health status related to both physical and mental health. Scores for each domain range from 0-100, with higher scores indicating better health status.
8 weeks
36-Item Short Form Survey
Time Frame: 6 months
The SF-36 is a 36 item scale that is composed of 2 summary scores that measure health status related to both physical and mental health. Scores for each domain range from 0-100, with higher scores indicating better health status.
6 months
36-Item Short Form Survey
Time Frame: 12 months
The SF-36 is a 36 item scale that is composed of 2 summary scores that measure health status related to both physical and mental health. Scores for each domain range from 0-100, with higher scores indicating better health status.
12 months
Multidimensional Fatigue Symptom Inventory-Short Form
Time Frame: Baseline
Fatigue will be measured using the MFSI-SF, which is a 30 item self-report measure comprised of five subscales (general, emotional, physical, mental, vigor) and a total fatigue score. Each subscale score ranges from 0 to 24. The Total MSFI-SF score is calculated by adding the general, physical, emotional and mental subscale scores and subtracting vigor subscale score. Total MFSI-SF score ranges from -24 to 96 with a higher score indicating higher levels of cancer-related fatigue experienced by the patient.
Baseline
Multidimensional Fatigue Symptom Inventory-Short Form
Time Frame: 8 weeks
Fatigue will be measured using the MFSI-SF, which is a 30 item self-report measure comprised of five subscales (general, emotional, physical, mental, vigor) and a total fatigue score. Each subscale score ranges from 0 to 24. The Total MSFI-SF score is calculated by adding the general, physical, emotional and mental subscale scores and subtracting vigor subscale score. Total MFSI-SF score ranges from -24 to 96 with a higher score indicating higher levels of cancer-related fatigue experienced by the patient.
8 weeks
Multidimensional Fatigue Symptom Inventory-Short Form
Time Frame: 6 months
Fatigue will be measured using the MFSI-SF, which is a 30 item self-report measure comprised of five subscales (general, emotional, physical, mental, vigor) and a total fatigue score. Each subscale score ranges from 0 to 24. The Total MSFI-SF score is calculated by adding the general, physical, emotional and mental subscale scores and subtracting vigor subscale score. Total MFSI-SF score ranges from -24 to 96 with a higher score indicating higher levels of cancer-related fatigue experienced by the patient.
6 months
Multidimensional Fatigue Symptom Inventory-Short Form
Time Frame: 12 months
Fatigue will be measured using the MFSI-SF, which is a 30 item self-report measure comprised of five subscales (general, emotional, physical, mental, vigor) and a total fatigue score. Each subscale score ranges from 0 to 24. The Total MSFI-SF score is calculated by adding the general, physical, emotional and mental subscale scores and subtracting vigor subscale score. Total MFSI-SF score ranges from -24 to 96 with a higher score indicating higher levels of cancer-related fatigue experienced by the patient.
12 months
Pittsburgh Sleep Quality Index
Time Frame: Baseline
The Pittsburgh Sleep Quality Index contains 19 self-rated questions that assesses sleep quality and disturbances. Global scores range from 0-21, with a score of 5 or more indicating poor sleep quality. The higher the score, the worse the sleep quality.
Baseline
Pittsburgh Sleep Quality Index
Time Frame: 8 weeks
The Pittsburgh Sleep Quality Index contains 19 self-rated questions that assesses sleep quality and disturbances. Global scores range from 0-21, with a score of 5 or more indicating poor sleep quality. The higher the score, the worse the sleep quality.
8 weeks
Pittsburgh Sleep Quality Index
Time Frame: 6 months
The Pittsburgh Sleep Quality Index contains 19 self-rated questions that assesses sleep quality and disturbances. Global scores range from 0-21, with a score of 5 or more indicating poor sleep quality. The higher the score, the worse the sleep quality.
6 months
Pittsburgh Sleep Quality Index
Time Frame: 12 months
The Pittsburgh Sleep Quality Index contains 19 self-rated questions that assesses sleep quality and disturbances. Global scores range from 0-21, with a score of 5 or more indicating poor sleep quality. The higher the score, the worse the sleep quality.
12 months
Alcohol Use Disorders Identification Test
Time Frame: Baseline
The Alcohol Use Disorders Identification Test contains 10 questions (each question is scored 0-4). The range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).
Baseline
Alcohol Use Disorders Identification Test
Time Frame: 8 weeks
The Alcohol Use Disorders Identification Test contains 10 questions (each question is scored 0-4). The range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).
8 weeks
Alcohol Use Disorders Identification Test
Time Frame: 6 months
The Alcohol Use Disorders Identification Test contains 10 questions (each question is scored 0-4). The range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).
6 months
Alcohol Use Disorders Identification Test
Time Frame: 12 months
The Alcohol Use Disorders Identification Test contains 10 questions (each question is scored 0-4). The range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).
12 months
PROMIS Global Health v1.2
Time Frame: Baseline
The PROMIS Global Health scale v1.2 contains 7 items that measure physical and mental health. Each question is scored on a 1-5 scale with a total score range of 7-35. Higher scores indicate better overall health.
Baseline
PROMIS Global Health v1.2
Time Frame: 8 weeks
The PROMIS Global Health scale v1.2 contains 7 items that measure physical and mental health. Each question is scored on a 1-5 scale with a total score range of 7-35. Higher scores indicate better overall health.
8 weeks
PROMIS Global Health v1.2
Time Frame: 6 months
The PROMIS Global Health scale v1.2 contains 7 items that measure physical and mental health. Each question is scored on a 1-5 scale with a total score range of 7-35. Higher scores indicate better overall health.
6 months
PROMIS Global Health v1.2
Time Frame: 12 months
The PROMIS Global Health scale v1.2 contains 7 items that measure physical and mental health. Each question is scored on a 1-5 scale with a total score range of 7-35. Higher scores indicate better overall health.
12 months
PROMIS Satisfaction with Sex Life
Time Frame: Baseline
The PROMIS Satisfaction with Sex Life scale v.20 contains 5 items that measure satisfaction with one's sex life. Each question is scored on a 1-5 scale with a total score range of 5-25. Higher scores indicate higher satisfaction with one's sex life.
Baseline
PROMIS Satisfaction with Sex Life
Time Frame: 8 weeks
The PROMIS Satisfaction with Sex Life scale v.20 contains 5 items that measure satisfaction with one's sex life. Each question is scored on a 1-5 scale with a total score range of 5-25. Higher scores indicate higher satisfaction with one's sex life.
8 weeks
PROMIS Satisfaction with Sex Life
Time Frame: 6 months
The PROMIS Satisfaction with Sex Life scale v.20 contains 5 items that measure satisfaction with one's sex life. Each question is scored on a 1-5 scale with a total score range of 5-25. Higher scores indicate higher satisfaction with one's sex life.
6 months
PROMIS Satisfaction with Sex Life
Time Frame: 12 months
The PROMIS Satisfaction with Sex Life scale v.20 contains 5 items that measure satisfaction with one's sex life. Each question is scored on a 1-5 scale with a total score range of 5-25. Higher scores indicate higher satisfaction with one's sex life.
12 months
UAMS Health Literacy Measure
Time Frame: Baseline
The UAMS Health Literacy measure consists of 3 items that assess health literacy. Each question is scored on a 1-5 scale, with a possible total score range of 3-15. Higher scores indicate worse health literacy.
Baseline
UAMS Health Literacy Measure
Time Frame: 8 weeks
The UAMS Health Literacy measure consists of 3 items that assess health literacy. Each question is scored on a 1-5 scale, with a possible total score range of 3-15. Higher scores indicate worse health literacy.
8 weeks
UAMS Health Literacy Measure
Time Frame: 6 months
The UAMS Health Literacy measure consists of 3 items that assess health literacy. Each question is scored on a 1-5 scale, with a possible total score range of 3-15. Higher scores indicate worse health literacy.
6 months
UAMS Health Literacy Measure
Time Frame: 12 months
The UAMS Health Literacy measure consists of 3 items that assess health literacy. Each question is scored on a 1-5 scale, with a possible total score range of 3-15. Higher scores indicate worse health literacy.
12 months
Penn State Worry Questionnaire
Time Frame: Baseline
The Penn State Worry Questionnaire consists of 16 items that assess the trait of worry. Each question is scored on a 1-5 scale with a possible total score range of 16-80. Higher scores indicate higher levels of trait worry.
Baseline
Penn State Worry Questionnaire
Time Frame: 8 weeks
The Penn State Worry Questionnaire consists of 16 items that assess the trait of worry. Each question is scored on a 1-5 scale with a possible total score range of 16-80. Higher scores indicate higher levels of trait worry.
8 weeks
Penn State Worry Questionnaire
Time Frame: 6 months
The Penn State Worry Questionnaire consists of 16 items that assess the trait of worry. Each question is scored on a 1-5 scale with a possible total score range of 16-80. Higher scores indicate higher levels of trait worry.
6 months
Penn State Worry Questionnaire
Time Frame: 12 months
The Penn State Worry Questionnaire consists of 16 items that assess the trait of worry. Each question is scored on a 1-5 scale with a possible total score range of 16-80. Higher scores indicate higher levels of trait worry.
12 months
Ten Item Personality Inventory
Time Frame: Baseline
The Ten Item Personality Inventory consists of 10 items that assess the Big 5 personality domains (i.e., conscientiousness, openness, agreeableness, extraversion, neuroticism). Each personality domain is assessed by 2 items. Each item is scored on a 1-7 scale. Higher scores on each personality trait domain indicates higher levels of that personality trait.
Baseline
Ten Item Personality Inventory
Time Frame: 8 weeks
The Ten Item Personality Inventory consists of 10 items that assess the Big 5 personality domains (i.e., conscientiousness, openness, agreeableness, extraversion, neuroticism). Each personality domain is assessed by 2 items. Each item is scored on a 1-7 scale. Higher scores on each personality trait domain indicates higher levels of that personality trait.
8 weeks
Ten Item Personality Inventory
Time Frame: 6 months
The Ten Item Personality Inventory consists of 10 items that assess the Big 5 personality domains (i.e., conscientiousness, openness, agreeableness, extraversion, neuroticism). Each personality domain is assessed by 2 items. Each item is scored on a 1-7 scale. Higher scores on each personality trait domain indicates higher levels of that personality trait.
6 months
Ten Item Personality Inventory
Time Frame: 12 months
The Ten Item Personality Inventory consists of 10 items that assess the Big 5 personality domains (i.e., conscientiousness, openness, agreeableness, extraversion, neuroticism). Each personality domain is assessed by 2 items. Each item is scored on a 1-7 scale. Higher scores on each personality trait domain indicates higher levels of that personality trait.
12 months
TWente Engagement with Ehealth Technologies Scale (TWEETS)
Time Frame: Baseline
The TWEETS scale consists of 9 items on a 5-point Likert scale (0-4). Of the 9 items, 3 are aimed at assessing behavioral engagement, 3 on cognitive engagement, and 3 of affective engagement. Higher scores indicate higher levels on each of the engagement domains.
Baseline
TWente Engagement with Ehealth Technologies Scale (TWEETS)
Time Frame: 8 weeks
The TWEETS scale consists of 9 items on a 5-point Likert scale (0-4). Of the 9 items, 3 are aimed at assessing behavioral engagement, 3 on cognitive engagement, and 3 of affective engagement. Higher scores indicate higher levels on each of the engagement domains.
8 weeks
TWente Engagement with Ehealth Technologies Scale (TWEETS)
Time Frame: 6 months
The TWEETS scale consists of 9 items on a 5-point Likert scale (0-4). Of the 9 items, 3 are aimed at assessing behavioral engagement, 3 on cognitive engagement, and 3 of affective engagement. Higher scores indicate higher levels on each of the engagement domains.
6 months
TWente Engagement with Ehealth Technologies Scale (TWEETS)
Time Frame: 12 months
The TWEETS scale consists of 9 items on a 5-point Likert scale (0-4). Of the 9 items, 3 are aimed at assessing behavioral engagement, 3 on cognitive engagement, and 3 of affective engagement. Higher scores indicate higher levels on each of the engagement domains.
12 months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Digital Intervention Evaluation Questionnaire
Time Frame: 8 weeks
A single questionnaire with subscales of perceived utility and perceived impact; 18 items each scored on a 0 (not at all) to 5 (very) scale
8 weeks
Digital Intervention Adherence Questionnaire
Time Frame: 8 weeks
A single questionnaire that assesses barriers to program use; 32 items each scored on a 0 (not at all) to 2 (very) scale
8 weeks
Limited List of Questions for Exit Interview
Time Frame: 8 weeks
Only those that receive the IntelliCare apps will be administered a qualitative interview that contains items assessing how the app intervention met their needs as a breast cancer survivor and possible changes to improve fit. Study staff will administer this interview on the phone. 10 questions will assess overall impressions of the IntelliCare app program. Additional questions will focus on specific apps within the IntelliCare program and how they can be tailored in future studies.
8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 27, 2021

Primary Completion (Estimated)

January 31, 2024

Study Completion (Estimated)

November 30, 2024

Study Registration Dates

First Submitted

August 25, 2020

First Submitted That Met QC Criteria

October 6, 2020

First Posted (Actual)

October 12, 2020

Study Record Updates

Last Update Posted (Actual)

September 29, 2023

Last Update Submitted That Met QC Criteria

September 28, 2023

Last Verified

September 1, 2023

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 200218

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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