JMIR Publications

ABSTRACT

Background:

One in three cancer patients experience significant psychological distress. Mindfulness-based interventions are effective in reducing psychological distress in this patient group. However, these interventions lack availability and flexibility, which may compromise participation in the intervention for cancer patients experiencing late symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via internet. However, much is unknown regarding the usage of these online mindfulness-based interventions.

Objective:

The current study aimed to a) map different user groups; b) predict update and adherence with demographics and cancer, personality and psychological variables; and c) examine the relation between adherence and intervention outcomes in online Mindfulness-Based Cognitive Therapy (eMBCT) for cancer patients.

Methods:

A total of 125 cancer patients were assigned to eMBCT in a parent randomized controlled trial comparing MBCT and eMBCT with treatment as usual in distress cancer patients. Various usage measures of eMBCT were automatically tracked within the online program. These measures included the number of log-ins (frequency of use), the total log-in time, and mean log-in time per log-in (duration of use), and the number of emails sent and the number of exercises completed (activity of use). Based on activity of use, participants were classified as non-users, minimal users, low users and intended users. Questionnaires were used to assess baseline characteristics (pre-intervention) and outcomes (pre- and post-intervention). To answer the research questions data were analyzed with t-tests, χ2 tests and linear regression models.

Results:

Based on weekly activity, participants were classified as; non-users (N=17, 14%), who completed no exercises in MBCT; minimal users (N=31, 25%), who completed at least one exercise of 1-3 sessions; low users (N=12, 10%), who completed at least one exercise of 4-7 sessions; and intended users (N=65, 52%), who completed at least one exercise of 8-9 sessions. As expected, user groups differed on all usage measures. Non-users had higher baseline levels of fear of cancer recurrence compared to users (uptake), and intended users were more conscientious than minimal/low users (adherence). Intended users had a greater reduction of psychological distress and increase in mental health after the intervention than the other participants.

Conclusions:

Around half of participants in eMBCT completed the intervention as intended, suggesting eMBCT is an acceptable and feasible intervention. Extra attention should be paid to patients with high levels of fear of recurrence and low levels of conscientiousness, as they may have difficulties to complete eMBCT. High activity of use, but not frequency and duration, resulted in improved outcomes after the intervention, suggesting a link between adherence and outcomes. Clinical Trial: na