JMIR Publications

ABSTRACT

Background:

Psychosocial stress-management interventions can reduce stress and distress and improve quality of life for cancer survivors. 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 cancer survivors. Few such digital interventions exist so far, few if any have been developed specifically for breast cancer survivors, and few if any have attempted to explore more than one distinct type of intervention framework.

Objective:

The current study aimed to develop two digital psychosocial stress-management interventions for breast cancer survivors; one cognitive behavioral therapy-based intervention (CBI), and one mindfulness-based intervention (MBI).

Methods:

The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for cancer survivors, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multi-disciplinary 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 breast cancer survivors 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 were refined in iterative user-centered design processes (e.g., usability testing) and adjusted to electronic format through stakeholder centered iterations.

Results:

For the CBI-version, mindfulness-based content of the original StressProffen was removed, and for the MBI-version, cognitive behavioral content removed. Varying degrees of new content were created for both versions, using similar layout as for the original StressProffen program. New content and new excercises in particular were tested by breast cancer survivors 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 based on user feedback 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 was included to meet ethical, privacy and security requirements.

Conclusions:

The current study shows how theory specific digital stress-management interventions for breast cancer survivors can be developed through extensive collaborations between key stakeholders, including scientists, health care providers and breast cancer survivors. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for, outreach and impact of psychosocial interventions for cancer survivors.