JMIR Publications

ABSTRACT

Background:

E-health is an increasingly utilized method of healthcare in the field of psycho-oncology. While many reports highlight the positive impact of psychological e-health tools, there are patients who refuse to use them.

Objective:

Our goal was to expand our knowledge of the motivation and psycho-emotional functioning of patients who consciously refuse to use e-health technology in the form of a mobile psycho-oncology app for their phone as part of a clinical trial. To our knowledge, this is the first study of its kind.

Methods:

A retrospective study was conducted between December 2022 and February 2023 to investigate the reasons why 56 breast cancer patients refused to use the psycho-oncology mobile app offered as part of a clinical trial by the Breast Cancer Unit. The study aimed to analyze their psycho-emotional functioning, including stress levels (measured using the Distress Thermometer), personality traits (measured using the TIPI), coping strategies (measured using the Mini-Cope), and self-efficacy (measured using the GSES) and reasons for refusal to participate in the clinical trial.

Results:

The patients experienced a clinically meaningful elevation in stress levels (5 ± 2.1 points) and self-efficacy (32.1 ± 5.1 points). Among five dimensions of personality treats patients scores highest in Agreeableness (6.5 ± 0.8 stens) and Conscientiousness (6.4 ± 0.9) and lowest in Neuroticism (3.4 ± 1.8) (other dimension: Extraversion - 5.8 ± 1.6 and Openness to experiences 4.4 ± 1.5). In terms of coping with stress, patients most frequently used the strategies of Active coping (2.6 ± 0.5 points), Acceptance (2.6 ± 0.6) and Seeking emotional suport (2.6 ± 0.6), and least frequently used the strategies of Psychoactive substance use (0,2 ± 0.6) and Resistant (0,5 ± 0.7). Patient responses regarding refusal to participate in app testing were divided into four categories: 1) Focus on life outside the disease, 2) Focus on disease and treatment, 3) Denial mechanism, 4) Technical issues. Statistically significant differences were found between the groups. Focus on life outside the disease group of patients had higher levels of self-efficacy, lower neuroticism and more frequent use of Positive re-evaluation strategy compared to the other groups.

Conclusions:

Our patients' decision not to use the eHealth psycho-oncology app was mainly influenced by characteristics suggesting their better emotional coping with the disease and treatment. These were significantly more influential than other factors studied, particularly those related to technology. In the light of our study, assessing the reason for opting out of e-health and the associated psycho-emotional functioning is crucial for patients' adoption of e-health solutions.