Project Overview +

FOCUS on the Web offers an individually tailored, interactive, web-based intervention for cancer patients (lung, colorectal, breast, prostate) and their family caregivers that will lead to better patient-caregiver communication, more dyadic support, higher self-efficacy, increased perceived benefits of the illness experience, and less emotional distress. This intervention is based on an efficacious, family-based program of care (the FOCUS Program). In this study, we translate this primarily face-to-face, family-based program to an internet-based version.

Aims +

Aim 1. Develop an individually-tailored, interactive, web-based and email-based, Family Involvement Module. The three-session module will be completed jointly by patients and caregivers to increase patients' and caregivers' effective communication, dyadic support, self-efficacy, perceived benefits of the illness, and to decrease their emotional distress.

Aim 2. Conduct a Phase II study with cancer patients and their family caregiver using baseline (Time 1) and two-month follow-up assessments (Time 2). Between Times 1 and 2, all participants jointly will complete the web-based Family Involvement Module.

Participants +

1. Formative Testing: The sample for this study consists of 11 patients with lung, colorectal, breast or prostate cancer and a family caregiver (N=11 dyads) who participate in one of four focus groups. Focus group participants are stratified by type of cancer and stage of disease.

2. Usability Testing: The sample for this study consists of 8 patient-caregiver dyads stratified by cancer site and stage of disease.

3. Feasibility Study: The sample consists of 38 patients with lung, colorectal, breast, or prostate cancer and one family caregiver per patient (i.e., 38 dyads) who are stratified by cancer site and stage of disease. Participants are drawn from three Michigan sites: 1) the University of Michigan Comprehensive Cancer Center, Ann Arbor; 2) St Joseph Mercy Cancer Center, Ypsilanti; and 3) Karmanos Cancer Center, Detroit.

Intervention +

This project translates the Family Involvement Module of FOCUS to a web-based intervention. This is the core module of the program, and serves as the prototype for developing other FOCUS modules.

The Family Involvement Module covers information on:

  1.  family history and roles,
  2.  personal and family strengths,
  3. family reactions to the illness,
  4. communication effectiveness,
  5. family concerns about the cancer,
  6. family and outside supports,
  7. planning for the longer-term, and
  8. review of progress and lessons learned.

In the web-based module, we aim to recreate some of the personalized nurse-patient-caregiver interactions (used in FOCUS) by offering individually- and dyad-based tailored feedback, as well as by engaging dyads through posing questions, giving feedback, and asking them to discuss their reactions with each other.

Dyads complete three web-based sessions, with two weeks between each session. A three-session intervention was selected to enable patients and caregivers to learn information in a sequential manner and to have practice time between each session. Participants individually answer the baseline (Time 1) and follow-up (Time 2) assessments. Dyads complete the three web-based sessions together (i.e., side-by-side at a computer), as instructed during enrollment.

The sessions include individual- and dyad-based tailored feedback generated from their responses to questions in the baseline questionnaire and the web-based sessions. From this feedback, patients and caregivers learn about each other's responses, receive tailored advice about improvements they can make as individuals or as a dyad, and get prompts for activities to practice between sessions.

Each member of the dyad receives an email message alerting him/her to visit the website (includes the URL that will link directly to the tailored program). A week after each session, participants receive tailored email reviews that summarize the previous session. The email reviews are in HTML, a format that looks like a website and can easily be printed. Participants are also encouraged to revisit the webpage where they may review all previous content.

Findings +

Participants from four focus groups (n=22) and two rounds of usability testing (n=16) report:

  • The program is easy to use. The structure, design, and content of the program is appropriate for the target population.
  • The program is appropriate for participants with varied levels of computer comfort or experience.
The phase 2 usability study consisted of 38 dyads consisting of cancer patients and their family caregivers. Findings include:
  • Significant decrease in emotional distress
  • Increase in quality of life
  • Caregivers had significant improvement in self-efficacy
  • Overall, participants were satisfied with the program, but recommended additional content.

Conclusion +

This study found that it was possible to translate a clinician-delivered program for use on the web. This program was found to have positive effects on dyadic outcomes.