Effect of Computer Support on Younger Women with Breast Cancer

Authors

  • David H. Gustafson PhD,

    Corresponding author
    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Robert Hawkins PhD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Suzanne Pingree PhD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Fiona McTavish BS,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Neeraj K. Arora PhD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • John Mendenhall PhD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • David F. Cella PhD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Ronald C. Serlin PhD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Funmi M. Apantaku,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • James Stewart MD,

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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  • Andrew Salner MD

    1. Received from the Departments of Industrial Engineering and Preventive Medicine (DHG), the School of Journalism and Mass Communication (RH), the Department of Life Sciences Communication (SP), the Center for Health Sytems Research and Analysis (FM), the Department of Educational Psychology (RCS), The Department of Clinical Oncology (JS), the Department of Psychiatry and Behavioral Science (DFC),and the Department of Radiation Oncology and The Cancer Program (AS), the University of Wisconsin–Madison, Madison, Wis; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (NKA); SBC Technology Resources, Inc., Austin, Tex (JM); Evanston Northwestern Healthcare, Evanston, Ill (DFC); National Black Leadership Initiative on Cancer, University of Illinois at Chicago, Chicago, Ill (FMA); and Hartford Hospital, Hartford, Conn (AS).
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Address correspondence and reprint requests to Dr. Gustafson: Center for Health Systems Research and Analysis, Room 1119, 610 Walnut St., University of Wisconsin-Madison, Madison, WI 53705 (e-mail: dhgustaf@facstaff.wisc.edu).

Abstract

OBJECTIVE: Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved.

DESIGN: Randomized controlled trial conducted between 1995 and 1998.

SETTING: Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients.

PARTICIPANTS: Newly diagnosed breast cancer patients (N = 246) under age 60.

INTERVENTIONS: Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support.

MEASUREMENTS AND MAIN RESULTS: Pretest and two post-test surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group.

CONCLUSIONS: Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations.

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