1. References/Acknowledgements
The Effectiveness of Online Therapeutic Facilitation with Cancer Survivors Alexandra Ann Gits, BA, Philip L. Ritter, PhD, Kathryn Plant, MPH, and Kate Lorig, DrPH
Stanford University Patient Education Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
Introduction
Results
Discussion
There are an estimated 11.7 million U.S. cancer survivors. Like other people with chronic disease, these survivors are heavy Internet users, with estimates as high as 25% using social media. Much of this media, such as online groups, is facilitated by either a health professional or a peer. Little is known about how the quality of this social networking affects outcomes. With the continuing increase in cancer survivors and chronic disease patients in general seeking help online and participating in facilitated online interventions, we need to increase our knowledge about what constitutes therapeutic facilitation.
The evaluation techniques developed in this study were designed to contribute to validating and understanding the role of facilitators in online cancer survivor programs, as well as online self-management in general.
Two coding schemes of facilitator posts to cancer survivor online participants were developed and utilized. Associations were made from the codes to changes in 6-month health outcomes, categorized as behavioral, symptomatic or quality-of-life.
Significant correlations were found between “Supportive” and Total posts and increased use of mental relaxation techniques and decreased illness intrusiveness in daily living. Reliability/reputability in the codes was established by 97% agreement in coders.
10 online facilitators presided over the six workshops that were evaluate, containing cancer survivor participants each. Participants logged in a mean of 25.2 times (SD=28.7). A total of 1,538 facilitator posts with a mean of 10.6 (SD= 6.3) posts per participant were evaluated.
The most frequent subcategory of post was Supportive-Expressive, with mean 3.6 posts per participant.
The agreement between coders was 97% (377 out of 389, un-weighted kappa= .96).
Total posts and Supportive posts were significantly correlated with increased mental relaxation and decreased illness intrusiveness. (p<.05) (Fig. 3)
Several subcategories of types of posts were associated with 6-month improvements (Fig. 1).
In 4/6 workshops Supportive posts were correlated with positive outcomes, as well as 5/6 workshops with Total posts.
Male participants had a stronger and more statistically significant correlation between number of posts and health outcomes.
The high rate of agreement between two independent coders suggests that the coding scheme is consistent, comprehensive and reproducible at least in the context of cancer survivor online therapy groups.
This was a very heterogeneous population with different types of cancer, different lengths of survival, and wide range of ages. Therefore it is not surprising that type of facilitator posts had little association with most behaviors. However, many subcategories were correlated with 6-month improvements, suggesting that a larger study may provide more information on their effect.
It does appear more facilitation and more supportive facilitation is better especially in the context of illness intrusiveness and mental relaxation. Cancer survivors in particular harbor a lot of stress.
The stronger association for males may indicate that they are a self-selective group, or more amenable to female facilitator suggestions. A larger study with more participants and/or facilitators would need to validate this claim.
Future research should include applying the coding scheme to 1) additional cancer survivor workshops and to 2) other kinds of facilitated online interventions (ex. diabetes/chronic disease self-management).
In particular, facilitators should be evaluated for their attentiveness to emotion in the absence of visual cues.
Objectives
Figure 2. Final Codes for Facilitator Posts, with Examples
Figure 3. Correlations Between Types of Facilitator Posts and 6-Month Outcomes, Pearson r (p value)
The purposes of the study included:
Develop a unified coding scheme to code facilitator posts using 1) grounded theory, and 2) the Spiegel and Classen (2000) coding categories.
Code facilitator posts using the coding scheme.
Identify if and how facilitation strategies are related to participant outcomes in three broad categories (behavior, symptoms and quality of life).
It is our hope that in developing and applying a coding scheme for facilitator posts in online cancer workshops, we can begin to better understand facilitators and the types of interactions they have with participants. This knowledge may lead to stronger online interventions and improved facilitation of programs for cancer survivors and/or other online chronic disease self-management therapy workshops and groups.
Figure 2. Caption here
References/Acknowledgements
Figure 1. Associations between Specific Sub-categories of Types of Posts and 6-month Improvement in Outcomes
Spiegel, D., & Classen, C. (2000). Group therapy for cancer patients. New York, NY: Basic Books.
Thank you to everyone at the Stanford Patient Education Research Center; especially Phil, Kate and Katie for their guidance, inspiration and valuable help.
Thank you to Eastern Virginia Medical School for funding the development and presentation of this poster.
Outcome
Sub-category of Type of Post
r value
Increased Communication with MD
Group-transparency
0.26
Instructional-emotive
0.2
Increased Mental Relaxation
Supportive-agreement
0.24
Supportive-expressive
0.22
Informative-evocative
0.35
Decreased Stress
Instructional-identification
-0.23
Decreased Insomnia
-0.2
Decreased Illness Intrusiveness