At-Home Group Video Calling to Support Rural Women

Institution: Stanford University
Investigator(s): Cheryl Koopman, Ph.D. - Mary Anne Kreshka, M.A. - Joanne Hild, M.S. Zoology -
Award Cycle: 2011 (Cycle 17) Grant #: 17AB-1600 Award: $93,961
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 17AB-1601 -

Initial Award Abstract (2011)

Introduction:
The Sierra Stanford Partnership studies report that women diagnosed with breast cancer benefit from psychosocial support groups lead by a trained facilitator. The groups offer an opportunity to share their experiences. Women in isolated rural areas have limited options for support and the regions lack trained facilitators. Recent changes in technology are changing this picture. Now groups of up to ten individuals can be participants in a private group meeting using their own computers at home and easy to learn software. Traditionally, even when programs were available, it was difficult to reach the targeted audience. The advent of near universal access to the Internet and the growing use of social media bring new possibilities for women to learn about the proposed breast cancer support services.

Question(s) or hypotheses:

  1. Will it be effective to bring together women who have had an experience with breast cancer using group video calling for psychosocial support group meetings?
  2. Will women use an at-home computer successfully to be full participants in a study, including initial recruitment, screening and completing assessments?

General methodology:
Participants will be 32 women living in rural zip codes in the 19 counties of northern California who have had an experience with breast cancer. As much as possible, interaction with study participants will be Internet based. Recruitment efforts will take place through websites such as the Love/Avon Army of Women website, the Clinical Trials.gov website, and our project website. Referrals from our Community Advisory Board, our contacts with survivors in the region, the local medical providers and the media will supplement the Internet sources. From their home computers women will access a screening assessment tool and a signed consent to participate in the study. Once enrolled, they will complete baseline assessments (medical status, demographics and quality of life measures) via computer. The research team will place women in either the eight-week group video calling intervention (the experimental group) or in a group receiving printed educational materials on nutrition and exercise (the control group). The experimental group will also receive a copy of “One in Eight” our Workbook Journal used as a text for the group sessions. Three months after women join the study they will repeat the online questionnaires reporting on their experience and participate in individual interviews about their experiences. These interviews will be recorded and analyzed by our qualitative researcher.

Innovative elements:
Our research of the literature confirmed that there are many Internet based cancer support groups. However, we were unable to identify any cancer support groups using group video calling. When we tried this technology in focus groups in our rural California region, we found that it was effective. Women felt like they were in the same room with the participants in the video-calling group. Voices and facial expressions were clear and they experienced a real sense of connection with the other women.

Community involvement:
A successful three-year study was conducted in our rural region. The study provided support groups to breast cancer survivors using Telemedicine video conferencing equipment at local clinics. Participants in that study urged us to find a way to make the support groups more accessible in their isolated areas. The answer to the accessibility issue is now available using Internet programs like “Skype” or “WebEx,” which allow audio and visual communications between multiple parties. Rural areas finally have greater access to broadband connections making this option possible in many communities. Our rural women advocates are eager for psychosocial support and education, and are committed to trying this innovative approach.

Future Plans:
We plan to use the results of this pilot study to develop a grant application for a major study using Internet support group access. This future grant would study whether providing support to rural women using group video calling is effective in reducing stress, depression and social isolation.




Final Report (2014)

To increase access to breast cancer support groups, our current study aims to evaluate the feasibility, satisfaction, and acceptability of providing at-home breast cancer support groups using on-line video calling software that is similar to Skype, which allows audio and visual communication among participants. We hypothesize that at-home on-line video calling will be a feasible, satisfactory, and acceptable method of delivery for psychosocial support and that Internet based recruitment and assessment tools will be useful in doing this research in rural communities.

This study was successful in demonstrating the feasibility, acceptability and satisfaction of providing breast cancer support groups delivered via on-line video calling to women living in rural communities of California. The results also supported the feasibility of using on-line methods to recruit, screen, treat and assess women in rural communities. We recruited all 32 women for this pilot study, showing the feasibility of using on-line methods to screen and conduct baseline assessments of research participants. We learned that mailing recruitment materials to women identified through the California Cancer Registry was more effective than on-line methods for recruiting women living in very rural CA communities. The on-line delivery of the follow-up questionnaire assessment succeeded in yielding a 94% follow-up rate, demonstrating the feasibility of using on-line methods to follow participants. We also obtained rich qualitative data from interviews of 25 participants who had completed the intervention that will help to inform future research with this population.

This pilot study provided the foundation for a randomized clinical trial (RCT) to evaluate the efficacy of using on-line video calling to provide support groups to breast cancer survivors in rural communities. We presented on this research at the California Breast Cancer Research Symposium in Costa Mesa, CA, as well as giving a presentation on community-based participatory research opportunities in California at the Breast Cancer, the Environment and Disparities Workshop in Nevada City. We published two commentaries on research on posttraumatic stress disorder in women with breast cancer, which is one of the outcomes we are exploring in this pilot study.

We will meet with our Community Advisory Board to discuss the findings and to receive guidance on dissemination. According to this feedback, we will disseminate the results to participants in this study, local health providers, and representatives of local advocacy groups. We will compute effect sizes based on the quantitative data to help inform determination of sample size for a large RCT and will write-up the results of this study for publication and presentation at BCRP and national conferences. As results are published, press releases will be prepared and distributed to journalists in rural communities. We will apply for a large RCT based on this pilot study, which if successful will provide a basis for training social workers and psychologists to use group video calling to provide breast cancer support groups to women from the comfort of their homes.