Interactive cancer communication systems (ICCS) have great potential to provide cancer patients withaccurate information on their diseases and treatments in a cost-effective manner. While data suggest thatICCS may benefit cancer patients, important knowledge gaps remain: gaps that should be addressed beforeICCS are more broadly incorporated into healthcare. Data are needed on ICCS effects on such outcomes aspatients' emotional well being, on clinicians' reactions to clinical encounters, and on healthcare utilization andcost-effectiveness. In addition, almost all data on ICCS come from efficacy trials. Little is known about howmuch ICCS will be used, what their effects will be, and how to foster their use in real world healthcare contexts.This proposal describes a study that will be conducted within the Kaiser Permanente Northwest (KPNW)healthcare system. Breast cancer patients will be informed of the availability of a KPNW Breast CancerInformation website. The number of patients visiting that site will reflect interest in KPNW internet breastcancer resources and potential reach of an ICCS within the KPNW population. After entering the website,women (N=600) will be offered the opportunity to join a 2 X 2 randomized trial in which they can volunteer onlineto be randomized to either: (1.) a Basic ICCS that provides static information on KPNW resources andarticles on breast cancer, or (2) an Enhanced ICCS condition that comprises those same static resources +CHESS (an ICCS that has benefited breast cancer patients in efficacy trials). CHESS availability will becrossed with a Prompt condition in which some women will have ICCS use prompted by letters and phone callsfrom KPNW while others will not. Outcome measures will include amount of ICCS use and women's ratings ofcancer information competence, perceived social support, and emotional well being, Other outcomes willinclude healthcare utilization, cost-effectiveness, and clinician ratings of healthcare visits. The proposedresearch should provide information about the business and clinical cases for a comprehensive ICCS in thecontext of real world use for cancer care. This center grant focuses on CHESS, a computer program that isdesigned to give support and information to women with breast cancer. This 'Effectiveness' study will showhow CHESS works in real world healthcare setting, yielding new data on women's use of CHESS, whetherCHESS helps women feel better informed and less anxious, and whether it reduces healthcare costs.
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