When cancer strikes, patients desperately need help. But pressures to reduce costs of care are reducing provider time to help patients cope with these crises. Computers hold the potential to help providers improve patient support. This is a proposal to compare the cost and effectiveness of four combinations of Internet-based and stand-alone computer systems, CHESS (the Comprehensive Health Enhancement Support System). Both pilot tests and randomized clinical trials have found that CHESS: is widely accepted and used, improves quality of life and leads to more efficient use of health services. Three fundamental ways in which CHESS and Internet differ are: 1) Content: CHESS content is carefully filtered-and focused on meeting needs identified in studies of women with breast cancer. Internet content is vast but unfocused. 2) Social Support: internet chat groups involve large numbers of people, are facilitated and occur off-line through a bulletin board format. 3) Platform: CHESS uses an interface that is convenient and very easy to use. The Internet's platform can operate on virtually any computer but is subject to delays and is less easy to use. The question is: does any of this make a difference and if so, what changes are need to make these systems more effective for patients facing a health crisis? To examine these issues we propose to construct and evaluate four systems: combinations of CHESS and Internet platforms, content and support. Women with breast cancer, 200 Caucasian and 100 African-American will be randomly assigned to one of the four computer systems. Patients will have computers placed in their homes (unless they own an appropriate computer) and will have access to that system for five months. They will complete a pre-test survey and post tests at 2 and 4 months. Primary Outcome measures will compare the impact on: quality of life, and decision satisfaction. Secondary outcomes explore the impact of platform, content and support on: decision choices and criteria, system acceptance and use, knowledge of breast cancer, satisfaction of needs, operational costs, as well as demographic effects on use and outcome. Implications for systems design will result.
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