Optimizing smartphone psychotherapy for depressive symptoms in patients with cancer: Multiphase optimization strategy using a decentralized multicenter randomized clinical trial (J-SUPPORT 2001 Study).
Journal: Psychiatry and clinical neurosciences
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Affiliated Institutions:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan.
Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Higaki Breast Clinic, Hiroshima, Japan.
Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan.
Division of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan.
Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.
Akahane Breast Clinic, Nagoya, Japan.
Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan.
Department of Breast and Thyroid Surgical Oncology, Hakuaikai Medical Corporation, Sagara Hospital, Kagoshima, Japan.
Department of Nursing Administration and Management, Nagoya City University Graduate School of Nursing, Nagoya, Japan.
Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, Nagoya, Japan.
Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Survivorship, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.
Cancer Solutions, Tokyo, Japan.
Department of Breast Surgery, National Cancer Center Hospital East, Chiba, Japan.
Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Thoracic Surgery, Aichi Cancer Center, Nagoya, Japan.
Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan.
Abstract summary
Patients with cancer experience various forms of psychological distress, including depressive symptoms, which can impact quality of life, elevate morbidity risk, and increase medical costs. Psychotherapy and pharmacotherapy are effective for reducing depressive symptoms among patients with cancer, but most patients prefer psychotherapy. This study aimed to develop an efficient and effective smartphone psychotherapy component to address depressive symptom.This was a decentralized, parallel-group, multicenter, open, individually randomized, fully factorial trial. Patients aged ≥20 years with cancer were randomized by the presence/absence of three cognitive-behavioral therapy (CBT) skills (behavioral activation [BA], assertiveness training [AT], and problem-solving [PS]) on a smartphone app. All participants received psychoeducation (PE). The primary outcome was change in the patient health questionnaire-9 (PHQ-9) total score between baseline and week 8. Secondary outcomes included anxiety.In total, 359 participants were randomized. Primary outcome data at week 8 were obtained for 355 participants (99%). The week 8 PHQ-9 total score was significantly reduced from baseline for all participants by -1.41 points (95% confidence interval [CI] -1.89, -0.92), but between-group differences in change scores were not significant (BA: -0.04, 95% CI -0.75, 0.67; AT: -0.16, 95% CI -0.87, 0.55; PS: -0.19, 95% CI -0.90, 0.52).As the presence of any of the three intervention components did not contribute to a significant additive reduction of depressive symptoms, we cannot make evidence-based recommendations regarding the use of specific smartphone psychotherapy.
Authors & Co-authors:
Akechi
Furukawa
Noma
Iwata
Toyama
Higaki
Matsuoka
Zenda
Iwatani
Akahane
Inoue
Sagara
Uchida
Imai
Momino
Imaizumi
Yamaguchi
Mashiko
Miyaji
Horikoshi
Sakurai
Onishi
Kanemitsu
Murata
Wanifuchi-Endo
Kuroda
Nishikawa
Miyashita
Abe
Uchitomi
Study Outcome
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