Developing and testing a web-based intervention to support pain and symptom self-management in breast cancer surgery

Introduction: Surgery for breast cancer confers comorbidities including high rates of persistent post-surgical pain (PPSP). An audit revealed that the surgical pathway does not support patient self-management of symptoms. Web-based interventions (WBIs) have been shown to improve self-management in chronic conditions. A mixed-methods approach was used to develop a WBI to capture patient self-reported post-operative symptoms and provide individualised self-management advice.

Methods: Developing the WBI comprised a scoping review, systematic review and development study. The scoping review found a paucity of WBIs within breast cancer whilst the systematic review of WBIs in any surgical setting found tentative evidence of effectiveness. A development study including patient and HCP interviews confirmed post-surgical self-management was sub-optimal with a need for real-time symptom monitoring and informed the development of a WBI.

Results: The WBI comprised two parts; a website and daily post-operative symptom questionnaire. Intervention components included generic education and specific algorithm-based advice based on themes identified in development. Intervention questions included pain, infection, swelling, and factors reducing QoL. Advice was generated for all questions with different levels within each to ensure appropriate tailored advice generation. Levels were agreed with clinicians based on CTCAE grading. Testing included IT, patient, HCP and academic feedback to ensure the WBI was fit for purpose, user-friendly, accurate and reliable. Feedback was used to finalise the content of the intervention.

Conclusion: The WBI was developed in response to patient identified needs. A prospective clinical feasibility study was subsequently designed to evaluate acceptability, usability and perceived usefulness of the WBI in newly diagnosed breast cancer patients.