Background/rationale: Few digital psycho-oncology programs have been implemented into routine practice; how well these programs are adopted and utilised after clinical trial completion is relatively unexplored. To address this gap, following the completion of our Finding My Way RCT, we implemented this 6 module CBT-based program into routine practice. This paper summarises differences in uptake, usage, and psychosocial outcomes between RCT and implementation.
Methods: Implementation data was collected for two years to match the RCT (16th February 2017- 14th February 2019). The program was promoted via (1) media / social releases; (2) public lectures; (3) radio interviews and podcasts; and (4) clinician referral. Measures included the number of enrolled users, number of modules completed, and optional pre- and post-measures of distress (DASS-21) and QOL (SF-12).
Results: Uptake was lower in implementation (n=120) than RCT (n=191). Usage differed markedly: 50% of RCT intervention participants completed a ‘therapeutic dose’ (4+ modules), vs 13% in implementation. Specifically, in implementation 32% completed only 1 module (vs 19% in RCT), and 31% completed 0 modules (vs 12% in RCT). Only 5% of implementation registrants completed the program (vs. 29% in RCT). Attrition was high (n=13 participants completed post-treatment). ‘Real world’ users had higher levels of baseline distress (M=36.67) than their clinical trial counterparts (M=27.1); with larger decreases occurring from pre- to post in implementation (M=25.85) vs RCT (M=21.2). Moderate improvements in mental QOL were observed during implementation (Mpre=37.27; Mpost=44.45).
Conclusion and clinical implications: While digital health is cited as a way of addressing workforce shortfalls and meeting user preferences, usage is concerningly low in implementation. This has implications for sustainability, thus further research is required to explore ways of increasing uptake and engagement during implementation of evidence-based programs.