Wonshik Chee

Breast cancer is the most diagnosed cancer among women in the United States, with a greater increase in incidence among Asian American women than among others. Despite having resided in the United States for decades, Asian American breast cancer survivors face unique cultural challenges, including stigma and reluctance to disclose their illness. We present a Viewpoint to discuss practical issues encountered in implementing a culturally tailored, technology-based program aimed at reducing pain and depressive symptoms in Asian American breast cancer survivors. This Viewpoint is a simple ancillary content analysis of meeting minutes and research diaries from a parent study of cancer pain management; here, we identify themes related to practical issues in conducting a culturally tailored, technology-based intervention among Asian American breast cancer survivors with pain and depressive symptoms. Key issues identified include (1) reluctance to disclose, (2) variability in engagement based on disease status, (3) the need for personalized support, and (4) intraethnic differences related to various factors. Suggestions for future research include (1) tailoring communication to participants’ preferences while building trust over time, (2) applying flexible care strategies, (3) assessing individual needs early and adapting materials based on feedback, (4) matching participants with interventionists according to language and level of acculturation, and (5) respecting differences in cultural identities between ethnic subgroups. Addressing these challenges can improve the effectiveness of technology-based interventions for racial or ethnic minority groups.

BACKGROUND Breast cancer is the most diagnosed cancer among women in the U.S., with a greater increase in incidence among Asian American women than among others. Despite having resided in the U.S. for decades, Asian American breast cancer survivors face unique cultural challenges, including stigma and reluctance to disclose their illness. OBJECTIVE This study aimed to discuss practical issues encountered in implementing a culturally tailored, technology-based program aimed at reducing pain and depressive symptoms in Asian American breast cancer survivors. METHODS This study was analyzed using simple content analysis based on meeting minutes and research diaries from the parent study to identify themes related to practical issues in conducting a culturally tailored, technology-based intervention among Asian American breast cancer survivors with pain and depressive symptoms. RESULTS Key issues identified include (a) reluctance to disclose; (b) variability in engagement, based on disease status; (c) need for personalized support; and (d) intra-ethnic differences related to various factors. CONCLUSIONS Suggestions for future research include (a) tailoring communication to participants’ preferences while building trust over time, (b) applying flexible care strategies, (c) assessing individual needs early and adapting materials based on feedback, (d) matching participants with interventionists according to language and level of acculturation, and (e) respecting differences in cultural identities between ethnic subgroups. Addressing these challenges can improve the effectiveness of technology-based interventions for racial/ethnic minority groups CLINICALTRIAL ClinicalTrials.gov NCT06085313; https://clinicaltrials.gov/study/NCT06085313

Background: Virtual interventions using computers and mobile devices have increasingly been developed and tested among racial and ethnic minorities in recent years. Yet, few virtual interventions have been developed for Asian American midlife women who are family caregivers of persons living with Alzheimer’s disease (AD). Furthermore, little is known about the feasibility of recruiting this specific group of racial/ethnic minority midlife women to a virtual intervention study. Objective: The purpose of this paper is to discuss practical issues in recruiting and retaining this specific group of racial/ethnic minority midlife women for a virtual intervention study. Methods: The ongoing parent study is to develop and test a preliminary version of a virtual intervention for this specific population. During the research process, the research team had regular meetings to have discussions on recruitment and retention issues and each team member wrote research diaries. A content analysis was conducted with the written records including the research team’s research diaries and meeting minutes. Results: The issues were: (1) an extremely small pool of Asian American midlife women who were family caregivers of persons living with AD; (2) competitions with other studies, (3) practicality of inclusion/exclusion criteria, (4) lack of time and interests in research participation, and (5) negative perception of small monetary incentives. Conclusion: Future researchers need to consider the unique cultural and social dynamics of this specific population, foster trusted connections with the communities before initiating the study, and obtain feedback from potential gatekeepers and the communities in advance.

Background: Midlife women play a major role as the family caregivers of persons living with Alzheimer’s disease (PLAD). Cultural differences are frequently the major reason for the high risk faced by racial and ethnic minority family caregivers. However, little is known about the characteristics of midlife women family caregivers that are linked to their negative attitudes toward Alzheimer’s disease and dementia care. Objective: This study aimed to determine the characteristics of midlife women who were family caregivers of PLAD that were linked to their negative attitudes toward Alzheimer’s disease and dementia caregiving. Methods: A secondary data analysis was conducted using data from 172 midlife women who were family caregivers of PLAD and participated in a large cross-sectional online survey. Linear multiple regression analyses were used for the data analysis. Results: Participants’ attitude toward Alzheimer’s disease and related dementia scores were significantly associated with employment status, race/ethnicity (Hispanic), and instrumental activities of daily living. Those who were unemployed, Hispanic, and with low instrumental activities of daily living tended to have negative attitudes toward Alzheimer’s disease and dementia care. Conclusions: Additional interventions should be developed to improve attitudes toward caring for persons with Alzheimer’s disease and dementia in this specific group of midlife women who are family caregivers of PLAD.

Background: Mainly due to their cultural attitudes toward symptoms and breast cancer, Asian American breast cancer survivors tend to suffer from symptoms and often delay in getting treatments, information, and support. To improve their symptom management, it would be important to determine risk groups among them. Decision tree analyses reportedly help determine risk groups by identifying the characteristics that are directly associated with target health outcomes. Objective: Using a decision tree analysis, this study aimed at identifying the characteristics that were closely linked to the symptom experience of Asian American breast cancer survivors. Methods: This was a part of a parent randomized controlled trial among Asian American breast cancer survivors. Only the data from 135 women at the pre-test were included. Multiple instruments were used to collect the data: the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the PRQ-2000, the Perceived Isolation Scale, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using latent profile analysis and decision tree analyses. Results: Two most frequently found profiles included the low symptom experience profile (72.6%) and the high symptom experience profile (27.4%). The high symptom experience profile was predicted by 2 combined characteristics; (a) high psychological needs for help (over 60.00 points), and (b) low psychological needs for help (cut point = 60.00), high perceived barriers (cut point = 1.62), and high social isolation (social support) (cut point = 2.33). Conclusions: These characteristics linked to Asian American breast cancer survivors with high symptom experience need to be considered in future intervention development.

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC’s survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1

Background: Patients with colorectal cancer (CRC) receiving chemotherapy often experience psychoneurological symptoms (PNS; ie, fatigue, depression, anxiety, sleep disturbance, pain, and cognitive dysfunction) that negatively impact both patients’ and their caregivers’ health outcomes. Limited information is available on PNS management for CRC patient and caregiver dyads. Objective: The purposes of this study are to (1) develop a web-based dyadic intervention for patients with CRC receiving chemotherapy and their caregivers (CRCweb) and (2) evaluate the feasibility, acceptability, and preliminary effects of CRCweb among patient-caregiver dyads in a cancer clinic. Methods: A mixed methods approach will be used. Semistructured interviews among 8 dyads will be conducted to develop CRCweb. A single-group pre- and posttest clinical trial will be used to examine the feasibility, acceptability, and preliminary effects of the intervention (CRCweb) among 20 dyads. Study assessments will be conducted before (T1) and after intervention (T2). Content analysis will be performed for semistructured interviews. Descriptive statistics will be calculated separately for patients and caregivers, and pre-post paired t tests will be used to evaluate treatment effects. Results: This study was funded in November 2022. As of April 2023, we have obtained institutional review board approval and completed clinical trial registration and are currently recruiting patient-caregiver dyads in a cancer clinic. The study is expected to be completed in October 2024. Conclusions: Developing a web-based dyadic intervention holds great promise to reduce the PNS burden in patients with CRC receiving chemotherapy and their caregivers. The findings from this study will advance intervention development and implementation of symptom management and palliative care for patients with cancer and their caregivers. Trial Registration: ClinicalTrials.gov NCT05663203; https://clinicaltrials.gov/ct2/show/NCT05663203 International Registered Report Identifier (IRRID): PRR1-10.2196/48499

BACKGROUND Patients with colorectal cancer (CRC) receiving chemotherapy often experience psychoneurological symptoms (PNS; ie, fatigue, depression, anxiety, sleep disturbance, pain, and cognitive dysfunction) that negatively impact both patients’ and their caregivers’ health outcomes. Limited information is available on PNS management for CRC patient and caregiver dyads. OBJECTIVE The purposes of this study are to (1) develop a web-based dyadic intervention for patients with CRC receiving chemotherapy and their caregivers (CRCweb) and (2) evaluate the feasibility, acceptability, and preliminary effects of CRCweb among patient-caregiver dyads in a cancer clinic. METHODS A mixed methods approach will be used. Semistructured interviews among 8 dyads will be conducted to develop CRCweb. A single-group pre- and posttest clinical trial will be used to examine the feasibility, acceptability, and preliminary effects of the intervention (CRCweb) among 20 dyads. Study assessments will be conducted before (T1) and after intervention (T2). Content analysis will be performed for semistructured interviews. Descriptive statistics will be calculated separately for patients and caregivers, and pre-post paired t tests will be used to evaluate treatment effects. RESULTS This study was funded in November 2022. As of April 2023, we have obtained institutional review board approval and completed clinical trial registration and are currently recruiting patient-caregiver dyads in a cancer clinic. The study is expected to be completed in October 2024. CONCLUSIONS Developing a web-based dyadic intervention holds great promise to reduce the PNS burden in patients with CRC receiving chemotherapy and their caregivers. The findings from this study will advance intervention development and implementation of symptom management and palliative care for patients with cancer and their caregivers. CLINICALTRIAL ClinicalTrials.gov NCT05663203; https://clinicaltrials.gov/ct2/show/NCT05663203 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/48499