Congress Abstracts 2006

135

WEB-BASED INTERVENTIONS IN ONCOLOGY: MAINTAINING TREATMENT FIDELITY. Kristin Roper, RN, MS, OCN^®, Dana-Farber Cancer Institute, Boston, MA, and Sheila Judge Santacroce, PhD, APRN, CPNP, Yale University School of Nursing, New Haven, CT.

Treatment fidelity has been described, explained, and investigated in clinical trials in the field of behavioral science almost exclusively. The assessment of treatment fidelity is essential for clinical trials because it demonstrates that an intervention is conducted as intended. Oncology nurse researchers are using web- based support groups more frequently to assist and educate cancer patients before, during, and after treatment. It is therefore vital that the integrity of web-based oncology interventions be established.

The purpose of this presentation is to discuss the Technology Model as a framework to evaluate and monitor nursing interventions conducted over the Internet.

A computerized review of the literature was conducted from 1991 to 2005, using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PsychInfo databases. Published research reports reviewed examined the use of web-based interventions for psycho-education, coping skills training, and self-care management.

The literature describes common threats to the receipt and delivery of web-based interventions ranging from incidental technical difficulties creating slow transmission speeds to poor typing skills that create lag times and interfere with spontaneity. The Technology Model identifies three major fundamental requirements for monitoring the fidelity of clinical interventions: (1) specification of behavioral treatments in manuals; (2) therapist training; and (3) monitoring of treatment delivery. The first step in monitoring interventions is to include a detailed treatment manual of intervention logistics that creates an environment that fosters the consistent delivery of an intervention. Descriptions of study design, format structure, script instructions, intended dose, intervention frequency, timelines, and cost should be included in a manual that can be housed on internet web-sites. Secondly, standards for the ongoing supervision and evaluation of therapists in terms of skill level and treatment adherence to established guidelines can contribute to the precise delivery of an intervention. Training can involve participation in creative scenarios with computer-based role-playing sessions and the debriefing of transcribed communications. Lastly, the monitoring of web-based interventions can include the review of text communications for adherence to guidelines and oversight of therapist competence.

Oncology nurse researchers who apply the Technology Model can help ensure intervention fidelity and sound empirical nursing research.