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Grant Details

Grant Number: 5R37CA262025-02 Interpret this number
Primary Investigator: Thomas, Teresa
Organization: University Of Pittsburgh At Pittsburgh
Project Title: Efficacy of a Self-Advocacy Serious Game Intervention for Women with Advanced Cancer
Fiscal Year: 2022


Project Summary Individuals with cancer must overcome multiple, ongoing challenges (“self-advocate”) related to their cancer experience to receive patient-centered care. Women with metastatic breast or advanced gynecologic cancer often face significant challenges managing their quality of life concerns and cancer- and treatment-related symptoms. If they do not self-advocate to manage these concerns, they risk having poor quality of life, high symptom burden, and care that is not patient-centered. Serious games (video games that teach) are effective health interventions that allow users to vicariously engage in situations reflecting their personal experiences, receive meaningful information, and learn personally relevant skills that they can apply in real life. The long- term objective of this work is to prepare patients with cancer to engage in patient-centered care by teaching them self-advocacy skills using immersive, accessible technologies. The goal of the current study is to test the efficacy of a novel intervention using a serious game platform to teach self-advocacy skills to women with metastatic breast or advanced gynecologic cancer. The Strong Together intervention consists of a multi- session, interactive serious game application with tailored self-advocacy goal-setting and training. The serious game is based on a self-advocacy conceptual framework and applies behavior change theories and serious game mechanisms to promote skill development and implementation. The game works by immersing users in the experiences of characters who are women with advanced cancer; requiring users to make decisions about how the characters self-advocate; demonstrating the positive and negative consequences of self-advocating or not, respectively; and providing multiple, individualized feedback mechanisms and game features to enforce self-advocacy skill acquisition and transference to real life. This study evaluates the efficacy of the Strong Together intervention by conducting a randomized clinical trial in 336 adult (ages >18 years) women within three months of a metastatic breast or Stage III or IV gynecologic cancer diagnosis. Participants will be randomly assigned to receive the 3-month Strong Together intervention or a paper self-advocacy guide. The primary outcome is patient self-advocacy. Secondary outcomes include quality of life, symptom burden, and patient-centered care. The central hypothesis is that the experimental group will have higher self-advocacy, quality of life, and patient-centered care and lower symptom burden compared to the paper self-advocacy guide group. As an exploratory outcome, we will determine if the intervention reduces suboptimal healthcare utilization. The study will also evaluate the behavioral and game mechanisms that influence the efficacy of the Strong Together intervention. This study provides the first theoretically based self-advocacy intervention for adult women with cancer and clarifies the mechanisms by which serious games teach skills and assist in transferring those skills to real life. Self-advocacy interventions have the potential to advance patient-centered care by providing patients with tangible skills that prepare them to meaningful engage in their cancer care.


Associations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer.
Authors: Bell S.G. , Althouse A.D. , Belin S.C. , Arnold R.M. , Smith K.J. , White D.B. , Chu E. , Schenker Y. , Thomas T.H. .
Source: Journal of palliative medicine, 2024 Apr; 27(4), p. 515-520.
PMID: 38574330
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The female self-advocacy in Cancer Survivorship scale is a psychometrically sound measure of self-advocacy in male cancer survivors.
Authors: Thomas T.H. , Scott P.W. , Nilsen M.L. , Lee J. , McCarthy M.E. , Harris A. , Johnson J. , Donovan H.S. .
Source: Psycho-oncology, 2024 Jan; 33(1), p. e6269.
EPub date: 2023-12-14.
PMID: 38095337
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Describing Self-Advocacy in Underrepresented Women With Advanced Cancer.
Authors: Bell S. , Bergeron R. , Murray P.J. , Gazaway S. , Hagan Thomas T. .
Source: Oncology nursing forum, 2023-10-19; 50(6), p. 725-734.
PMID: 37874756
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A Scoping Review on Work Experiences of Nurses After Being Diagnosed With Cancer.
Authors: You K.L. , Cummings M.H. , Bender C.M. , Fennimore L.A. , Rosenzweig M.Q. , Dierkes A.M. , Raina K.D. , Hagan Thomas T. .
Source: Oncology nursing forum, 2023-10-19; 50(6), p. 714-724.
PMID: 37874755
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What are We Asking Patients to Do? A Critical Ethical Review of the Limits of Patient Self-Advocacy in the Oncology Setting.
Authors: Wilkenfeld D.A. , Hagan Thomas T. .
Source: The New bioethics : a multidisciplinary journal of biotechnology and the body, 2023 Jun; 29(2), p. 181-190.
EPub date: 2022-11-14.
PMID: 36377241
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Testing the effects of the Strong Together self-advocacy serious game among women with advanced cancer: Protocol for the STRONG randomized clinical trial.
Authors: Thomas T.H. , Bender C. , Rosenzweig M. , Taylor S. , Sereika S.M. , Babichenko D. , You K.L. , Terry M.A. , Sabik L.M. , Schenker Y. .
Source: Contemporary clinical trials, 2023 Jan; 124, p. 107003.
EPub date: 2022-11-13.
PMID: 36379436
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Empowerment through technology: A systematic evaluation of the content and quality of mobile applications to empower individuals with cancer.
Authors: Thomas T.H. , Go K. , Go K. , McKinley N.J. , Dougherty K.R. , You K.L. , Lee Y.J. .
Source: International journal of medical informatics, 2022 Jul; 163, p. 104782.
EPub date: 2022-04-29.
PMID: 35525126
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Oncology Nurses' Role in Promoting Patient Self-Advocacy.
Authors: Alsbrook K.E. , Donovan H.S. , Wesmiller S.W. , Hagan Thomas T. .
Source: Clinical journal of oncology nursing, 2022-06-01; 26(3), p. 239-243.
PMID: 35604742
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Identifying Language Features Associated With Needs of Ovarian Cancer Patients and Caregivers Using Social Media.
Authors: Lee Y.J. , Jang H. , Campbell G. , Carenini G. , Thomas T. , Donovan H. .
Source: Cancer nursing, 2022 May-Jun 01; 45(3), p. E639-E645.
PMID: 33577203
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"I pretty much followed the law, and there weren't any decisions to make": A qualitative study of self-advocacy experiences of men with cancer.
Authors: Thomas T.H. , Hadley M.L. , Nilsen M.L. .
Source: Nursing & health sciences, 2022 Mar; 24(1), p. 34-43.
EPub date: 2021-12-26.
PMID: 34850513
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Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer.
Authors: Thomas T. , Althouse A. , Sigler L. , Arnold R. , Chu E. , White D.B. , Rosenzweig M. , Smith K. , Smith T.J. , Schenker Y. .
Source: Psycho-oncology, 2021 Jul; 30(7), p. 1086-1094.
EPub date: 2021-03-08.
PMID: 33547717
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