Finding My Way from clinical trial to open access dissemination: comparison of uptake, adherence, and psychosocial outcomes of an online program for cancer-related distress

PURPOSE: Few digital psycho-oncology programs have been adopted into routine practice; how these programs are used after trial completion remains unexplored. To address this, the present study transitioned our evidence-based 6-module CBT-based program, Finding My Way, into open access (OA) after completion of the RCT, and compared uptake, usage, and psychosocial outcomes to the earlier RCT. METHODS: Recruitment was passive, via promotion through (1) media and social media releases, (2) public lectures, (3) radio interviews and podcasts, and (4) clinician-initiated referral. Measures included number of enrolled users, number of modules completed, and pre- and optional post-measures of distress and quality of life (QOL). RESULTS: Uptake was lower in OA (n = 120; 63% of RCT). Usage was markedly lower: 1.5 modules were completed on average (vs 3.7 in RCT), and only 13% completed a ‘therapeutic dose’ of 4 + modules (vs. 50% in RCT). Research attrition was high; n = 13 completed post-measures. OA users were more sociodemographically and clinically diverse than RCT users, had higher baseline distress (OA M(pre) = 36.7, SD = 26.5; RCT M(pre) = 26.5, SD = 21.7), and reported larger pre-post reductions than their RCT counterparts (OA M(post) = 23.9, SD = 20.7; RCT M(post) = 21.2, SD = 21.2). Moderate improvements in mental QOL occurred during OA (M(pre) = 37.3, SD = 12.6; M(post) = 44.5, SD = 12.1), broadly replicating RCT findings. CONCLUSION: Findings that OA users were more medically and sociodemographically diverse and distressed at baseline than their RCT counterparts, and — despite having lower usage of the program — achieved larger changes from baseline to post-program, will help to shape future intervention design, tailoring, and dissemination.