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.

Abstract 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 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 the post-measures. OA users were more sociodemographically and clinically diverse than RCT users; had higher baseline distress (OA Mpre=36.7, SD = 26.5; RCT Mpre= 26.5, SD = 21.7), and reported larger pre-post reductions than their RCT counterparts (OA Mpost=23.9, SD = 20.7; RCT Mpost=21.2, SD = 21.2). Moderate improvements in mental QOL occurred during OA (Mpre=37.3, SD = 12.6; Mpost=44.5, SD = 12.1), broadly replicating RCT findings. Conclusion Findings that OA users were more medically and socio-demographically 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 designed, tailoring, and dissemination.