Improving Oral Health and Quality of Life After Oral Cancer: A Web-based Approach

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DESCRIPTION (provided by applicant): Survivors of oral cancers experience persistent sequelae, including abnormally reduced salivation or difficulty swallowing related to their disease and treatment. To minimize subsequent cancer risk and reduce these sequelae, survivors are advised to follow intensive home-based oral care protocols, swallowing rehabilitation regimens, and to make healthy lifestyle changes. Adherence, however, is poor. Although family caregivers can support adherence, they are often unprepared for their caregiving role and have significant knowledge gaps about oral care and rehabilitation. Behavioral interventions that actively involve survivors and their caregivers may prove effective in improving oral health and QOL in this population. This project seeks to establish the feasibility of an interactive, web-based, multimedia intervention called Computer Assisted oral health REhabilitation and Support (CARES). The intervention is based on Self Determination Theory (SDT), which focuses on individuals' needs for developing autonomy (a sense of choice and volition), competence (self-efficacy), and relatedness (a sense of belonging and connection to similar others). CARES seeks to deliver: 1) expert information and personalized behavioral self-assessment to improve motivation for adherence; 2) skills-building exercises to enhance competence for behavioral self- management; 3) reminders sent via text message and email to increase adherence; 4) strategies for caregivers to provide motivating support; and, 5) message boards to promote connection and support. Intervention content will be developed by the multidisciplinary research team, and evaluated by both an external advisory board and in-depth interviews with 18 oral cancer survivors/caregivers. Feasibility of the web-based prototype will be evaluated with 14 oral cancer survivors/caregivers. We will consider the project feasible if at least 75% of participants rate the program as easy to use and relevant to their concerns, easy to understand, and easy to navigate. Finally, 35 survivor-caregiver dyads will be recruited upon completion of radiation treatment (baseline) and we will assess whether those receiving the intervention (N=20) experience significant improvements 1 and 3 months later on self-report and objective measures of dental health, swallowing rehabilitation, and QOL relative to those in a usual care (UC) control group (N=15). Innovation: CARES is the first interactive multimedia intervention that targets oral cancer survivors and their caregivers. It is also the first that takes a multiple-behavioral approach to improving oral health and rehabilitation in this population. Simultaneously addressing oral care, swallowing, and nutritional issues may result in maximal risk reduction and improve QOL. Impact: By providing a personalized self-management and entertaining, interactive, and highly informative oral health modules, CARES holds great promise for motivating adherence and improving QOL for both oral cancer survivors and their caregivers. The web-based platform has great potential for nationwide dissemination and reach to the target population.