Tailoring information to older colorectal cancer patients: Effects of using a web-based patient-directed tool

H1: Exposure to the Patient Navigator as compared to usual care will have a short-term positive effect on anxiety before the consultation (H1a), patient participation during consultation (H1b), anxiety directly after the consultation (H1c), evaluation of the communication (H1d) and information recall (H1e).



H2: Exposure to the Patient Navigator as compared to usual care will have an intermediate (4 weeks) and long term (3 months) positive effect on anxiety (H2a), communication evaluation (H2b) and information recall (H2c).



H3: The relationship between exposure to the Patient Navigator and recall of information is mediated by anxiety before and after the consultation (H3a), patient participation during consultation (H3b) and evaluation of the communication (H3c).



H4: Age and age-related differences in ability and motivation moderate the effects of exposure to a tailored website on information recall.



For the website evaluation, we will observe the patients' website usage. Therefore, the number of website visits and the number and kind of pages viewed will be logged. In addition website involvement and website satisfaction will be measured. The following research questions are posed to evaluate website usage, website involvement and website satisfaction, and the relationship with patient participation during consultation:



RQ1: What are the differences between younger (< 70) and older (> 70) cancer patients in website usage, website involvement and website satisfaction?



RQ2: What is the relationship between usage of the Patient Navigator to prepare for the consultation and patient participation during consultation?



RQ3: What is the effect of website usage on recall of information, and to what extent is this effect mediated by website involvement and website satisfaction?

T1a: Patient questionnaire 1a (one day before the consultation by phone)

T1b: Patient questionnaire 1b (paper questionnaire prior to consultation)

T2a: First consultation with surgeon (audio-taped for content analysis)

T2b: Patient questionnaire 2b (paper questionnaire immediately after consultation)

T2c: Patient questionnaire 2c (one day after the consultation by phone)

T3: Patient questionnaire 3 (follow-up after 4 weeks by phone)

T4: Patient questionnaire 4 (follow-up after 3 months by phone)

Patients will be assigned to an experimental condition that receives the Patient Navigator in addition to usual care or to a control condition that receives usual care. Randomization takes place at hospital level, i.e. three hospitals will implement the Patient Navigator and three hospitals will serve as control condition hospitals and will implement the Patient Navigator after the study has finished. The Patient Navigator is a website for older colorectal cancer patients that is systematically developed in the first part of the OCA-2 study. The Patient Navigator offers tailored information about diagnostic tests, treatments and follow-up facilities (i.e., only content that is relevant for the specific patient is showed). Moreover, the Patient Navigator offers the possibility to upload audiotaped consultations and contains tools to help patients preparing for consultations (so called Question Prompt Lists; one with general questions that people can ask about every treatment, and 13 about specific tests or treatments).