e-Coach: Tailored cognitive-behavioral e-Health care for patients with chronic somatic conditions
The major aim is to develop, evaluate, and implement disease-generic cognitive-behavioral interventions through the internet in order to optimize tailored health care for patients with chronic somatic conditions.
- Henriët van Middendorp
- VSB Fonds
- Innovatiefonds Zorfverzekeraars
Having a chronic somatic condition can result in a variety of impairments in patients’ daily lives, including not only physical complaints such as pain, itch, and fatigue, but also problems of negative mood and impairments in social relationships. This is especially true for patients with a psychological risk profile (e.g., patients with elevated levels of distress), which is an estimated 30-40% of patients. Both face-to-face and e-Health cognitive-behavioral treatments have shown to be effective in helping patients cope with these impairments. However, patients can experience difficulty accessing face-to-face treatments, due to limited physical mobility, high treatment costs, and stigma associated with psychological treatment. Internet-based cognitive-behavioral treatments have the potential to largely bypass these barriers, as these interventions can be attended at home with minimal remote therapist guidance.
This research program encompasses a series of applied studies developing and testing the (cost-)effectiveness of online disease-generic cognitive-behavioral interventions for chronic somatic conditions, termed e-Coach. This intervention enables patients to follow treatment online, potentially saving time and costs for both patients and caregivers. The E-coach intervention is guided by an e-Coach therapist, who gives individualized feedback on treatment assignments.
The goal of the intervention is to reduce the impact of the chronic somatic disease on the patients’ daily life. Patients’ treatment goals can be diverse; while the focus for one patient may be primarily on decreasing high levels of fatigue by finding a better balance of rest and activities, another patient may want to work on his/her mood problems by working on maladaptive negative cognitions, for example. The e-Coach consists of tailored treatment modules corresponding with the specific risk profiles of individual patients. Themes of these modules include physical, psychological, and social adjustment, such as pain, fatigue, mood problems, and social relationships. Each treatment module includes multiple assignments and reading texts, which the e-Coach therapist can tailor to the individual patient to suit individual needs.
Previous research has found positive results of the e-Coach intervention in patients with psoriasis and rheumatoid arthritis, and among living kidney donors (Ferwerda et al., 2017; Ferwerda et al., 2018; Spillekom-Van Koulil et al., 2018; Van Beugen et al., 2016; Van Beugen et al., 2019; Wirken et al., 2018). The e-Coach intervention has been implemented as part of the treatment program at the 'Leids Universitair Behandel- en Expertisecentrum' (LUBEC). Several research projects are currently ongoing with regard to the e-Coach program:
A current research project focuses on developing and evaluating an online screening tool to detect psychological distress and barriers for adopting and maintaining a healthy lifestyle, as well as an e-Coach treatment program to eliminate those barriers and promote facilitators for healthy life style behavior among patients with chronic kidney disease. This e-care path is being evaluated in a multicenter randomized controlled trial in four Dutch hospitals (PhD student Katja Cardol).
Another research project aims at assessing the effectiveness of the e-Coach treatment in kidney failure. It is expected that this online treatment will result in a decreased impact of the disease and its effects on patients' daily life. The effectiveness of the treatment will be evaluated in a multicenter randomized controlled trial in several Dutch hospitals and dialysis centers (PhD student Judith Tommel).
A different project ‘Grip on pain’ is part of a national project (‘Grip op klachten’) that is conducted in collaboration with the University Medical Center Groningen and the ‘Nederlands Kenniscentrum Chronische Vermoeidheid’ (NKCV; or ‘Expert Centre for Chronic Fatigue’). Grip on Pain aims to evaluate and implement an online chronic pain treatment among patients with hand osteoarthritis, fibromyalgia and chronic migraine within various health care centers (PhD student Jessy Terpstra).
Ferwerda M., Van Beugen S., Van Middendorp H., Spillekom-Van Koulil S., Donders A.R.T., Visser H., Taal E., Creemers M.C.W., Van Riel P.L.C.M. & Evers A.W.M. (2017), A tailored guided internet-based cognitive-behavioral intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care: Results of a randomized controlled trial, Pain 158(5): 868-878.
Ferwerda M., Van Beugen S., Van Middendorp H., Visser H., Vonkeman H.E., Creemers M.C.W., Van Riel P.C.L.M., Kievit W. & Evers A.W.M. (2018), A tailored, therapist-guided internet-based cognitive behavioral intervention as an addition to care as usual for patients with rheumatoid arthritis: economic evaluation, Journal of Medical Internet Research 20(10): e260.
Spillekom-Van Koulil S., Ferwerda M., Van Beugen S., Van Middendorp H., Van de Kerkhof P.C.M., Van Riel P.L.C.M. & Evers A.W.M. (2018), Tailored therapist-guided internet-based cognitive-behavioral treatment for psoriasis and rheumatoid arthritis: Two case reports, Acta Dermato-Venereologica 98(2): 225-233.
Van Beugen S., Ferwerda M., Spillekom-Van Koulil S., Smit J.V., Zeeuwen-Franssen M.E.J., Kroft E.B.M., De Jong E.M.G.J., Otero M.E., Donders A.R.T., Van de Kerkhof P.C.M., Van Middendorp H. & Evers A.W.M. (2016), Tailored therapist-guided internet-based cognitive behavioral treatment for psoriasis: a randomized controlled trial, Psychotherapy and Psychosomatics 85(5): 297-307.
Van Beugen S., Ferwerda M., Van Middendorp H., Smit J.V., Zeeuwen-Franssen M.E.J., Kroft E.B.M., De Jong E.M.G.J., Van de Kerkhof P.C.M., Kievit W. & Evers A.W.M. (2019), Economic evaluation of a tailored therapist-guided internet-based cognitive behavioural treatment for patients with psoriasis: a randomized controlled trial, British Journal of Dermatology 181(3): 614-616.
Wirken L., Van Middendorp H., Hooghof C.W., Bremer T.E., Hopman S.P.F., Pant K.A.M.I. van der, Hoitsma A.J., Hilbrands L.B. & Evers A.W.M. (2018), Development and feasibility of a guided and tailored internet-based cognitive-behavioural intervention for kidney donors and kidney donor candidates, BMJ Open 8: e020906.
Link toevoegen: https://www.universiteitleiden.nl/sociale-wetenschappen/lubec
Pillar: Diagnostics and treatments
Pillar: Evaluation and implementation
Topic: Healthy lifestyle and self-regulation
Topic: Itch and pain
Topic: Persistent physical symptoms