Using Smart-Messaging to Enhance Mindfulness-Based Cognitive Therapy for Cancer Patients: A Mixed Methods Proof of Concept Evaluation

<p>Objective. Depression and anxiety lead to reduced treatment adherence, poorer quality oflife, and increased care costs amongst cancer patients. Mindfulness-Based Cognitive Therapy(MBCT) is an effective treatment, but dropout reduces potential benefits. Smart-messagereminders can prevent dropout and improve effectiveness. However, smart-messaging isuntested for MBCT in cancer. This study evaluates smart-messaging to reduce dropout andimprove effectiveness in MBCT for cancer patients with depression or anxiety.Methods. Fifty-one cancer patients attending MBCT in a psycho-oncology service wereoffered a smart-messaging intervention, which reminded them of prescribed between-sessionactivities. Thirty patients accepted smart-messaging and 21 did not. Assessments ofdepression and anxiety were taken at baseline, session-by-session and one-month follow-up.Logistic regression and multilevel modelling compared the groups on treatment completionand clinical effectiveness. Fifteen post-treatment patient interviews explored smartmessaginguse.Results. The odds of programme completion were eight times greater for patients usingsmart-messaging compared with non-users, controlling for age, gender, baselinedepression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smartmessagingusers also reported greater improvement in depression over the programme (B = -2.33, SEB = .78, p = .004), when controlling for baseline severity, change over time, age, andnumber of sessions attended. There was no difference between groups in anxietyimprovement (B = -1.46, SEB = .86, p = .097). In interviews, smart-messaging was describedas a motivating reminder and source of personal connection.Conclusions. Smart-messaging may be an easily integrated telehealth intervention toimprove MBCT for cancer patients.</p>