Table 3

Internet-based support interventions randomised controlled trials: study characteristics and results

Author/year/country	Sample size (I/C)	Intervention description	Intervention characteristics	Intervention content elements	Duration	Outcomes/ measurements	Results
Lally et al 2020 USA16	43/57	Name: Tailored self-mannagement psychoeducational programme Structure: Five module of supportive oncology-based psychoeducation and cognitive-behavioural techniques, coping skills, problem solving, communication strategies and validation.	Delivery: Web Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: √	Information support; Psychological support; Peer Support.	12 weeks	Psychological distress (DT, CES-D, IES）	No significant outcomes.
Zhu et al 2018 China17	57/57	Name: Mobile Breast Cancer e-Support Programme Structure: Learning Forum (information related to breast cancer disease and symptom management), Discussion Forum (anonymous support group), Consult an Expert (online consultation) and Personal Stories (interview stories of breast cancer survivors).	Delivery: Application Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support;Interaction with healthcare professionals; Peer support.	3 months	QOL (FACT-B) Symptom distress (MDASI) Self-efficacy (SICPA) Social support (MSPSS) Anxiety and depression (HADS)	6.64; 95% CI 0.77 to 12.50; p=0.03, d=0.46 –0.73; 95% CI −1.35 to −0.11; p=0.002; d=−0.51 21.05; 95% CI 1.87 to 40.22; p=0.03; d=0.53 No significant outcomes. No significant outcomes.
Korkmaz et al 2020 Turkey18	24/24/ 24	Name: A web-based education programme Structure: Provides education or coach to patients with breast cancer in the preoperative and postoperative process.	Delivery: Web Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: ×	Information support.	1 month	Anxiety (STAI) QOL (SF 36)	P<0.05 P<0.05
White et al 2018 Australia19	177/202	Name: An information- based, breast cancer specific website Structure: Information module, emotional responses, support services, family responses and life after cancer, a diary.	Delivery: Web Self-guided: √ Automated reminders: √ Face-to-face contact: × Tailored: ×	Information support; Psychological support.	6 months	Anxiety and Depression (HADS) QOL (FACT-B	No significant outcomes. T1–T2 (χ2_df=1=6.46, p=0.01)
Admiraal et al 2017 Netherlands20	69/69	Name: Tailored self-mannagement psychoeducational programme Structure: (1) problem orientation; and (2) fully automated and customised psychoeducation for reported problems; and (3) resources and services for reported problems.	Delivery: Web Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: √	Information support; Psychological support.	12 weeks	QOL (EORTC QLQ-C30 and the QLQ-BR23) Psychological distress (DT/PL)	No significant outcomes.
Ventura et al 2017 Sweden21	121/105	Name: Swedish Interactive Rehabilitation Information programme Structure: Includes links to web pages and lectures last for 4 hours about two modules: medical issues arising and psychosocial aspects.	Delivery: A computer-based programme Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support.	9 months	Anxiety and depression (HADS) Self-efficacy (CHESS)	No significant outcomes.
Wheelock et al 2015 USA22	41/59	Name: A web-based system for symptom management Structure: Three routine clinical follow-up appointments, self-reported symptoms, with review by nurse practitioners, targeted education and triage.	Delivery: Web +computer system Self-guided：× Automated reminders: × Face-to-face contact: × Tailored: √	Information support; Symptom management; Interaction with healthcare professionals.	18 months	Symptom prevalence (patients self-reported)	7.36 vs 3.2; p=0.0045
Du and Yao 2021 China23	40/40	Name: Follow-up management intervention based on clinical decision support system Structure: Fills in the corresponding health status evaluation sheet, the system automatically interprets the results of the evaluation sheet and triggers an abnormal state alarm, the normal state gives a follow-up/treatment reminder, and the abnormal state pushes-related health education courses or intervention from medical staff.	Delivery: A full-process information management system Self-guided: × Automated reminders: √ Face-to-face contact: × Tailored: √	Information support; Symptom management; Interaction with healthcare professionals.	6 months	Symptom severity (myelosuppression) Self-efficacy (SUPPH)	P<0.05 P<0.05
Hou et al 2020 Taiwan24	59/53	Name: A Self-Management Support mHealth Application Intervention Structure: Eight main features (1) evidence or knowledge about breast cancer, (2) exercise and rehabilitation after surgery, (3) diet and nutrition for breast cancer patients, (4) emotional support to prevent anxiety and depression, (5) personal health records to track treatment and side effects, (6) information on social resources, (7) experience sharing and (8) expert consulting.	Delivery: Application Self-guided: √ Automated reminders: √ Face-to-face contact: × Tailored: ×	Information support; Symptom management; Behaviour management Psychological support; Interaction with healthcare professionals; Peer support.	3 months	QOL (QLQ-C30 andQLQ-BR23)	83.45 vs 82.23, p=0.03 (QLQ-C30) ; 265.53 vs 63.13, p=0.04 (QLQ-BR23)
Graetz et al 2018 USA25	25/23	Name: A mobile application for managing adverse symptoms. Structure: Test the use of the application designed with and without weekly reminders for patients to report real-time symptoms and AI use outside of clinical visits with built-in alerts to patients’ oncology providers.	Delivery: Application Self-guided:√ Automated reminders:√ Face-to-face contact: × Tailored:√	Information support Symptom management; Behaviour management.	8 weeks	Symptom distress (FACT-ES)	No significant outcomes.
Fjell et al 2020 Sweden26	75/74	Name: An interactive application intervention Structure: Symptom self- reporting, an alert system for contacting healthcare professionals, access to self-care advice and a visual chart of symptom history.	Delivery: Application Self-guided: √ Automated reminders: √ Face-to-face contact: × Tailored: √	Information support; Symptom management; Interaction with healthcare professionals.	2 weeks	QOL (EORTC QLQ-C30) Symptom distress (MSAS)	Emotional functioning (p=0.008); nausea and vomiting (p=0.007), appetite loss (p=0.027), constipation (p=0 .007), P=0.033, Effect size (0.26 to 0.34)
Handa et al 2020 Japan27	52/50	Name: A breast cancer patient support system application. Structure: Record the patient’s subjective and objective symptoms by time and number, provides tips for self-care, including advice on when the patient should go for check-ups, and ways to manage side effects.	Delivery: Application Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Symptom management.	12 weeks	Anxiety and depression (HADS)	No significant outcomes.
Rosen et al 2018 USA28	55/57	Name: Application-delivered mindfulness training intervention Structure: Includes techniques for calming meditation (eg, focus on the breath) and insight meditation (eg, cultivating awareness, insight and compassion).	Delivery: Application Self-guided:√ Automated reminders: Face-to-face contact: × Tailored ×	Information support; Psychological support.	8 weeks	QOL (FACT-B)	t (258.40)=3.09, P<0.01, 95% CI (2.71 to 11.90)
Zhou et al 2019 China29	66/66	Name: Cyclic adjustment training intervention Structure: Relaxed deep breath training; music listening; anticancer stories reading/ listening/watching; adjust experiences and feelings sharing with peers;be instructed to self-ask the following questions.	Delivery: WeChat Self-guided: × Automated reminders: × Face-to-face contact: √ Tailored: ×	Information support; Psychological support; Interaction with healthcare professionals; Peer support.	12 weeks	Depression (SDS) Anxiety (SAS)	F=26.32, p<0.001 F=31.85, p<0.001
Zhou et al 2020 China30	55/56	Name: WeChat-based multimodal nursing program Structure: Provision of information, training, support, and counselling centred and oriented to the needs of breast cancer patients, involving physical, psychological and social adjustment distress.	Delivery: WeChat Self-guided: × Automated reminders: × Face-to-face contact: √ Tailored: ×	Information support; Psychological support; Interaction with healthcare professionals; Peer support.	6 months	QOL (FACT-B) Pain/fatigue/sleep symptom (NRS)	F=16.28, p<0.001 No significant outcomes.
Foley et al 2016 Ireland31	26/13	Name: Patient accessed tailored information Intervention Structure: Tailored surgical information pertaining to individual patients and the scripts were reviewed by the National Adult Literacy Agency and contain basic breast cancer biology, the different treatments used and surgical techniques.	Delivery: Application Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: √	Information support.	2 weeks	Anxiety and depression (HADS)	P=0.022 (anxiety) P=0.029 (depression)
Wang et al 2019 China32	44/44	Name: Continuous rehabilitation nursing support intervention Structure: Knowledge sharing, health consultations, sharing of feelings and experiences between patients, relax training; cope with negative emotions.	Delivery: WeChat Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Psychological support; Interaction with healthcare professionals; Peer support.	6 months	QOL (FACT-B) Pain, fatigue, and sleep severity (NRS)	P<0.001 No significant outcomes.
Sherman et al 2018 Australia33	155/149	Name: Structured Online Writing Exercise Intervention Structure: Individuals could describe their deepest thoughts and emotions with specific prompts focused on self-compassion according to a modified expressive writing prompt.	Delivery: Web Self-guided：√ Automated reminders：× Face-to-face contact: × Tailored: ×	Psychological support.	NA	Anxiety and depression (DASS) Body image distress (BIS)	P=0 .001 (depression); P=0.007 (anxiety) P=0.035
Villani et al 2018 Italy34	14/15	Name: E-health Stress Inoculation Training (SIT) intervention Structure: Face-to-face counselling with a psychologist, live videos simulating the chemotherapy process, watching live video interviews with women who have experienced breast cancer, relaxation videos with guided meditation audio.	Delivery: Web Self-guided: × Automated reminders:× Face-to-face contact:√ Tailored: ×	Psychological support; Interaction with healthcare professionals; Peer support.	3 months	QOL (FACT-B) Emotional Depression (ERQ)	P<0.05 (3 months after the end of the intervention) P<0.05 (3 months after the end of the intervention)
Liu et al 2019 China35	50/50	Name: Innovative Follow-Up Intervention Structure: Provide preoperative rehabilitation guidance, discharge follow-up form and endocrine medication survey form, health consultation.	Delivery: WeChat Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Behaviour management; Interaction with healthcare professionals; Peer support.	12 months	Self-efficacy (GSES)	P<0.05
Kim and Kim 2020 North- Korea36		Name: A web-based expert support self-management programme (WEST) Structure: Keep a health diary, self-diagnose lifestyle, learn health information and receive individualised feedback from a nurse, phone counselling with experts.	Delivery: Application Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: √	Information support; Behaviour management; Interaction with healthcare professionals.	6 months	Self-efficacy (health-specific self-efficacy scales)	No significant outcomes.
Im et al 2020 USA38	66/49	Name: Technology-Based Information and Coaching/ Support Programme on Pain and Symptoms Structure: Online knowledge or education with cultural characteristics, online assistance resources, group and one-on-one guidance in the form of online forums on the website.	Delivery: Web Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: √	Information support; Interaction with healthcare professionals; Peer support.	3 months	Symptom distress (MSAS-SF)	P=0.0229
Wang et al 2019 China39	75/74/\	Name: Specialised case management intervention Structure: Establish case management files, push the answers to patient questions, share knowledge, remind and supervise the implementation of the patient’s personal plan daily, including medication, symptoms, and weight.	Delivery: WeChat Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Interaction with healthcare professionals; Peer support.	9 months	Symptom severity (CTCAE)	P<0.05
Visser et al 2018 Netherlands40	50/59	Name: Group medical consultations (GMCs) and tablet-based online support group sessions Structure: A face-to-face GMC and an online application, consisting of three tablet-based video GMCs, email, videos and additional information.	Delivery: Application Self-guided: × Automated reminders:√ Face-to-face contact: × Tailored: √	Information support; Interaction with healthcare professionals; Peer support.	3 months	Psychological distress (SCL-90)	No significant outcomes.
Peng et al 2020 China41	59/58	Name: Online and offline rehabilitation intervention Structure: online and offline rehabilitation volunteer support activities, case management file establishment and offline rehabilitation guidance, online rehabilitation knowledge guidance and rehabilitation consultation and Q&A.	Delivery: WeChat Self-guided: × Automated reminders: × Face-to-face contact: √ Tailored: ×	Information support; Psychological support; Interaction with healthcare professionals; Peer support.	12 months	QOL (QLQ-BR53) Body image distress (BIS)	P<0.05 P<0.05
Chee et al 2016 USA54	30/35	Name: A culturally tailored internet cancer support group Structure: (a) interactive online message board by moderated a registered nurse; (b) interactive online evidence-based educational sessions; and (c) online resources.	Delivery: Web Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Interaction with healthcare professionals; Peer support.	1 month	QoL (FACT-B) Symptom distress (MSAS-SF) Social support (PRQ) self-efficacy (CBI)	P<0.10 P<0.10 No significant outcomes. No significant outcomes.
Wang et al 2017 China57	320/ 318/	Name: Continuous nursing intervention Structure: Regularly provides the service like medical information, care reminders, health monitoring and health education.	Delivery: Application Self-guided: × Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Symptom management; Interaction with healthcare professionals; Peer support.	2 weeks	QOL (QLSBC) Anxiety and depression (EESS) Prevalence of adverse reactions	P<0.01 P<0.01 P<0.05
Li and Hanping 2018 China58	60/60	Name: Management of chemotherapy adverse events Structure: Information support, alert for chemotherapy adverse events, personalised management from a case manager or multidisciplinary expert, SMS alert feedback.	Self-guided: √ Automated reminders: √ Face-to-face contact: × Tailored: √	Information support; Symptom management; Interaction with healthcare professionals.	2 weeks	QOL (FACT-B) Symptom prevalence (CTCAE, V.4.0)	P<0.05 P<0.05
Chen et al 2015 China59	45/45	Name: Tracking intervention based on network information platform Structure: Through the system, follow-up nurses participate in the diagnosis and treatment process of the patient during the hospitalisation process,provide post-discharge patient greetings, rehabilitation guidance, reminders for follow-up and other nursing services.	Delivery: Web Self-guided: × Automated reminders: √ Face-to-face contact: √ Tailored: ×	Information support; Interaction with healthcare professionals Peer support.	3 months	QOL (FACT-B) Depression (CES-D)	P<0.05 P<0.01
Egbring et al 2016 Switzerland60	46/49/ 44	Name: A mobile and web-based application to record daily functional activity and adverse events. Structure: Record functional activity and adverse events, and collaborate with physicians in the monitoring and review of patient-reported symptoms.	Delivery: Application Self-guided: √ Automated reminders: × Face-to-face contact: × Tailored: ×	Information support; Symptom management; Interaction with healthcare professionals.	42 days	Symptom prevalence (patients self-reported)	n=1033 (supervised application group) vs n=656 (questionnaire group).

BIS, Body Image Scale; CBI, Cancer Behavior Inventory; CES-D, Center for Epidemiological Survey-Depression Scale; CTCAE, Common Terminology Criteria for Adverse Events; DASS, Depression Anxiety Stress Scale; EESS, Eysenck Emotional Stability Scale; EORTC, The European Organization for Research and Treatment of Cancer ; ERQ, The Emotion Regulation Questionnaire; FACT-B, Functional Assessment of Cancer Treatment-B; GSES, General Self-Efficacy Scale; HADS, The Hospital Anxiety and Depression Scale; MSAS-SF, The Memorial Symptom Assessment Scale–Short Form; NRS, Numerical Rating Scale; PRQ, Personal Resource Questionnaire; QLQ, quality of life questionnaire; QLSBC, quality of life scale of beast cancer; SAS, Self-Rating Anxiety Scale; SCL, Symptom Checklist; SDS, Self-Rating Depression Scale; SICPA, Stanford Inventory of Cancer Patient Adjustment; SMS, short message service; STAI, The State-Trait Anxiety Inventory; SUPPH, Strategies Used by People to Promote Health.