# Designing for sustainability: Co-designing and testing the efficacy of a web-based toolkit to improve cancer-related emotional distress and anxiety for rural older cancer survivors

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2024 · $827,872

## Abstract

PROJECT SUMMARY: From 2019-2022, telehealth uptake in rural health clinics surged by 73%. This rapid acceleration
in telehealth uptake was driven by COVID-19 precautions, the permanent closure of rural hospitals, a massive shortage
of mental health professionals, and $1.5 billion in federal investment in broadband access. However, despite the
availability and investment in telehealth, many rural patients, especially rural older adults, lack the digital literacy
necessary to fully utilize it, exacerbating barriers to quality healthcare and hindering the potential benefits of telehealth
in expanding access to quality healthcare. Increasing rurality and older age are associated with lower digital literacy and
telehealth adoption, and rural older cancer survivors (ROCS) face compounded vulnerabilities, which are exacerbated
by the reduced access to mental health professionals in rural areas for ROCS experiencing cancer-related distress.
Cancer-related distress is stress and anxiety related to a cancer diagnosis and treatment. Telehealth providing support
for cancer-related distress is a promising strategy to expand care in rural areas with a shortage of mental health
professionals. Still, without interventions to address digital literacy, many ROCS will go without this critical care, thus
compromising their overall cancer outcomes. To this end, we developed CONNECT, a web-based toolkit targeting
digital literacy and mental health support for ROCS, employing a user-centered design approach and the Designing for
Dissemination and Sustainability logic model. CONNECT addresses digital literacy and supports for cancer-related
distress management through interactive activities for setting up telehealth visits, accessing educational materials about
cancer-related distress, and providing individualized mental health resource recommendations. Feedback from our pilot
usability study was positive, reporting high levels of acceptability and usability from users. Yet, additional comments
underscored the need to enhance the platform with opportunities to engage caregivers remotely but synchronously to
provide additional real-time digital literacy assistance. Building on this pilot, we propose to adapt CONNECT using a co-
design process to include recommendations from our pilot, namely, functions that permit synchronous communication
with a caregiver (Aim 1). In Aim 2, we will conduct a 2-arm randomized controlled trial to evaluate the efficacy of the
adapted CONNECT for improving cancer-related distress among ROCS. We will randomly assign ROCS-caregiver
dyads (N=274) to a CONNECT intervention group (N=134) or enhanced standard of care (n=134). Dyads in the
intervention group will receive usual care and engage with CONNECT. Participants in the enhanced standard of care
group will receive usual care and survivorship care and cancer-related distress literature. Our primary outcome is levels
of cancer-related distress. We will secondarily assess digital literacy and h...

## Key facts

- **NIH application ID:** 11091805
- **Project number:** 1R01NR021666-01
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Marquita W. Lewis
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $827,872
- **Award type:** 1
- **Project period:** 2024-09-23 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11091805

## Citation

> US National Institutes of Health, RePORTER application 11091805, Designing for sustainability: Co-designing and testing the efficacy of a web-based toolkit to improve cancer-related emotional distress and anxiety for rural older cancer survivors (1R01NR021666-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/11091805. Licensed CC0.

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