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J Pain Symptom Manage. 2014 Feb;47(2):218-30. doi: 10.1016/j.jpainsymman.2013.04.005. Epub 2013 Sep 7.

Web-based symptom management for women with recurrent ovarian cancer: a pilot randomized controlled trial of the WRITE Symptoms intervention.

Author information

  • 1University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA. Electronic address: donovanh@pitt.edu.
  • 2University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA.
  • 3University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.
  • 4School of Medicine, Pittsburgh, Pennsylvania, USA.
  • 5University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
  • 6University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Carlow University, Pittsburgh, Pennsylvania, USA.



Little research has focused on symptom management among women with ovarian cancer. Written Representational Intervention To Ease Symptoms (WRITE Symptoms) is an educational intervention delivered through asynchronous web-based message boards between a study participant and a nurse.


We evaluated WRITE Symptoms for 1) feasibility of conducting the study via message boards, 2) system usability, 3) participant satisfaction, and 4) initial efficacy.


Participants were 65 women (mean age, 56.5; SD = 9.23) with recurrent ovarian cancer randomized using minimization with race/ethnicity (non-Hispanic white vs. minority) as the stratification factor. Measures were obtained at baseline and two and six weeks after intervention. Outcomes were feasibility of conducting the study, system usability, participant satisfaction, and efficacy (symptom severity, distress, consequences, and controllability).


Fifty-six (87.5%) participants were retained, and the mean usability score (range 1-7) was 6.18 (SD = 1.29). All satisfaction items were scored at 5 (of 7) or higher. There were significant between-group effects at T2 for symptom distress, with those in the WRITE Symptoms group reporting lower distress than those in the control group [t(88.4) = -2.57; P = 0.012], with a similar trend for symptom severity [t(40.4) = -1.95; P = 0.058]. Repeated measures analysis also supported a group effect, with those in the WRITE Symptoms group reporting lower symptom distress than those in the control condition [F(1, 56.7) = 4.59; P = 0.037].


Participants found the intervention and assessment system easy to use and had high levels of satisfaction. Initial efficacy was supported by decreases in symptom severity and distress.

Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.


Ovarian neoplasm; health communication; palliative care; patient education; randomized trial; symptom management; telenursing

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