Web-based Collaborative Care Intervention Study
Web-based Collaborative Care Intervention Study
To test the efficacy of a web-based stepped collaborative care intervention to reduce
 symptoms of depression, pain, and fatigue and improve health-related quality of life (HRQL)
 in advanced cancer patients and to reduce stress and depression, and fewer CVD risk factors
 in caregivers.
The investigators will enroll patients at two UPMC sites: Montefiore Hospital, an academic
 medical center, and Passavant Hospital, a community based hospital. Based on our sample size
 estimate the investigators will have at least 364 patients and caregivers with complete data
 at 12 months follow up.

 The patient and caregiver will be randomly assigned to one of two arms (intervention versus
 enhanced usual care) stratified by gender and vessel invasion. Because these factors are the
 two most robust prognostic factors in this patient population. At 6 and 12 months after
 enrollment, follow-up questionnaires and blood draws will be performed for patients and
 caregivers.

 The stepped WBCC intervention includes at least biweekly contact from a care coordinator by
 phone and face to face visits occurring approximately every 2 months, and 24 hour 7 day a
 week access to a website. Patients randomized to the "enhanced usual care" arm receive their
 usual care from their medical team. However, if the patient scores in the clinical range on
 one or more of the three symptoms s/he will receive education about the symptom and be
 referred to the appropriate health care provider for further treatment in their community.
 The care coordinator will follow up with the patient after 3 weeks to assess barriers to
 treatment and assist further with accessing treatment if needed.

 Intervention fidelity (e.g., consistency across care coordinators) will be reduced by
 requiring the care coordinators to follow a 300 page manual and providing standardized
 training by the PI who is a clinical psychologist. Dr. Steel (PI) has received training and
 certification from the American Psycho-Oncology Society in the design and analysis of
 psycho-oncology clinical trials and intervention fidelity. The study investigators will not
 prescribe any medications but rather make recommendations to the patient's oncologist, PCP,
 psychiatrist, or pain management specialist who will be free to accept or reject the
 recommendations by the study team. Medication type, dosage, and adherence to medication
 (e.g., self-report and pharmacy refills) will be recorded for patients in the WBCC
 intervention and enhanced usual care arms.
Inclusion Criteria:

 Patients:

 -  biopsy and/or radiograph proven diagnosis of hepatocellular
 carcinoma,cholangiocarcinoma, gallbladder carcinoma or breast, ovarian, or colorectal
 cancer with liver metastases with a life expectancy of at least one year;

 -  age >21 years;

 -  no evidence of thought disorder, delusions, or active suicidal ideation is observed or
 reported.

 Caregivers:

 -  a spouse or cohabitating intimate partner of an advanced cancer patient being
 evaluated at the UPMC's LCC; and

 -  age >21 years

 Exclusion Criteria:

 Patients:

 -  age < 21 years,

 -  lack of fluency in English,

 -  evidence of thought disorder, delusions, hallucinations, or suicidal ideation.

 Caregivers:

 -  lack of fluency in English; and

 -  evidence of thought disorder, delusions, hallucinations, or suicidal ideation.