a telephone-based education and support intervention for rural breast cancer survivors: a randomized controlled trial comparing two implementation strategies in rural florida

To compare two implementation telephone-based strategies of an evidence-based educational and support intervention to rural breast cancer survivors (rbcs) in which education was delivered early or after the support component. florida rbcs participated in a 12-month randomized clinical trial (rct) with two arms: early education and support (ee-s) and support and delayed education (s-de). arms differed in the timing of 6 support and 3 education sessions. main outcome was quality of life (qol, sf-36 physical and mental composite scores [pcs, mcs]). secondary outcomes were depressive symptoms (centers for epidemiologic studies depression scale, ces-d), mood (profile of mood states, poms), and social support (medical outcomes study social support survey, mos-sss). outcomes were analyzed longitudinally using repeated measures models fitted with linear mixed methods. of 432 rbcs (mean 25.6 months from diagnosis), about 48% were 65+, 73% married/partnered, and 28% with ≤high school education. there were no differences between ee-s and s-de in demographics or outcomes at baseline (mean (standard deviation): sf-36 pcs, 44.88 (10.6) vs. 45.08 (10.6); mcs, 49.45 (11.1) vs. 48.1 (11.9); ces-d, 10.11 (9.8) vs. 10.86 (10.5); poms-sf, 23.95 (38.6) vs. 26.35 (38.8); mos-sss, 79.2 (21.2) vs. 78.66 (21.2)) or over time. one exception was slightly worse mean scores at month 9 in mcs (cohen’s d, − 0.22; 95% ci, − 0.38, − 0.06) and poms (cohen’s d, 0.23; 95% ci, 0.07, 0.39) for ee-s vs. s-de. the implementation strategies were equivalent. enhancing support be considered before delivering not-in-person interventions to rbcs.