Reasons for not reaching or using web-based self-management applications, and the use and evaluation of Oncokompas among cancer survivors, in the context of a randomised controlled trial

Introduction: The web-based self-management application Oncokompas was developed to support cancer survivors to monitor health-related quality of life and symptoms (Measure) and to provide tailored information (Learn) and supportive care options (Act). In a previously reported randomised controlled trial (RCT), 68% of 655 recruited survivors were eligible, and of those 45% participated in the RCT. Among participants of the RCT that were randomised to the intervention group, 52% used Oncokompas as intended. The aim of this study was to explore reasons for not participating in the RCT, and reasons for not using Oncokompas among non-users, and the use and evaluation of Oncokompas among users. Methods: Reasons for not participating were assessed with a study-specific questionnaire among 243 survivors who declined participation. Usage was investigated among 320 participants randomised to the intervention group of the RCT via system data and a study-specific questionnaire that was assessed during the 1 week follow-up (T1) assessment. Results: Main reasons for not participating were not interested in participation in scientific research (40%) and not interested in scientific research and Oncokompas (28%). Main reasons for not being interested in Oncokompas were wanting to leave the period of being ill behind (29%), no symptom burden (23%), or lacking internet skills (18%). Out of the 320 participants in the intervention group 167 (52%) used Oncokompas as intended. Among 72 non-users, main reasons for not using Oncokompas were no symptom burden (32%) or lack of time (26%). Among 248 survivors that activated their account, satisfaction and user-friendliness were rated with a 7 (scale 0–10). Within 3 (IQR 1–4) sessions, users selected 32 (IQR 6–37) topics. Main reasons for not using healthcare options in Act were that the information in Learn was already sufficient (44%) or no supportive care needs (32%). Discussion: Main reasons for not reaching or using Oncokompas were no symptom burden, no supportive care needs, or lack of time. Users selected many cancer-generic and tumour-specific topics to address, indicating added value of the wide range of available topics

Role of eHealth application Oncokompas in supporting self-management of symptoms and health-related quality of life in cancer survivors:a randomised, controlled trial

Background Knowledge about the efficacy of behavioural intervention technologies that can be used by cancer survivors independently from a health-care provider is scarce. We aimed to assess the efficacy, reach, and usage of Oncokompas, a web-based eHealth application that supports survivors in self-management by monitoring health-related quality of life (HRQOL) and cancer-generic and tumour-specific symptoms and obtaining tailored feedback with a personalised overview of supportive care options. Methods In this non-blinded, randomised, controlled trial, we recruited patients treated at 14 hospitals in the Netherlands for head and neck cancer, colorectal cancer, breast cancer, Hodgkin lymphoma, or non-Hodgkin lymphoma. Adult survivors (aged ≥18 years) were recruited through the Netherlands Cancer Registry (NCR) and invited by their treating physician through the Patient Reported Outcomes Following Initial Treatment and Long term Evaluation of Survivorship (PROFILES) registry. Participants were randomly assigned (1:1) by an independent researcher to the intervention group (access to Oncokompas) or control group (access to Oncokompas after 6 months), by use of block randomisation (block length of 68), stratified by tumour type. The primary outcome was patient activation (knowledge, skills, and confidence for self-management), assessed at baseline, post-intervention, and 3-month and 6-month follow-up. Linear mixed models (intention-to-treat) were used to assess group differences over time from baseline to 6-month follow-up. The trial is registered in the Netherlands Trial Register, NTR5774 and is completed. Findings Between Oct 12, 2016, and May 24, 2018, 625 (21%) of 2953 survivors assessed for eligibility were recruited and randomly assigned to the intervention (320) or control group (305). Median follow-up was 6 months (IQR 6−6). Patient activation was not significantly different between intervention and control group over time (difference at 6-month follow-up 1·7 [95% CI −0·8–4·1], p=0·41). Interpretation Oncokompas did not improve the amount of knowledge, skills, and confidence for self-management in cancer survivors. This study contributes to the evidence for the development of tailored strategies for development and implementation of behavioural intervention technologies among cancer survivors

Socio-economische trends , macro-economische gevolgen en milieukosten

Ondanks verbeteringen van het milieu in Europa op een aantal terreinen, is een aangescherpt milieubeleid in de Europese Unie noodzakelijk om de gezondheidsschade en het natuurverlies te beperken. Een kosten-batenanalyse wijst uit dat zo'n beleid robuust is en dat de macro-economische gevolgen beheersbaar zijn. Belangrijke prioriteiten voor het EU-milieubeleid zijn klimaatverandering, stikstof-eutrofiering, fijn stof, ozon en biodiversiteit. Dit zijn de belangrijkste bevindingen van een internationaal studieconsortium onder leiding van het RIVM. De studie is verricht in samenwerking met EFTEC (UK), NTUA (Griekenland), IIASA (Oostenrijk). Daarnaast hebben TNO en TME bijdragen geleverd. Ook is in het kader van de studie intensief samengewerkt met het Europese Milieuagentschap in Kopenhagen. De studie is verricht op verzoek van de Europese Commissie als bijdrage voor het zesde Milieu-Actieprogramma, dat door de Europese Commissie is gepresenteerd. In de studie stonden vijf vragen centraal: Is het huidige beleid adequaat genoeg? Kan technologie de geconstateerde beleidstekorten oplossen? Zijn ambitieusere milieudoelstellingen te realiseren? Zo ja, zijn deze doelen ook in economische zin verstandig? Welke beleidsreacties en -instrumenten zijn aan te bevelen? Deze vijf vragen zijn geanalyseerd voor twaalf Europese milieuproblemen, zoals klimaatverandering, biodiversiteit en chemische risico's. De analyse bestaat uit een analyse van de kosten van vermeden schade, milieu-uitgaven, risicoschattingen, publieke opinie, sociale gevolgen en duurzaamheid. De studie bevat ook informatie over milieudoelstellingen, scenario's en beleidsopties en - maatregelen, inclusief de kosten en baten hiervan. Dit rapport is het technische achtergrondrapport dat behoort bij het hoofdrapport. Er zijn twaalf technische achtergrondrapporten opgesteld, waarvan negen een specifiek milieuprobleem behandelen (analyse van het probleem, scenarios, kosten-batenanalyse en beleidsopties). Daarnaast zijn er drie algemene achtergrondrapporten opgesteld over de macro-economische gevolgen, de uitbreiding van de EU en de gehanteerde batenmethodiek.The economic assessment of priorities for a European environmental policy plan focuses on twelve identified Prominent European Environmental Problems such as climate change, chemical risks and biodiversity. The study, commissioned by the European Commission (DG Environment) to a European consortium led by RIVM, provides a basis for priority setting for European environmental policy planning in support of the sixth Environmental Action Programme as follow-up of the current fifth Environmental Action Plan called 'Towards Sustainability'. The analysis is based on an examination of the cost of avoided damage, environmental expenditures, risk assessment, public opinion, social incidence and sustainability. The study incorporates information on targets, scenario results, and policy options and measures including their costs and benefits. Main findings of the study are the following. Current trends show that if all existing policies are fully implemented and enforced, the European Union will be successful in reducing pressures on the environment. However, damage to human health and ecosystems can be substantially reduced with accelerated policies. The implementation costs of these additional policies will not exceed the environmental benefits and the impact on the economy is manageable. This requires future policies to focus on least-cost solutions and follow an integrated approach. Nevertheless, these policies will not be adequate for achieving all policy objectives. Remaining major problems are the excess load of nitrogen in the ecosystem, exceedance of air quality guidelines (especially particulate matter), noise nuisance and biodiversity loss. This report is one of a series supporting the main report: European Environmental Priorities: an Integrated Economic and Environmental Assessment. The areas discussed in the main report are fully documented in the various Technical reports. A background report is presented for each environmental issue giving an outline of the problem and its relationship to economic sectors and other issues; the benefits and the cost-benefit analysis; and the policy responses. Additional reports outline the benefits methodology, the EU enlargement issue and the macro-economic consequences of the scenarios. This report documents Socio-Economic Trends, Macro-Economic Impacts and Cost Interface.European Commissio

Socio-economische trends , macro-economische gevolgen en milieukosten

The economic assessment of priorities for a European environmental policy plan focuses on twelve identified Prominent European Environmental Problems such as climate change, chemical risks and biodiversity. The study, commissioned by the European Commission (DG Environment) to a European consortium led by RIVM, provides a basis for priority setting for European environmental policy planning in support of the sixth Environmental Action Programme as follow-up of the current fifth Environmental Action Plan called 'Towards Sustainability'. The analysis is based on an examination of the cost of avoided damage, environmental expenditures, risk assessment, public opinion, social incidence and sustainability. The study incorporates information on targets, scenario results, and policy options and measures including their costs and benefits. Main findings of the study are the following. Current trends show that if all existing policies are fully implemented and enforced, the European Union will be successful in reducing pressures on the environment. However, damage to human health and ecosystems can be substantially reduced with accelerated policies. The implementation costs of these additional policies will not exceed the environmental benefits and the impact on the economy is manageable. This requires future policies to focus on least-cost solutions and follow an integrated approach. Nevertheless, these policies will not be adequate for achieving all policy objectives. Remaining major problems are the excess load of nitrogen in the ecosystem, exceedance of air quality guidelines (especially particulate matter), noise nuisance and biodiversity loss. This report is one of a series supporting the main report: European Environmental Priorities: an Integrated Economic and Environmental Assessment. The areas discussed in the main report are fully documented in the various Technical reports. A background report is presented for each environmental issue giving an outline of the problem and its relationship to economic sectors and other issues; the benefits and the cost-benefit analysis; and the policy responses. Additional reports outline the benefits methodology, the EU enlargement issue and the macro-economic consequences of the scenarios. This report documents Socio-Economic Trends, Macro-Economic Impacts and Cost Interface.Ondanks verbeteringen van het milieu in Europa op een aantal terreinen, is een aangescherpt milieubeleid in de Europese Unie noodzakelijk om de gezondheidsschade en het natuurverlies te beperken. Een kosten-batenanalyse wijst uit dat zo'n beleid robuust is en dat de macro-economische gevolgen beheersbaar zijn. Belangrijke prioriteiten voor het EU-milieubeleid zijn klimaatverandering, stikstof-eutrofiering, fijn stof, ozon en biodiversiteit. Dit zijn de belangrijkste bevindingen van een internationaal studieconsortium onder leiding van het RIVM. De studie is verricht in samenwerking met EFTEC (UK), NTUA (Griekenland), IIASA (Oostenrijk). Daarnaast hebben TNO en TME bijdragen geleverd. Ook is in het kader van de studie intensief samengewerkt met het Europese Milieuagentschap in Kopenhagen. De studie is verricht op verzoek van de Europese Commissie als bijdrage voor het zesde Milieu-Actieprogramma, dat door de Europese Commissie is gepresenteerd. In de studie stonden vijf vragen centraal: Is het huidige beleid adequaat genoeg? Kan technologie de geconstateerde beleidstekorten oplossen? Zijn ambitieusere milieudoelstellingen te realiseren? Zo ja, zijn deze doelen ook in economische zin verstandig? Welke beleidsreacties en -instrumenten zijn aan te bevelen? Deze vijf vragen zijn geanalyseerd voor twaalf Europese milieuproblemen, zoals klimaatverandering, biodiversiteit en chemische risico's. De analyse bestaat uit een analyse van de kosten van vermeden schade, milieu-uitgaven, risicoschattingen, publieke opinie, sociale gevolgen en duurzaamheid. De studie bevat ook informatie over milieudoelstellingen, scenario's en beleidsopties en - maatregelen, inclusief de kosten en baten hiervan. Dit rapport is het technische achtergrondrapport dat behoort bij het hoofdrapport. Er zijn twaalf technische achtergrondrapporten opgesteld, waarvan negen een specifiek milieuprobleem behandelen (analyse van het probleem, scenarios, kosten-batenanalyse en beleidsopties). Daarnaast zijn er drie algemene achtergrondrapporten opgesteld over de macro-economische gevolgen, de uitbreiding van de EU en de gehanteerde batenmethodiek

Afvalverwijdering

The economic assessment of priorities for a European environmental policy plan focuses on twelve identified Prominent European Environmental Problems such as climate change, chemical risks and biodiversity. The study, commissioned by the European Commission (DG Environment) to a European consortium led by RIVM, provides a basis for priority setting for European environmental policy planning in support of the sixth Environmental Action Programme as follow-up of the current fifth Environmental Action Plan called 'Towards Sustainability'. The analysis is based on an examination of the cost of avoided damage, environmental expenditures, risk assessment, public opinion, social incidence and sustainability. The study incorporates information on targets, scenario results, and policy options and measures including their costs and benefits. Main findings of the study are the following. Current trends show that if all existing policies are fully implemented and enforced, the European Union will be successful in reducing pressures on the environment. However, damage to human health and ecosystems can be substantially reduced with accelerated policies. The implementation costs of these additional policies will not exceed the environmental benefits and the impact on the economy is manageable. This requires future policies to focus on least-cost solutions and follow an integrated approach. Nevertheless, these policies will not be adequate for achieving all policy objectives. Remaining major problems are the excess load of nitrogen in the ecosystem, exceedance of air quality guidelines (especially particulate matter), noise nuisance and biodiversity loss. This report is one of a series supporting the main report: European Environmental Priorities: an Integrated Economic and Environmental Assessment. The areas discussed in the main report are fully documented in the various Technical reports. A background report is presented for each environmental issue giving an outline of the problem and its relationship to economic sectors and other issues; the benefits and the cost-benefit analysis; and the policy responses. Additional reports outline the benefits methodology, the EU enlargement issue and the macro-economic consequences of the scenarios. This report documents the Waste management issue.Ondanks verbeteringen van het milieu in Europa op een aantal terreinen, is een aangescherpt milieubeleid in de Europese Unie noodzakelijk om de gezondheidsschade en het natuurverlies te beperken. Een kosten-batenanalyse wijst uit dat zo'n beleid robuust is en dat de macro-economische gevolgen beheersbaar zijn. Belangrijke prioriteiten voor het EU-milieubeleid zijn klimaatverandering, stikstof-eutrofiering, fijn stof, ozon en biodiversiteit. Dit zijn de belangrijkste bevindingen van een internationaal studieconsortium onder leiding van het RIVM. De studie is verricht in samenwerking met EFTEC (UK), NTUA (Griekenland), IIASA (Oostenrijk). Daarnaast hebben TNO en TME bijdragen geleverd. Ook is in het kader van de studie intensief samengewerkt met het Europese Milieuagentschap in Kopenhagen. De studie is verricht op verzoek van de Europese Commissie als bijdrage voor het zesde Milieu-Actieprogramma, dat door de Europese Commissie is gepresenteerd. In de studie stonden vijf vragen centraal: Is het huidige beleid adequaat genoeg? Kan technologie de geconstateerde beleidstekorten oplossen? Zijn ambitieusere milieudoelstellingen te realiseren? Zo ja, zijn deze doelen ook in economische zin verstandig? Welke beleidsreacties en -instrumenten zijn aan te bevelen? Deze vijf vragen zijn geanalyseerd voor twaalf Europese milieuproblemen, zoals klimaatverandering, biodiversiteit en chemische risico's. De analyse bestaat uit een analyse van de kosten van vermeden schade, milieu-uitgaven, risicoschattingen, publieke opinie, sociale gevolgen en duurzaamheid. De studie bevat ook informatie over milieudoelstellingen, scenario's en beleidsopties en - maatregelen, inclusief de kosten en baten hiervan. Dit rapport is het technische achtergrondrapport dat behoort bij het hoofdrapport. Er zijn twaalf technische achtergrondrapporten opgesteld, waarvan negen een specifiek milieuprobleem behandelen (analyse van het probleem, scenarios, kosten-batenanalyse en beleidsopties). Daarnaast zijn er drie algemene achtergrondrapporten opgesteld over de macro-economische gevolgen, de uitbreiding van de EU en de gehanteerde batenmethodiek