Iris Kanera

1 17 INTRODUCTION eHealth as a source of guided self-help in cancer aftercare Since cancer survivors are very interested in information about cancer-related topics, an increasing number use the Internet as a source for cancer-related information (Chou, Liu, Post, & Hesse, 2011; Shea-Budgell, Kostaras, Myhill, & Hagen, 2014). However, public websites that offer generic cancer-related information may be incomplete and unable to give individualized patient-specific support (Shea-Budgell et al., 2014; Warren, Footman, Tinelli, McKee, & Knai, 2014). Moreover, cancer survivors consider the doctor or health professional as the most trusted source of cancer-related information. Among oncology care providers, there is a growing interest in web-based interventions as a means of supportive care, given the numerous advantages of web-based interventions (Chou et al., 2011). Evidence- based web-based interventions can provide reliable cancer aftercare support that can complement face-to-face counseling and may fill an important gap in current cancer aftercare by providing easily accessible information and supporting self-care (Leykin et al., 2012). Web-based interventions potentially have a high reach, can reduce treatment time and costs, and can comprise comprehensive and relevant self-management support in a structured and interactive way, enhanced by video, graphics, animations, and hyperlinks, while personalization is also possible by applying computer tailoring (Broekhuizen, Kroeze, van Poppel, Oenema, & Brug, 2012; Noar et al., 2007; Winkels et al., 2016). Additionally, a considerable advantage of eHealth interventions is that treatment becomes available at any time anywhere, and anonymity can be preserved. Web-based interventions that engage survivors more actively and stimulate self-management might be integrated into a stepped care approach, for example as guided self-help. In this approach, cancer survivors could be referred by an oncology professional to a trusted patient self-help portal with secure access (Shea-Budgell et al., 2014). However, it should be noted that not all cancer survivors have the same level of computer skills. In the Netherlands, the proportion of households with Internet access is high (94%), and from the individuals aged between 45-65 years, about 70% have at least basic computer skills. However, the number of persons with basic computer skills is lower among older (about 30%) and among lower educated individuals (about 50%; Statistics Netherlands, 2016). It can be expected that in the years ahead, the future elderly will increasingly be accustomed to computer programs, and operating computers probably will become easier. However, in the present time, online interventions for an older target population should be as easy as possible. Some eHealth programs have already been developed and tested for cancer survivors that will be described in the following paragraph. Overview of web-based interventions for cancer survivors In the current and past decades, an increasing number of Internet initiatives for cancer patients and survivors have been developed, such as patient platforms, educational programs, and interventions that link patients with their healthcare professional online.