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This study examined the interplay of depression and different types of e-health interventions on breast cancer patients' perceived healthcare competence, emotional processing, and social well-being over time. The three e-health interventions--Internet Only as a control condition, CHESS (Comprehensive Health Enhancement Support System) Only, and CHESS with a Human Mentor, a cancer information specialist--provided varying degrees of interactivity and presence. A total of 328 women with breast cancer participated in one of the three interventions for a 6-month period. Women were further split into two groups based on reported levels of depression. For perceived healthcare competence and social well-being, results revealed significant interaction effects for intervention type by depression over time, such that breast cancer patients with higher levels of depression benefited most from the CHESS with Mentor intervention over the 6-month study period. For emotional processing, depressed cancer patients benefited more from the CHESS with Mentor than the other two interventions, regardless of time. These findings have (a) theoretical implications on how mental health factors can intersect with interactivity and presence to influence psychosocial outcomes, (b) conceptual implications for the role of human interaction within e-health systems, and (c) practical implications for the development of e-health interventions for cancer patients with depression. [ABSTRACT FROM AUTHOR]

Introduction: Doctor-patient communication is a complex process where verbal and nonverbal interactions happen simultaneously. We systematically evaluated and compared these behaviors in geriatric clinical visits with depressed and non-depressed elderly patients using communication accommodation theory (CAT). Method: A cross-sectional analysis of doctor-patient interactions during 43 videotaped primary care geriatric sessions was conducted. Twenty-one of the patients had symptoms of depression, while 22 were not depressed. These sessions originated from a subset of 70 videos from the National Institute on Aging and were obtained for the purpose of studying doctor-patient communication. Results: Our study showed that for nonverbal communication, non-depressed elderly patients had longer eye gaze at the doctor than the group of depressed patients. Doctors gazed at the chart longer while seeing depressed versus non-depressed patients. For verbal communication, treatment discussion in seconds was significantly different between depressed elderly patients (420.30 s) and non-depressed elderly patients (468.58 s). The average duration in seconds of patient talking, doctor talking, symptom discussion, and silence time, were different between the two populations. Discussion: Elderly patients with depression have different communication patterns with providers than patients without depression. Different communication strategies need to be implemented to better accommodate these patients' different needs and expectations during their clinic visits. Our findings provide practical implications for facilitating better patient-centered care by educating healthcare providers about communication accommodation strategies. [ABSTRACT FROM AUTHOR]

A breast cancer diagnosis typically results in dramatic and negative effects on an individual's quality of life. Web-based interactive support systems such as the Comprehensive Health Enhancement Support System (CHESS) offer one avenue for mitigating these negative effects. While evidence supports the efficacy of such systems, evaluations typically fail to provide a true test of the theorized model of effects, treating self-determination theory's constructs of competence, relatedness, and autonomy as outcomes rather than mediators. Using path analysis, this study tests the nature of the proposed mediated relationship between system engagement and quality-of-life indicators utilizing data collected from women (N = 90) who participated in the treatment condition of a CHESS randomized controlled trial. Findings support a latent model, indicating that system effects are mediated through an intertwined measure of autonomy, competence, and relatedness. [ABSTRACT FROM AUTHOR]