A Telehealth-Based Behavioral Intervention for Cancer-Related Cognitive Decline in Older Adults Undergoing Systemic Therapy for Breast Cancer: Development and Usability Testing

Abstract

Background: Cancer-related cognitive decline (CRCD) is a significant problem; interventions are needed to mitigate CRCD for older adults (aged ≥65 years). Objective: Our objective was to develop and evaluate the usability of Memory and Attention Adaptation Training–Geriatrics (MAAT-G), a CRCD intervention for older adults with breast cancer undergoing systemic treatment. Methods: We conducted an intervention adaptation study to develop MAAT-G. MAAT-G is a cognitive behavioral therapy–based intervention delivered by a health professional over the course of 10 weekly individual workshops via videoconferencing. To develop MAAT-G, the contextual, cohort-based, maturity, and specific challenge framework was used for preliminary adaptations. Patient advocate collaborators guided further refinement, reviewing MAAT-G workshop content, the participant workbook, and intervention delivery via videoconferencing to optimize relevance and usability for older adults. The usability of MAAT-G and its videoconferencing delivery were subsequently evaluated in 4 older adults with breast cancer using the System Usability Scale (score range 0‐100; >67 being above average) and through semistructured qualitative interviews. Results: Numerous adaptations were made to address the unique needs of older patients using the contextual, cohort-based, maturity, and specific challenge framework and patient advocate feedback. Usability testing included 4 female patients with breast cancer (mean age 73.3, SD 3.77; range 67-77 years). Patients were receiving systemic therapy (2 receiving adjuvant therapy and 2 receiving advanced-stage disease therapy). One patient had an educational level lower than high school; 3 had some college education or higher. All 4 patients completed study procedures, including 10 MAAT-G workshop sessions (100% intervention adherence). The mean System Usability Scale score was 90.6 (SD 13.51), indicating good usability. Conclusions: MAAT-G is a behavioral intervention developed to mitigate CRCD. It is designed specifically for older adults and showed above-average usability in this population.