Supporting patients with advanced cancer and their relatives via an interactive online application: a study protocol...

Effective support for patients with advanced cancer and their relatives requires addressing individual needs, preferences and wishes, with communication as a central component. However, discussions about end-of-life issues are often perceived as difficult, and communication needs frequently remain unmet. While past interventions have primarily targeted healthcare professionals, evidence suggests that directly involving patients can have positive effects. eHealth solutions offer a promising approach to facilitate access to information, support communication and promote patient engagement. Building on this, we developed a web-based application (ASTENZ) and are now evaluating its feasibility, usability and acceptability in a pilot study.

A single-centre, randomised, controlled, two-arm trial with mixed-methods elements will be conducted to assess the feasibility of app usage and the study design. A realist approach will guide the study, with quantitative data complemented by qualitative interviews. Patients aged >18 years with advanced cancer and/or their relatives will be recruited from the interdisciplinary ambulatory chemotherapy unit, the palliative care unit and the dermatology cancer unit at the University Hospital of Marburg, Germany. Sample size calculations indicate a total of n=171 participants (114 patients, 57 relatives), randomly assigned in a 2:1 ratio to the intervention group (using the ASTENZ app) or control group (treatment as usual). Control group participants will receive app access after the survey period. Both groups will be assessed at 4 and 8 weeks. Primary outcomes: feasibility, usability and acceptability; secondary outcomes: knowledge on end-of-life topics, confidence, readiness for end-of-life conversations, functionality, anxiety and depression, psychosocial distress, technical data and number of consultations. Primary analyses will be descriptive. Trial status: recruitment is planned to start on 12 February 2026.

The study was approved by the Ethics Committee for Human Research at Philipps University Marburg (ref. 25-292 BO) and preregistered in the German Clinical Trials Register (DRKS00037577). All materials and procedures were reviewed and approved by the ethics committee, and written informed consent will be obtained prior to inclusion. Study results will be published in peer-reviewed journals, presented at conferences and used to inform the design of a future effectiveness trial, with potential options for wider app dissemination.

DRKS00037577.