Symptom Management Following Radioactive Iodine Treatment in Adults With Thyroid Cancer: Usability Evaluation and Proof-of-Concept Study

BACKGROUND: Thyroid cancer is often labeled a "good cancer" due to high survival rates. However, many patients diagnosed with differentiated thyroid cancer (DTC) treated with radioactive iodine (RAI) experience short- and long-term symptoms as a result of treatment. These include salivary dysfunction, dry mouth, dry eyes, and nausea. Despite these challenges, patients report limited knowledge and unmet informational needs regarding RAI symptoms and symptom management. Evidence-based, patient-centered education to support symptom management during DTC survivorship is needed. Our team developed Radioactive Iodine Support (RAI Support), a prototype of a 4-week web-based intervention for RAI symptom management among survivors of DTC. OBJECTIVE: This study aimed to evaluate the usability of the RAI Support intervention among survivors of DTC who completed RAI treatment and assess preliminary effect sizes of change in RAI symptom burden, self-efficacy for managing chronic symptoms, informational needs, global physical and mental health, and health-related quality of life (HRQOL). METHODS: We conducted a longitudinal usability testing study with 8 participants over a 4-week period. At baseline (T1), participants completed an online survey and a 90-minute virtual usability testing session. During usability testing sessions, study staff used a think-aloud protocol to elicit feedback on the content, language, and visual appeal of the prototype across 5 tasks. Participants also completed the System Usability Scale (SUS). Participants were encouraged to continue using the intervention over the 4-week period, during which use data were recorded. A follow-up after assessment (T2) was completed at the end of the 4-week period of home use. Survey outcomes included RAI symptom burden, self-efficacy for managing chronic symptoms, informational needs, global physical and mental health, and HRQOL. RESULTS: Among the 8 survivors of DTC who had undergone RAI treatment (age: mean 45, SD 8.2 years), the mean SUS score was 88.1 (SD 8.7), indicating above-average usability. All participants effectively completed each task, with ease of use ranging from 100% to 87.5% and error rates ranging from 0% to 25%. Preliminary r effect size signals of change were found for improved self-efficacy, global mental health, and HRQOL (r values ranged from 0.31 to 0.45). CONCLUSIONS: Survivors of DTC reported above-average usability of the RAI Support prototype and completed each task successfully. Variability in error rates and ease of use suggests that refinements are needed to further optimize usability and patient engagement. RAI Support also shows preliminary promise in improving self-efficacy for symptom management, global mental health, and HRQOL among survivors of DTC. Findings support future pilot testing.