Comprehensive Health Enhancement Support System (CHESS)

"Without CHESS I would have been in the dark and the doctor would have been making all of the decisions. But CHESS armed me with information that made me part of my treatment. Thanks!" - CHESS study participant in Detroit

The Markle Foundation and the National Cancer Institute (NCI) funded a study to evaluate the ways in which underserved women with breast cancer use and benefit from a computerized patient support system, and to better understand proposed methods of disseminating it to a large population. Findings show a significant positive value of CHESS for underserved patients, and indicate that CHESS participants could be recruited effectively on a large scale using NCI's Cancer Information Services (CIS) phone support network in combination with other outreach vehicles.

CHESS provides users with up-to-date health information, software to help weigh treatment options, and 24-hour access to medical experts and other patients, all via an Internet connection from home. The CHESS breast cancer module was developed by the University of Wisconsin-Madison's Center for Health Systems Research and Analysis (CHRSA), in addition to modules for other conditions such as asthma, heart disease, and HIV/AIDS. While previous research has demonstrated CHESS' positive value among a variety of population groups, this study examined the impact of the breast cancer module specifically on the underserved by targeting women in rural areas of Wisconsin and inner city neighborhoods of Detroit. Study participants had been recently diagnosed with breast cancer.

Despite predictions that underserved women, many of whom had never used computers and did not have phones, would not benefit from CHESS as much as their more advantaged counterparts do, the research supported by Markle and NCI shows that they are equally or more likely to use CHESS, and that they benefit significantly from it according to eleven scales related to patients' functional and emotional well being that are used by health researchers to gage quality of life.

Simultaneously, the research evaluated ways to identify and recruit underserved women-a notoriously difficult to reach group-as CHESS users. They found the most effective strategy to be a combination of methods including using NCI's CIS phone support network and Medicaid as referral sources. CIS could also be an effective vehicle for recruiting CHESS patients from other demographic groups. The findings of these studies will be published in peer reviewed journals. They contribute understanding to questions about how CHESS can be made more broadly available, and which types of features and circumstances contribute to the success of interactive, technology-based health tools in community-based settings.