multiple dimensions, including emotional well-being, functional well-being, competence in dealing with health information, participation in health care, and quality of life. Other important findings are that underserved populations used CHESS more than socially advantaged populations and that they used it for different purposes. The former used the program more often to locate and analyze information and the latter more to participate in discussion groups (Gustafson et al., 2001, 2002).
Formerly a demonstration program, CHESS is now an ongoing program with continued operation and updating provided by the University of Wisconsin Comprehensive Cancer Center. Oncology practices and individual patients desiring to use it can do so.12 The CHESS breast cancer program is available on the web in English and Spanish versions. The English version (Living with Breast Cancer) can be accessed at http://www.uwchessbc.org. The Spanish-language site, “Conviviendo con el Cancer de Seno,” is a cultural and linguistic translation of the existing online Living with Breast Cancer program. The translation was performed by a multinational team from Mexico, Argentina, and Venezuela with guidance from the Dane County Latino Health Council. Partners, including the National Latino Cancer Research Network and the Center for Patient Partnerships, provided additional Latina-specific content. Conviviendo con el Cancer de Seno can be accessed at http://www.chess.wisc.edu/espanol/.13
As useful as approaches such as The Wellness Community, CHESS, and other online and telephone services may be, there are some obstacles to their use. First, not all consumers may have access to the technology or the ability to use it in their homes, even if it is provided to them. Patients using entry-level computers with slow modems can be “timed out” by their Internet provider during a support session, causing an interruption in their participation. Second, it may not be possible to deliver all needed psychosocial health services on line. Delivery of mental health services over the Internet is still an evolving technology, and other services, such as cognitive testing, educational support, and support in performing activities of daily living, must still be provided directly. Nevertheless, telephone and Internet support can be used to provide some psychosocial health services, and clinicians should not let an inability to ensure the provision of all such services prevent their taking action to ensure the provision of as many as possible.