The Effectiveness of the mHealth Survivorship Program on Enhancing Health-related Quality of Life Among Colorectal Cancer Survivors: Randomised Controlled Trial
Phase: NA
Conditions: Colorectal Cancer (Diagnosis)
Sponsor: The Nethersole School of Nursing

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The Chinese University of Hong Kong 
Faculty of Medicine 
The Nethersole School of Nursing 
 
Doctor of Philosophy in Nursing Programme 
2025-2026 
 
 
 
 
Effectiveness of mHealth-based survivorship programme on health-related quality 
of life among Vietnamese colorectal cancer survivors: A randomised controlled trial 
 
 
 
 
PhD student: Do Pham Nhat Vi 
Student ID: 1155215371 
Supervisor: Prof. Wong Cho Lee 
 
 
 
July 2025 

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Introduction 
The burden of colorectal cancer  
Cancer is the second-leading cause of worldwide mortality (Siegel et al., 2024). Colorectal 
cancer (CRC) ranks third among common causes of cancer-related deaths and diagnoses in both 
sexes. About 153,020 CRC diagnoses and 52,550 deaths occurred in 2023 (Siegel et al., 2023). By 
2030, the global burden of colorectal cancer is projected to increase by 60%, adding 2.2 million 
cases and 1.1 million deaths (Arnold et al., 2017). Despite these alarming statistics, advancements 
in CRC treatments, including surgery, chemotherapy, and radiation therapy, have significantly 
improved long-term survival rates (Kuipers et al., 2015). The overall 5-year survival rate for CRC 
ranges from 40% to 70% globally (Aguiar Junior et al., 2020; Onyoh et al., 2019). Vietnam had an 
average survival of 48.59 months, with a 3-year survival rate of 54.5% (Le et al., 2021). As survival 
rates continue to rise, this indicates an increasing number of individuals living in survivorship, 
highlighting the importance of providing ongoing support to these cancer survivors.  
CRC survivorship 
 
Mullan (1985) provided the first definition of cancer survivorship, identifying three distinct 
phases: acute (diagnosis to primary treatment), extended (watchful waiting with side effects), and 
permanent survival (long-term remission). Subsequently, the U.S. Institute of Medicine (IOM) 
(2006) expanded this concept to include the journey from diagnosis to end-of-life (Stovall et al., 
2005). In contrast, most studies define survivorship as the period following the completion of active 
treatment (Dirven et al., 2015; Duijts & Spelten, 2021; El-Shami et al., 2015). This study adopts 
the widely accepted survivorship definition, focusing on individuals who have completed active 
treatment and are in the extended and permanent phases. This period emphasises the challenges 
CRC survivors face due to inadequate healthcare support, often leading to decreased quality of life 
(QoL) (Andreu et al., 2022).  
QoL encompasses an individual’s perception of their life across physical, mental, social 
and spiritual dimensions, aligning with the criteria outlined in WHO’s health definition (Gurková, 
2011; Schramme, 2023). This concept has become increasingly important due to the increasing 
number of CRC survivors. However, a systematic review found that long-term CRC survivors 
typically reported a lower overall QoL than the general population (Jansen et al., 2010). Several 
factors contribute to this lower QoL, including lower satisfaction with continuity of care, unmet 

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information needs and limited access to support from healthcare providers after treatment, 
particularly in distant areas (Drury et al., 2020). Moreover, CRC survivors often experience various 
psychological and physical symptoms such as depression (11.6%), anxiety (17.9%), distress 
(78.5%), fatigue (67%) and bowel dysfunction (49%) (Denlinger et al., 2009; El-Shami et al., 2015; 
Han et al., 2020; Mitchell et al., 2013; Simard et al., 2019), leading to a reduction of QoL. 
Therefore, implementing effective programmes that address these needs and improve QoL is 
essential.  
Survivorship guidelines and programme for CRC 
The IOM recommends developing survivorship programmes specifically for CRC 
survivors (IOM, 2006). Since then, various organisations, including the National Comprehensive 
Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO), have issued 
guidelines focused on the prevention, addressing long-term/late effects on physical and 
psychological and management of symptoms, such as fatigue, anxiety, depression, and neuropathy, 
which adult cancer survivors commonly experience (Bower et al., 2014; Hershman et al., 2014; 
NCCN, 2013). Recognising the gaps in survivorship resources and clinical follow-up in post-
treatment, the American Cancer Society (ACS) released its CRC Survivorship Care Guidelines, 
which emphasise surveillance for recurrence (1), managing long-term effects (2), promoting 
healthy behaviours (3), and coordinating care (4) (Shulman et al., 2015). A literature review 
identified survivorship programmes for CRC survivors in the post-treatment phase based on the 
ACS’s guidelines. The results indicated an increasing focus on addressing ostomy issues and 
reducing distress, depression, and anxiety among survivors. Furthermore, evidence supports that 
exercise can reduce fatigue and enhance QoL. However, the review had several limitations, such 
as including various study designs, which made it difficult to evaluate the efficacy of the 
programme. Additionally, there was a lack of detailed information on specific programme 
components and their delivery (Luo et al., 2021).  
mHealth-based programme for CRC survivors 
Lack of resources and care coordination, particularly in distant areas, is the main cause of 
deficiencies in post-treatment follow-up care for cancer survivors (Lim et al., 2023). Since the 
COVID-19 pandemic, it has underscored the importance of technology for cancer survivors by 
promoting physical activity, meeting supportive care needs, and improving survival rates 

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(Koczwara, 2020). Technology-based interventions, including mobile apps, web platforms, video 
conferencing, and social media, have proven effective in supporting cancer survivors (Aapro et al., 
2020; Marthick et al., 2021). Recent studies highlight the value of these tech-driven solutions in 
addressing multi-domains of survivorship care simultaneously (Lim et al., 2023; Wang et al., 
2020). In Vietnam, a growing number of patients express willingness to use mobile apps for support 
(Dao et al., 2023), particularly given that 70% of the population uses Android smartphones 
(Nguyen, 2023) and internet access has risen from 72% in January 2021 to 79.1% in January 2024 
(Kemp, 2024; Nguyen, 2021). 
Ayyoubzadeh et al. (2020) found that mobile apps could enhance the health-related QoL 
for CRC survivors, recommending a framework to develop the app's layout. However, many 
studies address a wider range of cancer survivors, including those with CRC, which may be 
influenced when focusing solely on CRC survivors. Besides, the broad definition of "survivor" also 
encompassed individuals undergoing treatment, whose needs differ from those who have 
completed active treatments (Marthick et al., 2021). Given these gaps, it is essential to develop 
mHealth-based survivorship programmes aligned with ACS guidelines to enhance health-related 
QoL in this population. 
Literature Review 
The systematic review and meta-analysis were conducted to identify, analyse, and 
synthesise the available evidence on survivorship programmes that address health-related QoL 
among CRC survivors. This review followed the guidelines for reporting parallel group randomised 
trials based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 
(PRISMA) statement (Page et al., 2021). PROSPERO registration number: CRD42024580272. 
A systematic search was performed across nine databases (PubMed, Cochrane Library, 
Scopus, CINALH Ultimate, Embase, OVID EMCARE, OVID Nursing, OVID Medline, and Web 
of Science) using specific search strategies to identify relevant articles from the databases' 
inception to June 2024, and manual searching by citation was included. The search utilised titles, 
abstracts, keywords, MeSH terms, and no date restrictions. The search keywords for the databases 
included the following: Colorectal cancer survivor, survivorship, post-treatment, follow-up, 
intervention, programme, Randomized Controlled Trial, and health-related quality of life. Further 

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details about the search strategy are presented in Appendix 1. The details of the inclusion and 
exclusion criteria followed by the PICO framework are shown in Supplement A. 
Twenty studies were included in the review, and thirteen in the meta-analysis RevMan 
(version 5.4), and the study retrieval and selection process are provided in Figure 1. Data extraction 
encompassed the study population, participant demographics, settings, and intervention 
characteristics, including the theoretical basis, content, duration, frequency, format, deliverers, 
outcome measures, and results (Appendix 2). The Risk of Bias 2.0 tool was used to assess 
methodological quality. Overall, the studies ranged from having some concerns to having a high 
risk of bias (Figure 2). No trials were found to have impacts on the pooled results by sensitivity 
analysis. The results of this review are detailed in Supplement B. Briefly, we identified two key 
features of the available survivorship programmes and their efficacy in enhancing health-related 
QoL.  
First, many programmes have methodological weaknesses, with few studies adequately 
reporting allocation concealment or non-blinding. Only 7 out of 20 studies were grounded in 
different theoretical frameworks, and none were conducted in developing countries.  
Second, each programme was often treated in isolation, and the contents followed the ACS 
guidelines. They emphasise health promotion and managing late side effects over surveillance for 
second cancers and care coordination. Key components include: 1) CRC education on symptom 
management, nutrition, and exercise; 2) expert health coaching with survivorship care plans, 
delivered over 12 weeks, averaging 30-45 minutes, 6 to 12 sessions weekly; delivered mobile 
health, led by nurses. From these gaps, rigorous studies are warranted to integrate these contents 
to lay the foundation for future comprehensive interventions via mobile health, which can address 
multi-domains to improve the health-related QoL for this population. 
Study Aim and Objectives 
The study aims to examine the effectiveness of mHealth-based survivorship programme in 
enhancing health-related QoL among CRC survivors.  
Feasibility and Piloting  
A feasibility study will examine the feasibility, acceptability and preliminary effectiveness 
of the survivorship programme among CRC survivors in Vietnam.  

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Objective 1: To explore the feasibility and acceptability of the survivorship programme. 
Objective 2: To examine the preliminary effectiveness of the survivorship programme on 
the same outcomes as the main study at baseline and immediately post-intervention. 
Examine the effectiveness of the survivorship programme 
 
A two-arm, single-blind, randomised controlled trial will evaluate the effectiveness of the 
survivorship programme in enhancing health-related QoL among CRC survivors.  
Hypotheses 
It is hypothesised that participants receiving the mHealth-based survivorship programme 
will report significantly higher levels of health-related quality of life and a lower level of distress, 
depression, anxiety, fatigue, and bowel dysfunction compared to those in the control group. 
Theoretical framework 
The Quality of Cancer Survivorship Care Framework, developed by Dr. Larissa 
Nekhlyudov at Harvard Medical School in collaboration with the National Cancer Institute (NCI), 
underpins this study (Nekhlyudov et al., 2019). This evidence-based framework, guided by the 
IOM, aims to improve cancer survivors’ care by addressing recurrence, new cancers, physical and 
psychological effects, and chronic conditions. Most studies showed that nurse-led interventions 
effectively manage surveillance, side effects, and psychosocial support, improving care 
coordination and patient satisfaction while lowering costs; hence, this study adopted them  (Gan et 
al., 2022; IOM, 2006; Vaz-Luis et al., 2022). 
The framework identifies key factors influencing the quality of survivorship care, including 
clinical structure, care coordination, communication, and patient experiences (Nekhlyudov et al., 
2019). To reflect this study, the CRC survivorship programme addresses five aspects of 
survivorship phases through healthcare delivery. The clinical structure will provide education and 
survivorship care plans (SCP), while the nurse will coordinate with oncologists to develop SCPs 
before patient discharge. Communication and decision-making will be enhanced through 
discussions facilitated by nurse consultants and the app forum, which also encourages survivors to 
share experiences. This comprehensive approach, whose indicators reinforce one another, aims to 

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improve the QoL and functionality of survivors, ultimately reducing hospitalisations, costs, and 
mortality rates. 
 
Research Methodology 
 
Development of CRC survivorship programme 
Based on the results of a systematic review, meta-analysis, and framework, we developed 
this programme. It will be delivered over 12 weeks, averaging 30-45 minutes, in 6 sessions weekly 
via mobile health, and led by nurses. The modelling of intervention processes and outcomes was 
based on the results of the systematic review, qualitative study, ACS guidelines, oncology 
textbooks, and consultations with oncology professionals. The survivorship programme consists of 
four components: a survivorship care plan (SCP), CRC survivorship education, discussion forums 
(via a mobile application), and nurse-led consultations (via telephone). The SCP will provide 
general treatment information and pre-discharge care planning, while CRC survivorship education 
will focus on surveillance of second cancers, side effect management, and health promotion. 
Discussion forums encourage participants to interact and share their experiences. Nurse-led 
consultations will offer support and address any questions related to the intervention.  

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Mobile application:  
The mobile app developed by a Vietnamese tech company will have two main layers: IT 
support and CRC survivor support. The former includes sign-up/sign-in, settings, and Help, while 
the latter offers CRC survivorship education, SCP, reminders, and discussion forums 
(Ayyoubzadeh et al., 2020). Designed for Android devices, the app will be built using Android 
Studio and Java, with a PHP (Hypertext Preprocessor) and JavaScript-based admin system 
(Nguyen, 2023). To ascertain privacy, data on the app are encrypted and can only be accessed by 
the software engineer and the researcher. Similarly, users can choose to remain anonymous by 
changing their display name and not displaying their personal picture. Moreover, the app was not 
available on social networking sites or public domains. Each participant was required to create a 
unique username and password, which they were instructed not to share with any other person. 
They could also change their passwords anytime they desire. Furthermore, the app also had a 
tracking function to monitor app usage. The tracking feature tallied the number of times the 
participants used the app, including the number of words and characters they used in the discussion 
forums. 
It will feature a user-friendly interface with warm colours and images in audio or video 
formats, along with large black text on a white background for readability and guided navigation 
(Cole-Lewis & Kershaw, 2010). A tutorial video on usage will be provided. User data will be 
encrypted for privacy, allowing anonymity through display name changes and no personal photo 
uploads. The app will not be available on social media and will require unique usernames and 
passwords. Additionally, it will track usage, recording access frequency and discussion forum 
activity (Alzahrani et al., 2022). 
Content validation 
The content of the intervention was validated by an expert review and a layman review. A 
panel of experts—comprising an oncologist, an IT specialist, research professors, and two 
experienced oncology nurses—will evaluate for relevance, completeness, appropriateness, 
readability, and accuracy. They will have one week to review the mobile app before a meeting to 
discuss feedback and suggest improvements. For layman's review, three patients completing CRC 
treatment, with a variety of demographic characteristics, will be invited to evaluate the updated 

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content. They will be given access to the mobile application for one week, and their comments and 
suggestions will be collected. 
Pilot study 
Before the main RCT, a pilot study will assess the feasibility and acceptability of the CRC 
survivorship programme in Vietnam.  
Setting  
The study will be conducted at two oncology hospitals in Vietnam, being consistent with 
the proposed full-scale RCT setting. 
Sample size 
The sample size will be determined using the rules of thumb to find an appropriate sample 
size for continuous outcome measures. The pilot will include approximately 25 participants per 
group (Whitehead et al., 2016), based on recommendations for feasibility studies. The results will 
help refine and estimate the sample size for the full RCT. 
Data collection 
Quantitative data will be collected at baseline (T0) and immediately after the completion 
of the intervention (T1). Qualitative data will be collected from the intervention group at T1. Data 
collection will be carried out at the colorectal department and the outpatient department. A 
feasibility measure is based on the consent rate, attrition rate, adherence, and dose of the 
survivorship programme. Specifically, the consent rate measures agreement to participate, while 
adherence and dose reflect the extent and frequency of app usage among participants (Manojlovich 
& Sidani, 2008). The acceptability of the intervention is assessed through qualitative interviews 
between 15 and 20 minutes with participants in the intervention group at T1, focusing on their 
satisfaction and experiences, with the interview guide included in Supplement D. 
Preliminary Effects of the Intervention 
The preliminary effects of the survivorship programme are identified by measuring the 
health-related QoL, distress, anxiety, depression, fatigue, and bowel dysfunction outcome 

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variables. Details on the measurement instruments are the same as the ones presented for the main 
RCT. 
Data Analysis 
Quantitative data will be analysed using SPSS version 26.0. The sociodemographic and 
clinical data will be analysed using means, frequencies and percentages. The last observation 
carried forward (LOCF) method will be used to handle missing data (Robert M. Hamer  & Pippa 
M. Simpson 2009). The homogeneity of the participants’ socio-demographic characteristics is 
ensured using the Mann-Whitney U test for continuous variables and Fisher’s exact test for 
categorical variables. A baseline assessment is conducted for all the outcomes before the 
intervention and is presented using median and interquartile ranges. The Mann-Whitney U test is 
conducted to compare the changes in outcome variables between the intervention and control 
groups from pre- to post-intervention. Verbatim transcription of the recorded interviews is 
performed by the researcher, after which the data are analysed using the NVivo 15 software 
programme. 
Main study - RCT 
Study design: A two-arm, parallel-group, single-blind RCT will be conducted, following 
the Consolidated Standards of Reporting Trials (CONSORT) reporting guidelines. The assessor 
will be blinded (Turner et al., 2012).  
Setting: Participants will be recruited from the Hanoi Oncology Hospital and Can Tho 
Oncology Hospital in Hanoi and Can Tho city, which are the first-level cancer-specialized hospitals 
in the North and South of Vietnam (Hospital, 2024). The total number of hospital beds is 700 and 
3200 respectively (Hospital, 2024; MOH, 2021).  
Inclusion and exclusion criteria: Eligible participants will be 18 or older (1) Vietnamese-
speaking CRC patients who have completed active treatment and are preparing for discharge (2); 
provide consent and complete questionnaires independently (3); no metastatic and second cancers 
(4), as well as using the Android smartphone (5). Exclusion will include mental health diseases, 
receiving anxiety or depression treatment or cognitive/learning problems.  
Sample size: The sample size is calculated based on systematic review and meta-analysis 
findings for health-related QoL outcomes, with effect sizes of 0.75. To be conservative, the effect 

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size is estimated at 0.5. Using G*Power with 5% type 1 error, 80% power, and an effect size of 
0.5, the target sample is 128. From the review, allowing for 20% attrition, 160 participants (80 per 
group) will be recruited.  
Randomization and Blinding:  
Block randomization with block sizes of four or six and a 1:1 allocation will be conducted 
by independent research using a computer-generated randomization list to ensure equal group sizes 
over time (Kang et al., 2008). An independent statistician will create the randomization sequences 
in advance using an online tool like www.randomizer.org. To achieve allocation concealment, 
these sequences will be transferred to sequentially numbered, opaque, sealed envelopes, which 
participants will open only after their baseline assessment (Dettori, 2010). While it is not feasible 
to blind participants or interventionists due to the study's nature, outcome assessors will be blinded 
to minimise any potential bias. Participants will be asked not to share their treatment allocation 
with others. 
Intervention fidelity  
Intervention fidelity refers to following the intervention protocol, which will be registered 
on ClinicalTrial.gov (Moncher & Prinz, 1991). The researcher ensures fidelity in this study by 
completing a 40-hour training coaching course and a 6.5-credit Cancer Survivorship Certification. 
The researcher will deliver all session interventions and monitor adherence by documenting 
attendance rates. RA who are research team members with bachelor’s degree will be trained for 
one hour on quantitative data collection. To prevent contamination, eligible participants receive 
individual access links to the app, which are disabled after profile creation, and they are instructed 
not to share intervention content with others.  
 
Outcome and Instruments 
Primary outcomes include the health-related QoL. The second outcomes include distress, 
depression, anxiety, fatigue and bowel dysfunction (See Supplement E). The brief instruments are 
in the table below.  

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Outcomes 
 
Description 
 
Details 
Socio-
demographic 
Age, gender, education level, occupation, 
nationality, religion, marital status, living 
conditions, personal income, insurance, etc. 
 
Clinical 
information 
Follow in survivorship care plan (SCP), including 
diagnosis, treatment, nursing care, hospitalisation, 
cost 
 
Health-
related 
QoL* 
The Functional Assessment of Cancer Therapy-
General (FACT-G)  
Assesses health-related QoL, including 
physical function (consisting of 7 
items), social and family relationships 
(7 items), emotional state (6 items), and 
functional abilities (7 items). Scores 
range from 0 to 100, with higher scores 
indicating better QoL. Cronbach's alpha 
of 0.89 for the scale, received the 
approval to use the FACT-G from the 
FACIT organisation 
Distress 
The distress thermometer screening tool (DT) 
A self-report tool measuring distress on 
a scale from 0 (no distress) to 10 
(extreme distress), focusing on a cutoff 
score of 4 (NCCN, 2024), with α = 0.87 
(Nguyen et al., 2021) 
Depression 
& Anxiety 
The Depression Anxiety Stress Scales (DASS-21) 
(Lovibond & Lovibond, 1995) 
Consists of 21 items, with seven items 
for anxiety (DASS21-A), 
seven items for depression (DASS21-D) 
and seven items for stress (DASS21-S). 
It was validated for use in the 
Vietnamese 
population 
with 
good 
internal consistency (Cronbach’s alpha: 
depression 
subscale-0.72; 
anxiety 
subscale-0.77; stress subscale-0.70, and 
overall scale-0.88) (Tran et al., 2013). 
Fatigue 
The Functional Assessment of Cancer Therapy-
Fatigue subscale (FACT-F)  
with 13 items, likert scales from 0 (not 
at all) to 4 (ver much), which has been 
validated for use in the Vietnamese 
version 
with 
Cronbach's 
alpha 
coefficient α = 0.93 (Long et al., 2016).  

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Bowel 
Dysfunction 
The Low anterior resection syndrome (LARS), 
which has been validated for use in the Vietnamese 
version (Mai-Phan & Pham, 2024) 
A 5-question questionnaire evaluated 
bowel functional symptoms. Scores 
were assigned to responses, determining 
the LARS score, which categorized 
results into “no LARS” (0–20), “minor 
LARS” (21–29), and “major LARS” 
(30–42). Cronbach’s alpha was from 
0.874 to 0.934 
 
 
Recruitment  
Potential participants will be identified through informational posters, e-posters, and 
leaflets shared through hospital channels. RA will screen participants for eligibility and obtain 
signed informed consent on the last day of discharge preparation. Baseline data, including socio-
demographics and clinical characteristics, will be collected before randomization. Consenting 
participants will be randomly assigned to either the intervention or control group.  
Intervention 
Intervention group: Participants will access a link that will be disabled after download to 
prevent sharing. They will be guided on creating usernames and passwords, and RAs will provide 
10 to 15 minutes of app navigation training. In case of technical issues, a contact number of IT 
experts will be supplied. The app link will be disabled after intervention. The table below provides 
details of the intervention.  

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Nurse-led consultations aim to address participants' questions and provide informational 
support, conducted 15- to 20-minute phone calls at weeks 3, 5, 7, 9, and 11 by a principal 
investigator. 
The control group will be provided with usual care, including a survivorship care plan 
and health counselling before discharge.  
Data collection:  
Participants will be assessed at three-time points: baseline (T0), post-intervention (T1), and 
1-month follow-up (T2) by another RA.  Data for T0 and T1 will be collected in hospitals, while 
T2 will occur online. The details of data collection are in the table below:  
Outcomes 
Description 
Data collection procedures 

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Baseline 
(T0) 
Immediate 
post-
intervention 
(T1) 
1-month 
follow-up 
(T2) 
Socio-
demographic 
Age, gender, education level, 
occupation, nationality, religion, marital 
status, living conditions, personal 
income, insurance, etc. 
√ 
 
 
Clinical 
information 
Follow in survivorship care plan (SCP), 
including diagnosis, treatment, nursing 
care, hospitalisation, cost 
√ 
√ 
hospitalisation, 
cost 
√  
hospitalisation, 
cost 
Health-
related 
QoL* 
The Functional Assessment of Cancer 
Therapy-General (FACT-G)  
√ 
√ 
√ 
Distress 
The distress thermometer screening 
tool (DT) 
√ 
√ 
√ 
Depression 
& Anxiety 
The Depression Anxiety Stress Scales 
(DASS-21) (Lovibond & Lovibond, 1995) 
√ 
√ 
√ 
Fatigue 
The Functional Assessment of Cancer 
Therapy-Fatigue subscale (FACT-F)  
√ 
√ 
√ 
Bowel 
Dysfunction 
The Low anterior resection syndrome 
(LARS), which has been validated for 
use in the Vietnamese version (Mai-Phan 
& Pham, 2024) 
√ 
√ 
√ 
 
Data Analysis:  
Statistical analysis, SPSS version 26, will be used, and an intention-to-treat analysis will be 
used in line with the CONSORT statement (Supplement F). The chi-squared test or Fisher’s exact 
test, will be used for categorical data (e.g. family income, cancer stage), while the continuous 
variables (e.g. age) will use the independent T-test to test the homogeneity at baseline between 
groups. Categorical variables will be reported as frequencies and percentages and continuous 

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variables will be presented as mean± standard deviation. A two-tailed, two-sample T-test (normally 
distributed) or Mann-Whitney U test (non-normally distributed) will be used to compare the mean 
difference of FACT-G, DT, DASS-21, FACT-F, LARS of the intervention group and control group 
between T0, T1, and T2 respectively. Cohen’s d will be used to measure the intervention effect 
size on the QoL, distress, anxiety, depression, fatigue, and bowel dysfunction of the intervention 
group and control group. The Generalized Estimating Equations (GEE) model will be used to 
compare the differential changes of each of the primary/ secondary outcomes at T1, T2 with respect 
to the baseline (T0) between groups. 
Ethical consideration 
The ethical principles of the Declaration of Helsinki (World Medical Association, 2013) 
are adhered to in this study. Ethics approval will be sought from the Chinese University of Hong 
Kong-New Territories Eastern Cluster Clinical Research Ethics Committee and the oncology 
hospitals in Vietnam This study will follow ethical principles for research involving human 
subjects, including autonomy, non-maleficence, and confidentiality. Participants will provide 
informed consent and can withdraw at any time, with an information sheet for the study. Each 
participant will be labelled with a code for confidentiality, and data will be secured. They will 
receive 200,000 VND (70 HKD) for internet fees, ensuring payment does not influence their 
participation. Approval for using instruments in Vietnamese will be obtained from the original 
authors. 
Study plan 
 
Project Significance and Value: 
This study may provide evidence that supports oncology nurses in delivering mHealth 
survivorship programmes for CRC survivors. The findings can serve as a valuable resource for 
oncology nurses, enhancing survivorship care. In Vietnam, this study may be a pioneer for 

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oncology nurses to support CRC survivors, a population that has been neglected following 
treatment. Additionally, it is the first study in Vietnam to include technology in CRC nursing care, 
which aligns with the government's plans for healthcare digital transformation in the 2025–2030 
period. Furthermore, this survivorship programme may extend support to other cancer survivors as 
well. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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