A Web-Based Intervention to Reduce Distress After Prostate Cancer Treatment: Development and Feasibility of the Getting Down to Coping Program in Two Different Clinical Settings

Abstract

BackgroundDistress after prostate cancer treatment is a substantial burden for up to one-third of men diagnosed. Physical and emotional symptoms and health service use can intensify, yet men are reticent to accept support. To provide accessible support that can be cost effectively integrated into care pathways, we developed a unique, Web-based, self-guided, cognitive-behavior program incorporating filmed and interactive peer support.ObjectiveTo assess feasibility of the intervention among men experiencing distress after prostate cancer treatment. Demand, acceptability, change in distress and self-efficacy, and challenges for implementation in clinical practice were measured.MethodsA pre-post, within-participant comparison, mixed-methods research design was followed. Phase I and II were conducted in primary care psychological service and secondary care cancer service, respectively. Men received clinician-generated postal invitations: phase I, 432 men diagnosed <5 years; phase II, 606 men diagnosed <3.5 years. Consent was Web-based. Men with mild and moderate distress were enrolled. Web-based assessment included demographic, disease, treatment characteristics; distress (General Health Questionnaire-28); depression (Patient Health Questionnaire-9); anxiety (General Anxiety Disorder Scale-7); self-efficacy (Self-Efficacy for Symptom Control Inventory); satisfaction (author-generated, Likert-type questionnaire). Uptake and adherence were assessed with reference to the persuasive systems design model. Telephone interviews explored participant experience (phase II, n=10); interviews with health care professionals (n=3) explored implementation issues.ResultsA total of 135 men consented (phase I, 61/432, 14.1%; phase II, 74/606, 12.2%); from 96 eligible men screened for distress, 32% (30/96) entered the intervention (phase I, n=10; phase II, n=20). Twenty-four completed the Web-based program and assessments (phase I, n=8; phase II, n=16). Adherence for phase I and II was module completion rate 63% (mean 2.5, SD 1.9) versus 92% (mean 3.7, SD 1.0); rate of completing cognitive behavior therapy exercises 77% (mean 16.1, SD 6.2) versus 88% (mean 18.6, SD 3.9). Chat room activity occurred among 63% (5/8) and 75% (12/16) of men, respectively. In phase I, 75% (6/8) of men viewed all the films; in phase II, the total number of unique views weekly was 16, 11, 11, and 10, respectively. The phase II mood diary was completed by 100% (16/16) of men. Satisfaction was high for the program and films. Limited efficacy testing indicated improvement in distress baseline to post intervention: phase I, P=.03, r=−.55; phase II, P=.001, r=−.59. Self-efficacy improved for coping P=.02, r=−.41. Service assessment confirmed ease of assimilation into clinical practice and clarified health care practitioner roles.ConclusionsThe Web-based program is acceptable and innovative in clinical practice. It was endorsed by patients and has potential to positively impact the experience of men with distress after prostate cancer treatment. It can potentially b...

Systematic review of technology‐based interventions to improve anxiety, depression, and health‐related quality of life among patients with prostate cancer

“…After removal of duplicate papers and ineligible studies, 10 studies met our inclusion criteria, and thus, were included in this review. These studies included randomized control trials (N=6), and quasi‐experimental studies (N=4: three “2‐group pretest‐posttest” studies and one “1‐group pretest‐posttest” study) . These studies were conducted in Australia, Canada, Germany, Netherlands, Norway, Sweden, the United Kingdom, and the United States (Table ).…”

“…The TBIs aimed to provide informational, psychosocial, self‐care management, or communication support. These studies used self‐guided websites (N=5) ; web‐based programs supported by medical professionals (N=4); and a mobile health app with clinical nurse supervision (N=1) …”

“…Six studies specified that participants needed to complete 4 to 18 TBI sessions, whereas participants in four studies used the TBI programs as needed . Four studies reported that the length of each session ranged from 15 to 90 minutes . Seven studies provided technical assistance, IT training, or TBI user manuals to the participants …”

“…Four studies reported that the length of each session ranged from 15 to 90 minutes . Seven studies provided technical assistance, IT training, or TBI user manuals to the participants …”

“…Self‐care management components included self‐monitoring skills, symptoms history graph, symptoms management skills, and self‐care advice . Communication support components included e‐forum group discussion with other patients, e‐communication with health professional, risk assessment alert notification, and interactive exercises with automated feedback …”