Elsevier

European Urology

Volume 68, Issue 3, September 2015, Pages 471-479
European Urology

Prostate Cancer
Preliminary Results of a Randomised Controlled Trial of an Online Psychological Intervention to Reduce Distress in Men Treated for Localised Prostate Cancer

https://doi.org/10.1016/j.eururo.2014.10.024Get rights and content

Abstract

Background

Prostate cancer (PCa) poses many emotional and physical challenges for men following treatment. The unmet support needs of these men are well documented, and access to psychosocial support remains problematic.

Objectives

To assess the efficacy of an online psychological intervention for men who have localised PCa.

Design, setting, and participants

We undertook a randomised controlled trial to evaluate the intervention. Participants were randomly allocated to one of three conditions: My Road Ahead (MRA) alone (MRA Only), MRA plus access to an online forum (MRA + Forum), and access to the forum alone (Forum).

Intervention

The intervention was a 10-week self-guided online psychological intervention called My Road Ahead that consisted of six themed modules designed to facilitate improved emotional well-being in the context of PCa as well as a moderated peer forum.

Outcome measurements and statistical analysis

Pre- and postintervention assessments of psychological distress (the 21-question Depression, Anxiety and Stress Scale) [1] and the Prostate Cancer–related Quality of Life scale [2] were conducted. Multivariate analysis of variance, regression, and structural equation modelling were used to analyse the data.

Results and limitations

In total, 142 participants were randomly allocated to one of the three intervention arms. The mean age of participants was 61 yr of age (standard deviation: 7), and 88% had undergone radical prostatectomy. A significant improvement in psychological distress was observed for participants who had access to the combined condition (MRA + Forum) with a moderate effect size (p = 0.02; partial η2 = 0.07). In particular, the decline in the mean level of psychological distress was 8.8 units larger for the MRA + Forum group than the Forum group (95% confidence interval [CI], 0.9–16.7). Although the decline in the mean level of psychological distress was 7.0 units larger for the MRA + Forum group than for the MRA Only group, this difference was not significant (95% CI, 1.1–15.1). Structural equation modelling indicated that reductions in health worry and regret contributed significantly to the reductions in psychological distress for the MRA + Forum condition.

Conclusions

This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men who have PCa. The findings of this study indicate the potential for this programme to deliver support that men may not otherwise receive.

Patient summary

This study found that men who have localised prostate cancer who received access to the online psychological intervention called My Road Ahead combined with the online peer discussion forum had significantly improved reductions in distress compared with those who received access to the online intervention alone or the forum alone.

Introduction

Prostate cancer (PCa) is one of the most commonly diagnosed cancers in men worldwide [3], with Australia amongst the countries that have the highest incidence [3]. Five-year survival rates are high in part because of advances in treatment but also as a result of early diagnosis. Registry data demonstrate that 93% of men have localised disease at diagnosis in contemporary practice in Australia [4]. Unfortunately all treatment options may result in significant decrements in quality of life (QoL), including erectile dysfunction, urinary incontinence, and bowel urgency [5]. These residual symptoms can have a significant impact on patient QoL and mental health [6], [7]. The prevalence of mood, anxiety, and adjustment disorders amongst men who have PCa ranges from 9% to 24% [8], [9], [10], [11], and there is some evidence that physical side effects of PCa treatment (eg, incontinence and sexual dysfunction) are directly associated with anxiety and depressive symptoms [12].

The support needs of men who have PCa are well documented. Many men report high levels of unmet supportive care needs [13], particularly in the area of psychological support (54%) and sexual support (47%) [13]. Unfortunately, access to evidence-based and timely psychosocial support is often limited, particularly in rural and remote regions. Two recent systematic reviews evaluating psychosocial interventions for PCa patients have indicated that only a limited evidence base exists for psychosocial and psychosexual interventions in PCa and that further research is required [14], [15].

The online environment holds appeal for many in accessing information and support anonymously, at a convenient time and location, and in a format that is easily tailored and personalised [16], [17]. Internet-based interventions to support the mental health of people affected by cancer have shown promise in augmenting the limited face-to-face mental health services available in cancer care [16], [17]. In addition, we found only one intervention that specifically focused on supporting men who had PCa and that evaluated the efficacy of an online therapist-assisted psychological intervention compared with a traditional face-to-face psychological intervention [18]. This study found that the Internet-delivered intervention was as effective as the traditional face-to-face intervention in producing enduring improvements in sexual outcomes for men who had PCa and their partner or spouse [18]. Although this study highlighted the potential utility of online interventions for this population, to date, no self-guided online interventions that had no to minimal therapist support focusing on a range of identified PCa-specific problem areas have been developed and evaluated for localised PCa patients.

This article reports on the psychological outcomes of a randomised controlled trial (RCT) of a self-guided online psychological intervention called My Road Ahead (MRA). The overall aim of the RCT was to examine the efficacy of the online intervention in reducing participants’ psychological distress from baseline to postintervention. The three conditions for the RCT were MRA alone (MRA Only), MRA plus the use of a moderated online forum (MRA + Forum), and the forum alone (Forum). We hypothesised that participants randomised to receive MRA, with or without access to the forum, compared with those who received access to the forum-only condition would demonstrate significantly greater reductions in psychological distress from pre- to postintervention. Furthermore, we hypothesised that participants randomised to receive access to the moderated forum in addition to MRA compared with those who received access only to MRA would demonstrate significantly greater reduction in psychological distress from pre- to postintervention. We also planned an examination of the factors that predicted reductions in psychological distress.

Section snippets

Materials and methods

We obtained ethical approval to conduct the study from the Melbourne Health, Swinburne University of Technology, Deakin University, and Peter MacCallum Cancer Centre human research ethics committees.

Participants

Of the 152 participants recruited, 10 were excluded because they reported that they had received treatment for advanced or locally advanced PCa following their treatment for localised disease. The remaining 142 participants had received treatment only for localised disease and were randomly allocated to the three intervention conditions. The mean age was 61 yr of age (standard deviation [SD]: 7; range: 42–82), and the mean time since diagnosis was 3.5 yr (SD: 1.8; range: 6–60 mo). Sixty-five

Discussion

The combination of the intervention, My Road Ahead, with access to the forum showed significantly superior improvements in participant psychological distress from pre- to postintervention compared with the other two intervention conditions (MRA Only or Forum). A statistically and clinically significant improvement in psychological distress was seen for participants who had access to both the online intervention and moderated forum, while no significant change in psychological distress was seen

Conclusions

The current study indicates that there may be more benefit for those participants who were experiencing higher levels of distress at baseline, suggesting that delivery of this intervention only to those who were experiencing high levels of distress at baseline could improve the effect size of this intervention. Follow-up of participant outcomes is also important, and this data will be collected and reported. Future examination of the optimal timing of the provision of this intervention

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