Online support groups for young women with breast cancer: a proof-of-concept study

Experiences of peer support activities and the need for a metaverse-based program in young women with breast cancer: A qualitative study

Objective

This study aimed to explore young breast cancer survivors' experiences of peer support activities and their need for a metaverse-based peer support program.

Methods

This qualitative content analysis study involved 15 young women with breast cancer under the age of 40. Participants with diverse experiences in peer support activities were purposefully selected. Data were collected in March 2023 through three focus group interviews and three additional individual interviews. Saturation was reached when no new themes emerged from the interviews. The interviews were transcribed verbatim and analyzed using conventional content analysis. This study ensured the trustworthiness of the data based on criteria including truth value, applicability, consistency, and neutrality.

Results

Four categories emerged: advantages, disadvantages, preferences for peer support activities, and the need for metaverse-based peer support programs. Participants valued peer support activities for exchanging information, nurturing empathy, and encouraging healthy behaviors. Challenges included information confusion, peer conflict, isolation, and stigma. Preferences for group composition, size, and medium varied; however, all participants agreed on the importance of operational guidelines. Participants expected a metaverse-based peer support program to provide safe and enjoyable experiences despite concerns about unfamiliar platforms.

Conclusions

This study highlights the unique needs and preferences of young breast cancer survivors regarding peer support activities. Well-organized and tailored peer support can significantly enhance their quality of life. These findings provide valuable insights for developing effective metaverse-based peer support programs to meet the needs of young women with breast cancer.

Effects of nurse-led supportive-expressive group intervention for post-traumatic growth among breast cancer survivors: A randomized clinical trial

BACKGROUND

Post-traumatic growth induced from cancer diagnosis and treatment could benefit the prognosis of cancer survivors, but intervention based on self-disclosure in group is limited.

OBJECTIVE

Aimed to examine the effectiveness of a supportive-expressive group intervention on post-traumatic growth. The impact of the intervention on anxiety and depression were also explored.

DESIGN

This randomized clinical trial enrolled patients from June 2017 to September 2018 with a one-month follow-up. Data collectors were blinded to patient grouping.

SETTING

A single center study in Chengdu, China.

PARTICIPANTS

One hundred sixty-eight participants who met the eligibility criteria were randomly assigned to the intervention group (n = 84) or control group (n = 84); 46 were excluded and 122 patients finished the one-month follow-up.

METHODS

Participants in the intervention group received nurse-led support intervention focusing on topics such as "Being a Patient", "Interpersonal Relationships", "Journey for Recovery", and "Planning the Future" while participants in the control group received health education, rehabilitation training etc. according to the nursing routine of breast cancer patients. The intervention was designed in accordance with the diagnosis and treatment process as well as patient needs. Participants in both groups were evaluated three times (T1-baseline before the intervention, T2-end of the intervention, and T3-1 month follow up). Post-traumatic growth, anxiety and depression were evaluated.

RESULTS

Participants in the intervention group reported higher level of post-traumatic growth (p < 0.01 or 0.05) and reduced anxiety and depression (p < 0.01 or 0.05 and p < 0.01 or 0.05). The multilevel model indicated that the intervention significantly promoted post-traumatic growth (β_T3  = 7.87, p < 0.05) and dimensions of relating to others (β_T3  = 4.26, p < 0.001), personal strength (β_T3  = 4.27, p < 0.01), appreciation of life (β_T3  = 8.69, p < 0.001), and new possibilities (β_T3  = 1.91, p < 0.05), anxiety (β_T3  = -3.63, p < 0.001), and depression (β_T3  = -2.27, p < 0.001), but had no effect on the dimension of spiritual change. In addition, the multi-level model showed that patients with younger ages (β = -0.05~-0.52, p < 0.05-0.001), with high school and above education levels (β = 1.53~9.29, p < 0.01) and accompanied by husbands(β = -1.48~-8.51, p < 0.05) had more effective intervention and patients with religious belief had a better spiritual change level (β = 1.86, p < 0.001).

CONCLUSIONS

These findings provide evidence for the potential effectiveness of the nurse-led intervention on positive benefits of post-traumatic growth and relieved anxiety and depression for Chinese breast cancer survivors and will inform the design and development of a large randomized controlled trial.

CLINICAL RELEVANCE

The supportive-expression group intervention can be applied independently by nurses. The four themes of self-disclosure can help patients grow after trauma, and this method can be used as a psychological support technique for breast cancer patients during hospitalization.

The effect of COVID-19 prevention methods training given through distance learning on state anxiety level: the case of private sector

Purpose

The aim of this study was to determine the effect of coronavirus disease 2019 (COVID-19) prevention methods training given by distance learning technique on the state anxiety level of the workers of a company serving in the communication sector.

Design/methodology/approach

The sample of this experimental and cross-sectional study consisted of 52 people working in the communication sector. Data were collected using a questionnaire and the state anxiety inventory. Data were analyzed using descriptive statistics, t-test, variance analysis, Kruskal–Wallis, Mann–Whitney U and Tukey’s test.

Findings

While the state anxiety scores of the workers working in the communication sector were 47.94 ± 4.90 before the training, they were found to be 43.98 ± 5.20 after the training.

Research limitations/implications

As in every study, this study has some limitations. Although a homogeneous sample is tried to be formed since it only covers this group, it should be considered that there is a limitation in terms of generalizability. In addition, the fact that the knowledge score is not measured and the relationship between the knowledge score and the anxiety score is not evaluated should be considered as a limitation. Finally, it is also a limitation that the questionnaire form, which includes measurement tools, is applied online. It is thought that measuring errors can be minimized if questionnaires are applied face to face.

Practical implications

The results of the study showed that the training given to the workers in the communication sector contributed positively to the reduction of anxiety levels. It is important to provide training and support to those with high anxiety levels. After providing effective protection for nurses/midwives under pandemic conditions and preventing their uncertainties, they can contribute to the reduction of anxiety levels by providing training to individuals who serve the society. It is recommended to plan health trainings for the anxiety of other sector workers serving the society and to focus on these groups. Thus, the effective protection of individuals and their service quality will increase and their anxiety may decrease.

Originality/value

Informative support from nurses/midwives can make it easier to control anxiety arising from the COVID-19 pandemic. The results are important in order to draw attention to the anxiety of other sector workers serving the society and the importance of informative roles of nurses. In order to reduce the anxiety levels of workers in different sectors, it is recommended to conduct more supportive training activities and to draw attention to the workers serving the society.

Video conference vs face-to-face group psychotherapy for distressed cancer survivors: A randomized controlled trial

OBJECTIVE

This study assesses the effectiveness of face-to-face group positive psychotherapy for cancer survivors (PPC) compared to its online adaptation, online group positive psychotherapy for cancer survivors (OPPC), which is held via videoconference. A two-arm, pragmatic randomized controlled trial was conducted to examine the effects of both interventions on emotional distress, post-traumatic stress symptoms (PTSS), and post-traumatic growth (PTG) among cancer survivors and analyze attrition to treatment.

METHODS

Adult women with a range of cancer diagnoses were invited to participate if they experienced emotional distress at the end of their primary oncological treatment. Emotional distress, PTSS, and PTG were assessed at baseline, immediately after treatment, and 3 months after treatment. Intention-to-treat analyses were carried out using general linear mixed models to test the effect of the interventions overtime. Logistic regressions were performed to test differential adherence to treatment and retention to follow-up.

RESULTS

A total of 269 individuals participated. The observed treatment effect was significant in both modalities, PPC and OPPC. Emotional distress (b = -2.24, 95% confidence interval [CI] = -3.15 to -1.33) and PTSS (b = -3.25, 95% CI = -4.97 to -1.53) decreased significantly over time, and PTG (b = 3.08, 95% CI = 0.38-5.78) increased significantly. Treatment gains were sustained across outcomes and over time. Analyses revealed no significant differences between modalities of treatment, after adjusting for baseline differences, finding that OPPC is as effective and engaging as PPC.

CONCLUSIONS

The OPPC treatment was found to be effective and engaging for female cancer early survivors. These results open the door for psycho-oncology interventions via videoconference, which are likely to lead to greater accessibility and availability of psychotherapy.

What is known about the role of rural-urban residency in relation to self-management in people affected by cancer who have completed primary treatment? A scoping review

Purpose

Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas.

Methods

Arksey and O’Malley’s framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted.

Results

A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1).

Conclusion

If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.

Narrative-Informed, Emotion-Focused Psychotherapy in Synchronous, Online Chat Groups for Adolescents and Young Adults with Cancer: A Proof-of-Concept Study

Few, scalable, evidence-based psychosocial interventions exist for adolescent and young adult cancer survivors (AYAs, 18–39 years old). Using an existing, facilitated, online synchronous chat group-plus-education model (OSG+E), we replaced their educational workbook with an AYA-created film to stimulate an age-specific, emotion-focused group discussion (OSG+V). This randomized proof-of-concept trial compared the two models' content suitability, group processes, and feasibility over 9 months in 34 male and female AYAs with a range of cancers. AYAs rated the OSG + V model more suitable, cohesive, and as having higher levels of important group processes than the OSG+E. A larger randomized trial is feasible for this AYA-appropriate, emotion-focused OSG + V model.

Translating the Restoring Body Image After Cancer (ReBIC) Group Therapy Intervention Into an Online Version: A Successful Case Study and Recommendations

A growing number of face-to-face group therapy interventions are being translated into online versions in psycho-oncology. Yet few researchers have systematically described the complex translation process or systematic approaches used to maintain the integrity of the original empirically supported interventions. In this article, we present a case study to illustrate the process of translating an evidence-based face-to-face therapy group, Restoring Body Image after Cancer (ReBIC) into an online format. We highlight how three critical therapeutic components from the original intervention (guided imagery exercises, psychoeducational reading materials, and psychotherapeutic group processes) were maintained and translated for online delivery. We provide preliminary recommendations for future translation efforts of text-based online group therapies to encourage best practices.

Feasibility and acceptability of i-Restoring Body Image after Cancer (i-ReBIC): A pilot trial for female cancer survivors

OBJECTIVE

This pilot study aimed to evaluate the feasibility, acceptability, and psychosocial outcomes of a text-based online group therapy intervention, i-Restoring Body Image after Cancer (i-ReBIC). i-ReBIC was developed to reduce body image distress and psychosexual dysfunction among women diagnosed and treated for breast or gynecological cancer.

METHODS

i-ReBIC was adapted from an empirically tested face-to-face group therapy intervention, ReBIC. Over the 8-week intervention, participants engaged in 90-minute weekly text-based online discussions. Each week, a new topic associated with reconnecting to the body, adjusting to a postcancer identity, and improving psychosexual functioning was addressed. Homework assignments included readings, guided imagery exercises, and journaling.

RESULTS

Sixty women with cancer enrolled in the pilot study. Among them, 47 completed the intervention, and 44 filled out all prestudy and poststudy questionnaires. Ninety-three percent of participants (n = 41) were satisfied and reported that it met their expectations. Eighty percent of participants (n = 35) reported no technical difficulties during the intervention. Preoutcome and postoutcome measures on body image distress and experience of embodiment showed statistically significant improvements. Psychosexual distress and quality of life also showed improvements but were not statistically significant.

CONCLUSIONS

This study suggests that i-ReBIC is feasible, well accepted, and effective in addressing persistent body image concerns experienced by women treated for breast or gynecological cancer. As an online group therapy, i-ReBIC can expand the reach of its original face-to-face intervention by mitigating barriers and improving access to care in a cost-effective manner.

A critical literature review of dyadic web-based interventions to support cancer patients and their caregivers, and directions for future research

OBJECTIVE

With the rapid development of the Internet, e-health interventions are becoming popular and are showing positive impacts. Cancer affects not only patients but also their caregivers, leading to a recognition that cancer patient-caregiver dyads cope with cancer as a unit rather than as individuals. The objectives of this paper are to explore web-based interventions for cancer patient-caregiver dyads coping with cancer from the aspects of intervention content, delivery format, outcome measurements, and outcomes and to provide recommendations on developing patient-caregiver dyadic web-based interventions for future research.

METHODS

Literature focused on cancer patient-caregiver dyadic web-based interventions, published in English or Chinese from the launch of five databases (CINAHL, PsycINFO, EMBase, Medline, Science Citation Index Expanded) to April 2019, was systematically searched. Manual searching through the references of full-text articles was also conducted.

RESULTS

Of a total of 812 articles, 17 articles met the inclusion criteria. The content of these web-based dyadic interventions mainly included information support, communication and support, skills-building, and psycho-education. These web-based interventions reported a small to large positive impact on patients with cancer and their caregivers in terms of physical health (d = 0.17-0.75), psychological health (d = 0.04-0.80), overall quality of life (d = 0.20-0.68), and dyadic relationship (d = 0.30-0.95).

CONCLUSIONS

Web-based dyadic interventions can be designed for tailored content, which benefits both patients and their caregivers. Future research on cancer patient-caregiver web-based interventions should be conducted in diverse cultures.

The role of off-topic discussions in online health support groups: insights from a content analysis of an online rectal cancer group

PURPOSE

Both off-topic discussions and exchanges of social support are important to the success of online health support groups. Analyzing their relationship could enhance our understanding of the nature of helpful interactions in online cancer support groups and ways promoting their success.

METHODS

A total of 15,284 messages were collected and analyzed from an online support group for rectal cancer. Two coders coded and categorized the messages into 211 threads using directed content analysis and a social support classification system. The relationship between off-topic discussions and social support was explored using the quadratic assignment procedure.

RESULTS

There are 91 threads of off-topic discussions, 83 threads of informational support, 22 threads of emotional support, seven threads of tangible support, five threads of network support, and three threads of esteem support. More of the off-topic discussions are associated with more emotional and tangible support. Both off-topic discussions and informational support are mutually influenced by the mediating role of emotional support. In addition, off-topic discussions and network support are mutually influenced by the mediating role of emotional and tangible support, and off-topic discussions and esteem support are mutually influenced by the mediating role of tangible support.

CONCLUSIONS

Off-topic discussions directly or indirectly promote different types of social support in an online rectal cancer support group.

Psychological support for patients with cancer: evidence review and suggestions for future directions

PURPOSE OF REVIEW

Psychological distress and mental health comorbidity are common in cancer. Various therapeutic frameworks have been used for interventions to improve psychological wellbeing and quality of life in cancer patients with mixed results. This article reviews contributions to that literature published since January 2017.

RECENT FINDINGS

The majority of new psychological intervention research in cancer has used cognitive behavioural therapy (CBT) or mindfulness-based interventions. CBT has been considered a gold-standard intervention and recent evidence justifies continuation of this. Recent reviews call into question the validity of evidence for mindfulness-based interventions. A smaller number of trials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged, and whereas findings are promising, additional fully powered trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions.

SUMMARY

Efficacious, timely and acceptable psychological interventions are a necessary component of comprehensive cancer care. There is some way to go before the evidence conclusively points towards which interventions work for which cancer groups and for which specific outcomes. Methodological limitations must be addressed in future trials; at the forefront remains the need for fully powered, head-to-head comparison trials.

On the uniqueness of, and diversity within, cancers: A commentary on Kangas and Gross 2018

This commentary accompanies publication of Kangas and Gross' phase model of emotion coping throughout the process of cancer care. While supporting the model, this commentary additionally highlights the already existing knowledge about the critical role of tumor stage, patient age, uncertainty and fear of recurrence, and gender differences. It is briefly described how all of these factors moderate and mediate the emotion coping process.