Telephone counseling in psychosocial oncology: a report from the Cancer Information and Counseling Line

Perceived importance of emotional support provided by health care professionals and social networks: Should we broaden our focus for the delivery of supportive care?

INTRODUCTION

Emotional support provided by health care professionals (HCPs) for people diagnosed with cancer is associated with improved outcomes. Support via social networks may also be important.

AIMS

To report among a sample of distressed patients and caregivers, (1) the importance attributed to different sources of emotional support (HCPs and social networks) by distressed cancer patients and caregivers; (2) the proportion who indicate they did not receive sufficient levels of emotional support; and (3) potential associations between respondents' demographic and clinical characteristics and reported lack of emotional support.

METHODS

This study utilised cross-sectional data from telephone interviews collected during the usual-care phase of the Structured Triage and Referral by Telephone (START) trial. Participants completed a telephone interview 6 months after their initial call to the Cancer Council Information and Support service and included recall of importance and sufficiency of emotional support.

RESULTS

More than two-thirds of patients (n = 234) and caregivers (n = 152) reported that family and friends were very important sources of emotional support. Nurses (69% and 42%) and doctors (68% and 47%) were reported very important, while a lower proportion reported that psychologists and psychiatrists were very important (39%, and 43%). Insufficient levels of support were reported by 36% of participants. Perceptions of insufficient support were significantly associated with distress levels (p < .0001) and not having a partner (p = .0115).

CONCLUSION

Social networks, particularly family, are an important source of emotional support. Higher levels of distress, those without partners, and caregivers may require targeted interventions to increase their access to emotional support.

The effectiveness of telephone and Internet-based supportive care for patients with esophageal cancer on enhanced recovery after surgery in China: A randomized controlled trial

Objective

The aim of this study was to establish a nurse-led supportive care program based on telephone and Internet support and evaluate its efficacy in comparison with conventional care on enhanced recovery after surgery.

Methods

The study was designed as an open-label, randomized controlled trial to value the efficacy of a nurse-led supportive care program in comparison with conventional care. A convenience sampling method was employed to recruit patients with esophageal cancer in a tertiary Grade A cancer center in Beijing from November 2018 to January 2019. Patients were assigned randomly (1:1) to one of the two groups (intervention group vs control group) via a web randomization system. The control group received conventional care. Patients from the intervention group received conventional care and one-on-one phone calls from nurses following their discharge assessments and education about nutrition and symptoms. Nurses also set up a WeChat group, which they invited patients to join in before discharge for better communication during follow-up. Statistical testing, including nutritional status, quality of life, the helpfulness of the follow-up service, and the patients’ satisfaction with their care, was conducted 6 months after discharge to assess for differences between the two groups. The independent sample t, chi-squared, and Mann–Whitney tests were used to compare between the experiences of the intervention and control groups. The Spearman correlation analysis was used for the analysis of correlation of the nutritional index and quality of life.

Results

Finally, 168 patients were included in the study, with 86 patients in the intervention group and 82 in the control group. Significant differences between the intervention and control groups were found in the nutrition risk screening 2002 and simple diet self-assessment tool scores. The changes in blood albumin, prealbumin, and transferrin were also statistically significant. All (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) QLQ-C30 results of the intervention group were better than those of the control group. A significant positive correlation of the simple diet self-assessment tool (the higher, the better) and the scores for total health/quality of life were detected (r ​= ​0.214, P ​= ​0.005). A significant negative correlation of the nutrition risk screening 2002 (the lower, the better) and the scores of total health/quality of life was detected (r ​= ​−0.446, P ​= ​0.000). The patients’ scores on the helpfulness of the follow-up service and their satisfaction with it were both significantly higher in the intervention group than in the control group.

Conclusions

This study highlighted the important role of nurse-led supportive care based on telephone and Internet-based support for patients after enhanced recovery after surgery. The supportive care improved patients’ nutritional status, elevated their quality of life, and improved their satisfaction with the care provided to them.

Impact of individual background on the unmet needs of cancer survivors and caregivers - a mixed-methods analysis

BACKGROUND

Cancer survivors and their caregivers may have various unmet needs that are medically difficult to solve. Previous studies have suggested the relations between individuals' backgrounds and their unmet needs. We conducted a large-scale analysis to clarify the influence of individuals' backgrounds, primarily cancer type, on specific types of unmet needs.

METHODS

Using a mixed-methods approach, we analyzed records of first-time callers to a cancer-focused telephone consultation service that was provided by the Kanagawa Cancer Clinical Research Information Organization from October 2006 to May 2014. The qualitative approach concerned extracting unmet needs mentioned in each consultation and classifying them into themes of specific needs, while the quantitative approach comprised multi-variated analysis of the relationships between the frequency by which the needs in each theme arose and the associated callers' backgrounds.

RESULTS

A total of 1938 consultation cases were analyzed. In the qualitative analysis, the needs were classified into 16 themes. The mean number of unmet needs for each caller was 1.58 (standard deviation = 0.86). In the multi-variated analysis, caregivers for colorectal cancer survivors had a lower frequency of "emotional/mental health" needs (OR: 0.31, 95%CI: 0.11-0.88, p = 0.028) than did caregivers for breast-cancer survivors. Nevertheless, this was the only significant difference in needs frequency among callers (including survivors and their caregivers) with specific cancer types. Meanwhile, there significant difference in the frequency of occurrence of each unmet need theme was found among items concerning other background elements. Among survivors, sex was related to the frequency of needs among "physical" and "resources" themes, and "emotions/mental health"; their age group with "employment"; treatment course with "physical" and "resources" themes and "cure"; residence with "physical" themes; presence of symptom with "physical," "education/information," "resources," "emotions/mental health," and "cure" themes.

CONCLUSIONS

This large-scale study suggests that cancer type is not a significant factor for specific unmet needs and that individuals' backgrounds and presence of symptoms play a more important role. Through this study, it was found that instruments to predict people's needs and a system to provide individualized cancer care across cancer types should be developed in the future.

Distress screening and supportive care referrals used by telephone-based health services: a systematic review

PURPOSE

People affected by chronic diseases such as cancer report high levels of distress and a need for psychosocial support. It is unclear whether telephone-based services for people affected by chronic disease are a practical setting for implementing distress screening, referral protocols and rescreening to direct supportive care where it is needed. This systematic review aimed to describe the published literature regarding distress screening and supportive care referral practices in telephone-based services for people affected by chronic diseases such as cancer.

METHODS

A systematic literature search of MEDLINE, Embase, PsycInfo, CINAHL, Cochrane and Scopus was conducted in February 2018. Included quantitative studies involved: patients or caregivers affected by chronic diseases including cancer and describe a health service assessing psychosocial needs or distress via telephone. Extracted data included the type of cancer or other chronic disease, sample size, screening tool, referral or rescreening protocols, and type of health service.

RESULTS

The search identified 3989 potential articles with additional searches returning 30 studies (n = 4019); fourteen were eligible for full-text review. Of the 14 studies, 13 included cancer patients. Studies were across multiple settings and identified nine distress screening tools in use.

CONCLUSION

The reviewed studies indicate that validated distress-screening tools are being used via telephone to identify distress, particularly in relation to cancer. Screening-driven supportive care referrals are also taking place in telephone-based services. However, not all services use an established referral protocol. Ongoing rescreening of callers' distress is also limited despite it being an important recommendation from psycho-oncology guidelines.

An outreach telephone program for advanced melanoma supportive care: Acceptability and feasibility

PURPOSE

People with advanced melanoma face an uncertain trajectory as new treatments now have the potential to provide longer-term survival for some. However, the disease course is variable and unpredictable, with many expressing a need for better supportive care. This study aimed to investigate the acceptability and feasibility of extending an existing melanoma-specific self-referral or 'passive' telephone consultation support service to an 'active' outreach call to offer a supportive care program tailored to the needs of the patient.

METHOD

Participants were enrolled by their oncology nurse into a single group pre-post intervention study. Participants received an outreach telephone call focused on knowledge and skill development. Participants completed questionnaires at baseline and four weeks post-intervention. Post-intervention interviews with patients and involved staff were used to explore acceptability and feasibility of the outreach service call.

RESULTS

Of 18 participants approached, 15 enrolled and 14 received the intervention. Staff time required for intervention delivery provided evidence for feasibility. Participants perceived the intervention as acceptable, and beneficial. In interviews, having someone with melanoma-specific knowledge to talk with was a key benefit of the outreach call program. Many participants expressed that they would have wished to receive the outreach call at an earlier stage, for example at the time of recurrence of/progression to advanced melanoma.

CONCLUSIONS

Extending an existing self-referral support service model to use a more 'active' outreach approach is acceptable and feasible. The next step in the evaluation process for this intervention is a randomised controlled trial to determine effectiveness and cost-effectiveness.

Are cancer helplines effective in supporting caregivers? A systematic review

PURPOSE

The aims of this systematic review were to summarize the profile of caregivers accessing cancer helplines, to evaluate caregiver satisfaction with the helpline service, and to review the evidence base of intervention studies testing the efficacy of community-based cancer helplines in improving caregiver health and well-being.

METHODS

Four electronic databases (Medline, CINAHL, PsychINFO, and EMBASE) were systematically searched to identify relevant literature, including all articles published in English until May 2018. Reference lists of accepted papers were reviewed for the inclusion of additional potentially relevant articles, gray literature was excluded.

RESULTS

Forty-five publications met the inclusion criteria for this review. Forty-one papers reported on the proportion of caregivers accessing cancer helplines. Twenty-six studies described demographic and clinical characteristics of caregivers and eight reported on call characteristics. Reasons for contacting the service were stated in 21 studies and caregiver satisfaction with the helpline service was assessed in 12 articles. Fourteen studies investigated specific topics of interest (e.g., prevalence of sleep problems, distress screening, or clinical trial participation). Two randomized controlled trials examined the efficacy of cancer helplines in improving caregiver outcomes, with findings showing interventions to be effective in reducing distress and unmet needs, and in increasing positive adjustment.

CONCLUSIONS

There is limited scientific evidence regarding the efficacy of cancer helplines to improve caregivers' health and well-being. More intervention studies are needed to examine the benefits of cancer helplines to this study population to ensure structured referral pathways can be established.

Implementing Systematic Screening and Structured Care for Distressed Callers Using Cancer Council's Telephone Services: Protocol for a Randomized Stepped-Wedge Trial

Background

Structured distress management, comprised a 2-stage screening and referral model, can direct supportive care resources toward individuals who are most likely to benefit. This structured approach has yet to be trialed in Australian community-based services such as Cancer Council New South Wales (NSW) and Victoria Cancer Information and Support (CIS) 13 11 20 lines who care for a large community of cancer patients and caregivers.

Objective

The aim of this study was to evaluate the effectiveness of structured screening and referral in (1) increasing the proportion of distressed CIS callers who accept supportive care referrals and (2) reducing distress levels at 6-month follow-up.

Methods

In this stepped-wedge trial, Cancer Council NSW and Victoria CIS consultants are randomized to deliver structured care during inbound 13 11 20 calls in accordance with 3 intervention periods. Eligible callers are patients or caregivers who score 4 or more on the Distress Thermometer; NSW or Victorian residents; aged 18 years or older; and English proficient. Study data are collected via computer-assisted telephone interviews (CATIs) at 3- and 6-month follow-up and CIS record audit. CATIs include demographic and service use items and the General Health Questionnaire (GHQ-28) to assess distress. An economic analysis of the structured care model will be completed.

Results

The structured care model was developed by guideline review and identification of service characteristics to guide mapping decisions; place-card methodology; and clinical vignettes with think-aloud methodology to confirm referral appropriateness. The model includes an additional screening tool (Patient Health Questionnaire-4) and a referral model with 16-20 CIS services. Descriptive statistics will be used to assess referral uptake rates. Differences between GHQ-28 scores for structured and usual care callers will be tested using a generalized linear mixed model with fixed effects for intervention and each time period. The trial will recruit 1512 callers. The sample size will provide the study with approximately 80% power to detect a difference of 0.3 SD in the mean score of the GHQ-28 at an alpha level of .05 and assuming an intra-cluster correlation of .04. A random sample of recorded calls will be reviewed to assess intervention fidelity and contamination. To date, 1835 distressed callers have been invited to participate with 60.71% (1114/1835) enrolled in the study. A total of 692 participants have completed 6-month CATIs. Recruitment is anticipated to end in late 2019.

Conclusions

This trial is among the first to rigorously test the outcomes of a community-based structured approach to distress management. The model is evidence-informed, practice-ready, and trialed in a real-world setting. The study outcomes will advance the understanding of distress management internationally for both patients and caregivers.

Trial Registration

Australian New Zealand Clinical Trial Registry ACTRN12617000352303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372105&isReview=true (Archived by WebCite on http://www.webcitation.org/78AW0Ba09)

International Registered Report Identifier (IRRID)

DERR1-10.2196/12473

A smartphone Chatbot application to optimize monitoring of older patients with cancer

BACKGROUND

Almost two thirds of patients diagnosed with cancer are age 65 years or older. In order to follow up on older patients with cancer receiving chemotherapy at home, we implemented remote phone monitoring conducted by skilled oncology nurses. However, given the rising number of patients assessed and the limited time that hospital professionals can spend on their patients after discharge, we needed to modernize this program. In this paper we present the preliminary results and the ongoing evaluation.

METHOD

We implemented a semi-automated messaging application to upgrade the current follow-up procedures. The primary aim is to collect patient's key data over time and to free up nurses' time so that during phone calls they can focus on education and support. The Chatbot feasibility was assessed in a sub-sample of unselected patients before its wider dissemination and pragmatic evaluation.

MAIN RESULTS

During the first deployment period, 9 unselected patients benefited from the Chatbot (mean 83 y.o.) with a total of 52 completed remote evaluations. Each participant answered 6 questionnaires over 7 weeks with an 86% compliance rate. The average completion time for the questionnaires was 3.5 min and the answer rate was 100%. The 'free text' field was used in 58% of the questionnaires. The Chatbot solution is currently proposed to all eligible patients thanks to the regional cancer network support. We are measuring acceptability, health outcomes and health network impact.

DISCUSSION AND CONCLUSION

The results of this first phase are encouraging. The integration of the solution into the health care organization was feasible and acceptable. Moreover, the answers revealed serious health (e.g. fever) or adherence (e.g. blood test) issues that require timely interventions. The major strength of this solution is to rely on end-users' current knowledge of technologies (text-messaging), which allows a seamless integration into a complex clinical network.

Protocol for a Randomized Controlled Trial of Proactive Web-Based Versus Telephone-Based Information and Support: Can Electronic Platforms Deliver Effective Care for Lung Cancer Patients?

Background

Community-based services such as telephone support lines can provide valuable informational, emotional, and practical support for cancer patients via telephone- or Web-based (live chat or email) platforms. However, very little rigorous research has examined the efficacy of such services in improving patient outcomes.

Objective

This study will determine whether: proactive telephone or Web-delivered support produces outcomes superior to printed information; and Web-delivered support produces outcomes comparable to telephone support.

Methods

A consecutive sample of 501 lung cancer outpatients will be recruited from 50 Australian health services to participate in a patient-randomized controlled trial (RCT). Eligible individuals must: be 18 years or older; have received a lung cancer diagnosis (including mesothelioma) within the previous 4 months; have an approximate life expectancy of at least 6 months; and have Internet access. Participants will be randomly allocated to receive: (1) an information booklet, (2) proactive telephone support, or (3) proactive Web support, chat, and/or email. The primary patient outcomes will be measured by the General Health Questionnaire (GHQ-12) and Health Education and Impact Questionnaire (heiQ) at 3 and 6 months post recruitment. The acceptability of proactive recruitment strategies will also be assessed.

Results

It is hypothesized that participants receiving telephone or Web support will report reduced distress (GHQ-12 scores that are 0.3 standard deviations (SD) lower) and greater self-efficacy (heiQ scores that are 0.3 SDs higher) than participants receiving booklets. Individuals receiving Web support will report heiQ scores within 0.29 SDs of individuals receiving telephone support.

Conclusions

If proven effective, electronic approaches such as live-chat and email have the potential to increase the accessibility and continuity of supportive care delivered by community-based services. This evidence may also inform the redesigning of helpline-style services to be effective and responsive to patient needs.

Do cancer helplines deliver benefits to people affected by cancer? A systematic review

OBJECTIVES

To determine the: (1) proportion of studies that describe characteristics of helpline service delivery, compared to the proportion that report trials testing efficacy or effectiveness of helplines in changing user outcomes; (2) proportion of efficacy or effectiveness studies that meet EPOC criteria for methodological rigor; and (3) potential benefits of cancer helplines for people affected by cancer based on findings from rigorous efficacy or effectiveness trials.

METHODS

Electronic databases (Medline, PsycINFO, EMBASE and CINAHL) were searched to identify English-language studies describing original research published from 1991 to 2011.

RESULTS

Twenty-eight publications met the review inclusion criteria. From these studies, data on: the characteristics of cancer helpline users; call content; and user satisfaction, were extracted. The potential for helplines to improve the psychosocial outcomes of callers was examined for the three intervention trials.

CONCLUSION

There is a lack of robust evidence regarding the level and types of benefits that cancer helplines may deliver to callers affected by cancer. Given increased emphasis on delivering best-practise supportive care, building the evidence base in this field may assist cancer helplines to increase their service uptake, reach, and benefit to callers.

PRACTISE IMPLICATIONS

There is a need for more rigorous intervention-focussed studies in this field across a broader range of cancer populations. Future studies should focus on relevant patient-centred outcomes, such as improved knowledge and greater involvement in decision-making, while incorporating process measures to account for intervention fidelity and clinical performance.

Psychosocial telephone interventions for patients with cancer and survivors: a systematic review

OBJECTIVE

Over one third of patients with cancer experience elevated psychosocial distress. As screening for distress becomes more common, the number of patients referred for psychosocial care will increase. Psychosocial telephone interventions are recommended as a convenient and exportable alternative to in-person interventions addressing psychosocial distress. This study reviews the efficacy of randomized controlled trials (RCTs) of psychosocial telephone interventions for patients with cancer.

METHODS

We conducted a systematic review of peer-reviewed RCTs evaluating telephone interventions in adult patients with cancer across the survivorship continuum.

RESULTS

Through a database search, 480 articles were identified. After manual review, 13 were included, with 7 additional studies identified by back citation, totaling 20 studies. Participants were largely Caucasian, highly educated, with mean age ranging from 49 to 75 years. Most participants were patients with breast cancer (n = 13 studies). Sample sizes were generally small, with most patients recruited from large medical centers. Only one screened for psychosocial need. Interventions varied greatly in length and intensity. Eight studies reported significant effects post-intervention in the hypothesized direction on at least one psychosocial outcome measure. Of these eight studies, four included more than one follow-up assessment; of these, only one reported significant effects at last follow-up. No clear commonalities were found among studies reporting significant effects.

CONCLUSIONS

Methodological concerns and lack of consistency in adherence to CONSORT reporting guidelines were identified. This body of research would benefit from well-designed, theory-based RCTs adequately powered to provide more definitive evidence for intervention efficacy. This will probably require multi-institutional collaborations, guided by intervention and research methodology best practices.

Impact of counselling on quality of life and sleep in cancer patients

It has been acknowledged that poor quality of sleep significantly correlates with poor quality of life; evidence suggests that counselling has a positive impact not only on the cancer patient's quality of life, but also on family members and friends. The aim of this service evaluation was to determine if there was an improvement in clients' quality of life and sleep patterns following counselling as offered by a local cancer charity. A total of 60 matched pre- and post-counselling questionnaires were completed and subjected to statistical analysis. When considering quality of life, in the domains of Role Emotional, Mental Health and Mental Component Summary Score, it can be concluded that counselling has a positive effect on emotional health and mental wellbeing. The mean total number of hours sleep per night significantly increased from 6 hours sleep per night at baseline to 6.8 hours sleep per night at the completion of counselling (p=0.005) showing clients gained an extra 48 minutes sleep per night. The improved emotional and mental wellbeing alongside the extra 48 minutes sleep per night provides evidence that there is a positive outcome for those patients and families who use counselling services. Nurses and other members of the multidisciplinary team should be encouraged to discuss supportive therapies with patients and those affected by cancer at all stages of the cancer trajectory, regardless of social status, gender or cancer type.

Efficacy of an internet-based cognitive-behavioral intervention for long-term survivors of pediatric cancer: a pilot study

PURPOSE

Long-term survivors of pediatric cancer have an increased risk of post-traumatic stress symptoms (PTSS) and dysfunctional anxiety. However, there is a lack of evidence-based psychotherapy tailored to the needs of this target group. In this single-arm pilot study, an Internet-based psychological intervention ("Onco-STEP") for adolescent and young adult survivors was developed, and its efficacy in reducing PTSS and anxiety was evaluated.

METHODS

Former patients of pediatric cancer older than 15 years manifesting clinically relevant PTSS or anxiety were eligible. The cognitive-behavioral treatment consists of ten writing sessions and comprises two modules: the first aiming to reprocess the traumatic cancer-related experiences and the second aiming to build coping strategies with current cancer-related fears. Treatment was delivered via written messages on a secure Internet platform. Outcomes were assessed by the Post-traumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Fear of Progression/Relapse Questionnaire.

RESULTS

A total of 20 participants completed the intervention (mean age 27.3 ± 4.8 years at study; 13.8 ± 4.7 years since diagnosis; 70 % female). PTSS, anxiety, and fear of progression/relapse significantly declined at the end of the intervention, with pre-post effect sizes of 0.63, 0.74, and 0.48. In addition, we found a significant decrease in symptoms of depression. Except for the improvement in depression, all effects were sustained 3 months after the end of treatment.

CONCLUSIONS

The results show that the intervention is efficacious in reducing symptoms of post-traumatic stress and anxiety. Onco-STEP is a promising new way to treat young adult long-term survivors of pediatric cancer with late psychological effects. Future efforts need to focus on investigating specific evidence of the intervention in a randomized controlled trial.

Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication

OBJECTIVES

Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training.

METHODS

50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C.

RESULTS

Mean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice.

CONCLUSIONS

This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus.

PRACTICE IMPLICATIONS

Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.

Project connect online: randomized trial of an internet-based program to chronicle the cancer experience and facilitate communication

PURPOSE

Evidence suggests that expressing emotions related to cancer and receiving interpersonal support can promote psychological and physical health in women diagnosed with breast cancer. However, adaptive expression of feelings and communication with one's social network can pose challenges for patients with cancer. We report on a randomized controlled trial of an intervention, Project Connect Online, for patients with breast cancer to create personal Web sites to chronicle their experience and communicate with their social network.

PATIENTS AND METHODS

Women (N = 88) diagnosed with breast cancer (any stage, any interval since diagnosis) were randomly assigned to participate in a 3-hour workshop for hands-on creation of personal Web sites with a follow-up call to facilitate Web site use, or to a waiting-list control. Assessed before randomization and 6 months after the intervention, dependent variables included depressive symptoms, positive and negative mood, cancer-related intrusive thoughts, and perceived cancer-related benefits in life appreciation and strengthened relationships.

RESULTS

Relative to control participants, women randomly assigned to Project Connect Online evidenced significant benefit 6 months later on depressive symptoms, positive mood, and life appreciation, but not negative mood, perceived strengthened relationships, or intrusive thoughts. Treatment status moderated the intervention effects, such that women currently undergoing medical treatment for cancer benefitted significantly more from the intervention on depressive symptoms and positive mood than did women not receiving treatment.

CONCLUSION

Findings suggest the promise of an intervention to facilitate the ability of women diagnosed with breast cancer to chronicle their experience and communicate with their social network via the Internet.

Bridging the transition from cancer patient to survivor: pilot study results of the Cancer Survivor Telephone Education and Personal Support (C-STEPS) program

OBJECTIVE

To develop a feasibility study of a theory-driven telephone counseling program to enhance psychosocial and physical well-being for cancer survivors after treatment.

METHODS

Participants (n=66) were recruited from two Colorado hospitals with self-administered questionnaires at baseline and two weeks post-intervention. The one group, intervention only design included up to six thematic telephone counseling sessions over three months. Topics included nutrition, physical activity, stress management, and medical follow-up. Primary outcomes were cancer-specific distress, self-reported fruit and vegetable consumption and physical activity.

RESULTS

Of 66 subjects, 46 completed at least one counseling module and the follow-up assessment (70% retention rate). Mean satisfaction was 9 out of 10, and all participants would recommend C-STEPS to other survivors. Cancer-specific distress (Impact of Event Scale - Intrusion subscale) decreased for entire study population (p<0.001) and stress management session participants (p<0.001). Fruit and vegetable consumption increased for nutrition and exercise session participants (p=0.02) and the entire sample (p=NS). Physical activity increased in the entire group (p=0.006) and for nutrition and exercise session participants (p=0.01).

CONCLUSION AND PRACTICE IMPLICATIONS

C-STEPS is a feasible telephone counseling program that transcends geographic barriers, demonstrating the potential to decrease distress and promote coping and healthy lifestyles among cancer survivors.

A nonprofit community service and academic collaboration to increase outreach to older adults with cancer: lessons learned

This article describes the lessons learned by social work practitioners and nurse researcher faculty from a unique partnership between a 501(c) 3 nonprofit community service organization (cancer helpline) and an academic facility to improve outreach to older adults with cancer. In preparing the research proposal, carrying out the procedures, and instituting a community-based participatory research (CBPR) approach lessons learned included the importance of experienced researchers/writers, unpredictability of research activities, importance of collecting complete data, communicating underlying discipline and role-oriented assumptions, and effectiveness of CBPR to increase outreach to older adults with cancer in Delaware's eight cancer clusters.

[First year results of "APAAC infos services"]

CONTEXT

In Ivory Coast, the APAAC association "Let us help persons living with cancer or affected by cancer", in French "Aidons les Personnes Atteintes ou Affectées par le Cancer" (APAAC), set up the first ivorian call center to support persons living with or affected by cancer and to inform population about cancer.

PURPOSES OF THE STUDY

To show the feasibility of such a service in a developing country and to present the first results.

METHODOLOGY

This helpline is, since January 28th, 2010, directly accessible to the population by a fixed phone number. The population can, with a local cost call, contact a specialists team (psychologist, adviser in help relation or doctor), in total confidentiality, every Thursday from 3 pm till 5 pm. Outside Thursdays, informations about cancer are available on vocal server 24 hours a day and seven days a week. Callers are welcomed by a message inviting them either to listen to a recorded message about cancer or about APAAC association or finally to speak to a specialist online. Retrospective study based on the statistics of the call center. Because of a problem arisen on the statistics software, our results carry only over the period from August to December, 2010.

RESULTS

We had, during this period, 462 calls among which 23 in August, 58 in September, 67 in October, 230 in November and 84 in December. Reasons of the increasing of the figures are justify by the poster campaign in September and the communication around the service on television program in November. On these 462 calls, we had 35 real communications among whom 10 calls interrupted. The reason was the lack of call credit. The average of the call time was of 20 minutes for the conversations with the specialists. Three hundred and forty-three persons stopped to the welcome message, 341 (9%) listen information on the cancer, 27 (6%) listen information about the association. Sixteen persons wished to speak to specialists but were not regrettably able to make it because having called up except the hours of presence. Three hundred and fifty-five calls took place the working days. The most sought time slots were the ones of 7 am to 6 pm.

CONCLUSION

Those results raises questions about the necessity to create and to continue this kind of telephone counseling for cancer, but also on the need of communication and extension of listening days and hours. In our country context with a population with weak resources, the necessity of access to free call was also raised.

Cancer patient and survivor research from the cancer information service research consortium: a preview of three large randomized trials and initial lessons learned

The authors describe 3 large randomized trials from the Cancer Information Service Research Consortium. Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 also tests a telephone callback intervention delivered by a cancer information specialist. All participants receive standard print material specific to each project. Preliminary results from the 2-month follow-up interviews are reported for the initial wave of enrolled participants, most of whom were recruited from the Cancer Information Service (1-800-4-CANCER) telephone information program (Project 1: n =208; Project 2: n =340; Project 3: n =792). Self-reported use of the multimedia program was 51%, 52%, and 67% for Projects 1, 2, and 3, respectively. Self-reported use of the print materials (read all, most, or some) was 90%, 85%, and 83% for Projects 1, 2, and 3, respectively. The callback intervention was completed by 92% of Project 3 participants. Among those using the Cancer Information Service Research Consortium interventions, perceived usefulness and benefit was high, and more than 90% reported that they would recommend them to other cancer patients. The authors present 5 initial lessons learned that may help inform future cancer communications research.

Who benefits from a psychosocial counselling versus educational intervention to improve psychological quality of life in prostate cancer survivors?

OBJECTIVE

We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

DESIGN

Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

MEASURES

Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

RESULTS

For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

CONCLUSION

Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.

What happens now? Psychosocial care for cancer survivors after medical treatment completion

The growing population of adults living with a history of cancer in the United States mandates attention to quality of life and health in this group, as well as to the implementation of evidence-based interventions to address psychosocial and physical concerns at completion of medical treatments and beyond. The goals of this article are to document the need for attention to psychosocial domains during the re-entry and later phases of the cancer survivor trajectory, offer an overview of current evidence on efficacy of psychosocial interventions during those phases, and offer suggestions for application and research regarding post-treatment psychosocial care.

Working without a net: leukemia and lymphoma survivors' perspectives on care delivery at end-of-treatment and beyond

This study explored survivors' perspectives on care delivery and supportive care needs during reentry. Fifty-one individual interviews were conducted with adult leukemia and lymphoma survivors, 3 to 48 months from treatment cessation. Survivors reported poor continuity of care across the patient-survivor transition, difficulty finding appropriate information/services, lack of preparation, lack of support for survivorship issues, and inadequate or poorly timed follow-up as factors contributing to adjustment difficulties at end of treatment and beyond. Improved care coordination is needed after active treatment, including use of an exit interview and delivery of services that are more congruent and better timed to meet ongoing and emergent survivorship needs.

Can telephone counseling post-treatment improve psychosocial outcomes among early stage breast cancer survivors?

OBJECTIVE

To determine whether a telephone counseling program can improve psychosocial outcomes among breast cancer patients post-treatment.

METHODS

A randomized trial was conducted involving 21 hospitals and medical centers, with assessments (self-administered questionnaires) at baseline, 12 and 18 months post-enrollment. Eligibility criteria included early stage diagnosis, enrollment during last treatment visit, and the ability to receive the intervention in English. Endpoints included distress (Impact of Event Scale), depression (Center for Epidemiologic Studies Depression Scale), and two study-specific measures: sexual dysfunction and personal growth. The control group (n=152) received a resource directory for breast cancer; the intervention group (n=152) also received a one-year, 16 session telephone counseling program augmented with additional print materials.

RESULTS

Significant intervention effects were found for sexual dysfunction at 12 (p=0.03) and 18 months (p=0.04) and personal growth (12 months: p=0.005; 18 months: p=0.03). No differences by group were found in mean scores for distress and depression, with both groups showing significant improvement at 12 and 18 months (all p values for within-group change from baseline were <or=0.003). However, when dichotomized at cutpoints suggestive of the need for a clinical referral, the control group showed virtually no change at 18 months, whereas the intervention group showed about a 50% reduction in both distress (p=0.07) and depression (p=0.06).

CONCLUSIONS

Telephone counseling may provide a viable method for extending psychosocial services to cancer survivors nationwide.

A psychosocial cancer phone center staffed by professional psychologists as an integral part of the standard process of care: Its utility during the course of illness

Objective:

Major cancer centers cannot ignore psychosocial patient needs that have a significant impact on the process of adjustment to cancer and on compliance to treatments. We introduced a new service, the Gigi Ghirotti Psychosocial Cancer Phone Center (GGPCPC), staffed by professional psychologists, for use by our patients and their relatives. This article investigates its feasibility as a support delivery vehicle for patients in their follow-up phase, and also investigates patients' sense of abandonment related to their care setting.

Method:

A close collaboration was set up between GGPCPC psychologists and European Institute of Oncology (IEO) psychologists. Education and awareness sessions regarding the importance of such a source of psychological support were conducted by IEO psychologists with nurses, secretaries, and receptionists. IEO psychologists input monthly data, recorded on specific paper-tabs by GGPCPC psychologists for each call received by the phone center between March 2007 and March 2009, into a SPSS database.

Results:

Four hundred and thirty individuals contacted the center mainly to receive psychological support during their treatment phase, when they visited IEO for treatment sessions. Multiple indicators suggest that this telephone support program was feasible and provided support to a broad range of cancer patients. Patients seemed to prefer it to face-to-face psychological support during their treatment-phase.

Significance of results:

The GGPCPC was demonstrated to be an efficacious support and information delivery vehicle for patients and relatives during the illness course.

Randomized controlled trial of a psychosocial telephone counseling intervention in BRCA1 and BRCA2 mutation carriers

BACKGROUND

Responses following BRCA1/2 genetic testing are relevant for the comprehension of risk status and may play a role in risk management decision making. The objective of this study was to evaluate a psychosocial telephone counseling (PTC) intervention delivered to BRCA1/2 mutation carriers following standard genetic counseling (SGC). We examined the effect of the intervention on distress and the concerns related to genetic testing.

METHODS

This prospective randomized clinical trial included 90 BRCA1/2 mutation carriers. We measured anxiety, depression, and genetic testing distress outcomes at intervention baseline and 6 and 12 months following disclosure. We evaluated the effects of SGC versus SGC plus PTC on psychological outcomes using intention-to-treat analyses through generalized estimating equations.

RESULTS

At 6 months, PTC reduced depressive symptoms (Z = -2.25, P = 0.02) and genetic testing distress (Z = 2.18, P = 0.02) compared with SGC. Furthermore, women in the intervention condition reported less clinically significant anxiety at 6 months (chi(2)(1) = 4.11, P = 0.04) than women who received SGC. We found no differences in outcomes between the intervention groups at the 12-month follow-up.

CONCLUSIONS

As an adjunct to SGC, PTC delivered following disclosure of positive BRCA1/2 test results seems to offer modest short-term benefits for distress and anxiety. These results build upon a growing literature of psychosocial interventions for BRCA1/2 carriers and, given the potential impact of affect on risk management decision making, suggest that some carriers may derive benefits from adjuncts to traditional genetic counseling.

Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers

Background

Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model.

Methods

Consecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call.

Results

The Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care.

Conclusions

Our data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.

Feasibility and Preliminary Outcomes From a Pilot Study of Coping Skills Training for Adolescent—Young Adult Survivors of Childhood Cancer and Their Parents

Uncertainty is a central feature of long-term childhood cancer survivorship during which time it principally has to do with late effects. Therefore, the purposes of this article are (a) to assess feasibility of a randomized clinical trial of a telephone-delivered coping skills training (CST) intervention in terms of recruitment, retention, and timeline, as well as the performance of the study measures; and (b) to demonstrate trends in change on outcomes within the context of a small pilot study. The results of this pilot study suggest that HEROS PLUS CST has clinical relevance and that in-person long-term follow-up plus telephone-delivered psychosocial care is a practical way to deliver integrated care to adolescent—young adult childhood cancer survivors and their parents.

How acceptable is a referral and telephone-based outcall programme for men diagnosed with cancer? A feasibility study

The objective of this study was to determine the feasibility and acceptability of a referral and outcall programme from a telephone-based information and support service, for men newly diagnosed with colorectal or prostate cancer. A block randomized controlled trial was performed involving 100 newly diagnosed colorectal and prostate cancer patients. Patients were referred to the Cancer Information Support Service (CISS) through clinicians at diagnosis. Clinicians were randomized into one of three conditions. Active referral 1: specialist referral with four CISS outcalls: (1)<or=1 week of diagnosis; (2) at 6 weeks; (3) 3 months; and (4) 6 months post diagnosis. Active referral 2: specialist referral with one CISS outcall<or=1 week of diagnosis. Passive referral: specialist recommended patient contacts CISS, but contact at the patient's initiative. Patients completed research questionnaires at study entry (before CISS contact), then 4 and 7 months post diagnosis. Overall, 96% of participants reported a positive experience with the referral process; 87% reported they were not concerned about receiving the calls; and 84% indicated the timing of the calls was helpful. In conclusion, the referral and outcall programme was achievable and acceptable for men newly diagnosed with colorectal or prostate cancer.

Telephone and face-to-face consultation in breast cancer diagnosis: a comparative study

OBJECTIVE

This study compares telephone consultations with the results of clinical examinations to assess the value and accuracy of telephone consultations for the future planning in a breast cancer clinic in Tehran, Iran.

METHODS

In 2500 telephone calls, 800 Symptomatic patients were identified and asked to visit the center for the further investigations by the specialists. The agreement between two observers data were compared by the kappa statistic.

RESULTS

Totally 174 patients complied with the recommendation and included in the study. The most common chief complaints of visitors were: breast mass (42%) and breast pain (35%). Kappa statistic showed a very good agreement (K=0.62, P<0.001) between consultants' diagnosis and the specialists findings. This agreement for breast cancer diagnosis, although lower, was also good (K=0.55, P<0.001).

CONCLUSION

The study findings indicate that consultants may diagnose and manage some common conditions via telephone, usually following the established protocols. More studies are needed to determine the economic and logistic advantages of telephone consultations.

PRACTICE IMPLICATIONS

By assessment of strength and weakness of this service, it is possible to develop an easy to use information system for women who need breast care.

Women's Perceptions of the Effectiveness of Telephone Support and Education on Their Adjustment to Breast Cancer

PURPOSE/OBJECTIVES

Social support is believed to be important in helping women adjust to breast cancer. Reports have suggested limited positive effects of social support on well-being, mood disturbances, and relationships with significant others for women who receive telephone support. Women's perceptions of the role of social support in recovery, however, has had limited study. The purpose of this study was to describe women's perceptions of their emotional and interpersonal adaptations to breast cancer after their involvement in a randomized clinical trial in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only.

RESEARCH APPROACH

Content analysis was used to discover women's perceptions of their emotional and interpersonal adaptation to breast cancer following their participation in a study in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only.

SETTING

All participants were interviewed by telephone in their homes.

PARTICIPANTS

77 of 106 women with breast cancer from a randomized clinical trial were interviewed about their expectations of their adaptations and the effectiveness of the experimental and social support intervention delivered by telephone.

METHODOLOGIC APPROACH

Telephone interviews were recorded on audiotape and transcribed for analysis. Structured interviews were completed by a non-nurse interviewer. Frequency counts were obtained from the responses to items and comments were clustered for themes.

MAIN RESEARCH VARIABLES

Emotional and interpersonal adaptations to breast cancer, educational materials, and telephone support from oncology nurses.

FINDINGS

Fifty-four percent of the women who received the telephone support interventions reported improvement in attitude, whereas 43% of the interviewed women in the control group reported improvement. Only three participants, all in the control group, reported worsened emotional status. The percentage of those reporting improved or unchanged physical status was about equal in each group. The majority of participants in both groups indicated that their levels of involvement in activities remained the same or increased. Forty-six percent of participants in the intervention group reported improved relationships with their spouses compared to 38% in the control group. Women from both groups indicated that the diagnosis of cancer had caused them to review their lives and make changes in their relationships and activities.

CONCLUSIONS

Participants who received telephone support for one year, in addition to educational materials, reported improvement in their attitudes toward their breast cancer and better relationships with their significant others.

INTERPRETATION

The women's perceptions are consistent with quantitative results from the clinical trial. This article reports additional evidence that telephone support is an effective alternative to support groups and may be appropriate for those with limited access to such groups because of geography, work demands, or family situations.

Psychosocial Concerns and Interventions for Cancer Survivors

In light of the increasing population living with a history of cancer in the United States, it is important to attend to quality of life and health in this group, and to develop effective interventions to address psychosocial and physical concerns across the course of the cancer trajectory. The goals of this article are to document the need for attention to psychosocial domains; offer a brief overview of the current status of the empirical literature on effects of psychosocial interventions with cancer survivors, relying on systematic reviews and meta-analyses conducted in the last decade; highlight recent examples of randomized, controlled psychosocial intervention trials directed toward cancer survivors after the completion of primary medical treatments (ie, the re-entry phase and beyond); and identify directions for application and research.

The Dutch cancer information helpline: more critical patients after 10 years

OBJECTIVE

This study was conducted to assess the impact and evaluation of the Dutch national cancer information helpline and to assess differences in evaluation and impact with a comparable study conducted in 1994.

METHODS

A cross-sectional survey was conducted among all callers from the target groups patients, friends/relatives and the general public who contacted the information helpline from December 2003 until March 2004 (response 59%; N=665).

RESULTS

All characteristics of the helpline (provided information, educator's communication skills, and telephone aspects) were evaluated positively by a large majority of the respondents. All groups evaluated the impact of the helpline on overall satisfaction, anxiety, and meeting expectations positively. However, the three target groups showed different predictors for the outcome measures.

CONCLUSION

It can be concluded that 10 years after the first study, callers are still very positive in their evaluation. However, the different characteristics of the helpline are nowadays slightly more negatively judged, particularly by patients. The installation of the voice response system (VRS) as well as the fact that people have more easily access to information about their disease might account for these differences in evaluation.

PRACTICE IMPLICATIONS

To maintain the positive evaluations helpline educators as well as the VRS need to attune more to the different needs and problems of the target groups and provide tailored information.

Profiles of women with breast cancer: who responds to a telephone interpersonal counseling intervention

The purpose of this paper is to discuss the profiles of women with breast cancer for whom a telephone interpersonal counseling intervention (TIP-C) was beneficial for symptom management and quality of life. This analysis was based on 24 participants who completed the telephone counseling intervention and all three measurements over the course of 10-week pilot study. The typical woman with breast cancer was white, in her mid-fifties and married at the time of the study. The majority was Stage II and was receiving chemotherapy as their primary adjuvant treatment. Preliminary findings suggest that women who were in long-term marriages and reported no previous history of depression or cancer benefited most from the intervention. These women reported less depression, negative affect, symptom distress and fatigue, and improved quality of life. Several theories are proposed for these findings and implications for practice are discussed.

Psychotherapy in the medically ill: a commentary

OBJECTIVE

To overview the field of psychotherapy in the medically ill. Rather than attempting a systematic review of this very extensive area, the article seeks to capture some of the main threads and issues of importance.

METHOD

The subject is looked at under four headings: (i) which illnesses have attracted research interest in psychotherapy; (ii) which outcome measures have been chosen; (iii) which modes of intervention have been used; and (iv) finally a review of the methodology and the results obtained.

RESULTS

Some illnesses have attracted much more psychotherapeutic interest than others; the differences are haphazard. Outcome measures on the whole have focused on coping with illness and psychological distress, with a smaller number looking at disease outcome. Only short-term changes have been sought in the main. The most commonly used modalities of therapy have been cognitive-behavioural; additionally, supportive information-giving and group therapy have been trialled. Benefit in terms of all these have been reported, but the majority of studies are weakened by major methodological shortcomings.

CONCLUSION

There is an overall paucity of well-designed studies that clearly demonstrate psychotherapy as an efficacious treatment in the medically ill. The field is hampered by the lack of a clear conceptual thread recognizing the long-term and diverse experience of patients with medical illness and relating this to the question of the part psychotherapy should play. Future work needs to concentrate on appropriate selection of patients who might benefit, as well as including a wider range of more clinically relevant outcome measures and more stringent methodology.

Erectile dysfunction and premature ejaculation are the most frequently self-reported sexual concerns: profiles of 9,536 men calling a helpline

OBJECTIVES

To describe the range of sexual problems, as reported by men calling a help-line and to investigate factors associated with help seeking behaviour.

METHODS

The study included all calls between 1999 and 2004. The information used for analysis comprised caller's demographic characteristics, the sexual problem reported, previous doctor contacts, coexisting physical and mental health problems.

RESULTS

Erectile dysfunction (ED) and premature ejaculation (PE) were the most frequently reported problems (57 and 19.2% respectively). ED-reporting callers were older (OR 0.63 for the ages of 50-59 yrs), with co-morbidities (OR 1.75) and in stable relationship (OR 0.46), while PE-reporting callers were younger (OR 5.83 for the ages of 20-29 yrs), relatively healthy and more likely single (OR 2.62 and OR 2.92 respectively). Type and duration of sexual concern, age, coexisting health problems and marital status relate significantly (p<0.01) with willingness to seek medical help.

CONCLUSIONS

The study demonstrates that ED and PE are men's major sexual concerns with personal and interpersonal factors influencing their help-seeking behaviour. Help-lines can serve as a link between health services and callers, while provide useful information for policy formation and improvement of support services.

Women's Sexual Concerns: Data Analysis from a Help‐Line

PURPOSE

To report female sexual problems and concerns, as presented by women calling a help-line, and to evaluate women's help-seeking behavior regarding sexual matters.

MATERIALS AND METHODS

The study included all telephone calls from women who called for sexual concerns to a help-line dedicated to sexual problems during a 5-year period. During the call, the counselor addresses demographic characteristics of the caller, the sexual problem reported, their sexual function, any previous doctor contacts, coexisting physical and mental health problems, couple's relationship, and lifestyle factors that may influence sexual function. Data processing employed descriptive statistics and logistic regression analysis in order to detect possible associations between categorical variables.

RESULTS

Of a total of 3,523 calls made by women, 2,287 full forms were analyzed, reflecting a response rate of 64.9%. Most women (46.6%) called for problems encountered by their partners, 45.1% called for their own sexual problems, while 5.9% were calling for their children. Only 34.3% of them had already consulted a doctor. The most frequently reported difficulties were achieving orgasm (25.6%), reduced sexual desire (16.9%), and pain during intercourse (6.1%). Women in the 40-49 age group had the higher odds ratios for the sexual problems reported (reduced sexual desire: odds ratio [OR] 5.0; difficulties achieving orgasm: OR 6.3; pain during intercourse: OR 5.8). Both married and single women had high risk of experiencing low levels of sexual desire (40% and 30%, respectively).

CONCLUSIONS

Women's sexual concerns are not devoted to their sexual problems, but also their partner's and children's problems. Most frequently reported sexual problems are difficulties in reaching orgasm and reduced sexual desire. However, women are reluctant to seek medical advice on their sexual concerns. There is a need for general practitioners and family doctors to become aware of the possibility of a sexual problem and to be trained on how to manage this at a primary care level.

The effect of telephone social support and education on adaptation to breast cancer during the year following diagnosis

PURPOSE/OBJECTIVES

To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer.

DESIGN

Multisite, two-group experimental study with repeated measures.

SETTING

Arkansas and New Jersey.

SAMPLE

The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were randomly assigned to an experimental or control group. The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support resulted in more positive, statistically significant adaptation to the disease.

METHODS

The experimental group received 13 months of telephone social support and education. Both groups received educational materials via a mailed resource kit. The Profile of Mood States; Visual Analogue Scale-Worry; Relationship Change Scale; University of California, Los Angeles, Loneliness Scale-Version 3; and the modified Symptom Distress Scale provided data regarding the variables of interest. Data analysis included descriptive statistics, t tests, and multivariate analysis of variance with repeated measures.

MAIN RESEARCH VARIABLES

Mood, worry, relationships with significant others, loneliness, and symptoms.

FINDINGS

Data analysis showed no significant differences between groups, and both improved on some of the outcomes. Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey samples, thereby supporting the need to consider regional differences when developing interventions.

CONCLUSIONS

The mailed educational resource kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed resource kit.

IMPLICATIONS FOR NURSING

Mailed educational resource kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer, but their effect may differ according to region.

Information and support needs of callers to the Cancer Helpline, The Cancer Council Victoria

The broad aims of the present evaluation were, firstly, to describe the information and support needs of callers to a Cancer Helpline and, secondly, to describe the response of the service to these needs. A further aim was to use these results to develop strategies to improve the service. Anonymous caller information collected over a 6-year period was analysed. The setting of the study was the Cancer Helpline service operated by the Cancer Council Victoria within the state of Victoria, Australia. The caller profile was similar to that described in the literature, with the majority of callers being women, younger than the general cancer population and enquiring most commonly about breast cancer. Patients and their relatives called to obtain information about cancer diagnosis, treatment and management and to obtain psychological and emotional support. Callers received emotional support, were supplied with verbal and written information and were referred to a variety of support services. Some population groups are underrepresented in the data. Changes to the Helpline and other services over the 6-year period are described. The pattern of callers to the Cancer Helpline appears similar to that described in the USA and Europe. Many issues and challenges are common. The paper discusses additional strategies for meeting the information and support needs of those affected by cancer and describes current and suggested research areas.

Telephone interpersonal counseling with women with breast cancer: symptom management and quality of life

PURPOSE/OBJECTIVES

To examine the effectiveness of a telephone interpersonal counseling (TIP-C) intervention compared to a usual care attentional control for symptom management (depression and fatigue) and quality of life (positive and negative affect, stress) for women with breast cancer.

DESIGN

Experimental with repeated measures.

SETTING

Academic cancer center and urban, private oncology offices.

SAMPLE

48 women with breast cancer who were in their mid-50s, married, and employed at the time of the study.

METHODS

Women were assigned to either the six-week TIP-C or attentional usual care groups. Women were matched on stage and treatment. Data were collected at baseline, after the six interventions, and one month postintervention. Measures included the Center for Epidemiologic Studies Depression Scale, Positive and Negative Affect Schedule, Multidimensional Fatigue Inventory, and Index of Clinical Stress.

MAIN RESEARCH VARIABLES

Depression, positive and negative affect, fatigue, and stress.

FINDINGS

Women in the intervention group experienced decreases in depression, fatigue, and stress over time and increases in positive affect.

CONCLUSIONS

The preliminary results partially supported the effectiveness of TIP-C for symptom management and quality of life. The authors hypothesized that decreased depression, reduced negative affect, decreased stress, decreased fatigue, and increased positive affect over time would be the resulting psychosocial effects, given the theoretical underpinnings of the intervention.

IMPLICATIONS FOR NURSING

Nurses need to assess the quantity and quality of the social support network early in treatment; women with less social support need to be referred to counseling and support services. Because these women have limited participation in face-to-face interventions, they should be encouraged to participate in telephone or online support programs or in other programs or organizations (e.g., churches, social clubs) that would provide support.

Setting up a health education website: practical advice for health professionals

Recently, both popular and professional publications about health care have begun to express enthusiasm for the Internet as a source of medical information and possibly of psychological support for those with serious illnesses. However, there are pitfalls for practitioners and researchers who seek to capitalise on these patient education possibilities. We describe here the process and mixed outcomes of the efforts of a multidisciplinary team to set up and evaluate a website for rural women with breast cancer. We provide recommendations for other health professionals contemplating similar ventures, and also identify some future steps to develop and research this potentially valuable form of patient education and support.

Predictors of Participation in Psychosocial Telephone Counseling following Genetic Testing for BRCA1 and BRCA2 Mutations

Although adjunctive educational and psychosocial programs are now being developed for BRCA1 and BRCA2 (BRCA1/2) mutation carriers, limited information is available about whether mutation carriers will want to receive such programs or about the characteristics of individuals who participate. The goals of the present study were to describe rates of completing a psychosocial telephone counseling (PTC) intervention that was offered to female BRCA1/2 mutation carriers and to identify sociodemographic and psychological factors associated with decisions to complete the intervention. Subjects were 66 BRCA1/2 mutation carriers who were randomized to receive a PTC intervention following receipt of genetic test results. Sociodemographic and psychological factors were evaluated before notification of assignment to the PTC intervention. Completion of the intervention was determined from study records. Overall, 75.8% of subjects completed the PTC intervention. Compared to unaffected subjects, those affected with breast and/or ovarian cancer were 76% less likely to complete the intervention [odds ratio (OR) = 0.24, 95% confidence interval (CI) = 0.06, 0.98, P = 0.05]. In addition, subjects with higher levels of cancer-specific distress [OR = 4.74, 95% CI = 1.02, 22.03, P = 0.05] and those with greater perceptions of social support [OR = 5.81, 95% CI = 1.29, 26.16, P = 0.02] were also most likely to complete the intervention. The results of this study suggest that while most BRCA1/2 mutation carriers are likely to complete an adjunctive psycho-educational program, personal history of cancer, cancer-specific distress, and perceptions of social support are likely to influence participation.