gms | German Medical Science

Background: Prostate cancer is the most common cancer in men in the Western world. Physical (erectile dysfunction and incontinence) and psychological symptoms (mental disorders) associated with the disease and its treatment can cause the patient to experience a great amount of distress. To reduce the amount of distress, health care professionals use psychosocial interventions.

Research Question: The study went into the matter of acceptance and satisfaction with a psychosocial online aftercare program and the main goal was to evaluate the effectiveness of this program.

Methods: A quasi-experimental design was used to analyze the research questions. In sum, 384 prostate cancer patients were approached during and shortly after their inpatient treatment. 143 patients filled in the questionnaire at baseline. 18 prostate cancer patient followed five internet chat-group sessions in three different chat groups (intervention group). The chat group enabled patients to exchange concerns, problems and support with fellow patients and experienced psychotherapists in an anonymous atmosphere. 26 patients received treatment as usual (control group). Intervention and control group participants were assessed shortly after inpatient treatment and at a 6 month follow up. Outcome measures include distress (primary outcome), anxiety, depression, anger, need for help, health related quality of life, fear of disease recurrence or disease progression and coping skills.

To analyze the effectiveness of the chat groups, analyses of covariance were conducted. Primary and secondary outcomes were compared at follow up, with their baseline values as covariates. To control for potential sociodemographic confounding variables, the one variable (Usage of psychosocial support outside the clinic) that significantly differed between the two groups was included as an additional covariate.

Results: No significant differences between intervention and control group could be found in the baseline scores. However, the difference between intervention and control group in the scores on the MAX-PC (d=.463) and the PCS (d=.501) had a medium effect size. The intervention group participants scored higher on both scales.

The analysis of covariance revealed one significant difference between the two groups for the secondary outcome anger. The difference had a large effect size (η² = .160) and favored the control group. The difference found for the primary outcome distress had a small effect (η² = .039) size and also favored the control group.

Participants reported that the atmosphere in the chat sessions was confidential and believed that the chat program worked as a bridge between inpatient treatment and daily life.

The most frequent reported suggestions for improving the chat program were to ‘reduce the amount of patients per chat group’ and to ‘include a health professional in the chat conversation’.

Discussion: Intervention participants did not report greater improvements in the primary and/ or secondary outcomes in comparison to the control group patients from baseline to follow-up. The changes of primary and secondary outcome scores from baseline to follow up even indicate a greater improvement for control group patients than for intervention participants.

Explanations for not finding the expected outcome may be the low computer literacy of elderly patients, the somewhat higher baseline scores of the intervention group indicating more psychosocial distress of intervention participants and the higher proportion of patients who have taken psychosocial support outside the clinic in the intervention group.

The acceptance of and satisfaction with the intervention were quite high, therefore they can hardly explain the absence of measurable psychosocial benefits from the intervention.

Major limitations of this study were the modest amount of participants and the high dropout rate in the intervention as well as in the control group.

Implications for practice: We cannot conclude that psychosocial online aftercare is not helpful for prostate cancer patients, even though the expected outcomes could not be found. E- Mental health interventions remain a reasonable alternative to face-to-face intervention, because of the low costs and the convenient access for the patients. However, there is a need for better implementation of online interventions into daily clinical practice in order to raise the awareness and acceptability of online interventions.