Presentation on theme: "Katherine Chisholm & Prof Marita McCabe Dr Addie Wootten – Melbourne Health Dr Jo Abbott – Swinburne University An online program to address the psychological."— Presentation transcript:
Katherine Chisholm & Prof Marita McCabe Dr Addie Wootten – Melbourne Health Dr Jo Abbott – Swinburne University An online program to address the psychological needs of men with prostate cancer
Background Prostate cancer: 2nd most common form of cancer in Australia. Survival rates very high (around 84%). Quality of life issues very important. Common difficulties and concerns for men: Side effects: especially urinary and erectile dysfunction (persist long after medical treatment) Relationship concerns. Psychological distress. Patient reported needs (Smith et al., 2007) 54% unmet psychological needs. 47% unmet sexuality needs. 25% had moderate or high unmet sexuality needs. Smith, D. P., Supramaniam, R., King, M. T., Ward, J., Berry, M., & Armstrong, B. K. (2007). Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. Journal of Clinical Oncology, 25, 2560-2566.
Sexual function outcomes Sexual function Baseline6 m12 m24 m60 m Erections firm enough for intercourse? No1789817571 Yes819172228 How big a problem is sexual function? No problem5712151823 Small2318242831 Moderate to big 2070615446 5-year outcomes of sexual function after radical prostatectomy (Penson et al., 2005) Penson, D. F., McLerran, D., Feng, Z., Li, L., Albertsen, P. C., Gilliland, F. D., et al. (2008). 5-year urinary and sexual outcomes after radical prostatectomy: results from the Prostate Cancer Outcomes Study. The Journal Of Urology, 173, 1701-1705.
Past interventions Typically targeting – psychological function, sexual function, relationship function, coping/stress management, managing general symptom distress, general communication skills. Vary in platform (telephone, face-to-face); strategy (group, supportive, educative, counselling); partner inclusive; degree of assistance (self-management versus therapist assisted); single problem versus multi-problem focus. Very few studies have adequately targeted relationship, sexual, and psychological function in a single intervention.
Psychological based e-interventions: Anxiety Online; erectile dysfunction (i.e. McCabe et al., 2008), variety of medical conditions (i.e. diabetes, van Bastelaar et al., 2008). Leykin et al. (2011) reviewed internet interventions for improving psychological well-being in psycho-oncology: Some of the benefits of internet interventions: ◦ Greater privacy and anonymity ◦ Increased accessibility (especially rural populations) ◦ Time-effective and cost-effective Leykin, Y., Thekdi, S.M., Shumay, D.M., Munoz, R.F., Riba, M., & Dunn, L.B. (2011). Internet interventions for improving psychological well-being in psycho-oncology: review and recommendations. Psycho-Oncology. 10.1002/pon.1993 epub ahead of print on May 24 2011 McCabe, M.P., Price, E., Piterman, L., & Lording, D. (2008). Evaluation of an internet-based intervention for the treatment of erectile dysfunction. International Journal of Impotence Research, 20, 324-330. van Bastelaar, K.M., Pouwer, F., Cuijpers, P., Riper, H., & Snoek, F.J. (2011). Web-based depression treatment for Type 1 and Type 2 diabetic patients. Diabetes Care, 34,320-325. Internet based interventions
Men with prostate cancer have found the internet to be an attractive means to get information on sex (Davison et al., 2004) Schover et al. (2012) – found that an internet based version of a couples sexual counselling program as effective as brief traditional face-to-face program for men who have been treated for prostate cancer. Relied on therapist assistance Davison, B.J., Keyes, M.E., Berkowitz, J., & Goldenberg S.L. (2004). Preferences for sexual information resources in patients treated for early stage prostate cancer with either radical prostatectomy or brachytherapy. BJU International, 93, 965- 969. Schover, L.R., Canada A.L., Yuan, Y., Sui, D., Neese, J., Jenkins, R. et al. (2012). A randomized trial of internet –based versus traditional sexual counseling for couples after localised prostate cancer treatment. Cancer, 118, 500-509.
Program aims To develop and evaluate the effectiveness of an online self-directed psychological intervention for men with prostate cancer. To target the common problems men experience after treatment for prostate cancer, including: Management of side effects. Relationship and sexuality concerns. Psychological adjustment difficulties.
Development of intervention Program has been developed using a variety of sources. Literature review – issues faced by men with prostate cancer. Informed by clinical practice. Below the Belt: CBT group based psychotherapy program developed by Melbourne Health. Creative/IT input – 2 prostate cancer survivors who have helped market the program to this group of men. Pilot tested with prostate cancer survivors.
My Road Ahead The program is delivered over 6 self-directed modules (some basic email contact). CBT based. Open access to modules, however recommended sequential order. The program has been written to support both single men and men in an intimate relationship. www.myroadahead.org
Features of the program Videos from healthcare professionals and prostate cancer survivors. Online interactive exercises and offline exercises. Encouraged to include partners in the exercises throughout program and to specific partner information documents. Mood monitor. Bookmark subjects of interest. Personal log book. Moderated forum: Topic driven forum for discussion between participants. Information, questions and social support.
Understanding how prostate cancer can impact on a man’s life and emotions An overview about how prostate cancer and its treatment can affect different areas of a man’s life. Learn about common emotional reactions to prostate cancer and its treatment, and signs for when these reactions may be of concern. Learn tips for managing distress.
Tools for effective communication and helpful thinking Education around how communication plays a role in coping with prostate cancer and the side effects. Begin to develop assertiveness skills to aid communication about sensitive and personal topics. CBT psychoeducation. Exercises on identifying unhelpful thoughts, to aid with understanding how thinking influences our mood and actions.
Coping with physical changes Education about physical changes that can occur with prostate cancer. Learn tools for coping with incontinence – in particular around the anxiety-avoidance cycle. Learn stress management and relaxation techniques (includes audio files).
Sexuality and masculinity Education around the occurrence and nature of erectile dysfunction after prostate cancer treatment. Information on traditional male role norms about sexuality and masculinity. Assist men to identify and challenge any negative thoughts about sexuality and manhood that men might be experiencing.
Sexuality and intimacy Further education around the impact of erectile dysfunction on intimacy. Assist men to enjoy intimacy and sexual interactions even when an erection is not possible by redefining what good sex means. Learn and practice specific communication about sex and intimacy. Information on erectile aids.
Living with uncertainty and planning for the future Help men cope with uncertainty and explore the impact of cancer on beliefs about death and mortality. Explore specific thoughts about the future and learn tools for coping with fears about cancer recurrence and uncertainty. Relapse prevention: by reviewing what men have learnt and achieved through the program.
Testing Men with prostate cancer (n = 20) provided feedback: Found videos as means to provide information as engaging Open access to modules Usability rated as moderate (modifications consequently made) Limited contact/feedback
A Randomised Control Trial Participant consents to study Online assessment Randomisation Group 1: Online Program Online assessment at completion of 10-week program Online assessment 12- weels post completion of program Online assessment 6 months Group 2: Online Program-plus- forum Online assessment at completion of 10-week program Online assessment 12 weeks post completion of program Online assessment 6 months Group 3: Forum only Online assessment 10- weeks post consenting to the study Online assessment 22 weeks post consenting to study Online assessment 6 months
Outcome measures Demographic details, erectile dysfunction aid use, support use, program satisfaction questionnaires Prostate Cancer Specific Quality of Life Scale Depression, Anxiety and Stress Scale - short form (DASS-21) International Index of Erectile Function (IIEF) Kansas Marital Satisfaction Scale (KMSS) Communication Patterns Questionnaire - Short Form (CPQ- SF) Dyadic Sexual Communication Scale – Short Form
Recruitment Men who have received medical treatment for prostate cancer between 6 months and 5 years ago. Participants can be referred by healthcare providers or self- or peer-referral. Single men or in a relationship any sexual orientation. A minimum of 50 participants will be recruited to each of the three study arms.
Participant characteristics Motivated Not looking for a quick fix (homework etc) Able to self-monitor (ok with minimal feedback) Cannot afford treatment or too difficult to access Prefer the anonymity of internet (sexual issues) Want to access assistance at flexible times
Limitations Maintaining participants’ motivation Men might skip to preferred topic areas Difficulty engaging partners Language heterosexual orientated
Summary My Road Ahead: Will allow evaluation of an online self-directive, interactive, and comprehensive intervention. Is strongly informed by men with prostate cancer and professionals who have clinical skills in this area. Will demonstrate which aspects of sexual, relationship and psychological functioning are best targeted by the program. www.myroadahead.org