Abstract
Prostate cancer diagnosis and treatment give rise to challenging physical and functional outcomes that can have long-term consequences for men’s psychological and emotional well-being. A significant proportion of men experience psychological problems post-diagnosis and as a consequence of treatment. In recent years, improved treatments and screening mean men can enjoy longer survival, but if they are to live better rather than just longer, there is a requirement for timely psychological support in survivorship. Many men living with and beyond prostate cancer are reluctant to accept psychological support, which means that if support is to be provided it has to be emotionally relevant and engaging. Web-based programmes that incorporate user-driven models of communication and dialogue, whilst also reflecting men’s illness identity, can achieve this.
The thesis that follows considers the uniquely important characteristics and psychological support needs of this prostate cancer population; the extent to which they are being met and how men’s experiences can be brought to the forefront in the development-to-implementation pathway of web-based intervention.
Five publications form the central part of this research. A literature review article examined adjustment-focused and problem-focused psychosocial interventions for men with prostate cancer; it recommended that for beneficial outcomes there is a need to specifically address men’s distress. A further publication reports the feasibility of a self-management intervention to help men cope with urinary symptoms after radiotherapy treatment; this study spawned recognition of the need to provide peer support and gave rise to a subsequent randomised controlled trial of the same intervention which incorporated filmed peer support based on participatory research methods. The third publication reports a large-scale survey to examine men’s unmet supportive care needs after diagnosis and treatment for prostate cancer across seven European countries; this highlighted the long-term prevalence of men’s need for support and its relationship with the health care support they had received. The next publication provided insights into men’s experiential empathy by analysing the original filmed interviews to explore how men communicate their emotional reactions and coping strategies to other men. The most recent published article represents the culmination of learning from these previous studies and reports the development and feasibility testing of a web-based intervention, Getting Down to Coping, to help reduce men’s psychological distress after diagnosis and treatment for prostate cancer. Developed in full collaboration and partnership with men with lived experience of prostate cancer the intervention offered cognitive-behavioural therapy and filmed peer support, whilst incorporating persuasive design techniques to encourage men’s engagement and adherence. The intervention was uniquely developed for delivery within a clinical service for men with prostate cancer with clinically screened distress.
The introduction chapter of this thesis discusses men’s psychological needs, how these are not being met, and how web-based interventions can meet these needs. It then examines the research literature that sets the context for the web-based programme, Getting Down to Coping. The second chapter presents the five submitted publications. The concluding chapter explains the overall contribution of each publication to the programme of work and the wider knowledge base. The challenges and recommendations for moving the work forward to support psychological care for men living with and beyond prostate cancer are also presented.