Abstract
Background: Prostate cancer treatment-related distress is a substantial burden for up to a third of men diagnosed. Without support, physical and emotional symptoms, and health service use can increase; yet men are reticent to accept support. To provide easily accessible and acceptable support that can be cost effectively integrated into care pathways, we developed a unique, web-based, self-guided, cognitive-behavioural programme incorporating filmed and interactive peer support. We assessed feasibility among men with prostate cancer identified with distress and examined implementation in two settings: Phase I, a primary care psychological service; Phase II, a secondary care cancer service. Chat room facilitation was delivered by clinicians in the respective services. Objective We assessed: demand (engagement); acceptability (adherence, satisfaction, experience); potential for change in distress and self-efficacy; and challenges for implementation in clinical practice. Methods A pre-post, within-participant comparison, mixed-methods design. Men received clinician-generated postal invitations: n=432, diagnosed <5 years Phase I; n=606, diagnosed <3½ years Phase II. Consent was online; men with mild-moderate distress were enrolled. Web-based self-assessment included: demographic, disease, treatment characteristics; distress (General Health Questionnaire: GHQ-28); depression (Patient Health Questionnaire: PHQ-9); anxiety (General Anxiety Disorder Scale:GAD-7); self-efficacy (assessed only Phase II) (Self-Efficacy for Symptom Control Inventory: SESCI); satisfaction (author-generated, Likert-type questionnaire). Engagement assessment examined uptake and usage; adherence assessment reflected the Persuasive Systems Design Model. Telephone interviews explored participant experience (Phase II, n=10); facilitator/supervisor face-to-face interviews (n=4) explored implementation issues. Results 135 men consented (61/432, 14% Phase I: 74/606, 12% Phase II). 96 eligible men were screened for distress. 30 (30/96, 32%) with mild-moderate distress entered the intervention (n=10 Phase I; n=20 Phase II). 24 men completed the web-based programme and assessments (n=8 Phase I; n=16 Phase II). Adherence rates Phase I and II respectively were: module completion 63%/92%; CBT exercises 72%/88%; mood diary completion 100% both phases; films 75%/63%. 5/8 (63%) and 12/16 (75%) men posted in the chat room. Satisfaction was high for the programme and films; less so in Phase I for the chat room. Areas for programme enhancement were identified. Limited efficacy testing indicated potential for improvement in distress baseline to post-intervention: Phase I p=.027 r = -0.55; Phase II p=.001, r = -0.59. Self-efficacy improved for coping p=.02, r = -0.41, not performing daily activities (p=.078) or managing symptoms (p=.105). Service assessment confirmed ease of assimilation into clinical practice and clarified appropriate health care practitioner roles for facilitation. Conclusions The web-based programme is viable, practicable and innovative in clinical practice. It was endorsed by patients and has potential to positively impact the experience of men with distress as a result of prostate cancer. It can also potentially be delivered in primary or secondary care. Feasibility evidence is compelling and supports testing efficacy and cost-effectiveness in a multi-centre, randomised trial.