My Road Ahead study protocol: a randomised controlled trial of an online psychological intervention for men following treatment for localised prostate cancer

BACKGROUND There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone. METHODS/DESIGN This study utilises a RCT design with three groups receiving: 1) the 6-module My Road Ahead intervention alone; 2) the My Road Ahead intervention plus a moderated online forum; and 3) the moderated online forum alone. It is expected that 150 men with localised prostate cancer will be recruited into the RCT. Online measures will assess men's psychological distress as well as sexual and relationship adjustment at baseline, post-intervention, 3 month follow-up and 6 month follow-up. The study is being conducted in Australia and participants will be recruited from April 2012 to Feb 2014. The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress. DISCUSSION To our knowledge, My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer. The RCT will assess the efficacy of this intervention in improving psychological well-being, sexual satisfaction, relationship satisfaction and overall quality of life. If successful, this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000278932.The authors would like to acknowledge the funding partners involved in this study; the Prostate Cancer Foundation of Australia (PCFA), beyondblue: the National Depression and Anxiety Initiative with funding support from Movember Foundation

Does resilience 'buffer' against depression in prostate cancer patients? A multi-site replication study

Although psychological resilience has been shown to 'buffer' against depression following major stressors, no studies have reported on this relationship within the prostate cancer (PCa) population, many of whom are at elevated risk of depression, health problems and suicide. To investigate the effects of resilience upon anxiety and depression in the PCa population, postal surveys of 425 PCa patients were collected from two sites: 189 PCa patients at site 1 and 236 at site 2. Background data plus responses to depression and resilience scales were collected. Results indicated that total resilience score was a significant buffer against depression across both sites. Resilience had different underlying component factor structures across sites, but only one (common) factor significantly (inversely) predicted depression. Within that factor, only some specific items significantly predicted depression scores, suggesting a focused relationship between resilience and depression. It may be concluded that measures of resilience may be used to screen depression at-risk PCa patients. These patients might benefit from resilience training to enhance their ability to cope effectively with the stress of their diagnosis and treatment. A focus upon specific aspects of overall resilience may be of further benefit in both these processes

Differences in major depressive disorder and generalised anxiety disorder symptomatology between prostate cancer patients receiving hormone therapy and those who are not

Objective: The aim of this study is to explore the associations between hormone treatment variables and depression, and the nature of depression in prostate cancer (PCa) patients by comparing the severity and symptom profile of anxiety and depression in men who were currently receiving hormone therapy (HT) versus those who were not. Method: Self-reports of anxiety and depression on standardized scales of GAD and major depressive disorder (MDD) were collected from 156 PCa patients across two recruitment sites in Australia. Patients who were currently receiving HT were compared with patients not receiving HT for their severity and symptom profiles on GAD and MDD. Results: Participants receiving HT had significantly higher GAD and MDD total scores than patients who were not receiving HT. In addition, the symptom profiles of these two HT subgroups were differentiated by significantly higher scores on the key criteria for GAD and MDD plus fatigue and sleeping difficulties but not the remaining symptoms of GAD and MDD. However, there were no significant differences between HT subgroups for the degree of functional impairment experienced by these symptoms. Conclusion: Although these data confirm the association between HT and anxiety/depression, the range of GAD and MDD symptoms influenced is relatively restricted. Moreover, functional ability does not appear to be impaired by HT. These findings clarify the ways in which HT affects PCa patients and suggests that a simple total scale score for anxiety and depression may not be as helpful in designing treatment as consideration of the symptomatic profiles of PCa patients receiving HT

Variability over time-since-diagnosis in the protective effect of psychological resilience against depression in Australian prostate cancer patients:Implications for patient treatment models

Although there is some evidence that psychological resilience may "buffer" against depression following major stressors, no data have been reported on the nature and variability of this buffering effect among prostate cancer patients during the 5 years following their initial diagnosis. Patients from two sites in Australia and who had received their initial diagnosis within 5 years ('n' = 255) were surveyed, and the results indicated that there was a significant inverse relationship between resilience and depression in the overall data, but that was mostly accounted for by a single factor of the resilience scale ("Confidence to cope with change"). Variability in that buffering effect was noted over time since diagnosis, with peaks during the first 6 months, at 24 and 60 months. These findings support the argument to develop focused psychiatric interventions at various periods following a diagnosis of prostate cancer

Predictors of depression in prostate cancer patients:A comparison of psychological resilience versus pre-existing anxiety and depression

Background: Previous anxiety and depression can influence current anxiety and depression, and psychological resilience may be a buffer against current anxiety and depression. However, despite the relevance of these two sets of predictors of anxiety and depression, and their potential in treatment planning, no reports have been published on their role in post-diagnosis anxiety and depression among prostate cancer (PCa) patients. Therefore, this study aimed to determine the roles of these predictors in a sample of men with prostate cancer. Method: Retrospective self-reports of anxiety and depression for how they were before receiving their diagnosis of PCa and at the time of testing after their diagnosis were collected from 425 PCa patients across two states of Australia. In addition, self-reported current psychological resilience was measured. Results: Although there was a significant increase in depression and a nonsignificant increase in anxiety from before their diagnosis, for the whole sample, over 33% of participants reported decreases in anxiety and nearly 21% said that their depression had decreased after diagnosis. Current anxiety and previous anxiety were the strongest predictors of current depression, but resilience significantly moderated those relationships. Participants whose anxiety and depression did not change following diagnosis had significantly higher resilience scores than patients whose anxiety or depression either decreased or increased. Conclusion: Patients' pre-existing anxiety or depression were significant predictors of whether they became depressed following their diagnosis. However, the ability of some patients to cope effectively with their diagnosis suggested potential avenues for peer support for those patients who did not cope with their diagnosis and became depressed. The "buffering" role of psychological resilience against depression following major stress is supported by these data

Review : Psychosocial interventions addressing sexual or relationship functioning in men with prostate cancer

Introduction: Although previous research has evaluated the effectiveness of psychosocial interventions for men with prostate cancer, no previous review has investigated the effects of psychosocial interventions on both sexual and relationship functioning. Aim: To review the effectiveness of psychosocial interventions that focus on sexual and/or relationship functioning for men with prostate cancer and their partners. Method: A systematic literature review of research reported in the Medline, PsychINFO, PsychArticles databases from January 1990 to September 10, 2011. Main Outcome Measure: The review focused on the evaluation of interventions that aimed to improve the sexual and/or relationship functioning of men and their partners. Results: There was evidence that psychosocial interventions can improve men's sexual functioning, particularly when delivered face‐to‐face and when using more complex strategies to target sexuality in men and in relationships. There was inconclusive evidence for the effectiveness of psychosocial interventions in improving men's relationship functioning or the sexual or relationship functioning of their partners. Conclusions: There is a need for further research to target improving and measuring men and their partner's sexual and relationship functioning in the context of prostate cancer. The effectiveness of tailoring interventions to the specific needs of men and to their stage of cancer also needs to be further examined

Project-based knowledge in organizing Open Innovation

The book aims to extend the current theoretical debate on strategic organizing open and distributed innovation processes addressing some key open issues. The book provides empirical evidence on how the knowledge features of innovative projects impact on the organization of open innovation at firm level

Measuring masculinity in the context of chronic disease

Masculine beliefs are influential in men’s responses to illness; however, current measures of masculinity may not be salient for highly prevalent chronic diseases such as prostate cancer. To address this gap, a contextualized measure of masculinity for men with prostate cancer was developed. A novel measure of masculinity, the Masculinity in Chronic Disease Inventory (MCD-I), was developed based on existing qualitative data and tested for acceptability and face validity with 19 men previously treated for prostate cancer. A cross-sectional survey of 403 Australian men with prostate cancer (Mage = 70.34 years; SD = 7.25) then assessed convergent, divergent, and discriminant validity for the MCD-I using existing reliable and valid measures of masculinity, masculine self-esteem, quality of life, erectile dysfunction, and sexual help seeking. A 6-factor structure for the MCD-I (22 items) was confirmed with good to excellent internal reliabilities (alpha = 0.69–0.92) for the subscale domains of Strength, Sexual Importance/Priority; Family Responsibilities; Emotional Self-Reliance; Optimistic Capacity; and Action Approach. Acceptable convergent and divergent validity was supported, and the MCD-I was also able to discriminate between men with severe versus moderate to mild erectile dysfunction (p = .002) and the Sexual Importance/Priority domain discriminated between men who had sought sexual advice and those who had not (p = .005). A contextual approach to measuring masculinity in men with prostate cancer may help avoid reductionist approaches for focusing on erectile dysfunction in these populations. This also presents a way forward for gender-sensitive psychosocial services and programs for men experiencing prostate cancer. (PsycINFO Database Record (c) 2018 APA, all rights reserved

An online psychological intervention can improve the sexual satisfaction of men following treatment for localized prostate cancer : Outcomes of a randomised controlled trial evaluating my road ahead

BACKGROUND: Prostate cancer treatment often results in significant psycho-sexual challenges for men following treatment; however, many men report difficulty in accessing appropriate care. METHODS: A randomized controlled trial was undertaken to assess the efficacy of a 10-week self-guided online psychological intervention called My Road Ahead (MRA) for men with localized prostate cancer in improving sexual satisfaction. Participants were randomized to 1 of 3 conditions MRA alone or MRA plus online forum, or forum access alone. Pre, post, and follow-up assessments of overall sexual satisfaction were conducted. Mixed models and structural equation modeling were used to analyze the data. RESULTS: One hundred forty-two men (mean age 61 y; SD = 7) participated. The majority of participants had undergone radical prostatectomy (88%) and all men had received treatment for localized prostate cancer. Significant differences were obtained for the 3 groups (P = .026) and a significant improvement in total sexual satisfaction was observed only for participants who were allocated to MRA + forum with a large effect size (P = .004, partial eta2 = 0.256). Structural equation modeling indicated that increases in sexual function, masculine self-esteem, and sexual confidence contributed significantly to overall sexual satisfaction for the MRA + forum plus forum condition. CONCLUSIONS: This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men with prostate cancer. The findings indicate the potential for MRA to deliver support that men may not otherwise receive and also highlight the importance of psychological intervention to facilitate improved sexual outcomes