Who Benefits from a Counseling vs. Education Intervention to Improve
Psychological Quality of Life in Prostate Cancer Survivors?
Terry Badger, PhD, PMHCNS-BC, FAAN
Professor and Director, Community & Systems Health Science
Acknowledgements
Thank you to NCI for funding R21CA113409
Research Team and Co-Authors: Chris Segrin, PhD
Aurelio J. Figueredo, PhD
Joanne Harrington, PhD, ANP-BC, AOCNP
Kate Sheppard, PhD, RN, ANP-BC
Stacey Passalacqua, PhD
Alice Pasvogel, PhD, RN
Maria Bishop, MD, FACP
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Purpose
• Examine what selected factors specified in the stress process model might moderate the response to different interventions designed to improve psychological QOL– Depression, positive and negative affect,
perceived stress
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Stress Process Model
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CONTEXTUAL CHARACTERISTICS Survivor • age • gender • socioeconomic status • employment status • ethnicity • relationship type • co-morbid health conditions • medications • family history of cancer
INTERVENTION
Disease Specific • disease stage • treatment regime • symptom distress & management Prostate specific functioning
PSYCHOSOCIAL RESOURCES
● Social support ● Cancer knowledge and self-efficacy
QUALITY OF LIFE ● Psychological Distress ● Physical Well-being ● Social Well-being ● Spiritual well-being
Interventions
• Telephone Interpersonal Counseling Intervention (TIP-C)– Based on interpersonal psychotherapy– Address mood and affect management, emotional expression,
interpersonal communication & relationships, social support, cancer information and resources
• Telephone Health Education Intervention (THE)– Based on adult learning principles– Normal prostate health and cancer, treatment, side effects, side
effect management, nutrition and physical activity, resources
Both were about 30 minutes x 8 weeks
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Sample• 71 survivors randomly assigned to 1 of 2
interventions
• Typical Survivor– Late 60’s (M=66.99), white, married, retired
and college educated– Other illnesses than cancer (M=1.82, SD=1.5)– Medications (M=4.64, SD=3.7)
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Analyses
• Individual growth curve parameters for each dependent variable were tested in a series of moderated regression analyses– Intervention condition was the IV– Moderator variables
• Age, Education, Social support from friends, prostate specific functioning, cancer knowledge, symptom distress and management
– Psychological QOL variables were the DV
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Interaction of Age x Intervention on CES-D Slopes
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Telephone Interpersonal Counseling=TIP-CTelephone Health Education=THE
Interaction of Social Support from Friends x Intervention on Positive Affect Slopes
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Telephone Interpersonal Counseling=TIP-CTelephone Health Education=THE
Men with lowest levels of social support benefitted more in THE
Men with highest levels of social support benefitted more from TIP-C
Moderator
depression negative affect
positive affect
perceived stress
Demographic Characteristics
Age
-.20* -1SD b = -1.32
M b = -3.27**
+1SD b = -5.23***
-.02 .12 -.01
education .06 .65 -1.93* -1SD b = 1.28
M b = -0.69
+1SD b = -2.67*
.77a -1SD b = -3.08***
M b = -2.29***
+1Sd b = -1.50* Social Status social support-friends
.50* -1SD b = -5.80***
M b = -3.53***
+1SD b = -1.26
.11 -.49* -1SD b = 1.56
M b = -0.63
+1SD b = -2.82*
.14
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Moderator
depression negative affect
positive affect
perceived stress
Illness Characteristics
Prostate Specific Function
.08a -1SD b = - 5.36***
M b = -3.43***
+1SD b = -1.51
.06 -.07a -1 SD b = 0.90
M b = -0.74
+1SD b = -2.38*
.02
Chemotherapy -5.94a no b = -2.69*
yes b = -8.63**
-1.05 1.30 -1.21
Illness Context cancer knowledge
.59a -1SD b = -5.40***
M b = -3.48***
+1SD b= -1.55
.10 -.47a -1SD b = 0.87
M b = -0.66
+1SD b= -2.21a
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symptom distress
-.81 -.63a -1SD b = -1.70
M b = -3.43***
+1SD b =-4.55***
.34 -.14
symptom management
-.03 .75* -1SD b = -4.90***
M b = -3.41***
+1SD b = -1.93*
-.26 .08
Summary of Differential Intervention Effectiveness on Psychological QOL Outcomes
by Survivor Characteristics
THE > TIP-C
• Depression
– Older Age, Lower Social Support from Friends, Lower Prostate Specific Functioning, Active Chemotherapy, and Lower Cancer Knowledge
• Negative Affect
– Higher Symptom Distress and Lower Ability to Manage Symptoms
• Perceived Stress
– Lower Education
TIP-C > THE
• Positive Affect
– Higher Education, Higher Social Support from Friends, Higher Prostate Specific Functioning, and Higher Cancer Knowledge
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• Findings support interventions works to improve psychological QOL but– Select carefully who might benefit from which
intervention– Health education was clearly beneficial
among older men with less education, knowledge, social support, reduced prostate functioning, increased symptom distress and lower symptom management
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Conclusions
Conclusions
Men as survivors were more interested in receiving health information –many unmet informational needs
Health education can be routinely available to men and can reduce psychological distress-may act as prevention as well as treatment
Augment with counseling if needed
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Directions For Future Research• Additional research is needed to refine the
profiles of who might benefit from different interventions
• The goal is simple, rapid, and accurate triage
• Explore differential effectiveness in more diverse populations
• Examine other potential interventions for men with prostate cancer might improve QOL
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