BACKGROUNDA recent Pew Charitable Trust study found that 52,000,000 individuals used the Internet to obtain health/medical information. Clinical trials of face‐to‐face breast carcinoma support groups show evidence of 1) improvement in quality of life, 2) reduction of psychologic symptoms, 3) improvement in coping responses, and 4) a reduction in pain. To the authors' knowledge, a few studies published to date have investigated Internet‐delivered electronic support groups (ESGs) for cancer. The most sophisticated is the Comprehensive Health Enhancement Support System (CHESS) program, which provides integrated information, referral, and a newsgroup‐based social support program. However, to the authors' knowledge, no studies published to date have examined the impact of a breast carcinoma ESG in a clinical trial.METHODSSixty‐seven women completed the initial baseline questionnaires, 32 of whom accepted the authors' invitation and began the groups. With regard to geographic location, 49% lived in rural/small towns, 41% lived in medium‐sized cities, and 10% lived in large cities. Diagnostic stages of disease were: Stage I, 22%; Stage II, 56%; Stage III, 12%; and other forms, 10%. There were 4 intervention groups, of which 8 participants led by trained Wellness Community (TWC) (a national agency) leaders met for 1.5 hours once a week for 16 weeks. Student t tests for paired outcome data were computed using baseline and postgroup scores.RESULTSThe results of the current study indicated that breast carcinoma patients significantly reduced depression (Center for Epidemiologic Studies‐Depression [CES‐D] scale) and Reactions to Pain. They also demonstrated a trend toward increases on The Posttraumatic Growth Inventory (PTGI) in two subscales: New Possibilities and Spirituality. Counterintuitively, breast carcinoma patients appeared to demonstrate an increase in emotional suppression. Postinterview results indicated that approximately 67% of patients found the group to be beneficial. Those who withdrew from the groups (20%) demonstrated low scores in their ability to contain anxiety and appeared to be more likely to suppress their thoughts and feelings regarding their illness.CONCLUSIONSThe findings of the current study are encouraging, particularly because it was conducted through TWC, a national agency willing to make this type of intervention readily available at no cost. A limitation of the current study was the lack of randomization and a control group comparison. Although the authors were not able to demonstrate effectiveness without the addition of a control condition, the analysis of pregroup and postgroup outcomes suggests that a randomized trial is worthwhile. Women with a devastating disease will join and commit themselves to an online support group. In addition, because a large percentage of these women were from rural locations, this type of intervention may hold promise for those who have limited access to support groups. Cancer 2003;97:920–5. © 2003 American Cancer Society.DOI 10.1002/cncr.11145
Despite advances in the treatment of many side effects associated with chemotherapy, alopecia remains an issue that is difficult to resolve. Chemotherapy-induced alopecia (CIA) is a condition that can have profound psychosocial and quality-of-life consequences, resulting in anxiety, depression, a negative body image, lowered self-esteem, and a reduced sense of well-being. Patients who fear CIA may sometimes select regimens with less favorable outcomes or may refuse treatment. When supporting patients with CIA, health care providers should use an individualized approach with a focus placed on the actual moment of hair loss. Education, support groups, and self-care strategies are important components of any management approach. No treatment modality for preventing CIA has been clearly shown to be effective. Recent evidence suggests that new scalp hypothermic regimens may be safe and effective. There remains a critical need for effective new approaches to this problem.
Purpose Internet support group (ISG) members benefit from receiving social support and, according to the helper therapy principle, by providing support to others. To test the mental health benefits of providing support to others, this trial compared the efficacy of a standard ISG (S-ISG) and an enhanced prosocial ISG (P-ISG). Methods A two-armed randomized controlled trial with 1-month pretest and post-test assessments was conducted with women (N = 184) diagnosed in the past 36 months with nonmetastatic breast cancer who reported elevated anxiety or depression. Women were randomly assigned to either the S-ISG or P-ISG condition. Both conditions included six professionally facilitated live chat sessions (90-minute weekly sessions) and access to an asynchronous discussion board; P-ISG also included structured opportunities to help and encourage others. Results Relative to the S-ISG, participants in the P-ISG condition exhibited more supportive behaviors (emotional, informational, and companionate support), posted more messages that were other-focused and fewer that were self-focused, and expressed less negative emotion (P < .05). Relative to the S-ISG, participants in the P-ISG condition had a higher level of depression and anxiety symptoms after the intervention (P < .05). Conclusion Despite the successful manipulation of supportive behaviors, the P-ISG did not produce better mental health outcomes in distressed survivors of breast cancer relative to an S-ISG. The prosocial manipulation may have inadvertently constrained women from expressing their needs openly, and thus, they may not have had their needs fully met in the group. Helping others may not be beneficial as a treatment for distressed survivors of breast cancer.
The study tested the effects of leader behaviors on outcomes in 269 cancer patients in professionally led support groups. Both the direct effect and a mediation hypothesis, helpful group experiences, were examined. The leader model specifies 5 dimensions: evoke-stimulate, executive-management, meaning attribution, uses of self, and support-caring. Patients were drawn from The Wellness Community, a national organization that provides services to cancer patients. Outcomes included quality of life and depression. In a linear regressions analysis, leaders perceived as high on meaning attribution and management-structure had lower depression, fewer physical problems, higher well-being, and better functioning. In a test of the mediation hypothesis, leader behaviors associated with outcomes were substantially mediated through helpful group experiences.Many years ago Lieberman, Yalom, and Miles (1973) developed an empirical model to study encounter-group leader behavior. An analysis of leader behaviors and participant outcomes revealed a substantial and statistically significant relationship between leader behaviors and outcomes. According to the model developed, the leader-therapist expresses five basic dimensions of behavior: evoke-stimulate, executive-management, meaning attribution, uses of self, and support-caring. All leaders exhibit some of these behaviors, but they differ in frequency, intensity, and pattern.The present study examined a large sample of cancer patients who were participants in professionally led support groups to test the hypothesis that leader behaviors are associated with positive outcomes. Because leader behavior is a distal variable, the study tested a mediation hypothesis, that leader behaviors influence outcomes through impacting helpful group experiences reported by participants.On the basis of previous work, as well as the following review of leader studies, we anticipated that two types of leader behavior would be critical: meaning attribution (cognitive input) and executive-management (providing structure).(1) patients consistently value understanding and insight as mechanisms of therapeutic change, (2) interpretations that serve to integrate complex personal and
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