Title: Getting down to coping' On-line self-management after treatment for prostate cancer: a feasability study
Funder: Department of Health (England)

Abstract: Background The consequences for men of prostate cancer diagnosis and treatment can result in sexual, urinary, bowel and/or body-image problems that left unsupported affect quality-of-life and mental health. Previous research shows high levels of unmet needs for these men of which emotional distress is most prevalent. Despite this, men often feel vulnerable and hesitant to ask for support, and health practitioners do not readily identify mild or moderate psychological disorder in this situation. Symptoms of distress that are not addressed early can develop into mental health problems which over time, and with increasing numbers of men surviving prostate cancer, can put greater demands on health care resources, particularly in primary care. These men need psychological and practical support that facilitates involvement and engagement with services. Cognitive-behavioural programmes delivered face-to-face or by telephone have been shown to benefit men with prostate cancer particularly where distress is raised at study entry. Cognitive-behavioural therapy has also been delivered successfully over the internet in mental health but has not to-date been developed on-line for men with prostate cancer. Aim Our overall aim is to improve mental health and quality-of-life for these men by providing easily accessible psychological support within primary care. Our study aim is to assess the feasibility of an on-line self-referral, cognitive-behavioural self-management intervention based within the IAPT framework targeted at men experiencing distress after diagnosis and treatment for prostate cancer. Research Question What is the viability and practicability of the intervention, and what are the key issues to be assessed in subsequent testing of the intervention within primary care? Secondly, what is the prevalence of distress in this group of men and what is the extent of change in their levels of emotional distress over the course of the intervention? Plan of Investigation Our study is a within-participant comparison. Participants will be screened and assessed at baseline before the intervention and followed up for six months after the intervention. 60 men experiencing distress after diagnosis and treatment for prostate cancer will be targeted. Men will self-refer on-line having been given information about the study in GP practices across the NHS West Sussex locality. The intervention will comprise four weekly sessions: men will be able to log-in to each over a week and will start the programme in groups of 15. Assessments will measure distress, cancer and prostate cancer quality-of-life, and service usage. Risk governance assessments throughout the intervention will cover depression, anxiety, work and social adjustment. A preparatory stage of participatory action research carried out by users and the research team, will develop film tools for integration into the intervention as a resource to encourage participant motivation and confidence. Benefit to patients and the NHS This intervention is designed to provide assessable support for men distressed as a result of prostate cancer diagnosis and treatment. There is currently little provision for men at this level, but left unmanaged there is evidence they will use more health services longer-term. This intervention will provide equal access independent of geographical location, and support the planned transition of prostate cancer follow-up into primary care. It will also address under-reached groups, (men on hormone treatment, post-radiotherapy, on watchful waiting or living in rural areas) all of whom have higher needs but less opportunity to access support. Internet use among older men is growing and offers a medium through which a cost-effective and targeted intervention can address individual needs and provide benefit for health care services. The intervention could be offered though GP consortia linked to the IAPT programme, creating a sustainable approach; it could also provide a model of intervention for other cancers.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;CANCER AND NEOPLASMS