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Purpose: The purpose of this project is to evaluate whether psychosocial outcomes in women with breast cancer differ based on the format of online group support. This objective will be addressed by the following specific aims:
Specific Aim #1 is to determine if there is a difference in depressive symptoms between women with breast cancer assigned to one of two treatment conditions: moderated online support or peer-led online support.
• H1: Women with breast cancer who participate in moderated online support will report fewer depressive symptoms than women with breast cancer in peer led online support.
Specific Aim #2 is to determine if there is a difference in perceived social support between women with breast cancer who are assigned to one of two treatment conditions: moderated online support or peer-led online support.
• H2: Women with breast cancer who participate in moderated online support will report greater perceived social support than women with breast cancer in peer-led online support.
Specific Aim #3 is to determine if there is a difference in quality of life in women with breast cancer who are assigned to one of two treatment conditions: moderated online support or peer-led online support.
NOTE: Once the study began, it was obvious that we could not prevent anyone from joining a support group, if that was her choice. We also could not control if participants joined a second online support group or face-to-face group during the study. Therefore, we decided to omit a "usual care" (no support) group. The study was completed with just two groups: moderated and peer-support.
Purpose/Specific Aims: The purpose of this randomized two-group longitudinal study is to evaluate whether psychosocial outcomes in women with breast cancer differ based on the format of online group support. Rationale/Significance of study: No research has explored differences in psychosocial outcomes between online support groups that use a professional moderator and those that use a peer-led (self-help) format. This study will address one of the goals put forth in the 2003-2005 ONS Research Agenda, by studying the effects of technology based interventions (online support) on psychosocial outcomes (depression, perceived social support, quality of life) in women with breast cancer. This work will add to the nursing research base with regard to online support for women with breast cancer and provide a springboard for additional studies to enhance the research base. Conceptual Framework: The concept of openness, based on the mutual interaction between human beings and their environment, and emphasized in Rogers' Science of Unitary Human Beings provides a basis for this project. The research will utilize two different support environments and measure how interactions in each affect psychosocial outcomes over time. Main Research Variables: The independent variables are two treatment conditions (moderated online support, peer-led online support). The dependent variables are depressive symptoms, perceived social support, and quality of life. Design: A randomized longitudinal design, comparing two types of online support groups, on the basis of three principal measures, will be used. Each measure will be obtained at baseline and at three later timepoints. Setting: Support groups will be accessed from secure and password protected university web pages devoted exclusively to this study. Sample: Sixty women with breast cancer, at least 21 years of age, who have Internet access will be recruited. Methods: Women will be randomly assigned to one of the two treatment conditions (moderated online support, peer-led online support) given a password, and instructed to complete a Demographic Form and the study questionnaires online. All subjects will be asked to complete the study questionnaires again at 6, 12, and 16 weeks. Moderated groups will run in a semi-structured format over 12 weeks, with a different discussion topic moderated each week by the moderator. Peer-led groups will be run in a peer support format over 12 weeks. Implications for practice: Women with breast cancer are turning to online resources for support. Nurses should be aware of the benefits/limitations of this support alternative. A cost benefit may be suggested if it is shown that peer-led online support has psychosocial benefits similar to professionally facilitated groups. Additional research is needed to explore the impact of online support on psychosocial outcomes in people with other cancers, minorities, and men. This study will add important information to the research base regarding online support groups and help determine the best strategy for online cancer support.
NOTE: It was obvious that we could not prevent anyone from joining a support group, if that was her choice. We also could not control if participants joined a second online support group or face-to-face group during the study. Therefore, we dropped the "usual care" (no support) group. The study was completed with just two groups: moderated and peer-support.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| moderated online support | Experimental | 12-week online support led by a healthcare professional |
|
| peer-led support | Experimental | 12-week online support group in a peer-led format |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| moderated support | Behavioral | one 12-week online support group led by a professional healthcare provider |
|
| Measure | Description | Time Frame |
|---|---|---|
| Scores on the Personal Resource Questionnaire 85. | The Personal Resource Questionnaire 85 (PRQ85), Part II measures perceived social support and consists of 25 items in a seven-point Likert format which are rated from seven (7) strongly agree, to one (1) strongly disagree. Scores range from 25 to 175 with higher scores indicative of higher levels of perceived social support. Alpha reliability of the PRQ 85 has been demonstrated at >.90 | 16 weeks |
| Scores on the CES-D Scale | The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report scale widely used in the assessment of depression. Each item is given a rating of 0 to 3, with a potential range of 0 to 60 for the entire scale. Higher scores are associated with depression. The cutoff for the diagnosis of Major Depressive Disorder on the CES-D is 16. The instrument is a reliable measure (Alpha >.85) of depression | 16 weeks |
| Scores on the Quality of Life (QOL) Question on the Rotterdam Symptom Check List (RSCL). | The Rotterdam Symptom Checklist (RSCL) measures quality of life in cancer patients. The RSCL checklist includes a QOL life question on a scale of 1 (excellent) to 7 (extremely poor). This was used as a measure of overall QOL. | 16 weeks |
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Inclusion Criteria: Clinical diagnosis of breast cancer
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Paula Klemm, PhD | University of Delaware School of Nursing | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Delaware | Newark | Delaware | 19716 | United States |
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Subjects were recruited via flyers, word of mouth, at clinics, and via university electronic news. Participants were recruited from August 2005 through December 2008.
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| ID | Title | Description |
|---|---|---|
| FG000 | Moderated Group | one 12-week online support group led by a professional healthcare provider |
| FG001 | Non-facilitated (Peer-led) | 12-week online support in a peer-led format |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Moderated Group | one 12-week online support group led by a professional healthcare provider |
| BG001 | Non-facilitated (Peer-led) | 12-week online support in a peer-led format |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Scores on the Personal Resource Questionnaire 85. | The Personal Resource Questionnaire 85 (PRQ85), Part II measures perceived social support and consists of 25 items in a seven-point Likert format which are rated from seven (7) strongly agree, to one (1) strongly disagree. Scores range from 25 to 175 with higher scores indicative of higher levels of perceived social support. Alpha reliability of the PRQ 85 has been demonstrated at >.90 | Posted | Mean | Standard Error | Scores on a scale | 16 weeks |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Moderated |
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One limitation was the lack of a control group of women who did not take part in an online or face-to-face support group. The reasons for this are explained above.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Paula Klemm, PhD, RN, OCN | University of Delaware | (302) 831-8501 | klemmpa@udel.edu |
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| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
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| peer-led | Behavioral | 12-week online support in a peer-led format |
|
| BG002 | Total | Total of all reporting groups |
| Participants |
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| Age Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Primary | Scores on the CES-D Scale | The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report scale widely used in the assessment of depression. Each item is given a rating of 0 to 3, with a potential range of 0 to 60 for the entire scale. Higher scores are associated with depression. The cutoff for the diagnosis of Major Depressive Disorder on the CES-D is 16. The instrument is a reliable measure (Alpha >.85) of depression | Same as number of participants analyzed | Posted | Mean | Standard Error | Scores on a scale | 16 weeks |
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| Primary | Scores on the Quality of Life (QOL) Question on the Rotterdam Symptom Check List (RSCL). | The Rotterdam Symptom Checklist (RSCL) measures quality of life in cancer patients. The RSCL checklist includes a QOL life question on a scale of 1 (excellent) to 7 (extremely poor). This was used as a measure of overall QOL. | Posted | Mean | Standard Error | Scores on a scale | 16 weeks |
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| 0 |
| 25 |
| 0 |
| 25 |
| EG001 | Peer-led | peer-led group | 0 | 26 | 0 | 26 |
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| D017437 |
| Skin and Connective Tissue Diseases |