DEVELOPING AND TESTING THE EFFECTS OF A PSYCHOEDUCATION INTERVENTION ON PATIENTS WITH COLORECTAL CANCER: A MIXED METHOD STUDY

Abstract

Background Colorectal cancer is a major cause of morbidity and mortality worldwide. Patients’ health-related quality of life (HRQoL) can be affected due to physical, psychological and social challenges. There is paucity of studies examining the HRQoL and experiences of patients with colorectal cancer as well as developing theory-based psychoeducation intervention for these patients to improve their self-efficacy and HRQoL in Asia.

Aim The aims of this study were to examine the predictors of HRQoL of patients with colorectal cancer after surgery (Phase 1), to explore the experiences of patients with colorectal cancer (Phase 2) and to develop and evaluate the preliminary effects of Social Cognitive Theory-based Psychoeducation intervention (SCT-PEI) programme on outcomes of patients with colorectal cancer (Phase 3).

Methods This was a mixed methods study. Phase 1 was a cross-sectional survey on colorectal cancer patients using European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30), European Organisation for Research and Treatment of Cancer Colorectal Cancer Specific Quality of Life Questionnaire (EORTC QLQ-CR29) and Hospital Anxiety and Depression Scale (HADS). A convenience sample of 300 colorectal cancer patients was recruited. Phase 2 was a focus group interview study to explore 30 patients’ post-operative experiences from five focus groups. Phase 3 was a two-group, pre-and post-tests pilot randomised controlled trial. Patients were randomised into two groups with 20 in each group: intervention group received SCT-PEI over a six-week period with usual care; control group received usual care. Outcomes were measured by General Self-Efficacy Scale, EORTC QLQ-C30, EORTC QLQ-CR29, HADS and Self-Regulation Scale at baseline, immediate after six-week intervention, 1 and 3 months after intervention. Quantitative data were analysed using SPSS and qualitative data by thematic analysis.

Results Phase 1 results indicated anxiety, depression were major predictors of poorer HRQoL. Other predictors included age, religion, employment status, tumour site and stoma. Younger patients (p = 0.023) had poorer functional QoL. Patients with religion of Buddhism/Taoism had better global QoL (p = 0.008) and lesser symptoms (p = 0.024) when compared to other respective subgroups. Patients who were employed (p = 0.028), had rectal cancer (p = 0.019) and stoma (p = 0.001) had more symptoms than those in other respective subgroups. Phase 2 revealed that patients were most vulnerable to physical and emotional distress in initial two months following colorectal surgery. Phase 3 results showed significant time effect, group effect and time*group interaction effect for self-efficacy (p = 0.012) and self-regulation (p = 0.005) between groups over time. Significant within-group improvements were found on global health staus/QoL (p = 0.045) and anxiety (p = 0.029) in the intervention group only. The process evaluation supported the effects of intervention and confirmed the desirability, acceptability and value of SCT-PEI.

Conclusion This was the first study of its kind that used a mixed method design to develop and evaluate a SCT-based intervention to enhance self-efficacy, HRQoL and other outcomes of patients with colorectal cancer. A large scale study is needed to further confirm the preliminary results before integrating the intervention into clinical settings.