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Q In patients 18–65 years of age with cancer and psychological distress, is problem solving therapy (PST) effective for improving quality of life and reducing measures of pyschological stress.
Clinical impact ratings Mental health ★★★★☆☆☆ Oncology ★★★★★☆☆
randomised controlled trial.
Unclear allocation concealment.*
blinded (outcome assessors).*
Follow up period:
2 hospitals in Pennsylvania, USA.
150 patients 18–65 years of age with cancer and psychological distress who were able to identify a significant other (SO) person willing to participate in the study. Exclusion criteria included a known psychiatric disturbance before a diagnosis of cancer and mental retardation.
50 patients each were allocated to PST for the patient alone (PSTA), PST for the patient and a SO person (PSTSO), or waiting list control (WLC). PST comprised 10 weekly sessions of 1.5 hours each in which patients received training in rational problem soving skills, including how to better define and formulate the nature of problems, generate alternative solutions, select one to implement, and evaluate the outcome. Results in the abstract are based on outcomes assessed immediately after treatment because after this point, patients in the WLC group were offered either PSTA or PSTSO.
patients’ quality of life and psychological distress (2 scales rated by the clinician, 3 by the patients, and 1 each by the SO and physician).
Patient follow up:
88% (mean age 47 y, 67% women).
Improvement in overall quality of life and decrease in global psychological distress were greater in both the PSTA and PSTSO groups than in the WLC group (p values <0.01). More patients in the PST groups than in the WLC group achieved a clinically significant decrease in psychological distress (table).
In patients 18–65 years of age with cancer and psychological stress, problem solving therapy improved quality of life and reduced measures of pyschological distress.
The study by Nezu et al is important because not only does it provide data that further supports the benefits of PST already reported in other clinical populations but also uses robust study methods to show the potential for a psychological intervention to improve the lives of those affected by cancer related distress. Although many published studies evaluating the effect of psychological interventions on morbidity associated with cancer exist, many are fraught with methodological flaws.1 This high quality study constitutes a substantial improvement on many weaker studies in this area. Specific improvements include the fact that patients were followed up at 1 year and the use of inferential statistics, effect size, and ratings of clinical significance to examine the effect of the intervention. Outcome assessment using self report measures, clinician ratings, and ratings from an SO were included. The study also included measures to assess changes in problem solving, providing data suggesting that changes might be moderated by improvements in problem solving ability. Potential participants had to be able to name an SO, thus excluding people who may lack social support, a factor that is often associated with distress.
Although the benefits of supportive and psychological care interventions are well established, few patients with cancer receive these as part of routine care.2 The challenge now for those involved in the delivery of health care is how to ensure that patients access these interventions and that clinicians are properly trained to deliver psychological therapies such as PST to people with cancer who may benefit. Finally, it will be important to evaluate PST within a clinical effectiveness paradigm, chosen to reflect a wide range of clinical, sociodemographic, and psychological characteristics of patients.