A Novel Prosocial Online Support Group for Distressed Breast Cancer Survivors

描述(申请人提供)：乳腺癌(BC)幸存者经常使用在线支持小组(OSGs)来帮助应对他们的癌症，但关于OSGs减少心理痛苦的有效性的证据很弱。这项拟议的研究评估了一种创新的“亲社会”OSG(支持OSG)对痛苦的BC幸存者的潜在疗效(估计效果大小)、可接受性、可行性和介体。支持OSG提供有组织的帮助机会(博客、外展)，并就如何识别需求并为BC OSG中的其他人提供支持提供指导。该项目基于“帮助者治疗原则”，强调给予(与接受)帮助的心理益处。这是第一次在OSG的背景下评估亲社会干预的研究。在目标1中，我们建议使用一项随机试验来评估亲OSG相对于标准易化OSG(S-OSG)的疗效和效果大小。我们将使用适合人群的有效和可靠的措施，在干预前和干预后1个月收集陷入困境的卑诗省幸存者的数据。意向治疗分析将用于比较两种干预措施对抑郁/焦虑症状(主要结果)和目的感(次要结果)水平的影响(n=180；每组90例)。我们假设，相对于S-OSG，支持OSG的患者在干预后的症状水平较低，目的感水平较高。将使用参数估计技术的准确性(AIPE)来评估对结果的影响大小。在目标2中，我们将探讨：(A)支持OSG的受试者对心理症状的益处是否通过支持OSG的参与者比支持S的OSG组的参与者在积极情绪、自尊和归属感方面的增加更多地被中介；(B)支持OSG的对目的感的益处是否通过支持OSG的参与者比支持S的OSG的参与者的归属感更大的增加而中介；以及(C)归属感是否通过增加目的感而间接地改善心理症状。AIPE将用于评估对调解人的影响大小。在目标3中，我们将审查支持OSG的可接受性(例如，保留、满意度)和可行性(例如，帮助的数量)。该项目的重大成果将是一种创新的、基于理论的OSG干预模式，该模式最大限度地减少了心理痛苦，并增加了痛苦的BC幸存者的使命感。这种干预是可持续的，因为它可以由癌症支持社区等组织实施，癌症支持社区是该项目的合作伙伴，也是北美为癌症幸存者提供免费心理社会支持服务的最大提供商。这种干预也可以被其他组织采用，比如癌症中心，到目前为止，这些组织大多提供面对面的支持团体，患者的接触范围有限。未来的方向包括开发一项更大规模的试验来进一步评估支持OSG；在其他癌症人群中评估支持OSG；以及开发和评估支持OSG的培训方案的有效性，使同行领导者(与帮助专业人员)能够促进OSG。 公共卫生相关性：抑郁和焦虑症状和障碍在不列颠哥伦比亚省幸存者中非常普遍，而且往往得不到充分治疗。抑郁症在卑诗省幸存者中比许多其他癌症人群中更普遍，但现有的干预措施并不被广泛接受、可获得或高度有效。拟议的研究将开发和评估一个创新的“亲社会”在线支持小组，该小组提供结构化的帮助机会(博客、外展)，并就如何识别需求并为陷入困境的不列颠哥伦比亚省幸存者在线支持小组中的其他人提供指导。

DESCRIPTION (provided by applicant): Breast cancer (BC) survivors frequently use online support groups (OSGs) to help cope with their cancer, but evidence on the efficacy of OSGs for reducing psychological distress is weak. The proposed study assesses the potential efficacy (estimate effect sizes), acceptability, feasibility, and mediators of an innovative "prosocial" OSG (PRO-OSG) for distressed BC survivors. PRO-OSG provides structured helping opportunities (blogs, outreach) and coaching on how to recognize needs and give support to others in a BC OSG. The project is based on the "helper therapy principle," which emphasizes the psychological benefits of giving (vs. receiving) help. This is the first study to evaluate a prosocial intervention in the context of an OSG. In Aim 1, we propose using a randomized trial to assess the efficacy and effect sizes of PRO-OSG relative to a standard facilitated OSG (S-OSG). We will collect data from distressed BC survivors 1 month pre- and post-intervention using valid and reliable measures appropriate for the population. Intention-to-treat analyses will be used to compare the effects of the two interventions on levels of depression/anxiety symptoms (primary outcomes) and sense of purpose (secondary outcome) (n = 180; 90 per group). We hypothesize that relative to S-OSG, PRO-OSG will have a lower level of symptoms and a higher level of sense of purpose post-intervention. Accuracy in parameter estimation techniques (AIPE) will be used to assess effect sizes on outcomes. In Aim 2, we will explore: (a) if the benefits of PRO-OSG on psychological symptoms are mediated by greater increases in positive affect, self-esteem, and sense of belonging among participants in the PRO-OSG versus S-OSG group; (b) if the benefit of PRO-OSG on sense of purpose is mediated by a greater increase in sense of belonging in the PRO-OSG versus S-OSG; and (c) if sense of belonging indirectly improves psychological symptoms by increasing sense of purpose. AIPE will be used to assess effect sizes on mediators. In Aim 3, we will examine acceptability (e.g., retention, satisfaction) and feasibility (e.g., amount of helping) of the PRO- OSG. The significant outcome of this project will be an innovative, theory-based OSG intervention model that maximizes reductions in psychological distress and increases sense of purpose among distressed BC survivors. The intervention is sustainable, because it can be implemented by organizations such as the Cancer Support Community, a partner on this project and the largest provider of free psychosocial support services for cancer survivors in North America. The intervention also can be adopted by other organizations, such as cancer centers, which to date have mostly offered face-to-face support groups with limited patient reach. Future directions include developing a larger-scale trial to further evaluate PRO- OSG; evaluating PRO-OSG in other cancer populations; and developing and assessing the efficacy of PRO-OSG training protocols that will enable peer leaders (vs. helping professionals) to facilitate OSGs. PUBLIC HEALTH RELEVANCE: Depression and anxiety symptoms and disorder are highly prevalent among BC survivors and often undertreated. Depression is more prevalent among BC survivors than many other cancers populations, but existing interventions are not widely acceptable, accessible, or highly effective. The proposed study will develop and evaluate an innovative "prosocial" online support group that provides structured helping opportunities (blogs, outreach) and coaching on how to recognize needs and give support to others in an online support group for distressed BC survivors.