Efficacy of Cancer Support Programs: A Social Comparison Theory Analysis

描述（由申请人提供）团体社会心理项目可以改善前列腺癌患者的情绪，增加对患者的支持。一些研究表明，对经历痛苦的患者有益，而对那些低痛苦或没有痛苦的患者没有好处，然而，无论是否证明需要干预，患者通常都会参加试验。只有那些有痛苦的项目才能更好地解决病人的需求。由于非痛苦患者可能需要模拟适应性应对，研究人员对同质的痛苦患者群体进行项目有不同的看法。虽然包括社会比较理论（SCT）在内的理论模型都支持这一观点，但目前还没有专门设计或足够有力的研究来检验痛苦患者是否从非痛苦患者的存在中受益，以及非痛苦患者是否从参与中受益。根据SCT，癌症患者更喜欢通过对比不幸的人来评估自己，以增强自尊和管理情绪，同时，他们更喜欢从幸运的人那里获得信息，并与他们建立联系，以学习适应性应对。异质性支持方案（痛苦患者和非痛苦患者）为痛苦患者提供了最大的机会进行首选社会比较；一个同质的项目（仅限痛苦患者）则不然。对于非痛苦患者，首选社会比较的机会可能有限，可能对社会心理功能和生活质量（QOL）没有甚至负面影响。本研究的目的是检验群体组成对前列腺癌患者心理社会项目效果的影响，并评估在异质群体和同质群体中实施的项目是否对痛苦患者更有效。异质组对非痛苦患者的疗效也将被检查。在进行更大规模的试验以解决这些问题之前，这项可行性研究将对90名前列腺癌患者（60名痛苦患者和30名非痛苦患者）进行。苦恼患者将被随机分配到异质组进行为期3个月的心理社会项目，或同质组进行相同的项目。目的是：1a)收集可行性和过程评价数据；1b)对痛苦患者和社会比较倾向高、低患者的百分比进行估计；2a)估计两组痛苦患者在3个月时的心理功能和生活质量的效应量；2b)在3个月时估计两组患者对假设的sct介质的影响；2c)探讨异质组非痛苦患者的痛苦变化；(2)探讨痛苦患者和非痛苦患者在社会比较指标上的差异，并检查参与小组项目后这些指标的变化。

DESCRIPTION (provided by applicant) Group psychosocial programs may improve mood and increase support for prostate cancer patients. Some studies show benefits for patients experiencing distress and no benefit for those with low/no distress, yet patients are typically enrolled in trials regardless of any demonstrated need for an intervention. Programs including only those with distress may better address patient needs. Researchers have varying opinions about conducting programs with homogeneous groups of distressed patients since non-distressed patients may be needed to model adaptive coping. Though well-validated theoretical models including Social Comparison Theory (SCT) support this view, no research has been specifically designed or adequately powered to examine whether distressed patients benefit from the presence of non-distressed patients and whether non-distressed patients benefit from participation. According to SCT, cancer patients prefer evaluating themselves against less fortunate others to increase self-esteem and manage mood, and concurrently, prefer obtaining information from and affiliating with more fortunate others to learn adaptive coping. A heterogeneous support program (distressed and non-distressed patients) provides distressed patients maximal opportunity for preferred social comparisons; a homogeneous program (distressed patients only) does not. For non-distressed patients, opportunities for preferred social comparisons may be limited, creating the possibility for no or even negative effects on psychosocial functioning and quality of life (QOL). The purpose of this research is to examine the effect of group composition on psychosocial program efficacy for prostate cancer patients and evaluate whether programs are more efficacious for distressed patients when implemented in a heterogeneous versus a homogeneous group. The efficacy of the heterogeneous group for non-distressed patients also will be examined. Prior to the larger trial powered to address these questions, this feasibility study will be conducted with 90 prostate cancer patients (60 distressed and 30 non-distressed). Distressed patients will be randomized to a 3-month psychosocial program in a heterogeneous group or the same program in a homogeneous group. The aims are to: 1a) collect feasibility and process evaluation data; 1b) develop estimates of the percentages of distressed patients and of those high and low in social comparison orientation; 2a) obtain estimates of the effect sizes for distressed patients in both groups on psychological functioning and QOL at 3 months; 2b) estimate the effects on distressed patients in both groups on hypothesized SCT-mediators at 3 months; 2c) explore changes in distress in the non-distressed patients in the heterogeneous group; and 2d) explore differences in distressed and non-distressed patients on measures of social comparison and examine changes in these measures for both following participation in the group program. PUBLIC HEALTH RELEVANCE: This research may indicate that to address the needs of patients experiencing psychosocial distress, groups may be most efficacious when they comprise members experiencing mixed distress levels. If these heterogeneous programs prove harmful or offer no benefit to non-distressed patients, ethical issues emerge regarding their referral to support groups. Findings may suggest a modification to current research and clinical practice wherein non-distressed patients remain as participants, yet are properly trained to maximize benefit for distressed patients and minimize negative consequences for themselves.