Group rehabilitation for cancer patients: satisfaction and perceived benefits

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Abstract

Satisfaction with a group rehabilitation programme (GR) was evaluated in a heterogeneous group of cancer patients. Of the patients that were invited, 67% (N=132) participated in the GR. The GR included eight sessions plus one booster-session, each including information and/or cognitive–behavioural techniques combined with physical training and relaxation and started approximately 4 months after diagnosis. Men and women participated to the same extent. A mailed questionnaire was used to assess patients’ satisfaction, perceived benefits and level of difficulty of the GR components. The majority of patients stated that the number of sessions and timing of the GR was adequate. The usefulness of the GR components were rated in the following descending order: relaxation, physical training, encountering others in the same situation, breathing exercises, information and cognitive–behavioural skills. Patients were more satisfied with diagnosis-specific group meetings than with those including several diagnoses. Assessment of patient satisfaction seems appropriate to elucidate patient priorities.

Introduction

Since the late 1970s, research has demonstrated that psychosocial interventions can be expected to improve the quality of life in cancer patients. Three meta-analyses of studies on such interventions with adult cancer patients have been conducted recently. Meyer and Mark [1] reviewed 45 randomised, controlled studies and concluded that psychosocial interventions had positive effects on emotional and functional adjustments, and treatment- and disease-related symptoms. Devine and Westlake [2] analysed 116 intervention studies and found that psychoeducational care was of benefit to adults with cancer with respect to anxiety, depression, mood, nausea, vomiting, pain and for improving their knowledge about cancer. Sheard and Maguire [3] analysed 19 trials for anxiety and 20 trials for depression and concluded that preventive psychological interventions may have a moderate clinical effect upon anxiety but not depression. In addition to these traditional outcome measures, an evaluation of patient satisfaction with and the perceived benefits of components of psychosocial interventions is of interest. Patient satisfaction is a desirable goal in itself when offering an intervention and should constitute a foundation for the continous improvement of the intervention. Responses to general questions about satisfaction with care are customarily positive and may miss important information [4], whereas questions on specific programme components reveal greater variability [5], [6]. Measures of satisfaction are usually not included in standardised questionnaires for evaluating interventions, in spite of the fact that satisfaction is an important determinant of patient compliance [7], [8].

A review of the available literature revealed that few studies of group interventions for cancer patients have evaluated patient satisfaction. Nine studies were identified. Among these, two were cognitive–behavioural programs [4], [5], one concerned coping skills training (containing cognitive–behavioural elements) [9], four concerned education [6], [10], [11], [12], two dealt with support groups [12], [13] and one was concerned with an information programme [14]. Only three were randomised studies [6], [9], [14], and the remainder were pilot studies or reports of ongoing programs. Most interventions consisted of 6–10 sessions, one of a single group meeting [14], one of a 10-month intervention for newly diagnosed patients, and a 1-week program for patients 1 year after treatment [12]. Bottomley [4], Hammerlid et al. [12] and Heinrich and Schag [6] used interviews for data collection, while the rest used questionnaires. Some studies had small sample sizes of 6–14 patients [4], [5], [12]. The largest sample consisted of 114 patients who completed a questionnaire [14]. Thus, there was considerable variation between studies with respect to interventions as well as evaluation methodology.

In spite of this, the overall conclusion was that the majority of patients were highly satisfied with the intervention. In all studies, the opportunity to meet other patients in the same situation was rated as a most helpful component. When relaxation was included as a programme component, this was rated as most helpful [4], [5], [6]. Negative aspects of the group situation were too few participants [14], drop-outs in the middle of the programme [12], too short sessions [11], conflicts among group members and group heterogeneity [13], and some patients found the programme “scary” or “depressing” [10]. In several studies, the intervention as a whole was rated by patients, while for example Telch and Telch [9] investigated satisfaction with various aspects of the intervention, but reported only a brief conclusion. In two reports [10], [13], participants were asked to point out what aspect of the programme they fond most helpful or of most interest. Heinrich and Schag [6] reported that approximately 75% of the participants found the relaxation exercises, education and information and the experience of being in a group to be very helpful, but only 50% rated activity management and problem solving as very helpful. Watson [5] found that relaxation, discussions about treatments and handouts were rated as most helpful, whereas the least helpful was a psychological journal or diary to aid learning and to facilitate reflection.

In general, patients stated that they were satisfied with the evaluated interventions when asked to give an overall assessment. However, they expressed different levels of satisfaction when asked about the various components of the intervention given.

The present study concerns patients’ opinions of a group rehabilitation (GR) programme, including cognitive–behavioural techniques, information, relaxation and physical training, which was offered as one of several interventions in a randomised study. The aims are to describe patients’ self-reported degree of satisfaction with the GR, perceived benefits and perceived difficulty of the employed GR techniques. Participation rates, satisfaction, perceived benefit and perceived difficulty of the GR techniques were compared between diagnoses, genders, age groups and between groups of patients offered only GR and those offered a combination of GR+individual support (IS). The latter comparison was included to elucidate the extent to which the IS, including early individual psychological support, affected the need for later group rehabilitation.

Section snippets

Patients and procedures

Between October 1st, 1993 and December 31st, 1995, a consecutive series of patients that had been newly diagnosed (<3 months) with breast, gastrointestinal (colorectal, gastric) or prostate cancer and patients who were under medical investigation for a suspected breast cancer in Uppsala county (289 000 inhabitants) were approached by the “Support–Care–Rehabilitation”-project. A research nurse informed them about the project, both orally and in writing, as soon as possible after they had been

Results

Patients’ compliance with the programme was high. A total of 105 patients (≈80%) participated in five or more sessions, 17 (13%) in 2–4 sessions and 10 (≈8%) participated in only one session. The correlation between the number of self-reported sessions attended and those recorded by the group leaders was 0.89. There were no statistically significant differences between the diagnostic, gender, age or randomisation groups with respect to number of attended sessions.

The questionnaire concerning

Discussion

The results suggest that a substantial proportion of cancer patients experience benefits by participating in group rehabilitation. Men and women attended to the same extent, although the proportion of patients accepting inclusion was somewhat higher among women. When patients were informed about the GR at inclusion, the educational aspects were stressed. This may have been attractive to men [19], [20], explaining their relatively high participation rate [16].

The GR programme was a short-term

Implications for practice

A short-time intervention like the GR seems suitable for a large group of cancer patients. Compliance was high and most patients found 4 months after diagnosis to be an appropriate time for start. The program was considered generally useful. The usefulness of the program components were rated in the following descending order: relaxation, physical training, encountering others in the same situation, breathing exercises, information and CBT. The results indicate that GR programmes should be

Acknowledgements

This research was made possible by a grant from the Swedish Cancer Society.

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