This article was downloaded by: [University of Arizona]On: 18 September 2013, At: 10:00Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Psychology & HealthPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/gpsh20

Who benefits from a psychosocialcounselling versus educationalintervention to improve psychologicalquality of life in prostate cancersurvivors?Terry A. Badger a , Chris Segrin b , Aurelio J. Figueredo c , JoanneHarrington d , Kate Sheppard a , Stacey Passalacqua e , AlicePasvogel a & Maria Bishop fa College of Nursing, The University of Arizona, Tucson, AZ, USAb Department of Communication, The University of Arizona,Tucson, AZ, USAc Department of Psychology, The University of Arizona, Tucson,AZ, USAd Division of Hematology and Oncology, Phoenix Veterans’ AffairsHealth Care System, Phoenix, AZ, USAe Department of Communications, Rollins College, Winter Park,FL, USAf Arizona Cancer Center and Southern Arizona Veterans’ AffairsHealth Care System, Tucson, AZ, USAAccepted author version posted online: 20 Sep 2012.Publishedonline: 09 Oct 2012.

To cite this article: Terry A. Badger , Chris Segrin , Aurelio J. Figueredo , Joanne Harrington ,Kate Sheppard , Stacey Passalacqua , Alice Pasvogel & Maria Bishop (2013) Who benefitsfrom a psychosocial counselling versus educational intervention to improve psychologicalquality of life in prostate cancer survivors?, Psychology & Health, 28:3, 336-354, DOI:10.1080/08870446.2012.731058

To link to this article: http://dx.doi.org/10.1080/08870446.2012.731058

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as to

the accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Who benefits from a psychosocial counselling versus educational

intervention to improve psychological quality of life in prostate

cancer survivors?

Terry A. Badgera*, Chris Segrinb, Aurelio J. Figueredoc, Joanne Harringtond,Kate Shepparda, Stacey Passalacquae, Alice Pasvogela and Maria Bishopf

aCollege of Nursing, The University of Arizona, Tucson, AZ, USA; bDepartment ofCommunication, The University of Arizona, Tucson, AZ, USA; cDepartment of

Psychology, The University of Arizona, Tucson, AZ, USA; dDivision of Hematologyand Oncology, Phoenix Veterans’ Affairs Health Care System, Phoenix, AZ, USA;eDepartment of Communications, Rollins College, Winter Park, FL, USA; fArizonaCancer Center and Southern Arizona Veterans’ Affairs Health Care System, Tucson,

AZ, USA

(Received 11 January 2012; final version received 13 September 2012)

Objective: We examined selected survivor characteristics to determine whatfactors might moderate the response to two psychosocial interventions.Design: Seventy-one prostate cancer survivors (PCSs) were randomlyassigned to either a telephone-delivered health education (THE) interventionor a telephone-delivered interpersonal counselling (TIP-C) intervention.Measures: Psychological quality of life (QOL) outcomes included depres-sion, negative and positive affect, and perceived stress.Results: For three of the psychological outcomes (depression, negativeaffect and stress), there were distinct advantages from participating inTHE. For example, more favourable depression outcomes occurred whenmen were older, had lower prostate specific functioning, were in activechemotherapy, had lower social support from friends and lower cancerknowledge. Participating in the TIP-C provided a more favourableoutcome for positive affect when men had higher education, prostatespecific functioning, social support from friends and cancer knowledge.Conclusion: Unique survivor characteristics must be considered whenrecommending interventions that might improve psychological QOL inPCSs. Future research must examine who benefits most and from whatcomponents of psychosocial interventions to enable clinicians to recom-mend appropriate psychosocial care.

Keywords: psychosocial interventions; QOL; prostate cancer; psychologi-cal distress

Introduction

Over 2 million men are currently living with the significant challenges associated withprostate cancer diagnosis and treatment (ACS, 2011). Prostate cancer and itstreatment are associated with psychological and physical side effects that include

*Corresponding author. Email: tbadger@nursing.arizona.edu

� 201 Taylor & Francis

http://dx.doi.org/10.1080/08870446.2012.731058Psychology & Health, 2013Vol. 28, No. 3, 336–354,

3

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

urinary incontinence, sexual dysfunction, fatigue and psychological distress(Danjoux, Gardner, & Fitch, 2007; Namiki & Arai, 2010; Sharpley & Christie,2007). The incidence of psychological distress, specifically depression and anxiety,has been reported as 16% and 12%, respectively (Sharpley & Christie, 2007), whichis higher than population norms for older men. Depression and anxiety areassociated with decreased compliance with adjuvant therapy, feelings of nervousnessand worry, cognitive and functional impairments and reduced quality of life (QOL)(i.e. decreased psychological, physical, social and spiritual well-being) (Jacobsen &Jim, 2008; Korfage, Essink-Bok, Janssens, Schroder, & de Koning, 2006). High levelsof perceived stress have also been associated with high rates of depression and poorerQOL in adults with cancer (Faul, Jim, Williams, Loftus, & Jacobsen, 2010).

Studies of men with prostate cancer have identified the two prominent areas ofunmet need: (1) maintenance of psychosocial well-being, such as minimisingpsychological distress and improving interpersonal functioning, (Ezer et al., 2006)and (2) meeting informational needs for increased understanding of the illness and itsshort- and long-term effects (Docherty, Brothwell, & Symons, 2007; Traeger et al.,2009). Interventions that target psychological distress and provide information aboutcancer can help survivors to decrease the uncertainty and related psychological andphysical distress associated with cancer (Bailey, Wallace, & Mishel, 2007). In areview of psychosocial interventions for maintaining and improving QOL in menwith prostate cancer, Penedo and Dahn (2004) concluded that despite the promisingevidence of their effectiveness for reducing psychological distress and improvingQOL (Livingston et al., 2010; Penedo et al., 2006, 2007), additional research isneeded to determine who benefits most and from what components of psychosocialinterventions. This call reflects a move away from a one size fits all approach to usinga theoretical perspective to examine intervention benefit.

Telephone delivered interventions are an increasingly common component ofpsychosocial oncology practice (Marcus et al., 2002; Secura, Budin, & Garfing,2004). As part of a larger behavioural clinical trial, we developed two telephone-delivered psychosocial interventions (health education and interpersonal counselling)that were designed to target the psychological distress and informational needs ofprostate cancer survivors (PCS) and their family members and friends. We foundthat both interventions were effective in improving multiple dimensions of QOL(psychological distress, and physical, social and spiritual well-being) over the fourmonth course of the investigation (Badger et al., 2012). We adapted the stress processmodel stress process model (Pearlin, Mullan, Semple, & Skaff, 1990) to guide thestudy and predict intervention effectiveness on QOL outcomes. The model wasoriginally developed to describe care giving processes for Alzheimer’s patients, andto explain and predict outcomes among cancer patients (Judge, Menne, & Whitlatch,2010) and informal caregivers of cancer patients (Gaugler et al., 2005, 2008, 2009).The model proposes that contextual characteristics and psychosocial resources canmoderate the effect of the interventions on QOL.

In the stress process model, background variables include various demographicvariables that describe the patient’s standing in social strata and access to resources.In this investigation, these were indexed by the prostate cancer patients’ age,education and income. The stress process model also indicates that psychosocialresources (e.g. cancer knowledge, social support) and primary stressors (e.g. prostatefunctioning, symptom distress) will play a major role in maintaining or disruptingQOL and response to psychosocial treatment (Chambers, Ferguson, Gardiner,

2 337Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Aitken, & Occhipinti, 2012; Knight et al., 2007; Mishel et al., 2003). Both age andeducation have been reported as influencing QOL and intervention benefit.(Chambers et al., 2012; Knight et al., 2007) Younger men with prostate cancerwith good sexual functioning before treatment have been reported to experiencehigher levels of psychological distress following treatment (Chambers et al., 2012).The combination of younger age and loss of function puts younger men at higherrisk for psychological distress than older men with similar prostate specificfunctionality. Further, Chambers found that following an educational intervention,younger men with higher education reported benefits on important psychologicaloutcomes. Knight (Knight et al., 2007) and Mishel (Mishel et al., 2003) found thatmen with less education experienced both greater symptom distress/burden andinability to manage their daily lives due to cancer. Thus, both age and educationseem to influence QOL and intervention benefit.

Psychosocial resources are those variables such as social support or cancerknowledge that mediate the relationship between the contextual characteristics andpsychosocial distress (Gaugler et al., 2009). Social support is a key resource forcancer survivors and their social network members and lack of support is a cause ofpsychological distress among PCS (Manne, Badr, Zaider, Nelson, & Kissane, 2010).There is clear evidence that social support is beneficial for PCS (Arora, FinneyRutten, Gustafson, Moser, & Hawkins, 2007; Helgeson & Cohen, 1996; Zhou,Penedo, Lewis, et al., 2010; Zhou, Penedo, Bustillo, et al., 2010) and emotionalsupport provided by family members is associated with reduced anxiety, depressionand hostility (Gotcher, 1992). PCS have strong informational needs, and these unmetneeds have been linked to poor QOL (Kezia & Rees, 2002). Traeger et al. (2009),among others (Chambers et al., 2012), found that men with more severe illnessperceptions (due to poor knowledge) had poorer emotional well-being. Ourpreliminary results found that improvements in psychological distress and relatedphysical, social and spiritual well-being occurred when informational support wasprovided in a structured educational intervention (Badger et al., 2012).

Given the benefits of our interventions, the logical next step was to determine forwhom the interventions work best. Therefore, the purpose of this paper was toexamine what selected factors specified in the stress process model (e.g. age,education, prostate specific functioning, symptom distress and symptom manage-ment, social support, cancer knowledge) of the PCS might moderate the response todifferent interventions designed to improve psychological QOL (depression, positiveand negative affect and perceived stress). We wanted to answer the question, ‘whobenefits from these two different telephone delivered psychosocial interventions?’ toprovide clinicians with information for recommending the intervention that might bethe most beneficial to PCSs.

Methods

Sample

Participants for the larger study were a convenience sample of 71 PCSs and their 71social network members. For the purpose of this paper that focuses on PCS, we haveexcluded the social network members in all further analysis. Eligibility criteria for thePCS included a diagnosis of prostate cancer, currently undergoing or had completedtreatment within the past six months, ability to speak English, no physical or

338 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

psychological disabilities that would prevent participation in the interventions,and availability of a social network member who was willing to participate in theinvestigation. Descriptive information about the demographic characteristics of thesurvivors appears in Table 1. Table 2 lists the illness characteristics of the PCS.The typical participant was in his late 60s, white, married, retired and collegeeducated. Treatment included prostatectomy (almost 30%), radiation (56%) andhormone therapy (42%). All of the men listed at least one other chronic illness, withan average of 1.82 (SD¼ 1.5) illnesses and 4.64 (SD¼ 3.7) medications. At baseline,there were no significant differences in demographic characteristics between thehealth education and counselling groups.

Procedure

PCSs were recruited from regional cancer centers, regional Veterans Affairs HeathCare Centers, cancer support groups, and from research study websites throughwhich interested individuals could volunteer to enrol. After informed consent, PCSand their social network members (i.e. family members or friends) were randomlyassigned to one of two eight-week telephone delivered interventions: telephone healtheducation (THE) and telephone interpersonal counselling (TIP-C) described below.Thirty-six men and their social network members were assigned to the TIP-Cintervention and 35 men and their social network members were assigned to THE.The interventions were delivered between T1 and T2 of a three-wave longitudinalstudy with eight-week intervals. All participants completed baseline (T1) assessments

Table 1. Demographic characteristics of survivors.

Age (years) 66.99 (9.6)Race/ethnicityAmerican Indian/Alaska native 0Asian/Pacific Islander 0Black 6 (8.5%)Hispanic 5 (7.0%)White 60 (84.5%)Other/Unknown 0

Marital statusMarried 56 (78.9%)Unmarried 15 (21.1%)

Length of marriage/committee relationship (years) 32.98 (17.8)

Number of children 2.41 (1.7)Highest level of educationMiddle school 1 (1.4%)High school 9 (12.7%)Vocational/Technical/Some college 20 (28.2%)College 24 (33.8%)Post graduate/Professional degree 17 (23.9%)

Employment statusUnemployed, but seeking employment 2 (2.8%)Employed part time/full time 19 (26.8%)Retired 50 (70.4%)Disabled 0

339Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

over the telephone that included the instruments described here plus others notrelevant to the present report. Participants completed the second (T2) assessment(T1þ eight weeks) within one week of their final intervention session, and the finalassessment (T3) eight weeks later (T2þ eight weeks). After each assessment,participants were sent a US$10 gift card from a local retail merchant to thankthem for their time.

At T1, 71 PCSs were enrolled and five survivors withdrew from the study by T2(T1–T2 attrition rate¼ 7%). By T3, an additional two participants were lost tofollow-up because they declined to complete the T3 assessment (T1–T3 attri-tion¼ 10%). The Consort flowchart for this sample is available in the literature(Badger et al., 2012). There were no significant differences for demographic or illnesscharacteristics between those that discontinued and those that completed the study.

Interventions

The TIP-C intervention was delivered by two interventionists (one master’s preparedsocial worker and one master’s prepared nurse; both with oncology expertise).Sessions averaged 31 minutes (SD¼ 7.0) in duration. The TIP-C intervention wasdeveloped from standard interpersonal psychotherapy (Weissman, Markowitz, &Klerman, 2000), combined with cancer education, and modified for

Table 2. Prostate cancer information for survivors.

Weeks since diagnosis 186.77 (257.5)Type of treatmenta

Chemotherapy 10 (14.1%)Radiation 40 (56.3%)Hormones 30 (42.3%)Surgery 30 (42.3%)CAM 3 (4.2%)Watchful waiting 7 (9.9%)

Type of surgerya

Biopsy 57 (80.3%)Complete or radical prostatectomy 21 (29.6%)Prostate node dissection 5 (7%)Tumor removal 4 (5.6%)

Stage of cancerb

I 11 (15.5%)II 6 (8.5%)III 6 (11.3%)IV 8 (11.3%)

PSA level 17.26 (43.6)Gleason score 6.33 (1.6)Family history of prostate cancer

Yes 27 (38%)No 43 (60.6%)

Notes: aOver 100% because survivors had more than one type oftreatment.bStage was unknown by most participants and was dropped fromfurther analyses.

340 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

telephone delivery. The intervention addressed (1) mood and affect management, (2)emotional expression, (3) interpersonal communication and relationships, (4) socialsupport and (5) cancer information. The TIP-C focuses on enhancing emotionalsupport both through the direct effects of interaction with the interventionist, andmobilising the survivors’ naturally occurring support. The TIP-C targets socialsupport, and explains how life events and the social environment affect mood, theinfluence of mood on social functioning, and provides normalisation and validationof participants’ experiences and reactions to cancer. TIP-C is designed to improvethe quality of the relationships between survivors and other key players in the cancerexperience (e.g. family, health care team).

The THE intervention was delivered by two paraprofessionals (non-healthstudents/staff). Sessions averaged 28 minutes (SD¼ 6.2). Adult educational tech-niques guided the provision of information. Prior to receiving the intervention,standardised materials developed by the National Cancer Institute were sent to theparticipants, and these materials were reviewed over the telephone. THE focuses on(1) normal prostate health and prostate cancer, routine tests for the diagnosis,prevention and terminology; (2) treatment, side effects of treatment and strategies tocombat these side effects; (3) lifestyle interventions such as nutrition and physicalactivity and (4) referrals and resources. No counselling occurred in the healtheducation and sessions helped participants take a more active role in their care byasking more appropriate and relevant questions (i.e. patient activation (Hendrenet al., 2010)).

Both interventions had manuals and the intervention content was the samewhether the participant was a PCS or social network member. The PCS and hisdesignated social network member were called separately at times convenient toparticipate in the interventions. The interventionists, who were trained in theintervention for which they were responsible, called each PCS once weekly over eightweeks. Sessions of both interventions were recorded and reviewed by the first andsecond authors. After establishing a 490% adherence to the protocols, randomlyselected interventions (about 10%) were reviewed, giving feedback to the intervenersto maintain fidelity and prevent intervention drift.

Measures

Two sets of measures were used to test the differential effectiveness of the twointerventions. The first set included four indicators of psychological QOL (depres-sion, positive and negative affect and perceived stress).

Psychological QOL

Symptoms of depression were measured using the 20-item Center for EpidemiologicalStudies-Depression Scale (CES-D) (Radloff, 1977). Scores range from 0 to 60, withhigher scores indicating greater depression. The CES-D has strong evidence ofsatisfactory reliability and validity (Badger, Segrin, Dorros, Meek, & Lopez, 2007).Cronbach’s alphas over the three measurement times were �0.88.

Positive and negative affect were assessed with the 20-item Positive and NegativeAffect Schedule (PANAS) (Watson, Clark, & Tellegan, 1988). Scores range from10 to 50 on each scale. The PANAS has been used extensively with satisfactory

341Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

reliability and demonstrated convergent and construct validity (Manne & Schnoll,2001). Cronbach’s alphas were �0.87 for positive affect and �0.83 for negative affectover time.

Perceived stress was assessed with the 10-item Perceived Stress Scale (PSS)(Cohen, Kamarck, & Mermelstein, 1983) that measures subjective appraisals ofstress. The PSS has a scale range of 0–40. The PSS has demonstrated satisfactoryreliability and validity in numerous studies with a Cronbach’s alphas in this studywere �0.88 over time.

The second set of measures included selected contextual characteristic andpsychosocial resource variables that would be predicted by the stress process modelto moderate the association between intervention condition and QOL outcomes.These were grouped into the categories of demographic characteristics, illnesscharacteristics and context, and psychosocial resource variables. These potentialmoderating variables were assessed at baseline only.

Demographic characteristics tested as moderators were age and education.Education was measured through six ordered categories starting with elementaryschool and ending with post-graduate or professional degree.

Illness characteristics and context were assessed by the stage of cancer (1–4), PSA,and the UCLA Prostate Cancer Index (PCI) (Litwin et al., 1998). Given the amountof missing self-reported data for stage or PSA, these variables were dropped fromfurther analysis. Participants completed the PCI to assess their prostate-specifichealth related QOL or functioning. This Index has sound psychometric qualities,demonstrating good internal consistency, test-retest reliability and validity(Karakiewicz et al., 2003). The reliability of the PCI in this sample was �¼ 0.74.Symptom distress and symptom management were each assessed by a one-item scalethat ranged from 1 to 10. Higher scores indicated higher symptom distress andgreater abilities to manage one’s symptoms.

Participants were asked to respond yes/no to whether they were currentlyreceiving each of the following therapies for their prostate cancer: chemotherapy,radiation, and hormone blocking or if they had ever undergone surgery to treat theirprostate cancer.

Psychosocial resources included two measures of the participant’s cognitive oraffective background that could have a potential influence on the outcome of theinterventions: social support and cancer knowledge. Social support was measuredwith the 20-item Perceived Social Support-Friend (PSS-FR) scale (Procidano &Heller, 1983). The PSS scales have a strong record of psychometric quality,correlating with variables such as degree of relational reciprocity, and intangible andtangible support from Cancer knowledge determined the participant’s generalknowledge about prostate cancer with a 14-item index. Respondents answered trueor false to statements about biopsies, prostatectomy, routine exams, chemotherapy,radiation and fatigue. These statements were derived from health education materialsabout prostate cancer available from the National Cancer Institute.

Statistical analysis

Level 1 growth curve analyses

Multi-Level Modelling (MLM) was performed using SAS PROC MIXED.Individual growth curve parameters were obtained by Maximum Likelihood

342 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

estimation, quantifying the systematic changes in scores over time by empiricallyfitting regression lines for all variables (i.e. psychological QOL) on which repeatedmeasures were obtained. The following growth curve parameters were estimated:(1) the intercept, representing the starting score on each QOL variable prior toexperimental treatment and (2) the natural logarithmic slope, using the unstandar-dised regression weights, representing the direction and magnitude of average changein scores over time. Because we expected negatively accelerated functions for thegrowth curves, the slopes were theoretically pre-specified to be curvilinear; a naturallogarithmic transformation of time was therefore performed prior to the GrowthCurve Analyses (GCAs). A visual example of the estimate of growth curve slopesappears in Figure 1. An unstructured covariance matrix was specified in the MLM,in which all the variances and covariances among repeated observations were freelyestimated and thus permitted to be different from each other.

Moderation tests

The individual growth curve parameters generated in the Level 1 GCA weresubsequently treated as dependent variables in a series of moderated regressionanalyses. For each analysis, intervention condition (TIP-C or THE) was theindependent variable. Each of the potential moderator variables (demographiccharacteristics, illness characteristics and context and psychosocial resources) wasindividually tested to determine if it predicted a differential effectiveness of oneintervention over the other. The individual growth curve slopes for each of the fourpsychological QOL variables were the dependent variables. By analysing the growthcurve slopes, data from all three points of assessment were taken into accountbecause the growth curves represent the trajectory of change from T1 to T3. For allsuch analyses, the independent and moderator variables were mean centred prior tocreating the interaction terms, as recommended by Cohen, J., Cohen, P., West andAiken (2003). If a statistically significant interaction was found, this indicated thatthe moderator variable predicted a differential outcome in terms of individualgrowth curves for the two intervention conditions. When there were statistically

y = -18.89ln(x) + 25.9460

5

10

15

20

25

30

T1 T2 T3

CES-D (participant 481)

CES-D

Log. (CES-D)

Figure 1. Example of raw data and estimation of log rhythmic slope.Notes: Dashed line represents raw scores on CES-D scale. Solid line represents estimatedindividual growth curve slope.

343Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

significant interactions found, post hoc conditional regression analyses wereconducted at �1SD, the mean, and þ1SD for continuous moderator variables,and at two levels (e.g. present/absent) for dichotomous moderator variables. Theconditional slopes in these post-hoc analyses were also tested for statisticalsignificance (i.e. significant difference from 0). These tests reflect the differentialeffectiveness of the two interventions at differing levels of the moderator variable.Where the conditional slope is not significant, there is no statistically significantdifference in QOL trajectories (as indexed by the slope) in the two conditions.Significant conditional slopes indicate that the QOL trajectory was significantlydifferent in the two conditions. Because regression is generally underpowered fordetecting interactions in all but ideal experimental contexts (McClelland & Judd,1993), we implemented this post-hoc deconstruction of interaction effects that werestatistically significant at the p5 0.05 level, as well as those at the p¼ 0.05–0.09significance levels. With the sample size of this investigation, the smallest effect thatcould be detected for the interaction term at �¼ 0.05 and power¼ 0.80 would bef2¼ 0.11, which is equivalent to R2D¼ 0.10 for the interaction effect. BecauseR2D¼ 0.10 is a substantial effect, it is possible that there could be somewhat weakerinteraction effects that do not exceed the p5 0.05 threshold for statisticalsignificance, but that may still have some practical implications for identifyingsuperior outcomes in one intervention condition over the other.

Results

Table 3 shows the results of the tests for each moderator variable using the four QOLindividual growth curve slopes. For clarity of presentation, only the unstandardisedregression coefficient for the interaction term is listed in the table. Post hocdeconstruction of any significant or marginally significant interaction term isindicated immediately below the interaction term, again, in the form ofunstandardised regression coefficients. In all analyses the TIP-C condition wasdummy coded as 1 and THE as 2. To explain the nature of the interaction effects inmore detail, we focus on two specific examples (age and social support) examiningthe conditional effects at different levels of the moderator. Although we discussestimates of the effect for participating in each intervention for those at differentlevels of the moderator variable, this latter information is not included in Table 3.

Our first example illustrates that age was a significant moderator of interventionbenefit on depression slopes (Table 3). Because all of the conditional effects arenegative, improvements in depression (negative slopes) were always strongest in theTHE intervention compared to the TIP-C. Age caused substantial variability in theintervention effect. Among younger men (�1 SD from the mean or 57 years of age)the effect for intervention was not significant. Specific estimates of depression slopesare b¼�0.45 for younger men in the TIP-C intervention, and b¼�1.77 for youngermen in the THE intervention. These non-significant conditional slopes documentthat changes in depression were equivalent for younger men in the two interventions.For men at the mean age (67 years) in our sample, specific estimates of depressionslopes were b¼�0.10 in the TIP-C and b¼�3.38 for men in the THE. This showsthat there is an advantage for being in the health education intervention when theman is average aged (67 years) rather than younger (�57 years). Finally, for oldermen (þ1 SD from the mean or 77 years), the estimate of the TIP-C intervention’s

344 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Table

3.Dem

ographic,illnesscharacteristics,illcontextmoderators

andpsychosocialresourcemoderators

oftheeffect

ofinterventionconditionon

QOL

outcomes.

Moderator

Depression

Negativeaffect

Positiveaffect

Perceived

stress

Dem

ographic

characteristics

Age

�0.20*

�0.02

�0.12

�0.01

�1SD

b¼�1.32

Mb¼�3.27**

þ1SD

b¼�5.23***

Education

�0.06

�0.65

�1.93*

0.77a

�1SD

b¼1.28

�1SD

b¼�3.08***

Mb¼�0.69

Mb¼�2.29***

þ1SD

b¼�2.67*

þ1Sdb¼�1.50*

Illnesscharacteristics/context

Prostate

specific

function

0.08a

0.06

�0.07a

0.02

�1SD

b¼�5.36***

�1SD

b¼0.90

Mb¼�3.43***

Mb¼�0.74

þ1SD

b¼�1.51

þ1SD

b¼�2.38*

Chem

otherapy

�5.94a

�1.05

1.30

�1.21

nob¼�2.69*

yes

b¼�8.63**

345Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Symptom

distress

�0.81

�0.63a

0.34

�0.14

�1SD

b¼�1.70

Mb¼�3.43***

þ1SD

b¼�4.55***

Symptom

managem

ent

�0.03

0.75*

�0.26

0.08

�1SD

b¼�4.90***

Mb¼�3.41***

þ1SD

b¼�1.93*

Psychosocialresources

Socialsupport-friends

0.50*

0.11

�0.49*

0.14

�1SD

b¼�5.80***

�1SD

b¼1.56

Mb¼�3.53***

Mb¼�0.63

þ1SD

b¼�1.26

þ1SD

b¼�2.82*

Cancerknowledge

0.59a

0.10

�0.47a

0.16

�1SD

b¼�5.40***

�1SD

b¼0.87

Mb¼�3.48***

Mb¼�0.66

þ1SD

b¼�1.55

þ1SD

b¼�2.21a

Notes:

Table

values

are

unstandardised

regressioncoefficients

fortheinteractionterm

composedoftreatm

entgroup(dummycoded

asTIP-C¼1,

THE¼2)�moderatorvariable.Values

insuperscriptare

conditionalunstandardised

regression

coefficients

representing

therelationship

between

treatm

entgroupandthedependentvariable

at�1SD,M

andþ1SD

ofthemoderatorforcontinuousmoderatorvariables,

andatabsence

(no¼0)or

presence

(yes¼1)ofthemoderatorfordichotomousmoderatorvariables.

*p5

0.05.

**p5

0.01.

***p5

0.001.

ap¼0.05–0.09.

346 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

effect on depression is b¼ 0.24 and in the THE condition, it is b¼�4.99. Figure 2

illustrates the slopes at the three conditional values of age. As evident in Figure 2,

among older men there is a major advantage to being in the educational intervention

in improvements in depression, whereas among younger men the differential

advantage of one intervention over the other is minimal.Our second example shows how social support from friends moderated the effect

of intervention on positive affect slopes (Table 3). Social support from friends is a

particularly remarkable moderator in that it exhibited a disordinal interaction with

intervention condition on changes in men’s positive affect over time. Figure 3 plots

these slopes at the three conditional values of social support. As illustrated in

Figure 3, among men �1 SD from the mean on social support from friends (i.e. low

social support), the effect of the intervention was not significant. The average change

in positive affect for men in the TIP-C was b¼ 0.97 and was b¼ 2.54 for men in the

THE intervention. Positive affect increased for men with low social support in both

interventions, but the effect was more pronounced (but not significantly so) among

those men in the THE. Among men at the average for social support from friends,

the effect of intervention was also not significant, with an average slope of b¼ 1.40 in

the TIP-C intervention and b¼ 0.77 in the THE intervention. Both groups of men

evidenced increases in positive affect over time, but for men with average social

support, the advantage is now for the TIP-C intervention, but not significantly so.

Finally, the effect for intervention for men þ1 SD from the mean of social support

from friends (i.e. high social support) was b¼�2.82, p5 0.05. The average positive

affect slopes for these men were b ¼ 1.82 in the TIP-C intervention and b¼�1.00 for

men in the THE intervention. For men who have high levels of social support from

friends, the advantage of being in the TIP-C intervention is truly dramatic. Men in

-1SD age

M age

+1SD age

-6

-5

-4

-3

-2

-1

0

1

THETIP-C

Interaction of Age x Intervention on CES-D slopes

Figure 2. Illustration of age� intervention condition interaction on CES-D slopes.Notes: Plotted values represent slopes. Therefore, positive values indicate increases indepression over time and negative values indicate decreases in depression over time.

347Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

TIP-C had positive slopes for positive affect over time whereas men in THE had

negative slopes indicating decreases in positive affect over time.The results of the moderated regression analyses for the outcome measures are

summarised in Table 4. For three of the psychological outcomes (depression,

negative affect and stress), there were distinct advantages from participating in THE.

More favourable depression outcomes (reduced depression) occurred when men were

older, had lower prostate specific functioning, in active chemotherapy, and had lower

social support from friends and lower cancer knowledge. For negative affect, more

favourable outcomes (reduced negative affect) occurred when the men had higher

levels of symptom distress, and lower perceived ability to manage their symptoms.

The THE intervention also produced a more favourable outcome (reduced perceived

stress) when men had lower education. Participating in the TIP-C provided a more

favourable outcome for positive affect (increased positive affect) when men had

-1SD soc support-friends

M soc support-friends

+1SD soc support-friends

-1.5

-1

-0.5

0

0.5

1

1.5

2

2.5

3

THETIP-C

Interaction of Social Support from Friends x Intervention on Positive Affect Slopes

Figure 3. Illustration of social support from friends� intervention condition interaction onpositive affect slopes.Notes: Plotted values represent slopes. Therefore, positive values indicate increases in positiveaffect over time and negative values indicate decreases in positive affect over time.

Table 4. Summary of results of the effect of the intervention condition on psychological QOLoutcomes.

THE4TIP-CDepressionOlder age, active chemotherapy, lower prostate specific functioning, lower social support

from friends and lower cancer knowledgeNegative affectHigher symptom distress and lower ability to manage symptoms

Perceived stressLower education

TIP-C4THEPositive affectHigher education, higher prostate specific functioning, higher social support from friends

and higher cancer knowledge

348 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

higher education, prostate specific functioning, social support from friends andcancer knowledge.

Discussion and conclusions

Although both informational needs and psychosocial distress are paramount issuesduring survivorship (McDowell, Occhipinti, Ferguson, Dunn, & Chambers, 2010), a‘one size fits all’ approach to meeting the needs of PCSs is unlikely to be as effectiveas interventions more tailored to the unique characteristics of the survivor. Thisinvestigation provides evidence that the survivors’ contextual characteristics andpsychosocial resources predict differential intervention benefit. Demographic char-acteristics such as age and education were found to influence effectiveness of thedifferent interventions. Our findings that older men experienced a much moresignificant reduction in their depression in the health education intervention areconsistent with Wong et al. (2000) who found older PCSs predominantly wanteddetailed information. The results of this study show that older men clearly benefittedwhen they participated in an intervention designed to deliver such information versusone more focused on social relationships and psychological distress. Men with feweryears of formal education also demonstrated substantially decreased stress when theyreceived the information in the health education intervention. This may be due to thefact that these men have less access to informational resources. The qualitativecomments from these men supported this assumption. The majority reported thathaving easy access (i.e. we called them weekly, printed information was mailed totheir homes and discussed over the phone) to information about prostate cancer, itstreatment, side effects and general health information was the most beneficial part ofthe intervention.

Of note, and consistent with the literature (Chambers et al., 2012; Namiki & Arai,2010), prostate specific functioning influenced intervention benefit. Our sample wasmostly older men who reported below average to average prostate specific functionprior to treatment as well as active chemotherapy. Depression decreased significantlymore for men with below average or average prostate specific functioning and inactive chemotherapy in the THE versus the TIP-C intervention. It appears that theinformation delivered in the THE intervention is associated with more positiveoutcomes for men who are simultaneously grappling with the major insults tophysical well-being that are represented by lower specific prostate functioning andactive chemotherapy. Physiological challenges in these older men appear to be bestmet with straightforward health related information.

Similar to other studies related to illness severity (Given, 2008; Given et al., 2004,2006), men with higher symptom distress and lower abilities to manage theirsymptoms did better when the intervention focused on health education (e.g. reducednegative affect). Again, perhaps the information shared helped manage thosesymptoms, which had primary importance to the PCS and his QOL.

Psychosocial resources predicted a differential response to the interventions.Social support plays an important role in maintaining psychological QOL in PCSs(IOM, 2007). In this study, we found that social support from friends (Northouseet al., 2007) rather than family played a significant role in the differentialeffectiveness of the interventions. This may be due in part to the fact that thesocial support from friends is often viewed as voluntary, whereas social support from

349Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

family is viewed by many as obligatory. Therefore, for some people, social supportfrom friends may be viewed as a more valuable commodity. Also, it is likely that formany survivors, social support from friends may be coming from age and gendermatched peers who are in a good position to empathise and perhaps even share theirown experiences with prostate health related issues. Some of our sample reported noone other than their spouses for social support. In this investigation, men with lowersocial support from friends benefitted more when in the health educationintervention. This may be because many men with prostate cancer share informationwith each other. A man with lower social support from friends might thereforeparticularly benefit from an intervention that effectively replaces the informal peerinformation exchange that may be lacking. Also, because the TIP-C interventionfocuses more on roles and relationships, this type of intervention might be a moresalient for people who are more extensively embedded in their social network.

Men with lower cancer knowledge also had better improvements in outcomes inthe health education intervention. Presumably, the THE delivers the informationthat these men lack but may want (Chambers et al., 2012; Wong et al., 2000) as theygo through cancer treatment and survivorship. Our findings suggest that perhaps atwo-step approach to improving QOL in PCS is needed. First, we need to meet theunmet informational needs before tackling psychosocial well-being issues, such asimproving interpersonal functioning.

It is evident that on balance most of the significant moderators further enhancedthe salutary effects of the health education. This is consistent with related findings inthe literature showing that far more PCSs are interested in receiving informationalservices than psychosocial services and that informational support can help to reducepsychological distress (Davison, Goldenberg, Gleave, & Degner, 2003). At the sametime it is important to realise that most of the significant moderators only played arole in one or two of the psychological QOL outcomes. For many of thepsychological QOL variables, the predicted moderating variables were not associatedwith a differential effectiveness between the two interventions.

Survivor characteristics such as older age, lower education, lower specificprostate functioning, lower social support from friends and initially lower cancerknowledge were all associated with better outcomes if the PCS was received thehealth education intervention. In contrast, and with all other things being equal, menwith higher levels of education, social support from friends or prostate specificfunctioning had better psychological QOL trajectories when participating in aninterpersonal counselling intervention.

Interpretations of this study’s findings are limited by several issues. The analyseswere based on a relatively small white, well-educated sample. This limits bothstatistical power and the generalisability to the larger population of PCSs. Also, theaverage participant in this investigation was several years beyond the initialdiagnosis. It is possible that the different interventions might be more or less effectiveat different times during the survivorship trajectory and that would be worthinvestigating in a larger sample.

Our findings documented that men with prostate cancer benefitted from thepsychosocial interventions. For the older, less well-educated and less well-functioning men in the domains of social support, cancer knowledge and prostatefunctioning, the benefits of supplying health education to prevent potentialreductions in psychological QOL were clear. The advantage to the telephonedelivery is that clinicians will be able to document not only that their patients

350 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

received the information about prostate cancer and general health topics, butdemonstrated an understanding during the discussions on the telephone.

In conclusion, Penedo and Dahn (2004) deduced in their review of interventionsfor prostate cancer that the evidence supports that cancer survivors benefitsignificantly from psychosocial interventions, and our findings provide support forthis conclusion. However, they further observed that ‘additional research is neededto improve the understanding of who benefits most and from what components ofpsychosocial interventions’ (p. 532). This research provides some insight into whobenefits from what intervention. However, future research conducted to furtherexamine who benefits from different interventions, based on different survivorcharacteristics, will enable clinicians to recommend effective interventions that willimprove the QOL for PCSs.

Acknowledgements

Funding for this R21 study (R21CA113409) was provided by the National Cancer Institute toTerry Badger. We gratefully thank our recruitment sites: Arizona Cancer Center, Veteran’sAffairs Health Care Systems in Phoenix and Tucson. This material is the result of worksupported with the resources and the use of facilities at the Veterans Affairs Health CareSystems in Phoenix and Tucson. We thank our research staffs, Maria Figueroa, XochitlGaxiola, Jeannine Thomas, Jen Riech and Karina Othon-Tapia.

Disclaimer: The contents of this publication do not represent the views of the Department ofVeterans Affairs or the United States Government.

References

ACS (2011). Cancer facts & figures. Atlanta, GA: American Cancer Society.

Arora, N.K., Finney Rutten, L.J., Gustafson, D.H., Moser, R., & Hawkins, R.P. (2007).Perceived helpfulness and impact of social support provided by family, friends, and health

care providers to women newly diagnosed with breast cancer. Psycho-Oncology, 16,474–86.

Badger, T.A., Segrin, C., Dorros, S.M., Meek, P., & Lopez, A.M. (2007). Depression and

anxiety in women with breast cancer and their partners. Nursing Research, 56, 44–53.Badger, T., Segrin, C., Figueredo, A.J., Harrington, J., Sheppard, K., Passalacqua, S., . . .

Bishop, M. (2012). Psychosocial interventions to improve quality of life in prostate cancer

survivors and their intimate or family partners. Quality of Life Research: An InternationalJournal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 20, 833–844.

Bailey Jr, D.E., Wallace, M., & Mishel, M.H. (2007). Watching, waiting and uncertainty inprostate cancer. Journal of Clinical Nursing, 16, 734–741.

Chambers, S.K., Ferguson, M., Gardiner, R.A., Aitken, J., & Occhipinti, S. (2012).

Intervening to improve psychological outcomes for men with prostate cancer. Psycho-Oncology. Advance online publication. DOI: 10.1002/pon.3095.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress.

Journal of Health and Social Behavior, 24, 385–396.Cohen, J., Cohen, P., West, S.G., & Aiken, L.S. (2003). Applied multiple regression/correlation

analysis for the behavioral sciences (3rd ed.). Hillsdale, NJ: Erlbaum.Danjoux, C., Gardner, S., & Fitch, M. (2007). Prospective evaluation of fatigue during a

course of curative radiotherapy for localised prostate cancer. Supportive Care in Cancer:

Official Journal of the Multinational Association of Supportive Care in Cancer, 15,1169–1176.

351Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Davison, B.J., Goldenberg, S.L., Gleave, M.F., & Degner, L.F. (2003). Provision of

individualized information to men and their partners to facilitate treatment decision

making in prostate cancer. Oncology Nursing Forum, 30, 107–114.Docherty, A., Brothwell, C.P., & Symons, M. (2007). The impact of inadequate knowledge on

patient and spouse experience of prostate cancer. Cancer Nursing, 30, 58–63.Ezer, H., Ricard, N., Bouchard, L., Souhami, L., Saad, F., Aprikian, A., & Taguchi, Y.

(2006). Adaptation of wives of prostate cancer following diagnosis and 3 months after

treatment: A test of the family adaptation theory. International Journal of Nursing Studies,

43, 827–838.

Faul, L.A., Jim, H.S., Williams, C., Loftus, L., & Jacobsen, P.B. (2010). Relationship of stress

managment skills to psychological distress and quality of life in adults with cancer.

Psycho-Oncology, 19, 102–109.Gaugler, J.E., Hanna, N., Linder, J., Given, C.W., Tolbert, V., Kataria, R., & Regine, W.F.

(2005). Cancer caregiving and subjective stress: A multi-site, multi-dimensional analysis.

Psycho-Oncology, 14, 771–785.Gaugler, J.E., Linder, J., Given, C.W., Kataria, R., Tucker, G., & Regine, W.F. (2008). The

proliferation of primary cancer caregiving stress to secondary stress. Cancer Nursing, 31,

116–123, quiz 124–125.

Gaugler, J.E., Linder, J., Given, C.W., Kataria, R., Tucker, G., & Regine, W.F. (2009).

Family cancer caregiving and negative outcomes: The direct and mediational effects of

psychosocial resources. Journal of Family Nursing, 15, 417–444.Given, B. (2008). Cancer-related fatigue: A brief overview of current nursing perspectives and

experiences. Clinical Journal of Oncology Nursing, 12, 7–9.Given, B., Given, C.W., Sikorskii, A., Jeon, S., Sherwood, P., & Rahbar, M. (2006). The

impact of providing symptom management assistance on caregiver reaction: Results of a

randomized trial. Journal of Pain and Symptom Management, 32, 433–443.Given, C.W., Given, B., Rahbar, M., Jeon, S., McCorkle, R., Cimprich, B., . . . Bowie, E.

(2004). Does a symptom management intervention affect depression among cancer

patients: Results from a clinical trial. Psycho-Oncology, 13, 818–830.Gotcher, D.F. (1992). Interpersonal communication and psychosocial adjustment. Journal of

Psychosocial Oncology, 10, 21–39.Helgeson, V.S., & Cohen, S. (1996). Social support and adjustment to cancer: Reconciling

descriptive, correlational, and intervention research. Health Psychology, 15, 135–148.Hendren, S., Griggs, J.J., Epstein, R.M., Huniston, S., Rousseau, S., Jean-Pierre, P., . . .

Fiscella, K. (2010). Study protocol: A randomized controlled trial of patient navigation-

activation to reduce cancer health disparities. BMC Cancer, 10, 551. doi:10.1186/1471-

2407-10-551.IOM (2007). Cancer Care for the whole patient: Meeting psychosocial health needs.

Washington, DC: The National Academies Press.Jacobsen, P.B., & Jim, H.S. (2008). Psychosocial interventions for anxiety and depression in

adult cancer patients: Achievements and challenges. CA: A Cancer Journal for Clinicians,

58, 214–230.Judge, K.S., Menne, H.L., & Whitlatch, C.J. (2010). Stress process model for individuals with

dementia. The Gerontologist, 50, 294–302.Karakiewicz, P.I., Kattan, M.W., Tanguay, S., Elhilali, M.M., Bazinet, M., Scardino, P.T., &

Aprikian, A.G. (2003). Cross-cultural validation of the UCLA prostate cancer index.

Urology, 61, 302–307.

Kezia, E., & Rees, C.E. (2002). Information needs and information-seeking behaviors of men

with prostate cancer and their partners. Cancer Nursing, 25, 35–41.

Knight, S.J., Latina, D.M., Hart, S.L., Sadetsky, N., Kane, C.J., DuChane, J., & Carroll, P.R.

(2007). Education predicts quality of life among men with prostate cancer cared for in the

Department of Veterans Affairs. Cancer, 109, 1769–1776.

352 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Korfage, I.J., Essink-Bok, M.L., Janssens, A.C., Schroder, F.H., & de Koning, H.J. (2006).

Anxiety and depression after prostate cancer diagnosis and treatment: 5-Year follow-up.

British Journal of Cancer, 94, 1093–1098.Litwin, M.S., Hays, R.D., Fink, A., Ganz, P.A., Leake, B., & Brook, R.H. (1998). The UCLA

prostate cancer index: Development, reliability and validity of a health related quality of

life measure. Medical Care, 36, 1002–1012.Livingston, P., White, V.M., Hayman, J., Mauseli, E., Dunn, S.M., & Hill, D. (2010). The

psychological impact of a specialist referral and telephone intervention on male cancer

patients: A randomised controlled trial. Psycho-Oncology, 19, 617–627.Manne, S., Badr, H., Zaider, T., Nelson, C., & Kissane, D. (2010). Cancer-related

communication, relationship intimacy, and psychological distress among couples coping

with localized prostate cancer. Journal of Cancer Survivorship, 4, 74–85.Manne, S., & Schnoll, R. (2001). Measuring cancer survivors’ psychological distress and well-

being: A factor analytic assessment of the Mental Health Inventory. Psychological

Assessment, 13, 99–109.

Marcus, A.C., Garrett, K.M., Kulchk-Pahm, A., Barnes, D., Dortch, W., & Juno, S. (2002).

Telephone counseling in psychosocial oncology: A report from the cancer information and

counseling line. Patient Education and Counseling, 46, 267–275.McClelland, G.H., & Judd, C.M. (1993). Statistical difficulties of detecting interactions and

moderator effects. Psychological Bulletin, 114, 376–390.McDowell, M.E., Occhipinti, S., Ferguson, M., Dunn, J., & Chambers, S.K. (2010). Predictors

of change in unmet supportive care needs in cancer. Psycho-Oncology, 19, 508–516.Mishel, M.H., Germino, B.B., Belyea, M., Stewart, J.L., Bailey Jr., D.E., Mohler, J., &

Robertson, C. (2003). Moderators of an uncertainty management intervention. Nursing

Research, 52, 89–97.Namiki, S., & Arai, Y. (2010). Health-related quality of life in men with localized prostate

cancer. International Journal of Urology, 17, 125–158.Northouse, L.L., Mood, D.M., Monte, J.E., Sandler, H.M., Forman, J.D., Hussain, M., . . .

Kershaw, T. (2007). Living with prostate cancer: Patients’ and spouses’ psychosocial

status and quality of life. Journal of Clinical Oncology: Official Journal of the American

Society of Clinical Oncology, 25, 4171–4177.Pearlin, L.I., Mullan, J.T., Semple, S.J., & Skaff, M.M. (1990). Caregiving and the stress

process: An overview of concepts and their measures. The Gerontologist, 30, 583–94.Penedo, F.J., & Dahn, J.R. (2004). Prostate cancer and QOL: Impact of treatment, disease

burden and psychosocial interventions. Expert Review of Pharmacoeconomics & Outcomes

Research, 4, 525–535.

Penedo, F.J., Molton, I., Dahn, J.R., Shen, B.J., Kinsinger, D., Traeger, L., . . . Antoni, M.

(2006). A randomized clinical trial of group-based cognitive-behavioral stress management

in localized prostate cancer: Development of stress management skills improves quality of

life and benefit finding. Annals of Behavioral Medicine: A Publication of the Society of

Behavioral Medicine, 31, 261–270.Penedo, F.J., Traeger, L., Dahn, J., Molton, I., Gonzalez, J.S., Schneiderman, N., & Antoni,

M.H. (2007). Cognitive behavioral stress management intervention improves quality of life

in Spanish monolingual hispanic men treated for localized prostate cancer: Results of a

randomized controlled trial. International Journal of Behavioral Medicine, 14, 164–172.Procidano, M.E., & Heller, K. (1983). Measures of perceived social support from friends and

from family: Three validation studies. American Journal of Community Psychology, 11(1),

1–24.

Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the

general population. Applied Psychological Measurement, 1, 385–401.

Secura, K.W., Budin, W., & Garfing, E. (2004). Telephone social support and education for

adaptation to prostate cancer: A pilot study. Oncology Nursing Forum, 31, 335–338.

353Psychology & Health

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13

Sharpley, C.F., & Christie, D.R. (2007). An analysis of the psychometric profile and frequencyof anxiety and depression in Australian men with prostate cancer. Psycho-Oncology, 16,660–667.

Traeger, L., Penedo, F.J., Gonzalez, J.S., Dahn, J.R., Lechner, S.C., Schneiderman, N., &

Antoni, M.H. (2009). Illness perceptions and emotional well-being in men treated forlocalized prostate cancer. Journal of Psychsomatic Research, 67, 389–397.

Watson, D., Clark, L., & Tellegan, A. (1988). Development and validation of brief measures

of positive and negative affect: The PANAS sclae. Journal of Personality and SocialPsychology, 54, 1063–1070.

Weissman, M.M., Markowitz, J.C., & Klerman, G.L. (2000). Comprehensive guide to

interpersonal psychotherapy. New York, NY: Basic Books.Wong, F., Stewart, D.E., Dancey, J., Meana, M., McAndrews, M.P., Bunston, T., & Cheung,

A.M. (2000). Men with prostate cancer: Influence of psychological factors on

informational needs and decision making. Journal of Psychosomatic Research, 49, 13–18.Zhou, E.S., Penedo, F.J., Lewis, J.E., Rasheed, M., Traeger, L., Lechner, S., . . . Antoni, M.H.

(2010). Perceived stress mediates the effects of social support on health-related quality oflife among men treated for localized prostate cancer. Journal of Psychosomatic Research,

69, 587–90.Zhou, E.S., Penedo, F.J., Bustillo, N.E., Benedict, C., Rasheed, M., Lechner, S., . . . Antoni,

M.H. (2010). Longitudinal effects of social support and adaptive coping on the emotional

well-being of survivors of localized prostate cancer. Journal of Supportive Oncology, 8,196–201.

354 T.A. Badger et al.

Dow

nloa

ded

by [

Uni

vers

ity o

f A

rizo

na]

at 1

0:00

18

Sept

embe

r 20

13