An online stress management workbook for breast cancer

May combine two claims.

Our literature search revealed only two CBT-based online interventions for cancer patients, one by Owen et al. (2005) and one by Beatty et al. (2011), both providing structured CBT for distressed cancer patients.

“Our literature search revealed only two CBT-based online interventions for cancer patients, one developed by Owen and colleagues (2005) and the other by Beatty and colleagues (2011), both providing structured CBT for distressed cancer patients.”

• cites Owen et al., 2005 sourceNot checked yet

  Not checked in the free run.

• cites Beatty et al., 2011Not checked yet

  Not checked in the free run.

May combine two claims.

Among secondary outcomes, there was a significant condition by time interaction for cancer-related post-traumatic symptoms, which decreased at week 10 in the intervention group but not in the control group.

“there was a significant condition by time interaction for cancer-related post-traumatic symptoms, which decreased at week 10 in the intervention group but not in the control group”

May combine two claims.

No significant differences were found in regard to either social or functional well-being.

“No significant differences were found in regard to either social or functional well-being”

May combine two claims.

Inspection of the 95% confidence intervals for both measures of self-efficacy showed they did not overlap at week 10 but did overlap at week 20.

“support for this hypothesis was found in inspection of the 95% confidence intervals for both measures of self-efficacy, which did not overlap at week 10 but did overlap at week 20”

May combine two claims.

Unlike the in-person CBSM group intervention, the online adaptation did not appear to affect finding benefit in the cancer experience, for which no significant effects or interactions were found.

“unlike the in-person CBSM group intervention, the online adaptation did not appear to affect finding benefit in the cancer experience, for which we found no significant effects or interactions.”

The quote only partly states this claim.

MANCOVA revealed a multivariate main effect for condition on primary outcomes (self-efficacy for coping with cancer and negative mood), F(3, 98) = 3.04, p = .033, η2 = .085.

“MANCOVA revealed a multivariate main effect for condition, F(3, 98) = 3.04, p = .033, η2 = .085.”

Classified as probably not a substantial claim. May combine two claims.

One hundred thirty-two women completed baseline measures and were randomized.

“One hundred thirty-two women completed baseline measures and were randomized.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No acute exacerbations of distress were encountered during the biweekly phone calls.

“Acute exacerbations of distress would have prompted further intervention; however, none were encountered.”

May combine two claims.

The condition by time interaction was not significant for any of the other secondary outcomes, and there were no other significant effects.

“The interaction was not significant for any of the other secondary outcomes, and there were no other significant effects.”

May combine two claims.

Use of the workbook was not significantly different between intervention and control women even though the intervention women were contacted by phone five times during the 10 week intervention period and asked about their workbook use.

“use of the workbook was not significantly different between intervention and control women even though the intervention women were contacted by phone five times during the 10 week intervention period and asked about their workbook use.”

May combine two claims.

Most of our sample came from the Love/Avon Army of Women research registry and was comprised of women eager to participate in research that might help other women with breast cancer.

“most of our sample came from the Love/Avon Army of Women research registry and was comprised of women eager to participate in research that might help other women with breast cancer.”

Classified as probably not a substantial claim.

Most women diagnosed with breast cancer experience heightened distress.

“Most women diagnosed with breast cancer experience heightened distress (e.g., Boehmke & Brown, 2005)”

• cites Boehmke & Brown, 2005 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All procedures were approved by a human subjects review board, including a waiver of written consent.

“All procedures were approved by a human subjects review board, including a waiver of written consent.”

May combine two claims.

Dissemination of empirically-validated psychological interventions for cancer patients is challenging, and many patients who could benefit do not receive it.

“Despite substantial evidence for the effectiveness of psychological interventions in reducing distress among cancer patients, dissemination of empirically-validated interventions is challenging, and many patients who could benefit from this intervention do not receive it (Ellis et al., 2005; Jacobsen, 2009; Kerner et al., 2005; Stanton, 2006).”

• cites Ellis et al., 2005 sourceNot checked yet

  Not checked in the free run.

• cites Jacobsen, 2009 sourceNot checked yet

  Not checked in the free run.

• cites Kerner et al., 2005 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Interventions that include coping skills and stress management training increase coping self-efficacy, which can empower patients to face the future with less anxiety.

“Such interventions not only help patients learn new skills to cope with their current stressors, but also serve to increase coping self-efficacy (i.e., confidence in the ability to cope with cancer), which can empower patients to face the future with less anxiety (Bandura, 1991).”

• cites Bandura, 1991 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The gap in dissemination and implementation of empirically supported interventions is due to lack of therapists trained in delivering psychosocial interventions and because most interventions are delivered in urban clinic- and university-based settings using in-person groups, which can be difficult to access and fit into survivors' schedules.

“This gap in the dissemination and implementation of empirically supported interventions is due not only to a lack of therapists trained in delivering psychosocial interventions, but also to the fact that most interventions are delivered in urban clinic- and university-based settings using in-person groups, which can be difficult to access and fit into survivors’ schedules (Institute of Medicine, 2”

• cites Institute of Medicine, 2008Not checked yet

  Not checked in the free run.

May combine two claims.

Interventions that include coping skills and stress management training for cancer patients increase positive coping and decrease symptoms.

“interventions that include coping skills and stress management training for cancer patients have been found to increase positive coping and decrease symptoms (e.g., Andersen et al., 2004; Antoni et al., 2001; Cunningham et al., 1993; Cunningham & Tocco, 1989; Telch & Telch, 1986; Yates et al., 2005).”

• cites Andersen et al., 2004 sourceNot checked yet

  Not checked in the free run.

• cites Antoni et al., 2001 sourceNot checked yet

  Not checked in the free run.

• cites Cunningham et al., 1993 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The Beatty et al. (2011) intervention was modeled on existing self-help materials and appears promising, but has only been evaluated in a small pilot study.

“The Beatty et al (2011) intervention was modeled on existing self-help materials and appears promising, although to date it has only been evaluated in a small pilot study.”

• cites Beatty et al., 2011Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Participants were randomized into intervention or wait-list control according to a computerized random number table.

“Upon completing the questionnaires, participants were randomized into the intervention or wait-list control condition according to a computerized random number table.”

May combine two claims.

The Owen et al. (2005) study investigated an intervention not modeled on a specific empirically-validated intervention, and a small randomized trial revealed no differences between intervention and wait-list control.

“The Owen et al study (2005) investigated an intervention that was not modeled on a specific empirically-validated intervention and a small randomized trial of the intervention revealed no differences between the intervention group and a wait-list control condition.”

• cites Owen et al., 2005 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

According to a 2011 Pew Report, the internet is second only to physicians as a significant source of health information for 80% of online users.

“A 2011 Pew Report states that the internet is second only to physicians as a significant source of health information for 80% of online users (Fox, 2011).”

• cites Fox, 2011Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Dependent variables were not assessed during the biweekly phone calls and no explicit adherence troubleshooting took place.

“Dependent variables were not assessed during these calls and no explicit adherence troubleshooting took place.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The research assistant was not blind to condition assignment because intervention participants were asked about workbook use and offered technical support.

“Because intervention participants were also asked about their use of the workbook and offered technical support if necessary, the research assistant was not blind to condition assignment.”

Classified as probably not a substantial claim. May combine two claims.

Due to the relatively low amount of missing data and the psychosocial nature of the intervention and outcome variables, we did not impute data.

“Due to the relatively low amount of missing data and the psychosocial nature of the intervention and outcome variables, we did not impute data.”

Classified as probably not a substantial claim. May combine two claims.

All randomized participants were invited to complete outcome measures and were included in the analyses, without regard to their degree of participation in the intervention.

“All randomized participants were invited to complete outcome measures and were included in the analyses, without regard to their degree of participation in the intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cronbach's alpha for the Negative Mood Regulation Scale full scale was .902.

“Cronbach’s alpha for the full scale was .902.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the present study, Cronbach's alpha for the Cancer Behavior Inventory v2.0 full scale was .945.

“In the present study, Cronbach’s alpha for the full scale was .945.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cronbach's alpha for the Revised Impact of Event Scale full scale was .920.

“Cronbach’s alpha for the full scale was .920.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants signed on to the workbook on an average of 13.3 (SD = 8.8) days.

“Participants signed on to the workbook on an average of 13.3 (SD = 8.8) days.”

Classified as probably not a substantial claim. May combine two claims.

Given the time limited nature of the study, and the fact that there were never more than 50 women in the intervention arm of the study at any one time, it is perhaps not surprising that the users did not come together to form a support community.

“Given the time limited nature of the study, and the fact that there were never more than 50 women in the intervention arm of the study at any one time, it is perhaps not surprising that the users did not come together to form a support community.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cronbach's alpha for the Benefit Finding Scale full scale was .941.

“Cronbach’s alpha for the full scale was .941.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The week 10 assessment was completed by 115 (87%) of participants.

“Ten weeks after completing the baseline assessment, all participants were emailed a link to the week 10 assessment which was completed by 115 (87%).”

Classified as probably not a substantial claim.

Lazarus and Folkman's theory of stress, appraisal and coping states that feeling stressed results from appraising a situation as requiring more personal resources than one possesses.

“Lazarus and Folkman’s theory of stress, appraisal and coping (Lazarus & Folkman, 1984; Folkman, 2010) states that feeling stressed results from appraising a situation as requiring more personal resources than one possesses.”

• cites Lazarus & Folkman, 1984Not checked yet

  Not checked in the free run.

• cites Folkman, 2010 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Number of pages and number of days did not differ between groups.

“Independent groups t-tests indicated that number of pages and number of days did not differ between groups.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cronbach's alpha for the social well-being subscale of the Functional Assessment of Cancer Therapy-Breast was .833.

“Cronbach’s alphas for social and functional wellbeing subscales were .833 and .839, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Across conditions, 29% of participants completed all 10 chapters (defined as accessing the final page of each chapter).

“Across conditions, 29% of participants completed all 10 chapters (defined as accessing the final page of each chapter).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cronbach's alpha for the functional well-being subscale of the Functional Assessment of Cancer Therapy-Breast was .839.

“Cronbach’s alphas for social and functional wellbeing subscales were .833 and .839, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Cronbach's alpha for the five positive affect items was .844.

“Cronbach’s alpha for the five items was .844.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The week 20 assessment was completed by 116 (88%) of participants.

“Ten weeks after completing the week 10 assessment, all participants were emailed a link to the week 20 assessment completed by 116 (88%) of the participants.”

Probably not a substantial claim: may not pass S2 (checkable).

Coping self-efficacy is a theoretically important proxy for coping.

“coping self-efficacy is a theoretically important proxy for coping”

• cites Lazarus & Folkman, 1984Not checked yet

  Not checked in the free run.

• cites Folkman, 2010 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The pattern of results suggests that the condition by time interaction did not reach significance because women in the wait-list control group did not entirely catch up to the intervention group at week 20 although they were not significantly different at that time.

“The pattern of results apparent in the graphs suggests that the condition by time interaction did not reach significance because women in the wait-list control group did not entirely catch up to the intervention group at week 20 although they were not significantly different at that time.”

May combine two claims.

Meta-analyses have shown that internet-based CBT interventions are effective overall, with effect sizes similar to those found in meta-analyses of face-to-face treatment.

“Meta-analyses have shown that internet-based CBT interventions are effective overall, with effect sizes similar to those found in meta-analyses of face-to-face treatment (Andersson & Cuijpers, 2009; Spek et al., 2007).”

• cites Andersson & Cuijpers, 2009Not checked yet

  Not checked in the free run.

• cites Spek et al., 2007 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants visited an average 159.8 pages (SD = 93.1) of the 195 unique pages of the workbook (i.e., 82%).

“Participants visited an average 159.8 pages (SD = 93.1) of the 195 unique pages of the workbook (i.e., 82%).”

May combine two claims.

The present study found a self-directed online version of an empirically-supported cognitive behavioral stress management intervention for breast cancer patients to be effective in increasing coping self-efficacy, specifically self-efficacy for coping with cancer and self-efficacy for regulating negative mood.

“The present study found a self-directed online version of an empirically-supported cognitive behavioral stress management intervention for breast cancer patients to be effective in increasing coping self-efficacy, specifically self-efficacy for coping with cancer and self-efficacy for regulating negative mood.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The development process for the Coping with Cancer Workbook was iterative and included review by content and cultural competency experts, focus groups, and usability testing with breast cancer survivors.

“The development process was iterative and included review by content and cultural competency experts in addition to focus groups and usability testing with breast cancer survivors.”

May combine two claims.

Women who are more confident in their coping abilities may be more likely to appraise situations as manageable, resulting in decreased stress levels and the negative physiological and affective correlates of stress.

“Women who are more confident in their coping abilities may be more likely to appraise situations as manageable, resulting in decreased stress levels and the negative physiological and affective correlates of stress.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Coping with Cancer Workbook was developed by a team of clinical psychologists and oncology social workers with expertise in CBT and the original in-person CBSM intervention, as well as experience translating face-to-face interventions into self-directed internet interventions.

“the Coping with Cancer Workbook was developed by a team of clinical psychologists and oncology social workers with expertise in CBT interventions in general and the original in-person CBSM intervention in particular, as well as experience in translating face-to-face interventions into self-directed internet interventions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There are a number of existing active online communities for breast cancer survivors with memberships that number in the thousands.

“There are a number of existing active online communities for breast cancer survivors with memberships that number in the thousands (e.g., www.youngsurvival.org).”

• cites www.youngsurvival.orgNot checked yet

  Not checked in the free run.

May combine two claims.

This differential attrition rate is a weakness of the study as it is possible that women who did not find the workbook helpful were the ones who dropped out of the study, making it difficult to interpret the results.

“This differential attrition rate is a weakness of the study as it is possible that women who did not find the workbook helpful were the ones who dropped out of the study, making it difficult to interpret the results.”

May combine two claims.

While we were able to use server logs to track participation in the online intervention, it is unclear how many women practiced the relaxation exercises and for how long.

“While we were able to use server logs to track participation in the online intervention, it is unclear how many women practiced the relaxation exercises and for how long.”

May combine two claims.

The phone call protocol was instituted, in part, to keep the control women engaged in the study, and that strategy seems to have been successful.

“We instituted the phone call protocol, in part, to keep the control women engaged in the study and that strategy seems to have been successful.”