Bibliotherapy is a form of self-administered treatment that uses books to improve psychological

well-being. It is a low cost intervention with minimal demand on personnel resources.[1]

A substantial amount of research has shown the effectiveness of bibliotherapy for mental health conditions, especially for mild to moderate levels of depression and anxiety symptoms. [1,2,3] Yet, only a few studies have examined bibliotherapy as a method of reducing psychological distress in patients with cancer despite its low cost and ease of accessibility.[4,5]

NUCARE is a psycho-educational, cognitive behavioral self-help intervention program for individuals diagnosed with cancer. NUCARE focuses on the enhancement of a sense of personal control and the learning of emotional and instrumental coping responses [4,5]. The secondary analyses presented on this poster are based on a recent randomized controlled trial, which showed significantly greater increases in empowerment and quality of life and decreases of distress in the bibliotherapygroup than in the control group comparing pre-intervention to follow-up assessment.[6,7]

Patient’s motivation to complete readings and to engage in intervention material are determining factors for the effectiveness of bibliotherapy in alleviating mild to moderate psychological distress.[3]

Research Objectives:

Provide insight into the characteristics of patients interested in bibliotherapy. Assess patients’ motivation to engage and adhere to the self-help program.

Participants

89 self-selected patients (Mage = 54 years, SD= 12) with heterogeneous cancer diagnoses and varying tumour stages were recruited from two university-affiliated hospitals in Montréal, Canada.No significant differences between the bibliotherapy and the control group conditions were found at baseline for sociodemopgraphic, medical, and psychological variables.

Procedure

A mixed-method randomized control trial was conducted. In addition to having access to care as usual, the intervention group participants were asked to engage in the self-help workbook entitled: Mastering the art of coping in good times and bad[9]. The control group received usual care.All participants were asked to complete a questionnaire package at recruitment (Time 1), six weeks post-recruitment (Time 2) and ten weeks post-recruitment (Time 3). The current study examines socio-demographics, illness-related variables, treatment motivation and distress at Time 1, i.e., at pre-intervention, and treatment adherence at Time 2, i.e., immediately post-intervention.

Measures Sociodemographic and cancer-related information was gathered via self-report.

Motivation to engage in the coping intervention was assessed with the Treatment Self-Regulation Questionnaire (TRSQ).[10]

Adherence to the intervention was measured by a questionnaire about the percentage of the book that was read, the amount of time spent reading and engaging in the self-help material, and the frequency with which participants practiced the prescribed interventions each weak.

Psychological distress, i.e., symptoms of anxiety and depression, was assessed with the Hospital Anxiety and Depression Scale (HADS).[11]

INTRODUCTION

METHODS

Health Psychology

Research Group

Bibliotherapy has the potential to be a cost-effective minimal intervention that addresses psychosocial needs of patients with cancer. It might be most appropriate to rely on bibliotherapywhen using a stepped-care approach that provides low-intensity interventions before more intensive treatments are offered. Evidence-based bibliotherapy may reduce the burden on

health care resources and enhance the immediacy of psychosocial services.[6,7]

The findings regarding the efficacy of the NUCARE intervention program [6,7] and the here presented analysis of sociodemographic, psychological and cancer-related sample characteristics, speak for bibliotherapy as an intervention option for a broad range of patients with cancer including males, older persons, individuals with high-school as their highest educational degree, and patients with more advanced tumours as well as with newly diagnosed malignancies.

When prescribing bibliotherapy, clinicians need to be sensitive to the level of depressive symptomatology, which may get in the way of truly engaging with self-help materials.

Our study was limited by the small sample size, which did not allow us to detect smaller effects or to examine causal relationships while controlling for other potential influences, e.g., determine if NUCARE was less effective for individuals who reported more depressive symptoms and indicated less time engaging in the workbook.

CONCLUSION

DISCUSSION

REFERENCES:1. Gregory RJ, Canning SS, Lee TW, Wise JC. Cognitive bibliotherapy for depression: A meta-analysis. Professional Psychology: Research and Practice 2004; 35: 275-280.

doi:10.1037/0735-7028.35.3.2752. Fanner, D., & Urquhart, C. (2008). Bibliotherapy for mental health service users part 1: A systematic review. Health Information & Libraries Journal, 25, 237-252.3. Marrs, R. (1995). A meta-analysis of bibliotherapy studies. American Journal of Community Psychology, 23, 843-870. 4. Rosberger, Z., Edgar, L., Collet, J., & Fournier, M. (2002). Patterns of Coping in Women Completing Treatment for Breast Cancer. Journal of Psychosocial Oncology, 20(3), 19-37. 5. Edgar, L., Rosberger, Z., & Collet, J. (2001). Lessons Learned: Outcomes and Methodology of a Coping Skills Intervention Trial Comparing Individual and Group Formats for Patients

with Cancer. International Journal of Psychiatry in Medicine, 31(3), 289-304. 6. Roberts, N., Steele, R., Rosberger, Z., Brosseau, D., & Körner, A. (2015). Bibliotherapy for patients with cancer: A randomized controlled trial. Manuscript submitted for publication.7. Roberts, N., Lee, V., *Ananng, B., & Körner, A. (in press). Acceptability of bibliotherapy for patients with cancer: A qualitative descriptive study. Oncology Nursing Forum.8. Naylor, E. V., Antonuccio, D., O., Litt, M., Johnson, G. E., Spogen, D. R., Williams, R., McCarthy, C., Lu,, M. M., Fiore, D. C., Higgins, D. L., (2008). Bibliotherapy as a treatment for

depression in primary care. Journal of Clinical Psychology in Medical Settings, 17(3), 258-271.9. Edgar L. Mastering the art of coping in good times and bad. Ontario: Copelindaedgar; 201010. Williams, G. C., Grow, V. M., Freedman, Z., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social

Psychology, 70, 115-126.11. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 66, 361-370.12. Faller, H. et al. (2013). Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. Journal of

Clinical Oncology, 31(6), 782-793.13. Maunsell et al. (2014). Health-related empowerment in cancer: validity of scales from the health education impact questionnaire. Cancer, 3228-3236.14. Singer et al. (2009). Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. British Journal of Cancer, 100, 908 – 912.15. Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2015). Canadian Cancer Statistics 2015. Toronto, ON: Canadian Cancer Society; 2015.

Sociodemographiccharacteristics

Current sample N=89

Other oncology samples689 ≥ N ≤ 22,238

AGEAge

≤ 30 3 % 2 % [12]

31-50 31 % 20 % [12]

51-70 60 % 58 % [12]

≥ 71 6 % 21 % [12]

GENDER

Female 78 % 82 % [12]

Male 23 % 28 % [12]

YEARS OF EDUCATION

11-13 years (≤ high school) 24 % 43 % [13]

≥ 14 years (> high school) 45 % 54 % [13]

RELATIONSHIP STATUS

Single 57 % 75 % [13]

Not Single 43 % 24 % [13]

CANCER STAGE

Stage 0 2 % 2 % [14]

Stage 1 21 % 18 % [14]

Stage 2 18 % 22 % [14]

Stage 3 26 % 18 % [14]

Stage 4 8 % 10 % [14]

Missing/unknown 25 % 31 % [14]

90 %

72 %

82 %

62 %

55 %

46 %

62 %

0

10

20

30

40

50

60

70

80

90

100

Technique Type

PER

CEN

TAG

E %

Percentage of Patients Who Practiced the Prescribed Intervention One or More Times per Week

Mindfulness Cognitive Reappraisal Relaxation Goal Setting

Problem Solving I-Statements Companionship

Table 1. Sociodemographic characteristics of the current study sample compared toother oncology research samples.

The majority of patients interested in bibliotherapy were female, had completed an education beyond high-school level, and were over 50 years of age. These characteristics are comparable to other samples of patients partaking in psycho-oncological assessments or interventions. However, the number of patients above 70 years of age was smaller in our bibliotherapysample.[12,13,14,15]

Patients with various cancer types and tumour stages were interested in bibliotherapy, which also resembles the participants in other psychosocial oncology research. 35% of our participants indicated to have been recently diagnosed with a new or a recurring cancer while 62% reported having completed their treatment, and being in long-term follow-up, or under surveillance.

Participants indicated high autonomous motivation (MTRSQ at T1 = 5.8, SD = 1.3, possible range 1-7). The most strongly endorsed reason for wanting to join this coping intervention program was: “… it is very important for being as healthy as possible”, closely followed by “... wanting to take responsibility for my own psychological well-being”.

Half of our participants reported clinically significant psychological distress, i.e., MHADS ≥ 13 in 51% of the cases. The mean HADS total score was 12.8 (SD= 6.1, Median = 14, Range: 1 to 29), which is comparable to the mean of 13.6 (SD=7.8) in a sample of 689 patients with cancer.[14]

Participants completed between 25% and 100% of the book (M= 80%). 15% of our participants read less than half the book. 52% of our sample completed the entire workbook. Participants spent on average 57 minutes each week engaging in the self-help material (SD= 58). They most frequently practiced mindfulness and relaxation techniques.

Patients with more depressive symptomology spent less time reading/engaging with the self-help materials (rSpearman= -0.49, p < .05). Yet, depressive symptoms were unrelated to the percentage of the book read (rSpearman=0.18, p=.36).

Motivation for the self-help intervention, i.e., the TRSQ total score, was neither related to the weekly time spent engaging with the workbook nor to the percentage of the book read. However, the more someone wanted to take responsibility for their own well-being, the more often they sought social support.

A Self-help Program for Coping with Cancer

- Motivation for and Adherence to Bibliotherapy -

Bethsheba Ananng, BA1, Zofia Czajkowska, PhD Cand.1, Katelyn Ward, MA1, Nicole Roberts, PhD2, & Annett Körner, PhD1,2,3,4

1Department of Educational and Counselling Psychology, McGill University, Montréal; 2McGill Counselling Service , McGill University, Montréal; 3Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre - Jewish General Hospital, Montréal; 4Psychosocial Oncology Program, McGill University Health Centre, Montréal

RESULTS

ACKNOWLEDGMENT: The authors thank Tia Maric for her critical discussion of an early version of this poster.

CONTACT: annett.korner@mcgill.ca