A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial

Khle et al. BMC Public Health A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial Nadine Khle 0 Constance HC Drossaert 0 Karlein MG Schreurs 0 Marit Hagedoorn Irma M Verdonck-de Leeuw Ernst T Bohlmeijer 0 0 Department of Psychology, Health and Technology, University of Twente , P.O. Box 217, 7500 AE Enschede , The Netherlands Background: There is a growing recognition that cancer not only affects the lives of the patients, but also the lives of their partners. Partners of cancer patients are highly involved in the illness trajectory by providing informal care and they often experience distress. However, supporting interventions for this group are scarce and existing interventions bear several limitations. On the basis of the need for theory- and evidence-based supportive interventions for partners of cancer patients, the web-based self-help intervention Hold on, for each other has been developed. This intervention is based on Acceptance and Commitment Therapy. The primary objective of the RCT is to investigate the (cost-) effectiveness of the intervention. Additional goals are (1) to examine if psychological flexibility, self-compassion, mastery, supportive behavior, posttraumatic growth and resilience are mediators of the intervention's effects on the partners' mental health; (2) to examine the moderating effects of the socio demographics (age, gender, education, working situation, family situation) and disease-related characteristics of the patients (sort of cancer, stage of disease, duration and treatment of cancer); and (3) to investigate to what extend participants are satisfied with the intervention, which parts of the intervention are mostly used, and how adherent the users are. Methods/Design: A three-armed randomized controlled trial (RCT) will be conducted to compare two versions of the intervention Hold on, for each other with a waiting list control condition. Both intervention conditions contain the same content and differ only with regard to the form of professional support (personal support versus automatic support). Adult partners of cancer patients with mild to moderate depressive and anxiety symptoms, will be recruited through a multi-component strategy. Online measurements by self-assessment will be made on four measurement points (prior to randomization (baseline-measurement) and 3, 6 and 12 months after baseline). Discussion: When proven effective, Hold on, for each other can be an invaluable contribution to the healthcare system and it could be offered to all partners of cancer patients who are in need for additional support. Cancer; Oncology; Distress; RCT; Partners; Self-help; Web-based; Effectiveness; Cost-effectiveness; Acceptance and Commitment Therapy - Trial registration: Dutch Trial Register, trial registration number NTR4035, date of registration: 17 March 2013. Background Being partner of a cancer patient is highly demanding. Partners are often involved in the illness trajectory by providing informal care and emotional support, and they regularly have to take on responsibilities of their ill spouse and the household, in addition to their own [1,2]. In recent years, there is growing recognition that cancer not only affects the lives of the patients, but also the lives of their loved ones. Recent studies have shown that partners and other family caregivers are at risk of experiencing mental and physical health complications. In a systematic review by Stenberg et al [3] 200 problems and burdens have been identified related to caregiving responsibilities among family caregivers. The most frequently reported problems were emotional (e.g. anxiety, depression and fear) and social problems (e.g. financial difficulties, role strain, isolation). Partners even suffered from diminished physical functioning and experienced complaints as pain, sleep problems and fatigue. Partners of cancer patients play an important role in patient recovery and illness management [3]. Therefore, the presence of mental and physical health complaints not only has a paramount impact on the partners quality of life, but it has also a negative impact on the informal care for the patient [4]. To overcome these problems, supportive interventions are available for partners of cancer patients. A recent metaanalysis [4] and two recent systematic reviews [5,2] identified a variety of psychosocial interventions for partners. However, most of these interventions were aimed at couples instead of the partner alone, and as a consequence the primary focus was often on the well-being of the patients. The needs of the partners have been overlooked and only a few interventions target the partners self-care as primary aim [4,5]. Another shortcoming of the existing interventions is that partners of cancer patients seem to make no or only limited use of them [6-8]. This might be a result of poor diffusion strategies or (...truncated)