Chow, K.M., Chan, C.W., Chan, J.C., Choi, K.K., & Siu, K.Y. (2014). A feasibility study of a psychoeducational intervention program for gynecological cancer patients. European Journal of Oncology Nursing, 18, 385–392.

To test the feasibility of the implementation of a psychoeducational intervention program for patients with gynecologic cancer

This study consisted of a series of interventions consisting of multiple components based on a thematic counseling model for patients with newly diagnosed gynecologic cancers. Blinding was performed at randomization. Quantitative data on sexual functioning, uncertainty, quality of life, anxiety, depression, and support systems were collected at recruitment, following surgery, during hospitalization, and eight weeks following surgery. Both quantitative and qualitative methods were used in the data analysis. The intervention consisted of four psychoeducational sessions. An individual format was used for the first three sessions and a group format was used for the last session. All intervention sessions were conducted by the researcher. The researcher also met with the control group on four occasions during the same period: at recruitment, after surgery, once in-hospital, and once via telephone four weeks following surgery during which participants were invited to attend a support group. The researcher was a registered nurse experienced in gynecologic cancer care.

• N = 26  
• MEAN AGE = 54.5 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Cervical cancer, uterine cancer, and ovarian cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Preoperative for surgical resection of disease

• SITE: Single-site    
• SETTING TYPE: Inpatient    
• LOCATION: Hong Kong

• PHASE OF CARE: Diagnostic
• APPLICATIONS: Elder care, palliative care 

Single-blinded, randomized trial with a mixed-methods design

• Baseline data on outcome variables were measured at the initial intervention for both groups. Both groups were reassessed following surgery, during inpatient stay, and eight weeks after surgery. A Sexual Function-Vaginal Changes Questionnaire (SVQ) was given during the third interview. Interviews were recorded.
• The Traditional Chinese Functional Assessment of Cancer Therapy–General (FACT-G) was used to measure quality of life. 
• Mishel’s Uncertainty in Illness Scale (MUIS) was used to measure perceived uncertainty.
• The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression.
• The Medical Outcomes Study Support Survey (MOS-SS) was used to measure perceived social supports.
• Nonparametric inferential statistical methods were used in the analysis of quantitative data, including the Mann-Whitney U test and the Kruskal-Wallis test. Qualitative data were analyzed by content analysis based on transcriptions of the recordings.

Thirteen patients were in the intervention group and 13 were in the control group. There were no statistical differences between the populations of the two groups. The compliance rate was 69.2% in the intervention group with the greatest lack of compliance occurring during the final session. The compliance rate for the control group was 46.2%. Statistic significance regarding trends of change in the outcome variables was not obtained. There was no statistic significance in the comparison of baseline outcome variables of the two groups. There was no statistic significance of intervention effects between the two groups, except in the area of uncertainty. The inconsistency subscale showed a statistic significance between the two groups with the intervention group receiving less inconsistent information regarding their illnesses. The intervention group demonstrated better trends for improvement than the control group in all categories although there were contradictory results in the scales measuring quality of life, perceived social support, anxiety, and depression.

This patient population has healthcare needs that currently are not being met. This particular study did not show statistically significant results regarding anxiety, depression, quality of life, and sexual functioning in patients with gynecologic cancer. Further research is indicated.

• Small sample (< 30)
• Risk of bias (sample characteristics)
• Unintended interventions or applicable interventions not described that would influence results 
• Findings not generalizable
• Questionable protocol fidelity
• Other limitations/explanation: Three interventions took place during a relatively short period of time, and one took place two months later. The implementation period was six months long.

Further research is indicated regarding anxiety, depression, quality of life, and sexual functioning in patients with gynecologic cancer, particularly during the postoperative period. This study showed trends for overall improvement, indicating the importance of nursing in this population. Understanding the implications of cultural differences regarding the effects of gynecologic therapies is an important nursing responsibility.