Jones, R.B., Pearson, J., Cawset, A.J., Bental, D., Barrett, A., White, J., . . . Gilmour, W.H. (2006). Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: Randomised trial. BMJ, 332, 942–948.

The interventions included a variety of patient education materials delivered by the following methods.

• General cancer education material (Cancer BACUP, a cancer information and support service for patients in the United Kingdom) specific to the patient's cancer—This material included content about understanding radiation therapy, diet, and cancer-specific information.
• Patient-chosen information selected interactively via computer at the cancer center—The patient was given a choice of six booklets to print from the computer.
• A larger volume of material than in the booklets, not chosen specifically by the patient—This information included 40–47 sections of information.
• Patient-chosen personalized information selected interactively from topics based on the patient’s medical record—These topics included “problem list, treatment lists, or your cancer.”
• A subgroup of participants received anxiety management advice. This information was provided through written materials with self-help advice based on work in cognitive behavioral therapy for anxiety.

Participants were divided into eight groups (three factors, 2 x 2 x 2).

• Group 1: Interactively selected, personalized information, and anxiety management advice (N = 50, t2 N = 48, t3 N = 40)
• Group 2: Interactively selected, personalized information, and no anxiety management advice (N = 50, t2 N = 48, t3 N = 44)
• Group 3: Interactively selected, general information, and anxiety management advice (N = 49, t2 N = 44, t3 N = 35)
• Group 4: Interactively selected, general information, and no anxiety management advice (N = 50, t2 N = 50, t3 N = 49)
• Group 5: Automatically selected, personalized information, and anxiety management advice (N = 50, t2 N = 47, t3 N = 39)
• Group 6: Automatically selected, personalized information, and no anxiety management advice (N = 51, t2 N = 50, t3 N = 44)
• Group 7: Automatically selected, general information, and anxiety management advice (N = 50, t2 N = 49, t3 N = 40)
• Group 8: Automatically selected, general information, and no anxiety management advice (N = 50, t2 N = 48, t3 N = 38)

Measurements were taken at baseline, after intervention, and at three months follow-up.

• Study participants were patients starting radiation therapy.
• A total of 874 patients with cancer were identified through radiation clinic appointments. Of these, 604 patients were recruited to the study, and 270 were excluded.
• Patients were excluded if they were receiving palliative care, had severe symptoms causing distress, had cancer at other sites, did not have English-language skills, were receiving treatment for psychological or psychiatric problems, or were visually or mentally impaired.
• The study reported on a sample of 400 patients with cancer diagnosed from 5 weeks to six years before recruitment.
• Patients completed a questionnaire at home about their previous computer use, information preferences, coping styles, and HSSQ and HADS tests.
• Two-thirds of the patients had breast cancer, and roughly one-third had prostate cancer.
• A total of 348 patients finished follow-up.

Western Scotland

A longitudinal, randomized trial design was used.

• Helgeson’s Social Support Questionnaire (HSSQ)
• Hospital Anxiety and Depression Scale (HADS)
• Questions about the patients’ use and opinions of the booklets and their reported understanding of cancer

At three months follow-up, 45% of patients had improved anxiety scores. There were no statistically significant differences among the three intervention factors using a general linear model.

• The authors concluded that the single information intervention with anxiety management advice in this study did not significantly reduce levels of anxiety.
• This large study showed that brief written anxiety advice does not significantly reduce anxiety in patients with cancer who are starting radiation therapy.