Schofield, P., Gough, K., Lotfi-Jam, K., Bergin, R., Ugalde, A., Dudgeon, P., . . . Aranda, S. (2016). Nurse-led group consultation intervention reduces depressive symptoms in men with localised prostate cancer: A cluster randomised controlled trial. BMC Cancer, 16, 637-016-2687-1. 

To investigate the benefits of a group nurse-led intervention on psychological morbidity, unmet needs, treatment-related concerns, and quality of life in men with prostate cancer receiving radiotherapy with curative intent

This phase-III, randomized trial assessed the relative benefits of a tailored, group consultation intervention for men receiving curative intent radiotherapy for prostate cancer compared to the best supportive care. The aim was to communicate information about diagnosis, treatment, and side effects, and coaching in self-management. Content and discussion were based on expressed needs and concerns. It included four group consultation sessions and one individual consultation completed by uro-oncology nurse specialists. Survey assessments occurred before treatment, at the end of treatment, and six months postcompletion of treatment. Sessions were tape recorded, and random selections were used to evaluate intervention fidelity.

• N = 165 included in analysis of primary outcome   
• MEAN AGE = 67.2 years (intervention), 67.6 years (usual care group)
• MALES: 100%  
• CURRENT TREATMENT: Radiation
• KEY DISEASE CHARACTERISTICS: Low risk prostate cancer for both groups (about 11%), intermediate risk (prostate cancer control group) (42.3%), prostate cancer risk intervention group (41.1%), high risk prostate cancer (about 47% for both groups) 
• OTHER KEY SAMPLE CHARACTERISTICS: A little less than 80% were married, 82% were from urban areas, about 78% had previous treatment (e.g., prostatectomy, ADT). Included patients aged 18 years or older with prostate cancer

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: Australia

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care

Phase-III, two-arm cluster, randomized, controlled trial

• Hospital Depression and Anxiety Scale (HADS)
• Cancer Treatment Scale (CaTS)
• The Short-Form Supportive Care Needs survey questionnaire (SCNS-SF34-R)
• Expanded Prostate Cancer Index Composite (EPIC-26)

A higher consent rate existed at one site, but no other statistically significant differences in patient characteristics existed between the two groups. One hundred thirteen (out of 165) participants attended all sessions in the intervention group (p = 0.02). Mixed models analysis indicated that group consultations were statistically more beneficial on depressive symptoms (p = 0.009) and procedural concerns relating to cancer treatment (p = 0.049). Ninety-two percent completed surveys at all three time points. Descriptive analysis showed a slight reduction in depressive symptoms in the intervention group between baseline and the end of radiotherapy; the control (usual care) group reported an increase in these symptoms during the same time period. The difference between groups persisted six months post radiotherapy, although between groups, differences in mean changes was substantially reduced. No significant difference existed in rate of change in anxiety between the intervention group and the usual care group noted from the HADS. Descriptive analysis indicated a reduction in anxious symptoms in both groups at the follow-up assessments. Differences in mean changes from baseline to six months post-radiation also occurred, as it did with depressive symptoms.

Nurse-led group consultations may help address patient education, particularly among men who are experiencing depression.

• Findings not generalizable
• Participants had a baseline high level of baseline functioning.

Nurses must realize the importance of patient education and their role in counseling patients experiencing depression not only during treatment but following treatment as part of survivorship care.