Shepherd, L., Goldstein, D., Whitford, H., Thewes, B., Brummell, V., & Hicks, M. (2006). The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: Results of a pilot study. Journal of Pain and Symptom Management, 32, 453–461.

The intervention was cognitive behavioral therapy (CBT) offered as telepsychology. A clinical psychologist provided one-hour brief CBT to rural patients with cancer in Australia via videoconferencing. These brief CBT sessions were held weekly or biweekly for one to six sessions, depending on the patient’s Distress Thermometer rating and clinical judgment of oncology staff caring for the patient. After formal assessment, a treatment plan was individualized to include cognitive behavioral techniques, such as problem solving, activity scheduling, and controlled breathing. Each patient came to the rural clinic for the intervention. A staff member was in attendance with the patient throughout the videoconference session. Questionnaires were offered at pretreatment, post-treatment, and one month follow-up. The pretreatment questionnaire included demographic information, previous treatment by a psychologist, current use of psychotropic medications, time of initial diagnosis, and current cancer treatment prescribed.

• The sample included 25 patients with cancer living in rural Australia who scored 7+/10 on a Distress Thermometer tool or who were clinically identified by staff.
• All patients in the study received the intervention.

Rural Australia

A longitudinal pilot study design was used.

• Hospital Anxiety and Depression Scale (HADS): To assess anxiety and depression
• Functional Assessment of Cancer Therapy–General (FACT-G): To assess quality of life
• Patient satisfaction: 17 questions to assess patients’ attitudes toward their telepsychology experience postintervention

• The study needed 165 participants to make power levels: analyses of effect size was done with reported p values (p = 0.01).
• Patient anxiety levels over the intervention period decreased significantly, with large effect size sustained over one month.
• Anxiety scores (part of HADS) were F = 5.55, p = 0.01, and eta² = partial squared (magnitude of association) = 0.33.

The traditional “standard“ dose” of CBT is six to eight weeks (9–12 hrs) of therapy in a group setting. Even with this study’s “inadequate” dose of therapy, the individual, brief CBT made a significant decrease in patients’ anxiety levels.

• Lack of control group and limited sample size were significant flaws of the study.
• The study was a small pilot with numerous confounding variables (e.g., type of psychotropic medication taken, type and stage of cancer, time since diagnosis of cancer).
• Presence of a staff member during videoconference, which may have inhibited patient responses to therapy, was a minor flaw.