Supportive Care in Cancer

, Volume 21, Issue 12, pp 3451–3460 | Cite as

You need something like this to give you guidelines on what to do”: patients' and partners' use and perceptions of a self-directed coping skills training resource

  • Sylvie D. LambertEmail author
  • Afaf Girgis
  • Jane Turner
  • Tim Regan
  • Hayley Candler
  • Ben Britton
  • Suzanne Chambers
  • Catalina Lawsin
  • Karen Kayser
Original Article



This study aims to report on the acceptability of a self-directed coping skills intervention, called Coping-Together, for patients affected by cancer and their partners, including the strengths and limitations of the intervention design.


This initial version of Coping-Together included a series of four booklets, which aimed to provide practical coping strategies for the day-to-day management of common physical and psychosocial challenges. Thirty semi-structured interviews were conducted with 27 patients and/or 14 partners. Interviews were audiorecorded, transcribed verbatim, and analyzed for content.


Participants endorsed the self-directed format, and the focus of Coping-Together on practical information was a feature that set it apart from other resources. The majority of participants interviewed felt that the proposed coping strategies were “doable”; however, only half of the participants reported learning new coping skills after reading the booklets. Additional benefits of reading the booklets were increasing awareness of challenges to prepare for, giving hope that something can help you “pull through”, providing a sense of normality, connecting patients and partners to people and services, and complementing support received from health professionals. Despite the general acceptability of the intervention, some aspects of its design were criticized, including the workbook-like exercises, expectations about using the resource together, level of guidance provided, and amount of information included. In general, most participants felt that too much negative information was included, whereas more experiential information was desired.


Preliminary evaluation of Coping-Together supported its practical approach and highlighted improvements to enhance its contribution to patient and partner coping.


Oncology Cancer Coping Qualitative study Self-directed intervention Caregivers Partners 



The development and evaluation of Coping-Together was supported by the Clinical Oncological Society of Australia/Sanofi-Aventis, the National Health and Medical Research Council (NHMRC), Centre for Health Research and Psycho-oncology, Priority Research Centre in Health Behaviour, and The University of Newcastle. Dr Lambert was supported by an NHMRC Research Fellowship (APP1012869) and Prof Girgis is supported by a Cancer Institute New South Wales grant. We are also grateful to all clinicians who helped us recruit participants for this study—Drs Peter Chong, Jon Gani, Brian Draganic, and Charles Douglas. Thank you to the reviewers who have contributed their expertise and time to the development of the Coping-Together booklets, including Dr Jemma Gilchrist, Ms Alyssa White, and Cancer Nurses (cancer care coordinators, breast care nurses, clinical nurse consultants) from the Cancer Care Coordination network, Hunter New England Local Health District.

Conflict of interest statement

None of the authors have a financial relationship with the organization that sponsored the research. The authors have full control of all primary data and agree to allow the journal to review the data if requested.


  1. 1.
    Carlson LE, Bultz BD (2003) Cancer distress screening—needs, models, and methods. J Psychosom Res 55:403–409PubMedCrossRefGoogle Scholar
  2. 2.
    Chambers SK, Girgis A, Occhipinti S, Hutchison S, Turner J, Morris B, Dunn J (2012) Psychological distress and unmet supportive care needs in cancer patients and carers who contact cancer helplines. Eur J Cancer Care (Engl) 21:213–223CrossRefGoogle Scholar
  3. 3.
    Lambert S, Girgis A, Lecathelinais C, Stacey F (2012) Walking a mile in their shoes: anxiety and depression among caregivers of cancer survivors at six and 12 months post-diagnosis. Support Care Cancer 21(1):75–85. doi: 10.1007/s00520-012-1495-74 PubMedCrossRefGoogle Scholar
  4. 4.
    Boyes A, Girgis A, D'Este C, Zucca A (2011) Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis. J Affect Disord 135:184–192PubMedCrossRefGoogle Scholar
  5. 5.
    Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34PubMedCrossRefGoogle Scholar
  6. 6.
    Holland JC, Breitbart WS, Jacobsen PB, Lederberg MS, Loscalzo MJ, McCorkle R (eds) (2010) Psycho-oncology, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  7. 7.
    Regan T, Lambert SD, Girgis A, Kelly B, Turner J, Kayser K (2012) Do couple-based interventions make a difference for couples affected by cancer? BMC Cancer 12:279. doi: 10.1186/1471-2407-12-279 PubMedCrossRefGoogle Scholar
  8. 8.
    Northouse LL, Katapodi MC, Song L, Zhang L, Mood DW (2010) Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA Cancer J Clin 60:317–339. doi: 10.3322/caac.20081 PubMedGoogle Scholar
  9. 9.
    Beatty L, Oxlad M, Koczwara B, Wade T (2010) A randomised pilot of a self-help workbook intervention for breast cancer survivors. Support Care Cancer 18:1597–1603. doi: 10.1007/s00520-010-0962-2 PubMedCrossRefGoogle Scholar
  10. 10.
    Barney L, Griffiths K, Christensen H, Jorm A (2009) Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma. BMC Publ Health 9:61CrossRefGoogle Scholar
  11. 11.
    Lambert S, Kelly B, Girgis A, Boyes A, Cameron A, Adams C, Proietto A (2012) Self-reliance and perception of psycho-oncology service needs among distressed women with gynaecological cancer. Support Care Cancer 20(Suppl 1):s215Google Scholar
  12. 12.
    Dodd MJ, Miaskowski C (2000) The PRO-SELF Program: a self-care intervention program for patients receiving cancer treatment. Semin Oncol Nurs 16:300–308, discussion 308–316PubMedCrossRefGoogle Scholar
  13. 13.
    Jacobsen PB, Meade CD, Stein KD, Chirikos TN, Small BJ, Ruckdeschel JC (2002) Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. JCO 20:2851–2862. doi: 10.1200/jco.2002.08.301 CrossRefGoogle Scholar
  14. 14.
    Beatty L, Lambert S (2013) A systematic review of internet-based self-help therapeutic interventions to improve distress and disease-control among adults with chronic health conditions. Clin Psychol Rev 33:609–622PubMedCrossRefGoogle Scholar
  15. 15.
    Krischer MM, Xu P, Meade CD, Jacobsen PB (2007) Self-administered stress management training in patients undergoing radiotherapy. JCO 25:4657–4662. doi: 10.1200/jco.2006.09.0126 CrossRefGoogle Scholar
  16. 16.
    Sandelowski M, Barroso J (2003) Classifying the findings in qualitative studies. Qual Heal Res 13:905–923CrossRefGoogle Scholar
  17. 17.
    Folkman S (1997) Positive psychological states and coping with severe stress. Soc Sci Med 45:1207–1221PubMedCrossRefGoogle Scholar
  18. 18.
    Bodenmann G (1995) A systematic-transactional conceptualization of stress and coping in couples. Swiss J Psychol 54:34–49Google Scholar
  19. 19.
    Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice-Hall, Englewood CliffsGoogle Scholar
  20. 20.
    Griffin J, McKenna K, Tooth L (2003) Written health education materials: making them more effective. Aust Occup Ther J 50:170–177CrossRefGoogle Scholar
  21. 21.
    Sturges JE, Hanrahan KJ (2004) Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res 4:107–118CrossRefGoogle Scholar
  22. 22.
    Speziale HJ, Carpenter D (eds) (2003) Qualitative research in nursing: advancing the humanistic imperative. Lippincott, PhiladelphiaGoogle Scholar
  23. 23.
    Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19:349–357PubMedCrossRefGoogle Scholar
  24. 24.
    Rubin H, Rubin I (2005) Qualitative interviewing: the art of hearing data, 2nd edn. Sage, Thousand OaksGoogle Scholar
  25. 25.
    Loiselle CG, Profetto-McGrath J, Polit DF, Beck C (eds) (2007) Canadian essentials of nursing research, 2nd edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  26. 26.
    Chiovitti RF, Piran N (2003) Rigour and grounded theory research. J Adv Nurs 44:427–435PubMedCrossRefGoogle Scholar
  27. 27.
    Streubert Speziale H, Carpenter D (2003) Qualitative research in nursing, 3rd edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  28. 28.
    Reige A (2003) Validity and reliability tests in case study research: a literature review with “hands-on” applications for each research phase. Qual Market Res Int J 6:75–86CrossRefGoogle Scholar
  29. 29.
    Morrison-Breedy D, Côté-Arsenault D, Feinstein N (2001) Maximizing results with focus groups: moderator and analysis issues. Appl Nurs Res 14:48–53CrossRefGoogle Scholar
  30. 30.
    Jacobsen PB, Phillips KM, Jim HSL et al (2012) Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. Psychooncology 22:1229–1235PubMedCrossRefGoogle Scholar
  31. 31.
    Vanderwerker L, Laff R, Kadan-Lottick N, McColl S, Pigerson H (2005) Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. JCO 23:6899–6907CrossRefGoogle Scholar
  32. 32.
    Sharpley CF, Christie DRH (2007) Patient information preferences among breast and prostate cancer patients. Australas Radiol 51:154–158. doi: 10.1111/j.1440-1673.2007.01687.x PubMedCrossRefGoogle Scholar
  33. 33.
    Nagler RH, Gray SW, Romantan A, Kelly BJ, DeMichele A, Armstrong K, Schwartz JS, Hornik RC (2010) Differences in information seeking among breast, prostate, and colorectal cancer patients: results from a population-based survey. Patient Educ Couns 81:S54–S62. doi: 10.1016/j.pec.2010.09.010 PubMedCrossRefGoogle Scholar
  34. 34.
    Smith-McLallen A, Fishbein M, Hornik RC (2011) Psychosocial determinants of cancer-related information seeking among cancer patients. J Health Commun 16:212–225. doi: 10.1080/10810730.2010.522227 PubMedCrossRefGoogle Scholar
  35. 35.
    Weintraub D, Maliski SL, Fink A, Choe S, Litwin MS (2004) Suitability of prostate cancer education materials: applying a standardized assessment tool to currently available materials. Patient Educ Couns 55:275–280PubMedCrossRefGoogle Scholar
  36. 36.
    Finnie RK, Felder TM, Linder SK, Mullen PD (2010) Beyond reading level: a systematic review of the suitability of cancer education print and web-based materials. J Cancer Educ 25:497–505PubMedCrossRefGoogle Scholar
  37. 37.
    Lambert SD, Harrison JD, Smith E et al (2012) The unmet needs of partners and caregivers of adults diagnosed with cancer: a systematic review. BMJ Support Palliat Care 2:224–230CrossRefGoogle Scholar
  38. 38.
    Rutten LJ, Arora NK, Bakos AD, Aziz N, Rowland J (2005) Information needs and sources of information among cancer patients: a systematic review of research (1980–2003). Patient Educ Couns 57:250–261PubMedCrossRefGoogle Scholar
  39. 39.
    Kinnane N, Thompson L (2008) Evaluation of the addition of video-based education for patients receiving standard pre-chemotherapy education. Eur J Cancer Care 17:328–339CrossRefGoogle Scholar
  40. 40.
    Krouse HJ (2001) Video modelling to educate patients. J Adv Nurs 33:748–757. doi: 10.1046/j.1365-2648.2001.01716.x PubMedCrossRefGoogle Scholar
  41. 41.
    Diefenbach MA, Butz BP (2004) A multimedia interactive education system for prostate cancer patients: development and preliminary evaluation. J Med Internet Res 6:e3PubMedCrossRefGoogle Scholar
  42. 42.
    Cockle-Hearne J, Faithfull S (2010) Self-management for men surviving prostate cancer: a review of behavioural and psychosocial interventions to understand what strategies can work, for whom and in what circumstances. Psychooncology 19:909–922. doi: 10.1002/pon.1657 PubMedCrossRefGoogle Scholar
  43. 43.
    Rager KB (2009) I feel, therefore, I learn: the role of emotion in self-directed learning. New Horiz Adult Educ Hum Resour Dev 23:22–33CrossRefGoogle Scholar
  44. 44.
    Miller SM (1995) Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management. Cancer 76:167–177. doi: 10.1002/1097-0142(19950715)76:2<167::aid-cncr2820760203>;2-k PubMedCrossRefGoogle Scholar
  45. 45.
    Lambert SD, Loiselle CG, Macdonald ME (2009) An in-depth exploration of information-seeking behavior among individuals with cancer: part 2 understanding patterns of information disinterest and avoidance. Cancer Nurs 32:26–36PubMedCrossRefGoogle Scholar
  46. 46.
    Campbell MK, Quintiliani LM (2006) Tailored interventions in public health. Where does tailoring fit in interventions to reduce health disparities? Am Behav Sci 49:1–19Google Scholar
  47. 47.
    Houts PS, Doak CC, Doak LG, Loscalzo MJ (2006) The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns 61:173–190. doi: 10.1016/j.pec.2005.05.004 PubMedCrossRefGoogle Scholar
  48. 48.
    Rozmovits L, Ziebland S (2004) What do patients with prostate or breast cancer want from an Internet site? A qualitative study of information needs. Patient Educ Couns 53:57–64. doi: 10.1016/S0738-3991(03)00116-2 PubMedCrossRefGoogle Scholar
  49. 49.
    Lambert SD, Loiselle CG, Macdonald ME (2009) An in-depth exploration of information-seeking behavior among individuals with cancer: part 1 understanding differential patterns of active information-seeking. Cancer Nurs 32:11–23PubMedCrossRefGoogle Scholar
  50. 50.
    Hopkinson JB, Brown JC, Okamoto I, Addington-Hall JM (2012) The effectiveness of patient-family carer (couple) intervention for the management of symptoms and other health-related problems in people affected by cancer: a systematic literature search and narrative review. J Pain Symptom Manag 43:111–142. doi: 10.1016/j.jpainsymman.2011.03.01351 CrossRefGoogle Scholar
  51. 51.
    Sandelowski M (2002) Reembodying qualitative inquiry. Qual Health Res 12(1):104–115PubMedCrossRefGoogle Scholar
  52. 52.
    Lambert SD, Girgis A, Turner J, McElduff P, Kayser K, Vallentine P (2012) A pilot randomized controlled trial of the feasibility of a self-directed coping skills intervention for couples facing prostate cancer: rationale and design. Health Qual Life Outcome 10:119CrossRefGoogle Scholar
  53. 53.
    Lambert SD, Girgis A, Turner J, McElduff P, Levesque J, Kayser K, Mihalopoulos C, Shih S, Barker D (2013) A parallel-group, randomised controlled trial of a multi-media, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale. BMJ Open. doi: 10.1136/bmjopen-2013-003337

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sylvie D. Lambert
    • 1
    Email author
  • Afaf Girgis
    • 2
  • Jane Turner
    • 3
  • Tim Regan
    • 4
  • Hayley Candler
    • 2
  • Ben Britton
    • 5
  • Suzanne Chambers
    • 6
  • Catalina Lawsin
    • 7
  • Karen Kayser
    • 8
  1. 1.Ingram School of Nursing, Faculty of MedicineMcGill UniversityMontrealCanada
  2. 2.Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW MedicineThe University of New South WalesLiverpoolAustralia
  3. 3.K Floor, Mental Health CentreThe University of QueenslandHerstonAustralia
  4. 4.Centre for Translational Neuroscience and Mental Health (CTNMH), Calvary Mater NewcastleThe University of NewcastleWaratahAustralia
  5. 5.Psycho-Oncology ServiceCalvary Mater NewcastleWaratahAustralia
  6. 6.Griffith UniversityLogan CityAustralia
  7. 7.School of PsychologyThe University of SydneySydneyAustralia
  8. 8.Kent School of Social WorkUniversity of LouisvilleLouisvilleUSA

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