Journal of Cancer Survivorship

, Volume 9, Issue 3, pp 541–553 | Cite as

Development and preliminary testing of PROGRESS: a Web-based education program for prostate cancer survivors transitioning from active treatment

  • Suzanne M. MillerEmail author
  • Shawna V. Hudson
  • Siu-kuen Azor Hui
  • Michael A. Diefenbach
  • Linda Fleisher
  • Stephanie Raivitch
  • Tanisha Belton
  • Gem Roy
  • Anuli Njoku
  • John Scarpato
  • Rosalia Viterbo
  • Mark Buyyounouski
  • Crystal Denlinger
  • Curtis Miyamoto
  • Adam Reese
  • Jayson Baman



This formative research study describes the development and preliminary evaluation of a theory-guided, online multimedia psycho-educational program (PROGRESS) designed to facilitate adaptive coping among prostate cancer patients transitioning from treatment into long-term survivorship.


Guided by the Cognitive-Social Health Information Processing Model (C-SHIP) and using health communications best practices, we conducted a two-phase, qualitative formative research study with early stage prostate cancer patients (n = 29) to inform the Web program development. Phase 1 included individual (n = 5) and group (n = 12) interviews to help determine intervention content and interface. Phase 2 employed iterative user/usability testing (n = 12) to finalize the intervention. Interview data were independently coded and collectively analyzed to achieve consensus.


Survivors expressed interest in action-oriented content on (1) managing treatment side effects, (2) handling body image and comorbidities related to overweight/obesity, (3) coping with emotional and communication issues, (4) tips to reduce disruptions of daily living activities, and (5) health skills training tools. Patients also desired the use of realistic and diverse survivor images.


Incorporation of an established theoretical framework, application of multimedia intervention development best practices, and an evidence-based approach to content and format resulted in a psycho-educational tool that comprehensively addresses survivors’ needs in a tailored fashion.

Implications for Cancer Survivors

The results suggest that an interactive Web-based multimedia program is useful for survivors if it covers the key topics of symptom control, emotional well-being, and coping skills training; this tool has the potential to be disseminated and implemented as an adjunct to routine clinical care.


Prostate cancer Survivorship Web-based health intervention development Patient activation C-SHIP model Health adaptation and surveillance 



This research was supported by the National Cancer Institute grants, R01 CA158019 to Dr. Miller and the Fox Chase Cancer Center Behavioral Research Core Facility P30-CA06927. Dr. Hudson was supported by the following awards from the National Cancer Institute: K01 CA 131500, R03 CA154063, and R01 CA176838. Dr. Hui was supported by the National Cancer Institute grant R03 CA159903. Dr. Diefenbach was supported by the following awards from the National Cancer Institute: 1R01 CA158019-01, 1R21 CA155963, 1R21 CA164807; and W81XWH-11-1-0604, from the Department of Defense. We would like to acknowledge the contribution of James Williams and the patients who participated in this study or appeared in the patient videos for the Web program development. We thank the clinicians who appeared in the videos, Drs. Natan Bar-Chama, Neil Grafstein, and Christian Nelson. Other research team members, including Margaret Atchison, Javier Muniz, Craig Walt, Megan Grau, Eric Shaw, Sean O’Sullivan, Martin Cohen, Jennifer Burns, and Matt Hall, also made contributions to this study. We also thank Mary Anne Ryan for her technical and administrative assistance. Last but not least, we thank the team members from, Kevin Durr, Joe Ifi, Mayr Budny, Dan Alvare, and Anthony Wojtkowiak, for their help in the technical process of the website development and implementation.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

11764_2015_431_MOESM1_ESM.pdf (1 mb)
ESM 1 (PDF 1050 kb)


  1. 1.
    American Cancer Society. Cancer Facts & Figures 2014. Atlanta, Georgia: American Cancer Society; 2014.Google Scholar
  2. 2.
    Jemal A et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49.CrossRefPubMedGoogle Scholar
  3. 3.
    Siegel R et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220–41.CrossRefPubMedGoogle Scholar
  4. 4.
    American Cancer Society. Cancer Treatment and Survivorship Facts & Figures 2014–2015. Atlanta, Georgia: American Cancer Society; 2014.Google Scholar
  5. 5.
    Anandadas CN et al. Early prostate cancer—which treatment do men prefer and why? BJU Int. 2011;107(11):1762–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Singer EA et al. Active surveillance for prostate cancer: past, present and future. Curr Opin Oncol. 2012;24(3):243–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Skolarus TA et al. American cancer society prostate cancer survivorship care guidelines. CA Cancer J Clin. 2014;64(4):225–49.CrossRefPubMedGoogle Scholar
  8. 8.
    Bacon CG et al. The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients. Cancer. 2002;94(3):862–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Lintz K et al. Prostate cancer patients’ support and psychological care needs: survey from a non-surgical oncology clinic. Psychooncology. 2003;12(8):769–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Wootten AC et al. Psychological adjustment of survivors of localised prostate cancer: investigating the role of dyadic adjustment, cognitive appraisal and coping style. Psychooncology. 2007;16(11):994–1002.CrossRefPubMedGoogle Scholar
  11. 11.
    Bennett G, Badger TA. Depression in men with prostate cancer. Oncol Nurs Forum. 2005;32(3):545–56.CrossRefPubMedGoogle Scholar
  12. 12.
    Chipperfield K et al. Factors associated with adherence to physical activity guidelines in patients with prostate cancer. Psychooncology. 2013;22(11):2478–86.CrossRefPubMedGoogle Scholar
  13. 13.
    Badger TA et al. Who benefits from a psychosocial counselling versus educational intervention to improve psychological quality of life in prostate cancer survivors? Psychol Health. 2013;28(3):336–54.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Cegala DJ, Post DM. The impact of patients‘ participation on physicians’ patient-centered communication. Patient Educ Couns. 2009;77(2):202–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010(40):25–30.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Grant M et al. Educating health care professionals to provide institutional changes in cancer survivorship care. J Cancer Educ. 2012;27(2):226–32.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Bradley CJ et al. Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors. Cancer Invest. 2007;25(1):47–54.CrossRefPubMedGoogle Scholar
  18. 18.
    Grunfeld EA et al. “The only way I know how to live is to work”: a qualitative study of work following treatment for prostate cancer. Health Psychol. 2013;32(1):75–82.CrossRefPubMedGoogle Scholar
  19. 19.
    Boberg EW et al. Assessing the unmet information, support and care delivery needs of men with prostate cancer. Patient Educ Couns. 2003;49(3):233–42.CrossRefPubMedGoogle Scholar
  20. 20.
    Smith DP et al. Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer. J Clin Oncol. 2007;25(18):2560–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Stanton AL. What happens now? psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol. 2012;30(11):1215–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Miller SM, Diefenbach MA. The Cognitive-Social Health Information-Processing (C-SHIP model: A theoretical Framework for Research in Behavioral Oncology. In: Krantz DS, Baum A, editors. Technology and Methods in Behavioral Medicine. Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 1998. p. 219–44.Google Scholar
  23. 23.
    Miller SM et al. Tailoring psychosocial interventions to the individual’s health information-processing style: The influence of monitoring versus blunting in cancer risk and disease. In: Baum A, Andersen B, editors. Psychosocial interventions for cancer. Washington, DC: American Psychological Association; 2001. p. 343–62.Google Scholar
  24. 24.
    Project, P.R.I. Internet User Demographics, As of January 2014, 87 % of American adults use the internet. Internet and Tech 2014 [cited 2014 April]; Available from:
  25. 25.
    Sanchez MA et al. A systematic review of eHealth cancer prevention and control interventions: new technology, same methods and designs? Transl Behav Med. 2013;3(4):392–401.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Carpenter, K.M., et al., An online stress management workbook for breast cancer. J Behav Med, 2012Google Scholar
  27. 27.
    Pauwels E et al. Design and process evaluation of an informative website tailored to breast cancer survivors ‘and intimate partners’ post-treatment care needs. BMC Res Notes. 2012;5:548.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Wen KY et al. The development and preliminary testing of a multimedia patient-provider survivorship communication module for breast cancer survivors. Patient Educ Couns. 2012;88(2):344–9.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Marcus AC et al. Cancer patient and survivor research from the cancer information service research consortium: a preview of three large randomized trials and initial lessons learned. J Health Commun. 2013;18(5):543–62.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Schover LR et al. A randomized trial of internet-based versus traditional sexual counseling for couples after localized prostate cancer treatment. Cancer. 2012;118(2):500–9.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Van Bogaert D et al. The development of an eHealth tool suite for prostate cancer patients and their partners. J Support Oncol. 2012;10(5):202–8.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    McPherson, D.A. and D.A. Herxheimer. [cited 2014; Available from:
  33. 33.
    Wootten A et al. Development, feasibility and usability of an online psychological intervention for men with prostate cancwer: My road ahead. Internet Interv. 2014;1.Google Scholar
  34. 34.
    Burns SM, Mahalik JR. Understanding how masculine gender scripts may contribute to men’s adjustment following treatment for prostate cancer. Am J Mens Health. 2007;1(4):250–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Wall D, Kristjanson L. Men, culture and hegemonic masculinity: understanding the experience of prostate cancer. Nurs Inq. 2005;12(2):87–97.CrossRefPubMedGoogle Scholar
  36. 36.
    Mankowski ES, Maton KI. A community psychology of men and masculinity: historical and conceptual review. Am J Community Psychol. 2010;45(1–2):73–86.CrossRefPubMedGoogle Scholar
  37. 37.
    Mroz LW, Oliffe JL, Davison BJ. Masculinities and patient perspectives of communication about active surveillance for prostate cancer. Health Psychol. 2013;32(1):83–90.CrossRefPubMedGoogle Scholar
  38. 38.
    Rudd, R.E. Guidelines for Creating Materials-Resources for Developing and Assessing Materials. 2014; Available from:
  39. 39.
    Osborne H. Health literacy from a to Z, second edition: practical ways to communicate your health message. Burlington: Jones&Bartlett Learning; 2011.Google Scholar
  40. 40.
    Doak, C., L. Doak, and J. Root, Teaching patients with low literacy skills. 1985, Philadelphia: JB Lippincott.Google Scholar
  41. 41.
    Venderbos, L.D., et al., A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels. Psychooncology, 2014Google Scholar
  42. 42.
    Hudson SV et al. Cancer survivors and the patient-centered medical home. Transl Behav Med. 2012;2(3):322–31.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Hudson SV et al. Adult cancer survivors discuss follow-up in primary care: ‘not what i want, but maybe what i need’. Ann Fam Med. 2012;10(5):418–27.PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Diefenbach MA et al. Acceptability and preliminary feasibility of an internet/CD-ROM-based education and decision program for early-stage prostate cancer patients: randomized pilot study. J Med Internet Res. 2012;14(1):e6.PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Fleisher L et al. Application of best practice approaches for designing decision support tools: the preparatory education about clinical trials (PRE-ACT) study. Patient Educ Couns. 2014;96(1):63–71.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Neilsen J. Usability engineering. Cambridge: Elsevier; 1994.Google Scholar
  47. 47.
    Jaspers MW et al. The think aloud method: a guide to user interface design. Int J Med Inform. 2004;73(11–12):781–95.CrossRefPubMedGoogle Scholar
  48. 48.
    Crabtree, B.F. and W.L. Miller, Doing qualitative research. 2nd ed. 1999, Thousand Oaks, Calif.: Sage Publications. xvii, 406 p.Google Scholar
  49. 49.
    Miles, M.B., A.M. Huberman, and J. Saldaña, Qualitative data analysis : a methods sourcebook. Third edition. ed. 2014, Thousand Oaks, Califorinia: SAGE Publications, Inc. xxiii, 381 pages.Google Scholar
  50. 50.
    Connell R. Gender, health and theory: conceptualizing the issue, in local and world perspective. Soc Sci Med. 2012;74(11):1675–83.CrossRefPubMedGoogle Scholar
  51. 51.
    Connell RW. Masculinities. Berkeley: University of California Press; 1995.Google Scholar
  52. 52.
    Connell RW, Messerschmidt JW. Hegemonic masculinity: rethinking the concept gender. Society. 2005;19(6):829–59.Google Scholar
  53. 53.
    Buzaglo JS et al. Evaluation of the efficacy and usability of NCI’s facing forward booklet in the cancer community setting. J Cancer Surviv. 2013;7(1):63–73.PubMedCentralCrossRefPubMedGoogle Scholar
  54. 54.
    Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005;72(8):1503–10.PubMedGoogle Scholar
  55. 55.
    Weiss, D.S. and C.R. Marmar, The Impact of Event Scale-Revised, in Assessing psychological trauma and PTSD, J.P. Wilson and T.M. Keane, Editors. 1996, Guilford: New York.Google Scholar
  56. 56.
    Perez M et al. A novel intervention using interactive technology and personal narratives to reduce cancer disparities: African American breast cancer survivor stories. J Cancer Surviv. 2014;8(1):21–30.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Suzanne M. Miller
    • 1
    Email author
  • Shawna V. Hudson
    • 2
  • Siu-kuen Azor Hui
    • 3
  • Michael A. Diefenbach
    • 4
  • Linda Fleisher
    • 5
  • Stephanie Raivitch
    • 1
  • Tanisha Belton
    • 1
  • Gem Roy
    • 1
  • Anuli Njoku
    • 6
  • John Scarpato
    • 1
  • Rosalia Viterbo
    • 7
  • Mark Buyyounouski
    • 8
  • Crystal Denlinger
    • 9
  • Curtis Miyamoto
    • 10
  • Adam Reese
    • 11
  • Jayson Baman
    • 12
  1. 1.Department of Psychosocial and Behavioral MedicineFox Chase Cancer Center/Temple University Health SystemPhiladelphiaUSA
  2. 2.Department of Family Medicine and Community HealthRutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New JerseySomersetUSA
  3. 3.Cancer Prevention and Control ProgramFox Chase Cancer Center/Temple University Health SystemPhiladelphiaUSA
  4. 4.Department of Medicine and UrologyNorth Shore-LIJ Health SystemGreak NeckUSA
  5. 5.The Center for Injury Research and PreventionThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  6. 6.Department of Public HealthFerris State UniversityBig RapidsUSA
  7. 7.Department of Urologic OncologyFox Chase Cancer Center/Temple University Health SystemPhiladelphiaUSA
  8. 8.Stanford Cancer CenterStanford University Medical CenterStanfordUSA
  9. 9.Department of Medical OncologyFox Chase Cancer Center/Temple University Health SystemPhiladelphiaUSA
  10. 10.Department of Radiation OncologyTemple University School of MedicinePhiladelphiaUSA
  11. 11.Department of UrologyTemple University School of MedicinePhiladelphiaUSA
  12. 12.University of Rochester School of Medicine & DentistryRochesterUSA

Personalised recommendations