Abstract
Introduction
Over 1.5 million people in the United States will be diagnosed with cancer this year 1 and will endure suffering associated with cancer and its treatment. 2 –4 In response, psychosocial counseling techniques for individuals living with cancer have been developed and have been empirically shown to be efficacious in reducing cancer-related symptoms, side effects (pain, nausea/vomiting, fatigue), and emotional distress, as well as in improving quality of life, personal meaning, and dignity. 5 –13 Traditionally, these psychosocial interventions have been delivered “live” (face–to-face) by nurses, social workers, psychiatrists, and psychologists. However, meta-analyses have revealed that e-counseling, defined as the use of the Internet to deliver psychosocial interventions, is effective for many symptoms faced by cancer patients/survivors including panic attacks, posttraumatic stress disorder, negative body image, depression, pain, and anxiety. 14,15 Additionally, e-counseling is noted for its convenience and accessibility 16 –19 and can be a boon to cancer patients/survivors with limited access to face-to-face psychosocial services (e.g., rural patients), 16 –19 limited mobility, transportation difficulties, 16,17,20 and/or scheduling restrictions. 19,21 Yet despite the potential benefits of e-counseling in the cancer setting, to our knowledge, there are no data on the prevalence of e-counseling practice among psychosocial care providers or the e-counseling training needs of such providers. Therefore, we conducted an online survey to understand the state of e-counseling practice and training in cancer care.
Materials and Methods
Procedure
To recruit participants, an e-mail invitation was sent to the listservs of the Health Psychology Division of the American Psychological Association, the Society of Behavioral Medicine—Cancer Special Interest Group, the American Psychosocial Oncology Society, and the Association of Oncology Social Work. This e-mail described the survey, stated our interest in surveying the state of e-counseling practice among psychosocial cancer care providers, and contained a hyperlink to
Statistical Analysis
Survey data were analyzed using SAS version 9.2 (2009) (SAS Institute, Cary, NC). A paired sample t test was used to examine differences in preferences for live versus online e-counseling training. A total of 134 psychosocial cancer care providers responded to our online survey from March–April 2011, of whom 120 had complete data. All statistical analyses were conducted on these 120 complete cases.
Participants
Table 1 highlights characteristics of the participants.
Demographics of Respondents (n=120)
CCC, Comprehensive Cancer Center; NCI, National Cancer Institute.
Measures
The 14-item survey assessed professional characteristics, e-counseling practice with cancer patients/survivors, attitudes towards e-counseling and e-counseling training, availability of e-counseling training, and motivation to learn e-counseling. In the survey, e-counseling was described as counseling conducted between a client and a therapist, via the Internet, which could involve communication modalities such as e-mail, chat, or videoconferencing.
Results
Current E-Counseling Practice
Four percent of participants currently offered e-counseling to cancer patients/survivors.
E-Counseling Attitudes
Table 2 gives details on e-counseling attitudes.
E-Counseling Attitudes (n=120)
Training Opportunities
Eighty-one percent reported no adequate opportunities for e-counseling training, 12% said opportunities are somewhat adequate, 7% said opportunities are adequate, and no participants reported that opportunities were “more than adequate.”
Desired E-Counseling Training Medium
Ninety-three percent were at least somewhat motivated to participate in online training in e-counseling (8% somewhat motivated, 22% motivated, 24% very motivated, 39% extremely motivated). Ninety percent of participants indicated that they would be at least somewhat motivated to participate in live training in e-counseling (21% somewhat motivated, 36% motivated, 20% very motivated, 13% extremely motivated). A mean comparison indicates that in this sample, online training was preferred relative to live: live mean=2.94, online mean=3.87, t(1,119)=9.48, p<0.001.
Open-Ended Question
Participants reported a belief that e-counseling would be beneficial for patients with travel issues, who are too sick to travel to the hospital, living in rural areas, and who work and cannot come for treatment during business hours. Furthermore, participants indicated that e-counseling would likely improve continuity of care when cancer patients transition from active treatment to survivorship.
Discussion
Results indicate that only 4% of psychosocial cancer care providers surveyed conduct e-counseling with cancer patients/survivors, despite the fact that e-counseling is viewed as an important tool for clinical work with this population. This discrepancy may be due to the finding that 88% of the sample believed they did not have the necessary skills to conduct e-counseling and that 81% reported feeling there was no available e-counseling training for psychosocial cancer care. Based on these results, as well as the finding of provider preference for online training, we recommend the development of effective e-learning training programs in e-counseling for psychosocial cancer care providers. It is our opinion that such a course should focus on training in five foundational competency areas: Scientific knowledge (i.e., the empirical basis of e-counseling for cancer), legal compliance in e-counseling for cancer, ethical conduct in e-counseling for cancer, therapeutic relationship development in e-counseling for cancer, and culturally sensitive e-counseling for cancer. Training in each area should begin broadly and then focus on e-counseling issues unique to cancer patients and survivors (e.g., privacy issues and disclosure of cancer status).
Like any study, this has limitations. First, we do not know how many members of each listserv there are, the total number of e-mail recipients, or how much overlap there is between listservs. Consequently, we cannot report a response rate for these data. Second, the survey was designed to keep participant burden to a minimum by tightly focusing on professional attitudes, experiences, and characteristics. Future work is needed to extend these findings and to explore whether individual difference factors (e.g., sex, ethnicity, attitudes towards computers, computer anxiety, Internet self-efficacy, baseline level/patterns of Internet use, and available information technology support) may influence success with online training. 22 Third, the majority (62%) of the respondents were psychologists. Future research is required to better understand the attitudes of other professional groups, as well as between-profession differences. Fourth, we did not inquire about how respondents perceived privacy and confidentiality using e-counseling and whether that was a barrier to e-counseling usage. Future research should explore this issue.
In sum, despite e-counseling's promise for improving the reach of psychosocial cancer care and psychosocial care providers' interest in e-counseling, few psychosocial cancer care providers feel trained to deliver e-counseling. It is critical that this training–practice gap be overcome to increase implementation of e-counseling and thus ensure that psychosocial interventions are made available to cancer patients in need.
Footnotes
Acknowledgments
This work was supported by the National Cancer Institute at the National Institutes of Health (grant numbers K07 CA131473, R25 CA129094, and R03 CA159530). We would like to acknowledge Ms. Karen Clark, Program Evaluation Manager at City of Hope, for her assistance in administering the survey, as well as all of the participants for their informative and thoughtful responses.
Disclosure Statement
No competing financial interests exist.