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Adding to the evidence base: effects of an online support group for prostate cancer survivors: a randomized trial.

Research on the use of an online support group provides evidence that technology treatment methodologies are emerging and may well be valid care measures to assist with such care issues as quality of life. The authors (Osei, Lee, Modest, & Pothier, 2013) are forward thinking to seek information regarding effectiveness of this use of technology as a treatment strategy at an early time in its use so health care providers know the benefit to patients.

An examination of the reference list in the current study demonstrates a significant number of articles and studies generated for most of the 21st century regarding the use of Internet resources not only for a support community, but also for eliciting health information. The purpose of this review will be to determine if the current research (Osei et al., 2013) related to the effectiveness of the use of the online resources can be added to the evidence base. New learning in this review will be about the multivariate analysis of variance (MANOVA), not previously discussed in this column.


The design of the current study achieved rigor as a randomized controlled trial (RCT) to determine the effectiveness of online support groups for prostate cancer survivors. Readers will remember that the randomized trial, as second in the hierarchy of evidence next to a systematic review of RCTs (Polit & Beck, 2012), will usually provide good supporting evidence for new practices. In the early history of nursing research, there were not many RCTs. Those that did exist were thought to provide enough evidence for a change in practice (Burns & Grove, 2009). Currently, most individuals prefer to examine data from more than one RCT to support any change in practice, especially major changes (Burns & Grove, 2009).

The current study purpose is to examine the effectiveness of an intervention. As an experimental research design, this is a typical purpose of an RCT in nursing research, similar to the Phase III medical study to determine drug effectiveness (Burns & Grove, 2009). Experimental studies involve randomization, control, and manipulation of an intervention variable. The randomization provides the possibility that anyone who fits the inclusion criteria could participate in the study, giving the study power and eliminating as many biases as possible.

Forty individuals out of 1000 requests became participants in the current study. While that is a small response and a small sample, because of randomization to treatment groups, the experimental design of the study still offers the possibility of achieving significance even with a small sample size. The authors did not state how many participants they thought they would need to achieve significance. Perhaps a power analysis would offer strength to their findings.

The researchers achieved a near medium effect size of 0.38 (Burns & Grove, 2009). With a power of 0.8, important to achieve significance, and a one-tailed test at 0.05 level of significance, 40 participants may be sufficient to determine the presence of variables in the participant population. Given the homogeneity of the population or data collection from one source and the matched pairs prior to randomization to groups, the small sample size may have been adequate (Polit & Beck, 2012). Although the largest sample size possible is always the best course of action regardless of design (Burns & Grove, 2009), the current study did not receive the response hoped for in seeking participants.

In the literature review, the researchers discussed the variables of prostate cancer, prostate cancer online support groups, and online support groups and the transactional model. The literature review was extensive, spanning the years 1993 to 2012. They found no studies that examined the effects of online support groups on quality of life. This reviewer only found one study (Varre & Slettebo, 2011) that was not in the reference list of the current study. Its topic area was coping strategies of cancer patients through the use of an online discussion forum. Although not directly related to the use of an online support group, the discussion forum had some similar qualities.

It was impressive that four instruments with a total of 10 domains or scales within those four instruments were used to measure quality of life. All four instruments measured aspects of quality of life of the patient with prostate cancer following surgery. The instruments were described well, and the scales or domains of each instrument added to 10 domains or dependent variables that were measured in the current study. Scoring was described, as was the reliability and validity of each instrument. All were reliable and valid. Additionally, a program satisfaction questionnaire created by the researcher was presented.

Regarding the methods and procedures for the study, all were described completely. Particularly notable were the inclusion procedures, the lack of blinding to group, and the sharing of control and intervention resources with the opposite group at the end of the 8-week study time.

Typically, the multivariate analysis of variance (MANOVA) is used to determine group differences among independent variables on more than one dependent variable. In this case, the dependent variables included 10 quality-of-life scale scores from four reliable and valid instruments using an information packet on post-operative quality of life following prostate surgery versus an online support group from the same organization, the two independent variables. The researchers also examined the means of the two groups over time (baseline, 6 weeks, and 8 weeks). This is an appropriate use of the multivariate ANOVA (MANOVA). The MANOVA becomes more powerful than doing many separate ANOVAs to obtain the difference scores because it minimizes the chance for a Type I error and is less fragmented. It is a very complex statistic, one that also bears the need for careful consideration in use and interpretation (Mertler & Vannatta, 2010). Additionally, the authors used repeated measures, offering greater power to the statistical measure.

This reviewer found that the internal soundness of the study provided a strong basis for achieving the results of the study (Osei et al., 2013). While some potential for bias exists in most studies, it was minimized to the extent possible in the current study. Tables explaining the statistical analysis were clear and understandable and supported the report of findings.

Application to Evidence Base

As evidenced by the RCT study design, the current study is a Level II on the hierarchy of evidence according to Polit & Beck (2012). As mentioned earlier, the design of the study gives the study results prominence as best evidence because of its place on the evidence hierarchy. It then becomes important to consider how to add the results of this study to the evidence base and how practitioners should make use of the information in their practices.

Clearly, the intervention of an online support group is important. The factor of anonymity may be important to those men who choose to participate in this type of intervention. They need some support but may be reluctant to seek it more openly, and therefore, it is an option for clinicians to offer. The authors suggest further study for a longer time to determine more lasting effects of the intervention, which is important. Adding this relatively new technological intervention to care for patients to the evidence base gives clinicians another opportunity to provide the needed assistance with important quality-of-life issues. With further research and confirmation of its longer-term usefulness, it may well develop as a significant intervention for the population of post-surgery prostate cancer survivors.

Key Words: Prostate cancer, online support group, quality of life.

doi: 10.7257/1053-816X.2013.33.3.134

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The Society of Urologic Nurses and Associates is a professional organization committed to excellence in evidence-based clinical practice, research, and education of its members, patients, families, and the community.


Burns, N., & Grove, S. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.). St. Louis, MO: Elsevier Saunders.

Mertler, C., & Vannatta, R. (2010). Advanced and multivariate statistical methods: Practical application and interpretation (4th ed.). Glendale, CA: Pyrczak Publishing.

Osei, D., Lee, J., Modest, N., & Pothier, P. (2013). Effects of an online support group for prostate cancer survivors: A randomized trial. Urologic Nursing, 33(3), Epub ahead of print.

Polit, D., & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.).

Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Varre, P., & Slettebo, A. (2011). "It's about my life." Cancer patients' coping potential, as expressed through their messages in an online discussion forum. Nordic Journal of Nursing Research and Clinical Studies, 31(3), 4-8.

Cynthia M. Sublett, PhD, RN, CNL, is a Nursing Faculty Member, Xavier University, Cincinnati, OH.
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Title Annotation:Translating Evidence Clinical Practice
Author:Sublett, Cynthia M.
Publication:Urologic Nursing
Geographic Code:1USA
Date:May 1, 2013
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