Effectiveness of a Tailored Psychoeducational Intervention for Patients With Advanced Cancer in Indonesia: A Randomized Controlled Trial

Background

Patients with advanced cancer often face numerous physical, psychological, and practical challenges from their disease and treatments, yet interventions addressing their specific unmet needs remain limited.

Purpose

This study aimed to evaluate the effectiveness of a tailored psychoeducational intervention (PEI) on stress, anxiety, depression, coping, and fatigue among advanced cancer patients in Indonesia.

Design

A randomized controlled trial was conducted from August 2022 to March 2023 in Indonesia.

Methods

A total of 151 advanced cancer patients from a referral hospital in Indonesia were randomized into intervention and control (conventional management) groups. Participants were assessed using validated questionnaires including the Depression, Anxiety, and Stress Scale (DASS-21), Fatigue Severity Scale (FSS), and Brief COPE at three time points: baseline (T0, before intervention), after first intervention (T1), and after second intervention (T2). The PEI was delivered face-to-face with telephone follow-up calls. Generalized Estimating Equations (GEE) analysis was used to evaluate the intervention's effectiveness.

Results

The intervention was significantly associated with improved coping and reduced fatigue scores. Significant time effects were observed for depression, stress, coping, and fatigue scores. For anxiety, a significant impact was found at the second time point but not at the third, compared to the baseline. The difference-in-difference (DID) analysis revealed significant effects on coping and fatigue scores, while anxiety only showed significance at the second time point.

Conclusions

This study provides evidence for the potential effectiveness of PEI in improving coping strategies, relieving stress, anxiety, and depression, and reducing fatigue among advanced cancer patients in Indonesia.

Clinical Relevance

The tailored PEI, including follow-up phone calls, can be independently implemented by nurses. Focusing on patients' unmet needs and spirituality, this intervention can help manage mental health issues and strengthen coping mechanisms, potentially leading to positive effects on physical conditions such as fatigue.