Effectiveness of Psycho-Education Intervention Programme on Coping Strategies Among Jordanian Women Diagnosed with Breast Cancer: A Randomised Controlled Trial

Figures & data

Figure 1 CONSORT diagram.

Table 1 Tabular Illustration of Breast Cancer Psycho-Educational Intervention Modules Programme by Construct and Contents

Module	Domains/Session Title	Content	Estimated Time	Take-Home Message
Module 1	Introduction
	Health education	Definition, types, causes, risk factor, signs and symptoms, stage of the disease	2 hours	Cancer is not a death sentence
	Stress management	Practice deep breathing
	Coping	Type of coping strategies (adaptive, avoidant), sharing personal survival story (pre-diagnosis and diagnosis phases).
	Emotional support	Group leader(s) support by participation
Module 2	Lifestyle/Habit
	Health education	Type treatments, side effects	2 hours	The will is the secret of life
	Stress management	Calming technique
	Coping	How to deal with side effect and managing
		Sharing personal survival story (treatment issues).
	Emotional support	Group leader(s) support by participation
Module 3	Problem-solving skills
	Health education	Proper nutrition and foods, Physical activity and sport	2 hours	Everything has an answer and solution
	Stress management	Psychological De-Briefing (balloon technique)
	Coping	Write short-term and long-term goals, motivation and tracking the exercise.
	Emotional support	Group leader(s) support by participation
Module 4	Interpersonal relationships
	Health education	Problem-solving process, Communication skills among husband and children	2 hours	Letter to my dear husband
	Stress management	Review Calming technique
	Coping	Learning problem-solving techniques
	Emotional support	Group leader(s) support by participation
Module 5	Summing up, sharing experience and support
	Health education	Summarise all psycho-education sessions and answer any outstanding questions, sharing experience and dissection	2 hours	Where to go from here
	Stress management	Practice deep breathing
	Coping	Sharing personal survival story (returning to normal life).
	Emotional support	Group leader(s) support by participation

Table 2 Baseline Socio-Demographic and Clinical Characteristics of Participation

Variables/Questions/Statements	Frequency (%)/Mean (SD)		X^2/t (df)	P-value
	Intervention	Control
	n=100	n=100
Age	47.2 (8.3)	48.8 (8.2)	1.33 (198)	0.184^a
Age group years			3.20 (3)	0.374^b
26–36	11 (11.0)	5 (5.0)
37–46	38 (38.0)	35 (35.0)
47–56	36 (36.0)	43 (43.0)
≥57	15 (15.0)	17 (17.0)
Educational attainment level			3.31 (2)	0.192^b
Literacy	7 (7.0)	15 (15.0)
Secondary and less than high school	60 (60.0)	56 (56.0)
Diploma, Bachelor	33 (33.0)	29 (29.0)
Patients Employment status			4.54 (2)	0.103^b
Housewife	88 (88.0)	81 (81.0)
Private sector	6 (6.0)	4 (4.0)
Government sector	6 (6.0)	15 (15.0)
Marital state/social state			0.20 (1)	0.651^b
Never Married	10 (10.0)	12 (12.0)
Ever married	90 (90.0)	88 (88.0)
Husband’s employment state			0.83 (2)	0.661^b
No husband	21 (21.0)	25 (25.0)
Not working	29 (29.0)	22 (24.0)
Employed	50 (50.0)	51 (51.0)
Households monthly income Jordan dinars (JOD), mean (SD)	341.6 (159.5)	356 (249.7)	0.50 (198)	0.628^a
Income groups			5.96 (3)	0.114^b
50–220	23 (23.0)	27 (27.0)
221–440	52 (52.0)	49 (49.0)
441–660	22 (22.0)	14 (14.0)
>660	3 (3.0)	10 (10.0)
Medical health insurance			3.74 (1)	0.053^b
Yes	68 (68.0)	80 (80.0)
No	32 (32.0)	20 (20.0)
Type of Household`/residence			2.5 (1)	0.116^b
Rented House	37 (37.0)	48 (48.0)
Owned House	63 (63.0)	52 (52.0)
Number of Live births (children), median (IQR)	(2.4) 3.2	(2.7) 3.3	(198) 0.11	0.912
Socioeconomic Index, mean (SD)	0.042 (1)	−0.042 (1.1)	0.60 (198)	0.555^a
Socioeconomic Index Category			1.73 (3)	0.630^b
Very Low	12 (12.0)	18 (18.0)
Low	26 (26.0)	22 (22.0)
Medium	51 (51.0)	51 (61.0)
High	11 (11.0)	9 (9.0)
Family history of breast cancer			0.34 (1)	0.560^b
Yes	40 (40.0)	36 (36.0)
No	60 (60.0)	64 (64.0)
Menstrual cycle			5.30 (1)	0.022^b
Pre- menopause	66 (66.0)	50 (50.0)
Post- menopause	34 (34.0)	50 (50.0)
History of smoking			12.60 (2)	0.002^b
Active smoker	11 (11.0)	7 (7.0)
Past smoker	15 (15.0)	2 (2.0)
Never smoked	74 (74.0)	91 (91.0)
Comorbidity			0.022 (1)	0.880^b
Yes	33 (33.0)	34 (34.0)
No	67 (67.0)	66 (66.0)
History of loss of appetite			0.60 (1)	0.447^b
Yes	34 (34.0)	29 (29.0)
No	66 (66).0	71 (71.0)
History of weight loss			1.02 (198)	0.541^b
Yes	29 (29.0)	33 (33.0)
No	71 (71.0)	67 (67.0)
Duration of symptoms prior to diagnosis (months), mean (SD)	3.70 (4.7)	4.43 (5.6)	0.13 (198)	0.310^a
Size of the breast mass upon diagnosis (centimeters), mean (SD)	3.82 (2)	4.3 (2.4)		0.896^a
Itchiness in breasts			1.3 (1)	0.253^b
Yes	47 (47.0)	39 (39.0)
No	53 (53.0)	61 (61.0)
Nipple discharge			2 (1)	0.157^b
Yes	24 (24.0)	16 (16.0)
No	76 (76.0)	84 (84.0)
Nipple inversion			4.31 (1)	0.038^b
Yes	6 (6.0)	15 (15.0)
No	94 (94.0)	85 (85.0)
Painful breast			0.022 (1)	0.887^b
Yes	47 (47.0)	46 (46.0)
No	53 (53.0)	54 (54.0)
Enlarged Axillary Lymph Nodes			2.3 (1)	0.132^b
Yes	13 (13.0)	21 (21.0)
No	87 (87.0)	79 (79.0)
Breast Ulcer			1.000 (1)	<0.001^b
Yes	4 (4.0)	5 (5.0)
No	96 (96.0)	95 (95.0)
Peau de orange appearance			0.00 (1)	1.000^b
Yes	10 (10.0)	10 (10.0)
No	90 (90.0)	90 (90.0)
Enlarged Supraventricular Lymphadenopathy
Yes	2 (2.0)	5 (5.0)	0.00(1)	0.442^b
No	98 (98.0)	95 (95.0)
Total number of reported Breast symptoms, median (IQR)	2.2 (1.3)	2.2 (1.6)	0.14 (198)	0.886^c

Notes:^aStudent’s t-test. ^bChi-square test. ^cMann–Whitney U-test.

Table 3 Effects of Psycho-Education Intervention Program on Adaptive Coping Strategy Scores Among Participation

	Beta Coefficient	Std. Err.	t-Value	95% C.I (Beta Coefficient)		p-value
				Lower	Upper
(Intercept)	5.77	0.230	24.64	5.31	6.23	<0.001
Group=Intervention	0.92	0.175	5.25	0.58	1.27	<0.001
Group=Control-reference comparison	0
Time =Baseline	0.47	0.155	3.05	0.17	0.78	0.007
Time=Two weeks	0.08	0.127	0.60	−0.17	0.33	0.337
Time=Three weeks-Reference comparison	0	0	0	0	0
Interaction: Time-1x Intervention group	−0.95	0.221	−44.30	−1.38	−0.52	<0.001
Interaction: Time-2x Intervention group	−0.100	0.180	−0.56	−0.45	0.26	0.573
Interaction: Time-3x Intervention group	0	0	0	0	0
Interaction: Time-1x Control group	0	0	0	0	0
Interaction: Time-2 X Control group	0	0	0	0	0
Interaction: Time-3 X Control group	0	0	0	0	0
Depression score	−0.15	0.011	−14.01	−0.17	−0.13	<0.001
Socioeconomic Index score	0.20	0.067	3.03	0.07	0.34	0.003

Table 4 Effects of Psycho-Education Intervention Program on Avoidant Coping Strategy Scores Among Participation

	Beta Coefficient	Std. Err.	t-Value	95% C.I (Beta Coefficient)		p-value
				Lower	Upper
(Intercept)	3.71	0.36	10.34	3.002	4.41	<0.001
Group=Intervention Group	0.23	0.12	1.92	−0.005	0.47	0.055
Group=Reference comparison
Time =Baseline	0.20	0.12	1.70	−0.032	0.44	0.090
Time=Two weeks	−0.01	0.11	−0.11	−0.216	0.19	0.911
Time=Three weeks-Reference comparison	0	0	0	0	0
Interaction: Time-1x Intervention group	−0.13	0.16	−0.77	−0.446	0.19	0.439
Interaction: Time-2x Intervention group	0.28	0.14	2.08	0.016	0.55	0.038
Interaction: Time-3x Intervention group	0	0	0	0	0
Interaction: Time-1x Control group	0	0	0	0	0
Interaction: Time-2x Control group	0	0	0	0	0
Interaction: Time-3x Control group	0	0	0	0	0
Age (years)	−0.02	0.01	−3.39	−0.03	−0.01	0.001
Anxiety score	0.05	0.01	4.34	0.025	0.07	<0.001
Disease stage=3	0.00	0.16	2.43	0.08	0.70	0.016
Disease stage=2	0.22	0.16	1.38	−0.09	0.52	0.167
Disease stage=1	0	0	0	0	0