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How not to evaluate whether psychosocial interventions benefit patients



How not to evaluate whether psychosocial interventions benefit patients Psycho-Oncology Psycho-Oncology 20: 337–338 (2011) Published online in Wiley Online Library ( DOI: 10.1002/pon.1919 Letter to the Editor How not to evaluate whether psychosocial interventions benefit patients Dear Editor, Response to Salander. We had trouble recognizing Fors et al.’s [1] systematic review from its depiction by Salander. Despite a thorough effort, Fors et al. identified only 18 randomized controlled trails (RCTs) evaluating psychosocial interventions for patients with non-metastatic breast cancer meeting minimal methodological standards and concluded that ‘insufficient evidence exists to define optimal psychoeducational interventions beyond an infor- mation package that all cancer patients usually receive, [or]yto determine the most beneficial social and emotional support interventions, even though some subgroups with high initial cancer- related stress seem to benefit’. This stark evaluation was all the more impressive, given the tendency that we have noted [2,3] for some investigators to hide essentially null primary results with secondary and post hoc analyses so that interventions appear effective. Salander identifies serious problems in the psycho-oncology literature, but undercuts his credibility with overstatement. Rather than ‘few people with cancer desire psychological treatment’ and ‘there seems to be no relationship between psychological distress and desire for psychological treatment’, a more accurate assessment is that fewer cancer patients desire psychosocial interven- tion than is widely assumed and that a positive screening for distress is only a modestly efficient indicator of interest in psychosocial services [4]. One implication of our assessment is that intervention trials assuming that most cancer patients want services will fail to meet accrual goals and could be compromised methodologically by efforts to accrue sufficient numbers of patients. Anothe

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