This study examined characteristics of cancer patients interested in bibliotherapy and their motivation and adherence to a self-help program. The majority of participants were female, over 50 years old, and had education beyond high school. Participants had various cancer types and stages. They reported high autonomous motivation to engage in the program and over half had clinically significant psychological distress. Participants completed on average 80% of the workbook and spent 57 minutes weekly engaging with it. Those with more depressive symptoms spent less time reading. Motivation was unrelated to adherence measures but wanting responsibility for well-being related to seeking social support. The findings support bibliotherapy as an intervention option for a broad range of cancer patients.

1. Bibliotherapy is a form of self-administered treatment that uses books to improve psychological
well-being. It is a low cost intervention with minimal demand on personnel resources.[1]
A substantial amount of research has shown the effectiveness of bibliotherapy for mental health
conditions, especially for mild to moderate levels of depression and anxiety symptoms.[1,2,3] Yet, only
a few studies have examined bibliotherapy as a method of reducing psychological distress in patients
with cancer despite its low cost and ease of accessibility.[4,5]
NUCARE is a psycho-educational, cognitive behavioral self-help intervention program for individuals
diagnosed with cancer. NUCARE focuses on the enhancement of a sense of personal control and the
learning of emotional and instrumental coping responses [4,5]. The secondary analyses presented on
this poster are based on a recent randomized controlled trial, which showed significantly greater
increases in empowerment and quality of life and decreases of distress in the bibliotherapy
group than in the control group comparing pre-intervention to follow-up assessment.[6,7]
Patient’s motivation to complete readings and to engage in intervention material are determining
factors for the effectiveness of bibliotherapy in alleviating mild to moderate psychological distress.[3]
Research Objectives:
 Provide insight into the characteristics of patients interested in bibliotherapy.
 Assess patients’ motivation to engage and adhere to the self-help program.
Participants
89 self-selected patients (Mage = 54 years, SD= 12) with heterogeneous cancer diagnoses and varying
tumour stages were recruited from two university-affiliated hospitals in Montréal, Canada.
No significant differences between the bibliotherapy and the control group conditions were found at
baseline for sociodemopgraphic, medical, and psychological variables.
Procedure
A mixed-method randomized control trial was conducted.
In addition to having access to care as usual, the intervention group participants were asked to
engage in the self-help workbook entitled: Mastering the art of coping in good times and bad[9].
The control group received usual care.
All participants were asked to complete a questionnaire package at recruitment (Time 1), six weeks
post-recruitment (Time 2) and ten weeks post-recruitment (Time 3).
The current study examines socio-demographics, illness-related variables, treatment motivation and
distress at Time 1, i.e., at pre-intervention, and treatment adherence at Time 2, i.e., immediately
post-intervention.
Measures
Sociodemographic and cancer-related information was gathered via self-report.
Motivation to engage in the coping intervention was assessed with the Treatment Self-Regulation
Questionnaire (TRSQ).[10]
Adherence to the intervention was measured by a questionnaire about the percentage of the book
that was read, the amount of time spent reading and engaging in the self-help material, and the
frequency with which participants practiced the prescribed interventions each weak.
Psychological distress, i.e., symptoms of anxiety and depression, was assessed with the Hospital
Anxiety and Depression Scale (HADS).[11]
INTRODUCTION
METHODS
Health Psychology
Research Group
Bibliotherapy has the potential to be a cost-effective minimal intervention that addresses
psychosocial needs of patients with cancer. It might be most appropriate to rely on bibliotherapy
when using a stepped-care approach that provides low-intensity interventions before more
intensive treatments are offered. Evidence-based bibliotherapy may reduce the burden on
health care resources and enhance the immediacy of psychosocial services.[6,7]
The findings regarding the efficacy of the NUCARE intervention program [6,7] and the here
presented analysis of sociodemographic, psychological and cancer-related sample
characteristics, speak for bibliotherapy as an intervention option for a broad range of patients
with cancer including males, older persons, individuals with high-school as their highest
educational degree, and patients with more advanced tumours as well as with newly diagnosed
malignancies.
When prescribing bibliotherapy, clinicians need to be sensitive to the level of depressive
symptomatology, which may get in the way of truly engaging with self-help materials.
Our study was limited by the small sample size, which did not allow us to detect smaller effects
or to examine causal relationships while controlling for other potential influences, e.g.,
determine if NUCARE was less effective for individuals who reported more depressive symptoms
and indicated less time engaging in the workbook.
CONCLUSION
DISCUSSION
REFERENCES:
1. Gregory RJ, Canning SS, Lee TW, Wise JC. Cognitive bibliotherapy for depression: A meta-analysis. Professional Psychology: Research and Practice 2004; 35: 275-280.
doi:10.1037/0735-7028.35.3.275
2. Fanner, D., & Urquhart, C. (2008). Bibliotherapy for mental health service users part 1: A systematic review. Health Information & Libraries Journal, 25, 237-252.
3. Marrs, R. (1995). A meta-analysis of bibliotherapy studies. American Journal of Community Psychology, 23, 843-870.
4. Rosberger, Z., Edgar, L., Collet, J., & Fournier, M. (2002). Patterns of Coping in Women Completing Treatment for Breast Cancer. Journal of Psychosocial Oncology, 20(3), 19-37.
5. Edgar, L., Rosberger, Z., & Collet, J. (2001). Lessons Learned: Outcomes and Methodology of a Coping Skills Intervention Trial Comparing Individual and Group Formats for Patients
with Cancer. International Journal of Psychiatry in Medicine, 31(3), 289-304.
6. Roberts, N., Steele, R., Rosberger, Z., Brosseau, D., & Körner, A. (2015). Bibliotherapy for patients with cancer: A randomized controlled trial. Manuscript submitted for publication.
7. Roberts, N., Lee, V., *Ananng, B., & Körner, A. (in press). Acceptability of bibliotherapy for patients with cancer: A qualitative descriptive study. Oncology Nursing Forum.
8. Naylor, E. V., Antonuccio, D., O., Litt, M., Johnson, G. E., Spogen, D. R., Williams, R., McCarthy, C., Lu,, M. M., Fiore, D. C., Higgins, D. L., (2008). Bibliotherapy as a treatment for
depression in primary care. Journal of Clinical Psychology in Medical Settings, 17(3), 258-271.
9. Edgar L. Mastering the art of coping in good times and bad. Ontario: Copelindaedgar; 2010
10. Williams, G. C., Grow, V. M., Freedman, Z., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social
Psychology, 70, 115-126.
11. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 66, 361-370.
12. Faller, H. et al. (2013). Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. Journal of
Clinical Oncology, 31(6), 782-793.
13. Maunsell et al. (2014). Health-related empowerment in cancer: validity of scales from the health education impact questionnaire. Cancer, 3228-3236.
14. Singer et al. (2009). Hospital anxiety and depression scale cutoff scores for cancer patients in acute care. British Journal of Cancer, 100, 908 – 912.
15. Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2015). Canadian Cancer Statistics 2015. Toronto, ON: Canadian Cancer Society; 2015.
Sociodemographic
characteristics
Current sample
N=89
Other oncology samples
689 ≥ N ≤ 22,238
AGE
A
g
e
≤ 30 3 % 2 % [12]
31-50 31 % 20 % [12]
51-70 60 % 58 % [12]
≥ 71 6 % 21 % [12]
GENDER
Female 78 % 82 % [12]
Male 23 % 28 % [12]
YEARS OF EDUCATION
11-13 years (≤ high school) 24 % 43 % [13]
≥ 14 years (> high school) 45 % 54 % [13]
RELATIONSHIP STATUS
Single 57 % 75 % [13]
Not Single 43 % 24 % [13]
CANCER STAGE
Stage 0 2 % 2 % [14]
Stage 1 21 % 18 % [14]
Stage 2 18 % 22 % [14]
Stage 3 26 % 18 % [14]
Stage 4 8 % 10 % [14]
Missing/unknown 25 % 31 % [14]
90 %
72 %
82 %
62 %
55 %
46 %
62 %
0
10
20
30
40
50
60
70
80
90
100
Technique Type
PERCENTAGE%
Percentage of Patients Who Practiced the Prescribed
Intervention One or More Times per Week
Mindfulness Cognitive Reappraisal Relaxation Goal Setting
Problem Solving I-Statements Companionship
Table 1. Sociodemographic characteristics of the current study sample compared to
other oncology research samples.
The majority of patients interested in bibliotherapy were female, had completed an education
beyond high-school level, and were over 50 years of age. These characteristics are comparable to
other samples of patients partaking in psycho-oncological assessments or interventions.
However, the number of patients above 70 years of age was smaller in our bibliotherapy
sample.[12,13,14,15]
Patients with various cancer types and tumour stages were interested in bibliotherapy, which
also resembles the participants in other psychosocial oncology research. 35% of our participants
indicated to have been recently diagnosed with a new or a recurring cancer while 62% reported
having completed their treatment, and being in long-term follow-up, or under surveillance.
Participants indicated high autonomous motivation (MTRSQ at T1 = 5.8, SD = 1.3, possible range 1-
7). The most strongly endorsed reason for wanting to join this coping intervention program was:
“… it is very important for being as healthy as possible”, closely followed by “... wanting to take
responsibility for my own psychological well-being”.
Half of our participants reported clinically significant psychological distress, i.e., MHADS ≥ 13 in
51% of the cases. The mean HADS total score was 12.8 (SD= 6.1, Median = 14, Range: 1 to 29),
which is comparable to the mean of 13.6 (SD=7.8) in a sample of 689 patients with cancer.[14]
Participants completed between 25% and 100% of the book (M= 80%). 15% of our participants
read less than half the book. 52% of our sample completed the entire workbook. Participants
spent on average 57 minutes each week engaging in the self-help material (SD= 58). They most
frequently practiced mindfulness and relaxation techniques.
Patients with more depressive symptomology spent less time reading/engaging with the self-
help materials (rSpearman= -0.49, p < .05). Yet, depressive symptoms were unrelated to the
percentage of the book read (rSpearman=0.18, p=.36).
Motivation for the self-help intervention, i.e., the TRSQ total score, was neither related to the
weekly time spent engaging with the workbook nor to the percentage of the book read.
However, the more someone wanted to take responsibility for their own well-being, the more
often they sought social support.
A Self-help Program for Coping with Cancer
- Motivation for and Adherence to Bibliotherapy -
Bethsheba Ananng, BA1, Zofia Czajkowska, PhD Cand.1, Katelyn Ward, MA1, Nicole Roberts, PhD2, & Annett Körner, PhD1,2,3,4
1Department of Educational and Counselling Psychology, McGill University, Montréal; 2McGill Counselling Service , McGill University, Montréal;
3Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre - Jewish General Hospital, Montréal; 4Psychosocial Oncology Program, McGill University Health Centre, Montréal
RESULTS
ACKNOWLEDGMENT: The authors thank Tia Maric for her critical discussion of an early version of this poster.
CONTACT: annett.korner@mcgill.ca