Puromycin While our study provides evidence for
While our study provides evidence for the benefits of bibliother-apy for patients with cancer, appropriate caution should be taken when interpreting the results. Time constraints associated with completing this Puromycin doctoral research project prevented us from reaching the aspired sample size of N = 102, which reduced the power for detecting smaller effects. More importantly, the dropout rate was higher in our intervention group than in the control group and analyses revealed that people with lower levels of education were more likely to drop out. This could be interpreted as our self-help workbook being more appropriate or beneficial for individuals with higher education. Further, the sampling approach limits generalizability as patients self-selected based on their personal interest in receiving a self-help intervention. Studying this subpopulation still remains valuable as patients with a preference for treatment in a self-help format are part of the target audience for this intervention approach. Yet, our recruitment procedures did not allow determining participation rates or provide insight into persons, who were informed about this study but decided to not enroll. Moreover, about half of the intervention group patients were interviewed upon completion of the self-help intervention. Reflecting on their experience with the workbook may have served as a reinforcement to practice and implement the newly learned skills. As such, the intervention affect may not be solely due to the self-administered workbook and future research should investigate NuCare efficacy with versus without any such additional stimula-tion. One also has to keep in mind that study participants had access to other support services and that our study design did not allow to differentiate workbook effects from potential effects of other services used. Lastly, the statistical significance of findings does not necessarily imply clinical significance. Future research is needed to replicate the results in a larger study sample examining longer-term effects of the intervention and comparing adenosine triphosphate (ATP) to professionally administered treatments. Furthermore, research is needed to provide guidance regarding the question who should be offered self-directed interventions, at what point(s) during the illness trajectory, and with which level of professional guidance. Even though previous research has shown that purely self-administered interventions were efficacious for depression, distress, and self-efficacy, several of our interviewees pointed out that it could be beneficial having a coach (or another kind of “sounding board”) while engaging with the NuCare workbook . Adding a directory of support organizations to the workbook may be a simple way of enhancing the helpfulness of NuCare since there are local, provincial, and national organizations, which offer informational, counseling, and peer-support services . Self-directed interven-tions such as bibliotherapy might not only be efficacious but may also constitute an acceptable intervention for patients with emotional and psychological difficulties due to cancer who decline or unable to access clinician-administered supportive care services . It is further noteworthy that it was not feasible for us to only include patients whose distress scores surpassed clinical cut-offs, which made it less likely todetectintervention effects. The provided workbook may be even more efficacious for individualswith clinical levels of distress. Yet, this remains to be tested. Upon establishing efficacy of self-administered interventions – may it be in print, audio, video, online, or combined format – research into its cost-effectiveness is urgently needed given the growing need for mental health support and the already overburdened health care system.