CEBM Critical Appraisal for Therapy

What question did the study ask?

PICO?

Patients: Woman after breast cancer treatment

Intervention: Cognitive behavioral therapy
Outcome: Menopausal symptoms
The answer from this
paper: yes
the answer from this
paper : yes
In this article authors mention that in participants who located in CBT group, they
attended min 90 session every week for 6 weeks. The group CBT was psycho-
education, structured and interactive with presentations, group discussion, handouts,
and weekly homework. Paced breathing and relaxation were practiced at each session
and participant were given audio CD to practice at home daily during HFNS.
All participant in usual group had complete active breast cancer treatment and followed
every 6 months by an oncologist or clinical nurse specialist. They were sent leaflet and
offered telephoned support every 2 weeks. They also have information about HFNS
and advise on treatment options and practical ways of symptom management and
offered instructions for paced breathing and relaxation.
Both of group repeated the baseline questionnaires and 24-h SSC HFNS monitoring and
document any health and lifestyle change. At 26 weeks after randomization,
questionnaires were sent containing the same measurement.
So from this paper the answer is no.
From this article we could found :
From the baseline the total of participants in CBT group was 47 meanwhile in usual
care was 49 participants. At 9 weeks after randomization the total of the
participant in CBT group was 43 meanwhile in usual care was 45 participants. At
26 weeks after randomization the participants in CBT group was 40 meanwhile in
usual care was 40, but from the trial profile the participants were analyzed were
43 in CBT group and 45 in usual care.
So from this paper, losses to follow at the 9 weeks after randomization in CBT group
and usual care were 8% meanwhile after 26 weeks after randomization were 14%
in CBT group and 18% in usual care. So its mean losses to follow less than 20%.
So from this paper the answer is no intention –to-treat analysis but perprotocol
analysis.
The author stated that although
neither participants nor the
clinical psychologist could be
masked to group allocation,
researcher collecting outcome
data and analyzing result were
masked.
So from this paper the answer is yes
 Because the data is continuous, so we use effect size

Effect size = (Meantreatment – Meancontrol ） /SDpooled

= (3.13-4.60) /√(1.942 + 2.482)/2)
= -1.47/2.264
= -0.649 (medium effect)
• From the table by looking the at the confident intervals (CI) for each estimate ,the
confident interval is fairly narrow then we can be confident that our point estimate is a
precise reflection of the population value.
• At 9 weeks randomization : 95% confident interval ranged from -2.43 to -0.91, it does
not cross 0, therefore the mean different in HFNS problem rating by CBT compared with
usual is statistically significant at the α-level 0.05, with the greater reduction from
baseline in problem rating in CBT group compared to usual care group. At 9 weeks the
change in problem rating from baseline was
-3.05 (SD 2.3) in the CBT group compared with -1,06 (SD 1.7) in usual care group.
• At 26 weeks : 95% confident interval ranged from -2.54 to -0.99, it does not cross 0,
therefore the mean different in HFNS problem rating by CBT compared with usual care
is statistically significant at the α-level 0.05 with the greater reduction from baseline in
problem rating in CBT group compared to usual care group. At 26 weeks, the problem
rating HFNS had decrease from baseline by mean change -3.39 (SD 2.3) in the CBT group
and mean change -1.26 (SD 2.2) in the usual care group.
• From the table, there are some kind of measurement
that authors used, to know the effect of the
treatment on HFNS. The authors use 95% CI to
estimate the effect of treatment on the sample of
participants in both of group. The measurements
were more likely to lead to significant result.
• From the table, we could inform from the range of
the 95% confident interval that women in CBT group
reported more less depressed mood, fewer sleep
problems and better quality of life than in usual care.
• The result of the full study show that group CBT can reduce the effect
of hot flushes and night sweats for women who had menopausal
symptom after breast cancer treatment. This reduction were
sustained and associated with improvement mood, sleep and quality
of life. CBT seems to be safe, acceptable and effective treatment. The
outcome that may usefulness for the nurses especially who had
patient with HFNS after breast cancer treatment. Based on this study,
the evidence will assist nurses especially to consider that CBT can be
one of treatment option for the woman who had HFNS after breast
cancer treatment to decrease HFNS and increase their mood, sleep
and quality of live. CBT can be incorporated also into breast cancer
survivorship program and delivered by trained breast cancer nurses.