“The Unicorn Effect”: Statistical Significance in Psychosocial Program Evaluation

November 2020 Vol 11, No 11
Marina Baroff, MPH, LFACHE
The Clearity Foundation,
San Diego, CA
Susan Hess, MA, LPC
The Institute for Public Health, San Diego State University, School of Public Health

Background: With high recurrence and mortality rates, ovarian cancer often has a devastating impact on patients and their loved ones.1 Besides the arduous treatment of debulking surgery and chemotherapy, survivors frequently report intense fear of dying, extreme anxiety between checkups, overwhelming stress, and social isolation.2 Despite these physical and psychological hardships, GYN cancer patients are often the least likely to receive distress screening as part of oncology navigation.3 As a result of this structural disconnect, supportive coping resources are desperately needed to manage the harsh emotional aspects of the ovarian cancer experience.4

In 2017, The Clearity Foundation and the Susan Poorman Blackie Ovarian Cancer Foundation partnered to create Steps Through OC, a national, free, virtual psychosocial support program for ovarian cancer survivors and caregivers, with 2 long-term goals: (1) to improve the quality of life of women and their families; and (2) to increase overall survival of ovarian cancer patients.

Because prior research of similar cancer support programs had demonstrated limited efficacy, rigorous, external program evaluation measures were established, including (1) outcomes evaluation and analysis utilizing standardized psychometric instruments, and (2) assessment of participation satisfaction through the distribution and analysis of online satisfaction surveys.

Objectives: From October 2018 to April 2020, an online psychosocial support and education program was implemented to improve the lives of ovarian cancer survivors as evidenced by: (1) increased self-advocacy skills, (2) increased confidence in treatment decisions, (3) decreased physical and emotional symptom burden, (4) decreased physical and emotional impact of treatment side effects, (5) improved emotional well-being, (6) enhanced coping skills, and (7) progression toward personal goals.

Methods: With the help of the Institute of Public Health (IPH), San Diego State University: (1) initial literature review was conducted; (2) logic model was developed to guide the evaluation process; (3) 5 published, validated psychosocial assessments were administered at 3 timepoints; (4) field test analysis was completed; (5) 6-month, 10-session intervention model was delivered to 238 participants; (6) An Outcomes Evaluation5 report was compiled with descriptive statistics, clinically meaningful data, statistical testing; and (7) An Evaluation of Participant Satisfaction6 report was prepared.

Results: A statistically significant and clinically meaningful change was seen from baseline to final assessment across several domains, including quality of life, and emotional and functional well-being. Reductions in stress and improvements in positive coping skills were also observed. The IPH evaluation team reported, “In 30 years, we’ve only seen results like these a few times,” and called the surprisingly favorable results “a unicorn.”

Conclusions: The statistical analyses conducted provide strong evidence that Steps Through OC has a significant positive, lasting impact on women with ovarian cancer. Extremely rare in psychosocial support evaluations, these findings highlight the important role this program plays in the lives of the women it serves. Considered along with the favorable satisfaction survey findings, the outcome evaluation results make a compelling argument to expand oncology navigation distress screening for ovarian cancer patients. Furthermore, Steps Through OC should be considered as an essential supplemental resource to improve quality of life for women diagnosed with this deadly disease.


  1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Ovarian Cancer. https://seer.cancer.gov/statfacts/html/ovary.html.
  2. Stewart DE, Duff S, Wong F, et al. The views of ovarian cancer survivors on its cause, prevention, and recurrence. Medscape Womens Health. 2001;6:5.
  3. Johnston D, Watson L, Strusowski T, et al. National evidence-based oncology navigation metrics: multisite exploratory study to demonstrate value and sustainability of navigation programs. Journal of Oncology Navigation & Survivorship. 2019;10(11):481.
  4. Ekman T, Bergbom I, Ekman T, et al. Maintaining normality and support are central issues when receiving chemotherapy for ovarian cancer. Cancer Nurs. 2004;27:177-182.
  5. The Institute of Public Health, San Diego State University, School of Public Health. Steps Through OC: An Outcomes Evaluation. May 2020.
  6. The Institute of Public Health, San Diego State University, School of Public Health. Steps Through OC: An Evaluation of Participant Satisfaction. April 2020.
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Last modified: August 10, 2023

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