Cancer Control Research5R21CA155963-02
Diefenbach, Michael A.
BRIEF INTERVENTION TO IMPROVE QOL & COUPLE FUNCTIONING AFTER PROSTATE SURGERY
DESCRIPTION (provided by applicant): One in three men have a lifetime chance of being diagnosed with prostate cancer (PC). Spouses and intimate partners are the primary care-givers and sources of support for PC patients; however, patients often leave the hospital post surgery with knowledge deficits that can limit their ability to manage medical complications and engage in effective post-surgical home care. Couples are also often ill-prepared to cope with changes in sexual and urinary functioning, impacting their quality of life and relationships. In addition, couples often have difficulties communicating with each other following PC treatment. This application addresses these deficits. The overall goals of the application are to establish the feasibility and acceptability of a newly developed brief Dyadic Preparedness, Communication and Problem Solving (DPCP) intervention for prostate cancer patients and their spouses and to collect preliminary data of the effect of the intervention for evaluation in a future larger RCT. This is achieved by: a) taking a couples' approach to PC post-surgical care after hospital discharge; b) preparing couples to anticipate changes in sexual and urinary functioning and their potential impact on QOL and relationship functioning; c) providing practical strategies to couples to broach sensitive topics and to communicate their needs and concerns; and d) designing a brief intervention to fit within regularly scheduled clinic appointments. Specifically, we propose in Aim 1 to conduct 5 focus groups (3 with surgical patients and partners; 2 with radiation patients and partners) to obtain feedback and suggestions for the DPCP intervention and content of the nutrition comparison session. For the feasibility and acceptability evaluation of DPCP we will focus on surgical patients and their partners. In Aim 2a we propose to enroll couples (N = 50; 25 per group) into a small pilot RCT. Surgical patients and their partners randomized to the experimental condition will receive couples-focused post-surgical care instructions at day of discharge (30 min) and will receive the DPCP module (45 min) on the day of catheter removal (seven days after discharge). Couples randomized to the control condition will receive two modules with PC-relevant nutrition information. Aim 2b proposes to follow couples for a total of 6 months to record the emergence of PC-related psychosocial and clinical needs. This information will be useful for the timing of future booster sessions into long-term intervention programs. We hypothesize that the intervention is acceptable and feasible, and useful to patients, integrates easily into the clinic, and will produce preliminary evidence that couples in the DPCP condition will display better adjustment, higher QOL, less distress and improved relationship functioning compared to patients in the nutrition condition. The proposed study is innovative as it 1) addresses a clinical area of need; 2) incorporates a couples' focused approach to post-surgical care and illness-related communication; 3) consists of brief intervention modules designed to integrate easily into "everyday" clinic practice; and 4) evaluate the trajectory of psychosocial needs to allow for the exact timing of intervention content and boosters in future interventions.