Couple Communication Skills Training for Advanced Cancer

晚期癌症夫妻沟通技巧训练

• 批准号: 10517298
• 负责人: LAURA S PORTER
• 金额: $ 9.56万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10517298
• 关键词: Address; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Affect; Affective; Aftercare; Back; Buffers; Cancer Patient; Caregivers; Caring; Code; Communication; Couples; Development; Distress; Education; Educational Intervention; Emergency department visit; Emotional; Expressed Emotion; Family Caregiver; Goals; Health; Healthcare; Hospitalization; Individual; Internet; Intervention; Lead; Life; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Mediating; Modeling; Outcome; Palliative Care; Parents; Participant; Patient Care; Patient Outcomes Assessments; Patient Self-Report; Patients; Pattern; Peer Review; Personal Satisfaction; Persons; Psychological adjustment; Publications; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Research Project Grants; Risk; Science; Spouses; Symptoms; Tablet Computer; Testing; Translations; Videoconferencing; base; cancer diagnosis; care outcomes; career; clinical practice; commune; communication behavior; coping; design; efficacy testing; emotional distress; experience; follow-up; high risk; improved; intervention effect; intimate behavior; malignant breast neoplasm; patient response; process evaluation; programs; psychologic; psychological distress; satisfaction; showing emotion; skills training; symposium; symptom management; therapy design; treatment response

For patients and their intimate partners, advanced cancer poses significant physical and emotional challenges that can negatively impact both the individuals and the couple. Couples’ ability to communicate openly and effectively with each other about cancer-related concerns can improve their psychological adjustment and the quality of their relationship. It may also lead to better symptom management and goal-concordant care for the patient. However, many couples report difficulties communicating about cancer, even in the context of overall satisfying relationships. Prior research has found that couple-based interventions that target communication lead to positive outcomes for cancer patients and their partners. However, most have been limited by an in-person treatment delivery format that precludes many couples from participating; they have also not targeted interventions to couples most at risk for poor outcomes. To address these limitations, this study will conduct an RCT to test the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples facing advanced cancer. The intervention is targeted to couples who report high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning. The CCST intervention includes components to assist couples communicate effectively, decrease avoidance of important cancer-related issues, and provide each other with support. In this study, 230 patients with advanced GI, GU, breast, or lung cancer and their partners will be randomly assigned to one of two conditions: 1) CCST, or 2) Education. All participants will be provided with tablet computers with internet access for videoconferencing. Assessments, including self-report measures and audio recorded couple conversations, will be conducted with patients and partners at baseline, mid-treatment, and post- treatment. Self-report measures will also be collected at 3 months follow up. The primary hypothesis to be tested is that patients and partners in the CCST intervention will report significantly higher levels of relationship satisfaction and intimacy relative to those in the education condition. Secondary aims will focus on (a) improvements in patient and partner psychological adjustment; (b) improvements in patient health and health care outcomes; and (c) whether improvements in individual and relationship functioning are mediated by improvements in self-reported and objective measures of communication. Exploratory analyses include (a) examination of moderators of intervention effects, and (b) an implementation-related process evaluation of the intervention guided by the RE-AIM framework to expedite translation of the intervention into clinical practice.

对于患者及其亲密伴侣来说，晚期癌症带来重大的身体和情感上的影响 可能对个人和夫妻双方产生负面影响的挑战。夫妻的能力 就与癌症相关的问题相互公开、有效地沟通可以提高他们的 心理调整和他们的关系质量。它还可能会导致更好的症状 对患者进行管理和目标一致的护理。然而，许多夫妇表示遇到困难 就癌症进行交流，即使是在整体令人满意的关系的背景下。先前的研究有 发现以夫妻为基础的针对沟通的干预措施可为癌症带来积极的结果 患者及其伴侣。然而，大多数都受到面对面治疗的限制 这种形式使许多夫妇无法参与；他们也没有针对性地采取干预措施 夫妻最有可能出现不良结果。为了解决这些局限性，本研究将进行随机对照试验 测试夫妻沟通技巧培训 (CCST) 干预措施的有效性 为患有晚期癌症的夫妇举行视频会议。该干预措施针对的是以下夫妇： 报告称，他们不愿讨论与癌症相关的问题，这是与癌症相关的一个变量 心理和人际关系功能较差。 CCST 干预措施包括以下组成部分： 帮助夫妻有效沟通，减少对重要癌症相关问题的回避，以及 互相提供支持。在这项研究中，230 名患有晚期胃肠道、胃肠道、乳腺癌或肺部疾病的患者 癌症患者及其伴侣将被随机分配到以下两种情况之一：1) CCST，或 2) 教育。所有参与者都将获得可上网的平板电脑 视频会议。评估，包括自我报告措施和录音夫妇 将在基线、治疗中期和治疗后与患者和合作伙伴进行对话 治疗。自我报告措施也将在 3 个月的随访时收集。主要假设 需要测试的是，CCST 干预中的患者和合作伙伴将报告显着更高的水平 相对于受教育条件下的人的关系满意度和亲密程度。次要目标 将重点关注 (a) 改善患者和伴侣的心理调整； (b) 改进 患者健康和医疗保健结果； (c) 个人和人际关系是否有所改善 自我报告和客观沟通措施的改进可以调节功能的发挥。 探索性分析包括（a）检查干预效果的调节因素，以及（b） RE-AIM 框架指导下的与实施相关的干预流程评估 加快将干预措施转化为临床实践。