Couple Communication Skills Training for Advanced Cancer

对于患者和他们的亲密伴侣来说，晚期癌症会对他们的身体和情感造成重大影响。 可能会对个人和夫妇都产生负面影响的挑战。夫妻之间的能力 公开和有效地就癌症相关问题进行沟通可以提高他们的 心理调适与他们的关系质量。它还可能导致症状改善。 对病人的管理和目标一致的护理。然而，许多夫妇报告说他们遇到了困难 关于癌症的交流，即使是在总体令人满意的关系中也是如此。先前的研究已经 发现以夫妻为基础的以沟通为目标的干预对癌症产生积极的结果 病人和他们的伴侣。然而，大多数都受到了面对面治疗的限制。 阻止许多夫妇参与的形式；他们也没有有针对性的干预措施 夫妻结局不佳的风险最大。为了解决这些限制，本研究将进行一项随机对照试验 测试夫妻沟通技能培训(CCST)干预的有效性 为患有晚期癌症的夫妇举行视频会议。这项干预针对的是那些 报告称，人们在讨论与癌症相关的问题时犹豫不决，这是一种与 心理和人际关系功能较差。CCST干预包括以下组件 帮助夫妻有效沟通，减少对重要癌症相关问题的回避，以及 相互提供支持。在这项研究中，230名患有晚期胃肠道、胃溃疡、乳房或肺部疾病的患者 癌症和他们的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一台平板电脑，可以访问互联网 视频会议。评估，包括自我报告措施和夫妇录音 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个月的随访中收集。主要假设 需要测试的是，CCST干预中的患者和伴侣报告的水平将显著提高 相对于那些在教育条件下的人来说，他们的关系满意度和亲密度更高。次要目标 将侧重于(A)改善患者和伴侣的心理适应；(B)改善 病人的健康和保健结果；以及(C)个人和关系的改善 自我报告和客观沟通措施的改善是起调节作用的因素。 探索性分析包括(A)检查干预效果的调节因素，以及(B) 在RE-AIM框架指导下，对干预措施进行与执行有关的过程评估，以 加快将干预措施转化为临床实践。

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.