Couple Communication Skills Training for Advanced Cancer

对于患者和他们的亲密伴侣来说，晚期癌症对他们的身体和情感造成了严重的影响。 可能对个人和夫妻双方产生负面影响的挑战。夫妇的能力， 就癌症相关问题进行公开有效的沟通可以提高他们的 心理适应和人际关系的质量。它也可能导致更好的症状 管理和目标一致的照顾病人。然而，许多夫妇报告说， 即使在总体令人满意的关系背景下，也不能交流癌症。先前的研究 发现以夫妻为基础的针对沟通的干预措施对癌症有积极的效果 患者和他们的伴侣。然而，大多数人受到亲自治疗的限制 这种形式使许多夫妇无法参与;他们也没有针对性的干预措施， 最有可能出现不良结局的夫妇。为了解决这些局限性，本研究将进行一项RCT 测试夫妻沟通技能培训（CCST）干预的有效性， 为面临晚期癌症的夫妇举行视频会议。干预的对象是 报告说，在讨论与癌症有关的问题时， 心理和人际关系功能较差。CCST干预措施包括以下内容： 帮助夫妻有效沟通，减少对重要癌症相关问题的回避， 互相提供支持。在这项研究中，230例晚期GI、GU、乳腺或肺部 癌症及其伴侣将被随机分配到两种情况之一：1）CCST，或2） 教育所有与会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 对话，将在基线、治疗中期和治疗后与患者和合作伙伴进行 治疗还将在3个月随访时收集自我报告措施。主要假设 接受CCST干预的患者和伴侣将报告显著更高的水平， 的关系满意度和亲密度。次要目的 将侧重于（a）改善患者和伴侣的心理适应;（B）改善 患者健康和医疗保健结果;以及（c）个人和关系的改善 自我报告和客观的沟通措施的改善是调解功能。 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框架的指导下，对干预措施进行与实施相关的过程评价， 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.