Brief Intervention to Improve QOL & Couple Functioning after Prostate Surgery

改善生活质量的简短干预

• 批准号: 8301574
• 负责人: Michael A Diefenbach
• 金额: $ 22.07万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-14 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8301574
• 关键词: Acute; Address; Adverse effects; Affect; Aftercare; Appointment; Area; Attention; Back; Cancer Patient; Cancer Survivor; Caregivers; Caring; Catheters; Clinic; Clinic Visits; Clinical; Communication; Control Groups; Counseling; Couples; Data; Day Surgery; Diagnosis; Dietary Intervention; Disease; Distress; Emotional; Enrollment; Erectile dysfunction; Evaluation; Excision; Face; Feedback; Focus Groups; Future; Goals; Home environment; Hospitals; Incontinence; Instruction; Intervention; Knowledge; Left; Life; Malignant Neoplasms; Malignant neoplasm of prostate; Managed Care; Measurement; Mental Depression; Operative Surgical Procedures; Patients; Pilot Projects; Primary Health Care; Problem Solving; Provider; Quality of life; Radiation; Radical Prostatectomy; Randomized; Readiness; Recovery; Regrets; Reporting; Role; SF-12; Sampling; Schedule; Self Care; Services; Sex Functioning; Sexual Dysfunction; Social support; Source; Spouses; Suggestion; Symptoms; Testing; Time; Visit; Work; brief intervention; cancer therapy; caregiving; comparison group; coping; design; experience; follow-up; group intervention; improved; innovation; intervention effect; intervention program; intimate behavior; male; medical complication; men; nutrition; patient home care; post intervention; programs; prostate surgery; psychological distress; psychosocial; psychosocial adjustment; randomized trial; skills; urinary

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.

描述（由申请人提供）：三分之一的男性终生有机会被诊断出患有前列腺癌 (PC)。配偶和亲密伴侣是 PC 患者的主要照顾者和支持来源；然而，患者在手术后出院时往往存在知识缺陷，这可能会限制他们处理医疗并发症和进行有效的术后家庭护理的能力。夫妻通常也没有准备好应对性和泌尿功能的变化，从而影响他们的生活质量和人际关系。此外，在 PC 治疗后，夫妻之间常常难以沟通。该应用程序解决了这些缺陷。该申请的总体目标是确定新开发的针对前列腺癌患者及其配偶的简短的二元准备、沟通和问题解决 (DPCP) 干预措施的可行性和可接受性，并收集干预效果的初步数据，以便在未来更大规模的随机对照试验中进行评估。这是通过以下方式实现的： a) 在出院后采取夫妻方式进行 PC 术后护理； b) 让夫妻做好准备，预测性功能和泌尿功能的变化及其对生活质量和关系功能的潜在影响； c) 为夫妻提供实用策略，以提出敏感话题并传达他们的需求和担忧； d) 设计一个简短的干预措施以适应定期安排的诊所预约。具体来说，我们在目标 1 中建议开展 5 个焦点小组（3 个与手术患者及其伴侣；2 个与放射患者及其伴侣），以获得 DPCP 干预和营养比较会议内容的反馈和建议。对于DPCP的可行性和可接受性评估，我们将重点关注手术患者及其伴侣。在目标 2a 中，我们建议将夫妻（N = 50；每组 25 人）纳入小型试点随机对照试验。随机接受实验条件的手术患者及其伴侣将在出院当天（30 分钟）接受以夫妇为中心的术后护理说明，并将在拔除导管当天（出院后 7 天）接受 DPCP 模块（45 分钟）。随机分配到对照条件的夫妇将收到两个包含 PC 相关营养信息的模块。目标 2b 提议对夫妇进行为期 6 个月的跟踪，以记录与 PC 相关的社会心理和临床需求的出现。这些信息对于确定未来长期干预计划加强会议的时间安排很有用。我们假设该干预措施是可接受且可行的，对患者有用，易于融入临床，并将产生初步证据，表明与营养状况下的患者相比，处于 DPCP 状况下的夫妇将表现出更好的调整、更高的生活质量、更少的痛苦和改善的关系功能。拟议的研究具有创新性，因为它 1) 解决了临床领域的需求； 2) 纳入夫妻的术后护理和疾病相关沟通的集中方法； 3) 由简短的干预模块组成，旨在轻松融入“日常”临床实践； 4) 评估社会心理需求的轨迹，以便确定干预内容的准确时机和未来干预措施的加强措施。