Brief Intervention to Improve QOL & Couple Functioning after Prostate Surgery

描述（申请人提供）：三分之一的男性一生中有机会被诊断患有前列腺癌（PC）。配偶和亲密伴侣是PC患者的主要照护者和支持来源；然而，患者往往在术后离开医院时知识不足，这限制了他们处理医疗并发症和参与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功能和泌尿功能的变化，这会影响他们的生活质量和夫妻关系。此外，夫妻之间经常有沟通困难的PC治疗后彼此。这个应用程序解决了这些缺陷。本申请的总体目标是为前列腺癌患者及其配偶建立一种新开发的简短的二元准备、沟通和问题解决（DPCP）干预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)为夫妇提供实用的策略来提出敏感的话题，并沟通他们的需求和担忧；d)设计一个简短的干预，以适应定期安排的诊所预约。具体而言，我们在目标1中提议进行5个焦点小组（3个手术患者及其合作伙伴，2个放疗患者及其合作伙伴），以获得对DPCP干预和营养比较环节内容的反馈和建议。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合作伙伴。在Aim 2a中，我们建议将夫妇（N = 50，每组25人）纳入小型试点RCT。随机分配到实验条件的手术患者及其伴侣将在出院当天（30分钟）接受以夫妻为中心的术后护理指导，并在拔管当天（出院后7天）接受DPCP模块（45分钟）。随机分配到对照组的夫妇将收到两个与个人电脑相关的营养信息模块。目的2b建议对夫妻进行为期6个月的随访，记录与pc相关的心理社会和临床需求的出现情况。这一信息将对未来长期干预计划的加强会议的时间安排有用。我们假设干预是可接受和可行的，对患者有用，易于融入临床，并将提供初步证据，证明DPCP状态的夫妇比营养状态的患者表现出更好的适应性，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)结合以夫妻为中心的方法进行术后护理和疾病相关沟通；3)由简短的干预模块组成，旨在轻松融入“日常”临床实践；4)评估心理社会需求的轨迹，以便在未来的干预中确定干预内容和促进因素的确切时间。

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. PUBLIC HEALTH RELEVANCE: As the most common male cancer, prostate cancer affects a very large number of men and their partners. Finding ways to increase self-care after surgery and prepare couples to face treatment related changes in sexual and urinary functioning together is of great clinical and psychosocial importance. The relevance of the proposed brief intervention is further enhanced as it is designed to easily integrate into regularly occurring clinic visits thus facilitating future dissemination efforts.