Brief Intervention to Improve QOL & Couple Functioning after Prostate Surgery

描述（由申请人提供）：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患者的主要护理人员和支持来源;然而，患者在手术后经常离开医院，缺乏知识，这可能会限制他们管理医疗并发症和进行有效的术后家庭护理的能力。夫妻也往往准备不足，无法科普性功能和泌尿功能的变化，影响他们的生活质量和关系。此外，在PC治疗后，夫妻之间往往难以沟通。本申请解决了这些缺陷。本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，以在未来更大的RCT中进行评价。这是通过以下方式实现的：a）采取夫妇方法进行出院后的PC术后护理; B）使夫妇准备好预期性和泌尿功能的变化及其对QOL和关系功能的潜在影响; c）为夫妇提供实用策略，以提出敏感话题并传达他们的需求和担忧;以及d）设计简短的干预措施，以适应定期安排的诊所预约。具体而言，我们在目标1中建议进行5个焦点小组（3个与手术患者和伴侣; 2个与放射患者和伴侣），以获得对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，我们将重点放在手术患者及其合作伙伴。在目标2a中，我们建议将夫妇（N = 50;每组25例）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）接受以夫妇为中心的术后护理指导，并将在导管移除当天（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模块，其中包含与PC相关的营养信息。目标2b建议对夫妇进行为期6个月的随访，以记录PC相关的心理社会和临床需求的出现。这些信息将有助于未来长期干预计划的助推器会议的时间安排。我们假设干预是可接受的和可行的，对患者有用，容易融入临床，并将产生初步证据表明，夫妇在DPCP条件下将显示更好的调整，更高的生活质量，更少的痛苦和改善的关系功能相比，患者的营养状况。拟议的研究具有创新性，因为它1）解决了临床需求领域; 2）将夫妇的重点方法纳入术后护理和疾病相关沟通; 3）由简单的干预模块组成，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准确确定干预内容和助推器的时间。 公共卫生相关性：作为最常见的男性癌症，前列腺癌影响了大量男性及其伴侣。寻找方法来增加术后自我护理，并准备夫妇一起面对治疗相关的性和泌尿功能的变化是非常重要的临床和心理社会的重要性。拟议的简短干预措施的相关性得到进一步加强，因为它的目的是很容易融入定期发生的诊所访问，从而促进未来的传播工作。

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.