Brief Intervention to Improve QOL & Couple Functioning after Prostate Surgery

改善生活质量的简短干预

• 批准号: 8190005
• 负责人: Michael A Diefenbach
• 金额: $ 19.74万
• 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 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8190005
• 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. 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.

描述(由申请者提供)：三分之一的男性有一生被诊断为前列腺癌(PC)的机会。配偶和亲密伴侣是PC患者的主要照顾者和支持来源；然而，患者在手术后离开医院时往往缺乏知识，这可能限制他们管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排尿功能的变化，从而影响他们的生活质量和关系。此外，在接受PC治疗后，夫妻之间经常存在沟通困难。这个应用程序解决了这些缺陷。该应用程序的总体目标是为前列腺癌患者及其配偶建立新开发的简短二元准备、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，以便在未来更大规模的RCT中进行评估。这是通过以下方式实现的：a)采取夫妇在出院后接受PC手术后护理的方法；b)使夫妇能够预见性功能和排尿功能的变化及其对生活质量和关系功能的潜在影响；c)为夫妇提出敏感话题并交流他们的需求和关切提供实用战略；以及d)设计一种简短的干预措施，以适应定期的诊所预约。具体地说，我们在目标1中建议进行5个焦点小组(3个是外科患者和伴侣，2个是放射患者和伴侣)，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，我们将重点关注手术患者和他们的伴侣。在目标2a中，我们建议招募夫妇(N=50；每组25人)参加一项小型试点随机对照试验。随机进入实验条件的外科患者和他们的伴侣将在出院当天(30分钟)接受以夫妇为重点的术后护理指导，并将在拔除导管的当天(出院后7天)接受DPCP模块(45分钟)。被随机分配到控制条件的夫妇将收到两个模块，其中包含与PC相关的营养信息。Aim 2b建议对夫妇进行总共6个月的跟踪调查，以记录与PC相关的心理社会和临床需求的出现。这些信息将有助于为未来的长期干预计划安排助推器会议的时间。我们假设干预是可接受和可行的，对患者有用，很容易融入临床，并将产生初步证据，表明与营养条件下的患者相比，处于DPCP状态的夫妇将表现出更好的适应能力、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)针对一个临床需要领域；2)结合了夫妇手术后护理和与疾病相关的沟通的重点方法；3)包括简单的干预模块，旨在轻松融入“日常”临床实践；以及4)评估心理社会需求的轨迹，以便在未来的干预中考虑干预内容和助推器的准确时间安排。 公共卫生相关性：前列腺癌作为最常见的男性癌症，影响到非常多的男性及其伴侣。寻找增加术后自我护理的方法，并为夫妻共同面对与治疗相关的性功能和尿路功能变化做好准备，具有重要的临床和心理社会意义。拟议的简短干预措施的相关性进一步增强，因为它的目的是很容易地纳入定期进行的诊所访问，从而便利今后的传播工作。