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 可能对个人和夫妻双方产生负面影响的情感挑战。夫妻 能够就癌症相关问题进行公开有效的沟通， 提高他们的心理适应能力和人际关系质量。还可能导致 更好的症状管理和患者目标一致的护理。然而，许多夫妇 报告说，即使在总体满意的情况下， 关系。先前的研究发现，以夫妇为基础的干预措施， 沟通为癌症患者及其伴侣带来积极的结果。但大多数 一直受到亲自治疗的限制，这使得许多夫妇无法 参与;他们也没有针对最有可能成为穷人的夫妇采取干预措施 结果。为了解决这些局限性，拟议的研究将进行一项随机对照试验， 夫妇沟通技能培训（CCST）干预的有效性， 为面临晚期癌症的夫妇举行视频会议。干预将针对 那些报告说在讨论癌症相关问题时表现出高度克制的夫妇， 与较差的心理和关系功能相关的变量。CCST 干预措施包括协助夫妇有效沟通、减少 避免与癌症有关的重要问题，并相互提供支持。在 在一项研究中，230名晚期GI、GU、乳腺癌或肺癌患者及其伴侣 将被随机分配到两个条件之一：1）CCST，或2）教育。所有参与者 将提供可上网的平板电脑，用于视频会议。评估， 包括自我报告措施和录音夫妇的谈话，将进行与 基线、治疗中期和治疗后的患者和伴侣。自我报告措施将 也在3个月随访时收集。要检验的主要假设是， CCST干预中的合作伙伴将报告更高的关系满意度 和亲密度的关系。次要目标将集中在（a） （B）患者和伴侣心理适应的改善; 健康和保健结果;以及（c）个人和关系的改善 功能的改善是通过自我报告和客观的措施， 通信探索性分析包括（a）审查干预措施的调节因素 （B）对干预措施的实施相关过程评估， RE-AIM框架，以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, the proposed 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 will be 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 the proposed 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.