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 对个人和夫妻都有负面影响的情感挑战。情侣们的 能够就癌症相关的问题公开和有效地相互沟通 改善他们的心理适应，提高他们的关系质量。它还可能导致 为患者提供更好的症状管理和目标一致的护理。然而，许多夫妇 报告关于癌症的沟通困难，即使在总体满意的情况下也是如此 两性关系。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。然而，大多数 已经受到面对面治疗的限制，这使得许多夫妇无法 参与；他们也没有针对贫困风险最高的夫妇进行干预 结果。为了解决这些限制，拟议的研究将进行随机对照试验，以测试 夫妻沟通技能培训(CCST)干预的效果 为患有晚期癌症的夫妇举行视频会议。此次干预的目标将是 报告称不愿讨论与癌症相关的问题的夫妇 与较差的心理和人际关系功能相关的变量。CCST 干预措施包括帮助夫妻有效沟通的组成部分，减少 避免与癌症相关的重要问题，并相互提供支持。在 建议的研究：230名晚期胃肠道、胃肠道、乳腺癌或肺癌患者及其伴侣 将被随机分配到以下两种情况之一：1)CCST，或2)教育。所有参与者 将配备可上网的平板电脑，用于举行视频会议。评估， 包括自我报告措施和夫妇谈话的录音，将与 患者和合作伙伴在基线、治疗中期和治疗后。自我报告措施将 也要在3个月的随访中收集。需要检验的主要假设是，患者和 参与CCST干预的合作伙伴将报告更高的关系满意度 以及相对于那些处于教育条件下的人的亲密感。次要目标将侧重于(A) 改善患者和伴侣的心理适应；(B)改善患者 健康和保健结果；以及(C)个人和关系的改善 功能是通过自我报告和客观措施的改善来调节的 沟通。探索性分析包括：(A)审查干预的主持人 影响，以及(B)在指导下对干预措施进行与执行有关的进程评估 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.