Prostate cancer: Family care for patients and spouses
Saturday, 29 March 2008 - MILAN – The 23rd annual meeting of the EAU was a success for European Association of Urological Nurses (EAUN). 273 participants registered at this congress and attended the state-of-the-art sessions presented in Milan. For instance prof. Laurel Northouse from the University of Michigan lectured on prostate cancer:
“There is considerable research on the impact of prostate cancer on men’s quality of life, but little research on how the illness affects their spouses. In the few studies that have been conducted, spouses of prostate cancer patients report more emotional distress and greater mood disturbances than do their husbands with prostate cancer. Spouses also report feeling tired and tense, having problems with sleep, and experiencing decreases in their own sexual interests. As prostate cancer patients’ problems increase, especially in areas related to fatigue and urinary incontinence, spouses report a decrease in their own quality of life.
Although prostate cancer creates problems for both patients and their spouses, few intervention programs have been developed to help couples manage the effects of illness and maintain their quality of life. The purpose of this study was to determine if a family-based intervention (The FOCUS Program) could improve several intermediary outcomes (appraisal of illness or caregiving, hopelessness, uncertainty, self-efficacy, family communication, and symptom distress or bother) and the distal outcome of quality of life in men with prostate cancer and their spouses.
A randomized clinical trial was conducted with a sample of men with prostate cancer and their spouses or partners (N=263 couples or dyads). Men were in one of three phases of illness: a) newly diagnosed, localized phase following primary treatment (n=170); b) biochemical recurrence phase following two successive rises in their prostate-specific antigen (n=33); and c) advanced phase following disease progression or change of treatment (n=60). In the newly diagnosed phase men were treated with a prostatectomy or external beam radiation, the biochemical recurrence phase men were treated with observation or hormone therapy, and the advanced phase men received hormone-naïve or hormone-refractory treatments.
Eligible patient-spouse dyads were referred to the study by clinic staff. Among the eligible patients and their spouses, 263 dyads completed baseline assessments (enrolment rate: 68.7%) and were randomly assigned to treatment (129 dyads) or control group (134 dyads). The majority of dyads (236 dyads) completed a follow-up assessment at 4 months and 218 dyads completed all three follow-up sessions (retention rate 83%). Patients and spouses completed their assessments independent of one another. The intervention was a five-session, family-focused, supportive-educative program, that consisted of three home visits and two follow-up phone calls delivered by masters-prepared nurses whom were not affiliated with the patients’ clinics.
The content of the intervention addressed five core areas: family involvement, optimistic outlook, coping effectiveness, uncertainty reduction, and symptom management. Several instruments with established reliability and validity were administered: Appraisal of Illness and Caregiving Scales, Beck Hopelessness Scale, Mishel Uncertainty Scale, Lewis Self-Efficacy Scale, Lewis MIS scale, Symptoms Scale, EPIC, and the FACT quality-of-life scales. Patients’ risk for developing emotional distress in the future was also assessed at baseline using the Omega Screening Questionnaire. Descriptive statistics and repeated measures ANOVA were used for data analyses.
Results indicated that patients in the intervention group reported less uncertainty about the illness (p = 0.03) and better communication with their spouses (p = 0.03) than control patients. Spouses in the intervention group reported significantly less negative appraisal of caregiving (p = 0.002), less hopelessness (p = 0.03), less uncertainty about the illness (p = 0.009), more self-efficacy to manage the illness (p = 0.02), better communication with their husbands (p = .002), and higher quality of life than control spouses (p = .004). Some of these positive effects extended to 8 and 12-month follow-ups. No differential effects of the intervention were found according to the type of treatment patients received, their phase of illness, or risk for distress status.
Future interventions need to include spouses in programs of care, tailor interventions according to patients’ risk for distress (low versus high), and identify cost effective ways to implement supportive-educative programs in busy clinic settings.
Author: Laurel Northouse PhD, RN, FAAN
Professor, School of Nursing, University of Michigan
Co-director, Socio-behavioral Program, University of Michigan Comprehensive Cancer Center lnortho(at) med.umich.edu
EAUN programme, Friday March 28th, 10.00 - 10.45 hrs.
State-of-the-art lecture Prostate cancer: Family care for patients and spouses