A preliminary study to develop an intervention to facilitate communication between couples in advanced cancer

Abstract

Objective: Psychosocial interventions directed to couples where one has advanced cancer can reduce distress, enhance communication, and provide an opportunity for relational growth. The present study aimed to develop an intervention to facilitate communication about living with advanced cancer using the Patient Dignity Inventory (PDI) as the focus of a clinical interview with couples toward the end of life.Method: Couples were recruited from oncology and palliative care services at a Sydney hospital. After the PDI was developed and manualized as an intervention for couples, the PDICouple Interview (PDI -CI) was delivered by a clinical psychologist and comprised the following: (1) the patient completed the PDI; (2) the patient's identified partner completed the PDI about how they thought the patient was feeling; and (3) the clinician reviewed the results with the couple, summarizing areas of concurrence and discordance and facilitating discussion.Results: Some 34 couples were referred, of which 12 consented, 9 of whom completed the clinical interview. Reported benefits included enabling couples to express their concerns together, identifying differences in understanding, and giving "permission to speak" with each other. The focus of the interview around the PDI provided a structure that was particularly acceptable for men. Most couples confirmed that they were "on the same page," and where differences were identified, it provided a forum for discussion and a mutual understanding of the challenges in managing advanced cancer within a supportive context. Significance of Results: Participant couples' experiences of the PDI -CI provide valuable insight into the benefits of this intervention. This preliminary study indicates that the intervention is a relatively simple means of enhancing closer communication and connection between couples where one has advanced cancer and may be an important adjunct in helping prepare couples for the challenges inherent toward the end of life. Further investigation of feasibility with a larger sample is recommended.

The pervasive nature of uncertainty—a qualitative study of patients with advanced cancer and their informal caregivers

“…This has potential to provide an opening for early if not preventive intervention rather than waiting for other psychological sequelae to become established. A similar approach has been applied to facilitate discussion about disease progression and end of life using the Patient Dignity Inventory [ 48 ] as the focus of a clinical interview [ 49 ]. Further research is required to investigate whether the measures developed in PROACT, or trigger questions derived from them, could function in such a way to highlight some of the issues around uncertainty.…”

A forbidden topic at the end of life: “What about you after I'm gone?”

“…Cancer patients in an existentially focused Meaning‐Centered Group Psychotherapy group showed significantly better spiritual well‐being and life meaning compared with those in the control group . Furthermore, in a preliminary couples' intervention study, using the Patient Dignity Inventory, promising results such as reducing distress and relational growth were reported . In this study, “a permission to speak” about each other's concerns associated with advanced cancer, was an important component of this intervention [1: p.1384].…”

“…Although patients worry about the future of their family members, especially their spouses, end‐of‐life discussions often remain practical in nature—pain relief, funeral arrangements, and distributing personal belongings. Couples at this stage often struggle with relational distress and can benefit from couples interventions . However, discussing the surviving partner's romantic future—whether the surviving partner will stay single or find a new partner—is often avoided as it might be seen as a “forbidden topic.” Although the topic of future dating and remarriage should never be forcefully introduced, psycho‐oncologists may encourage couples to see if such a topic can help them find meaning in their life journey before death.…”

“…Long‐term couples therapy can be costly. Yet, a structured clinical interview using a focused outline (eg, Patient Dignity Inventory) could reduce duration and cost if routinely delivered by trained psych‐oncologists. More empirical studies are necessary to examine the effectiveness of existential interventions that specifically address couples' needs and concerns for the future.…”

Die Erfassung der Paarkommunikation bei Patienten mit einer fortgeschrittenen Krebserkrankung: Validierung einer deutschen Version der Couple Communication Scale (CCS)

“…Diese unterscheiden sich hinsichtlich des erfassten Aspektes der Paarkommunikation wie z. B. die Einschätzung des Kommunikationsstils [7,8], die Offenheit der Kommunikation [9], die krankheitsbezogene Kommunikation [10][11][12] oder die wahrgenommene Selbstoffenbarung [13,14]. Die CCS fügt diesem Spektrum an erfassbaren Inhalten die Einschätzung der allgemeinen Qualität und individuell empfundenen Zufriedenheit beim Austausch von Gedanken und Emotionen in der Paarkommunikation hinzu.…”