Project Overview +

This study tests the effectiveness of a family-based program of care in improving clinical outcomes, and tests the ability of a model to predict which patients and spouses are at increased risk of poorer quality of life.

Aims +

Aim 1. Determine if the family-based intervention can improve proximal clinical outcomes (better family communication, higher self-efficacy, more problem-focused coping, and less threat, uncertainty, and hopelessness) and improve the distal clinical outcome, better quality of life, in a culturally and socioeconomically diverse sample of men with prostate cancer and their spouses.

Aim 2. Test a stress-coping model designed to predict which prostate cancer patients and their spouses are at increased risk of poorer long-term quality of life.

Participants +

Men with prostate cancer and their spouses (N=263 couples) will be followed over a 12-month period of time.

Intervention +

The objective of the study is to assess whether a family-based intervention can improve family life. We look at appraisal variables (appraisal of illness, caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress (general and prostate-specific), and quality of life in patients and their spouses during 3 phases of prostate cancer; newly diagnosed, biochemical recurrence, and advanced. The phases of the cancer and risk for distress are evaluated as to whether they create a differential effect of the intervention on patient or spouse outcomes.

Couples are stratified by three phases of illness:

  • newly diagnosed-localized phase, following prostatectomy or radiation therapy
  • post-primary treatment phase with rising PSA (biochemical recurrence)
  • advanced/metastatic phase with evidence of disease progression

They are also stratified by type of treatment received. Following stratification, couples are randomized to the control (standard care) or experimental group (standard care plus FOCUS Program). FOCUS encourages families to work as a team, communicate openly about the illness, and provide one another with support.

The FOCUS Program is administered in three face-to-face home visits and two follow-up phone calls and provides core content in five areas:

  • Family involvement
  • Optimistic attitude
  • Coping effectiveness
  • Uncertainty reduction
  • Symptom management

The programs provide tailored content related to phase of illness and treatment received. Data are collected four times: baseline, prior to the intervention (Time 1); 4 months, shortly after the completion of the intervention (Time 2); 8 months (Time 3); and 12 months (Time 4) with a set of established standardized instruments.

Findings +

There were no differences between the arms regarding quality of life variables. The intervention and control groups did not differ on appraisal variables but patients in the intervention group did report less uncertainty about their illness than controls at 4 months.

Intervention patients reported more communication about the illness with their spouses than control men at 4 months. There were no differences between groups on general or prostate-specific symptom distress.

Intervention spouses reported better physical quality of life than control spouses at 8 and 12 months. They also had better mental quality of life scores. Intervention spouses had less negative appraisal of caregiving, less uncertainty about the illness, less hopelessness, higher self-efficacy about ways to manage the illness, and less general symptom distress. The phase of illness and risk for distress did not seem to moderate the effectiveness of the intervention.

Conclusion +

Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention.