Couples coping with cancer together: Successful implementation of a caregiver program as standard of care.

OBJECTIVE: The couples coping with cancer together program (CCCT) is used to illustrate practical strategies to implement, evaluate, and grow a successful couples-based program in an NCI-designated CCC. CCCT is multimodal program utilizing psychoeducational, strategic, strengths-based, and problem-solving theoretical frameworks. CCCT integrates multiple intervention modalities, as the standard of care: patients/partners biopsychosocial screening, a standardized psychoeducational session, group intervention, and short-term couples counseling. METHODS: Implementation strategies included: (a) identifying Values-Benefits-Outcomes for key stakeholders, (b) recruiting an interdisciplinary team, (c) utilizing a concurrent development model (implementing program components in small iterations), (d) integrating program into existing institutional processes, and (e) collecting data and credibility. RESULTS: CCCT prospectively screened 1995 patients/partners simultaneously for biopsychosocial distress and 913 patient/partner completed program evaluations. Program satisfaction was extremely high: "I recommend this program, for other patients/partners (Patients 95.4% Partners 96.4%)." Ten of the 11 participating physicians anonymously surveyed responded and indicated 100% likely/very likely "to recommend the program to other physicians." CONCLUSIONS: Couples-based programs are underutilized and have been shown to be important for adjustment and increased longevity. Despite barriers in the healthcare environment, implementing couples-based programs into standard of care are feasible. These strategies may be applicable to develop supportive care programs in various health-care settings.

Disparities in managing emotions when facing a diagnosis of breast cancer: Results of screening program of couples distress.

INTRODUCTION: Distress screening is now required for cancer center accreditation. Understanding patient and caregiver stress is critical to successful cancer care. This study examines the perceived emotional impact of breast cancer on both patients and partners. METHODS: From March 2011-February 2016, patients and partners undertook an electronic, 48-point distress screen during their first visit at a surgical breast clinic. Distress was measured via self-reported concerns on a five point Likert scale. Respondents were also asked about preferred interventions. The ability of the patient and partner to manage emotions was assessed in relation to education, ethnicity, fatigue, anxiety, and depression using ordered logistic regression. RESULTS: Of the 665 individuals screened, 51.7%(n = 344) were patients, while 48.3%(n = 321) were partners. Patients were more distressed than partners regarding fatigue, anxiety, depression, and worrying about the future (p < 0.005). Only 19.7% of partners requested information with regards to "managing emotions" compared to 46.3% of patients. In the univariate analysis, being a partner was protective (OR 0.49 (95%CI 0.34-0.70, p < 0.000) as was holding an advanced educational degree (OR 0.36 (95%CI 0.14-0.93) p = 0.035). In the multivariate regression, having more education remained protective, while being a partner was no longer protective (OR 0.93(95%CI 0.62-1.39, p = 0.789). Financial concerns, anxiety, depression, and worrying about the future remained statistically significant. Partners asked for help less than patients (OR 0.28 (95%CI 0.17-0.48), p < 0.000). CONCLUSION: While partners have similar concerns as patients, they do not seek information or help in managing emotions as often as do patients. Both patient and partners with less education and increased financial distress were likely to report difficulty in managing emotions. This study identifies groups who would benefit from supportive measures even in the absence of a request for help.

Addressing psychosocial needs of partners of breast cancer patients: a pilot program using social workers to improve communication and psychosocial support.

INTRODUCTION: Psychosocial (PsySoc) distress in caregivers is a well-described entity, with some caregivers experiencing more distress than patients themselves. The American College of Surgeons' Commission on Cancer mandates that psychosocial services be provided to all cancer patients and their caregivers, through the entire continuum of cancer care. METHODS: We developed a program for newly diagnosed breast cancer patients and their partners. Both were screened for biopsychosocial stressors. The couple was then paired with two clinican-educators trained in communication and gender differences, who educated the couple in communication-based problem solving and provided referrals to supportive services. RESULTS: Eighty-six patients and 82 partners returned surveys. Compared to partners, patients were more likely to report feeling anxious or fearful (59 vs. 38%, p = 0.014), report difficulty in managing their emotions (46 vs. 11%, p = 0.003), and experience distress over being unable to take care of themselves (37 vs. 6%, p = 0.000). Interestingly, there was no difference between patients and partners in feeling unsupported by their partner (6 vs. 5%, p = 0.85) or in feeling down or depressed (29 vs. 30%, p = 0.96). DISCUSSION: Both patients and partners experience significant distress after a breast cancer diagnosis. We found that partners are equally likely to feel unsupported by their partner (patient) and feel down or depressed. Further study is needed to learn about both patients' and partners' significant distress over lack of support. Partner-focused PsySoc interventions should be initiated in all cancer centers to address the emotional needs of both breast cancer patients and their partners.