Efficacy of problem-solving therapy for spouses of men with prostate cancer: A randomized controlled trial.

OBJECTIVE: Prostate cancer can have a significant negative impact on patients and their spouses. Problem-solving therapy (PST) has been shown to help reduce distress and improve quality of life among cancer and caregiver populations. This study tested the efficacy of PST for spouses of men with prostate cancer. METHODS: Spouses of men diagnosed with prostate cancer within the past 18 months (N = 164) were randomly assigned to PST (n = 78) or usual psychosocial care (UPC; n = 86). Spouses completed measures of constructive and dysfunctional problem solving, cancer-related distress, mood, physical and mental health, and dyadic adjustment at preintervention and post-intervention and 3-month post-intervention follow-up. RESULTS: Constructive problem solving increased from pre-intervention to post-intervention among spouses receiving PST but not for spouses receiving UPC; this was maintained at follow-up. There was no decrease in dysfunctional problem solving. Spouses receiving PST versus UPC reported less cancer-related distress post-intervention and at follow-up. There were no significant changes in mood or physical and mental health. Dyadic adjustment was significantly better for spouses receiving PST versus UPC at post-intervention but not at follow-up. Improvements in constructive problem solving mediated better mood and dyadic adjustment post-intervention. CONCLUSIONS: Results support the efficacy of PST for improving spouses' constructive problem solving. There was evidence of both direct and mediated positive effects of PST for both individual and dyadic adjustment. PST may be useful for improving individual and dyadic outcomes for spouses of men with prostate cancer.

A cluster randomized controlled trial to increase breast cancer screening among African American women: the black cosmetologists promoting health program.

BACKGROUND: African American women have disproportionately higher rates of breast cancer mortality than all other ethnic groups, thus highlighting the importance of promoting early detection. METHODS: African American women (N = 984) from San Diego, California, participated in a randomized controlled trial testing the efficacy of breast cancer education sessions offered in beauty salons. Cosmetologists received ongoing support, training, and additional culturally aligned educational materials to help them engage their clients in dialogues about the importance of breast cancer early detection. Posters and literature about breast cancer early detection were displayed throughout the salons and cosmetologists used synthetic breast models to show their clients how breast cancer lumps might feel. Participants in the control group received a comparable diabetes education program. Baseline and 6-month follow-up surveys were administered to evaluate changes in women's breast cancer knowledge, attitudes, and screening behaviors. RESULTS: This intervention was well received by the participants and their cosmetologists and did not interfere with or prolong the client's salon visit. Women in the intervention group reported significantly higher rates of mammography compared to women in the control group. Training a single educator proved sufficient to permeate the entire salon with the health message, and salon clients agreed that cosmetologists could become effective health educators. CONCLUSIONS: Cosmetologists are in an ideal position to increase African American women's breast cancer knowledge and adherence to breast cancer screening guidelines.

Dyadic concordance among prostate cancer patients and their partners and health-related quality of life: does it matter?

Serious and chronic illnesses occur within a family context, affecting not only the patient but also the spouse/partner, children and extended family network. Spouses/partners are likely to experience the greatest personal impact, and may influence patient adjustment. Also, the intimate relationship may be affected by the illness experience. This study examined whether dyadic concordance on the characteristics of prostate cancer (PC) was related to health-related quality of life (HRQOL), psychological distress and marital adjustment in PC patients and their female partners. Couples (N=164) completed questionnaires on the appraisals of PC, and individual and dyadic adjustment. Patient and partner PC appraisal ratings were positively correlated. There was a general pattern of patients and partners in concordant dyads, versus those in dyads in which spouses maximised or minimised PC characteristics, reporting significantly better individual HRQOL outcomes, although there were several exceptions. Patient-partner appraisal (dis)agreement generally did not significantly predict dyadic adjustment. Overall, results suggest that dyadic disagreement is associated with worse HRQOL in couples facing PC.

Increasing Asian American women's research participation: the Asian grocery store-based cancer education program.

BACKGROUND: Research study participants with diverse characteristics produce the most generalizable outcomes, but recruiting heterogeneous samples is difficult. METHODS: This pilot study tests whether Asian women (N=1079) with diverse language proficiencies, who were personally recruited to one study by a linguistically and culturally aligned recruiter, would enroll in another study with a single mailed invitation in English. RESULTS: The 134 participants in the second study represented 17.2% of those 779 women who had completed both baseline and follow-up surveys in the original study, making this characteristic the best predictor of future study participation. Of the 303 women in the first study who said they would be willing to participate in future studies, 17% (51) participated in the second study. Of the 733 who said they would not be willing to participate in future studies, 11% (83) participated. However, given the larger size of this group, researchers may recruit a greater absolute number of participants from it. While this rate of participation was less than the 25% rate achieved in the first study, the second study's single, mailed English language invitation was likely a barrier to participation. CONCLUSION: Securing IRB-approval to invite prior study participants from traditionally underrepresented communities to a new study is a strategy investigators can use to increase the diversity of their samples. Further research is warranted to determine whether Asian women who have participated in one study might also become effective recruiters for future studies.

Fatigued breast cancer survivors: the role of sleep quality, depressed mood, stage and age.

Cancer-related fatigue is associated with lower health-related quality of life and the majority of breast cancer survivors experience persistent fatigue after finishing treatment. The present study examines age, cancer stage, sleep quality and depressed mood as predictors of five dimensions of fatigue in 70 fatigued breast cancer survivors who no longer evidenced any signs of cancer and were finished with treatment. Discriminant function analyses were used to predict fatigue subgroup membership (higher, lower) from age, stage, mood and sleep for five subtypes: General, Mental, Emotional, and Physical fatigue, and Vigour. Significant discriminant functions were found for all subtypes. Findings suggest that age, staging, mood and sleep are all important predictors, but there are differential relationships when subtypes of fatigue are considered. Given current limitations in treating fatigue directly, interventions targeting mood and sleep should be considered as alternate approaches to reduce fatigue.

Breast cancer knowledge, attitudes, and screening behaviors among African American women: the Black cosmetologists promoting health program.

BACKGROUND: African American women have higher rates of breast cancer mortality than their white counterparts. Studies have suggested that this is partly caused by discovery of cancer at a later stage, highlighting the importance of encouraging early detection of breast cancer in this population. To guide the creation of a breast cancer education intervention and help focus other health educators' and clinicians' health promotion efforts, this study explored whether a cohort of African American women living in San Diego would demonstrate the possession of adequate baseline knowledge about breast cancer screening and adherence to widely recommended screening guidelines. METHODS: African American women (N = 1,055) from San Diego, California participated in a beauty salon-based survey about breast cancer knowledge, attitudes, and screening practices. Women's ages ranged from 20 to 94 years, with average age of 42.20 (SD = 13.53) years. Thirty-four percent reported completing college and/or some graduate school training, and 52% reported having some college or post high school formal training. Seventy-five percent of the sample reported working outside their home. Participating cosmetologists and their salons were recruited to the study through word-of-mouth referral by highly respected African American community leaders. RESULTS: Salon clients reported low rates of adherence to recommended breast cancer screening guidelines. Of the 1,055 participants, 31% reporting performing breast self-exam every month. Of those participants 40 and older, 57% reported having had a clinical breast exam and 43% reported having had a mammogram in the past year. Knowledge of breast cancer was associated with adherence to screening guidelines. While women recognized the serious health threat that breast cancer poses and that early detection of breast cancer is important, only 30% of women reported feeling well informed about the disease. Many participants demonstrated a lack of basic knowledge about breast cancer. The Health Belief Model postulates that access to such information is an essential element in the progression toward engaging in screening behaviors. CONCLUSION: Data from this study reflect a continuing need for increased breast cancer education for African American women. In light of the considerable mainstream information available related to breast cancer, these data reinforce the need for more breast cancer education programs that are clearly intended to attract the attention of African American women.

Costs of recruiting couples to a clinical trial.

Multiple barriers contribute to the slow recruitment of participants to research studies, which in turn extends the time required to translate promising scientific discoveries into proven therapeutic interventions. A small but growing literature is developing on the extraordinary costs of recruiting participants to studies, and thereby demonstrating that underestimating the cost of participant recruitment can contribute to these recruitment problems. These recruitment challenges and costs are exacerbated when the participants' study eligibility is determined by relatively narrowly defined illness parameters. Recruitment challenges are further compounded when dyads (two individuals engaged in a sociologically significant relationship, such as husbands and wives, siblings or extended families) must be recruited to an illness-focused study. For these latter groups, there are no data to guide researchers in how to anticipate those participant recruitment costs. This paper describes the staff costs for a variety of strategies used to recruit participants to a randomized supportive care study for couples who were within 18 months of a prostate cancer diagnosis. Pegged to the value of the U.S. dollar for the period, the average cost of staff time was $288 per recruited and enrolled dyad, plus a promised additional $100 incentive for study retention. Within the strategies used, the staff costs per recruited dyad ranged from $152 to $1688. Accrual per strategy ranged from 0 to 107 enrolled couples. When asked for secondary sources of information about the study, many participants reported more than one source of study referral, reflective of the multifaceted recruitment strategies deployed. In spite of innovative, culturally competent, and broad based recruitment methods, attainment of a diverse sample was difficult to accomplish in this study. Having estimates of the actual cost of recruiting dyads to research studies can help investigators prepare realistic study budgets.

Identifying problems faced by spouses and partners of patients with prostate cancer.

PURPOSE/OBJECTIVES: To describe problems chosen as targets of problem-solving therapy by spouses and partners of patients with prostate cancer. DESIGN: Descriptive, cross-sectional. SETTING: Spouses' and partners' homes. SAMPLE: Spouses and partners (N = 66) aged 32-79 years (mean = 60 years). The sample was predominantly Caucasian (82%) and African American (8%). METHODS: As part of a randomized clinical trial, women received problem-solving therapy to help manage issues related to their husbands' or partners' prostate cancer. The issues they chose to address during therapy and the categorization of the issues fell into four groups: treatment and side-effect issues, patient issues, family issues, and spouse issues. Scores on the Social Problem-Solving Inventory-Revised, which measures everyday problem-solving skills, and the Profile of Mood States, which measures mood disturbance, were contrasted with the problems women chose to address. MAIN RESEARCH VARIABLES: Problems faced by spouses and partners of patients with prostate cancer. FINDINGS: The most frequently reported categories were spouse issues (e.g., women's emotional wellness, balancing their medical concerns with their husbands' condition) and patient issues (e.g., men's lack of communication, fear, or depression). CONCLUSIONS: Findings of this study alert nurses to a variety of key problem areas for spouses and partners of patients with prostate cancer. IMPLICATIONS FOR NURSING: Spouses and partners play a critical role when their loved ones have cancer. Understanding the problems spouses and partners face can help nurses design optimal supportive care interventions.

Correspondence between daily and weekly fatigue reports in breast cancer survivors.

Fatigue is a contributor to decreased quality of life and one of the most common symptoms reported by cancer survivors. Most assessment of fatigue has been retrospective and/or unidimensional. Single-item visual analogue scale ratings are commonly used, despite arguments that fatigue is better conceptualized as multidimensional. The relationships of daily to weekly ratings of fatigue, or of unidimensional to multidimensional assessments, have not been explored. Twenty-five breast cancer survivors provided daily ratings of fatigue and completed the Multidimensional Fatigue Symptom Inventory-Short Form weekly for one month. Using hierarchical linear modeling, stronger relationships of weekly ratings to average and peak rather than most recent daily ratings were found. Visual analogue scale ratings shared more variance with the General Fatigue subscale than with the other four fatigue dimensions measured. Findings suggest that different information is captured by daily versus weekly reports, and that although visual analogue scale ratings can provide a quick assessment of general fatigue, they do not capture other important dimensions.

Improving the Deaf community's access to prostate and testicular cancer information: a survey study.

BACKGROUND: Members of the Deaf community face communication barriers to accessing health information. To resolve these inequalities, educational programs must be designed in the appropriate format and language to meet their needs. METHODS: Deaf men (102) were surveyed before, immediately following, and two months after viewing a 52-minute prostate and testicular cancer video in American Sign Language (ASL) with open text captioning and voice overlay. To provide the Deaf community with information equivalent to that available to the hearing community, the video addressed two cancer topics in depth. While the inclusion of two cancer topics lengthened the video, it was anticipated to reduce redundancy and encourage men of diverse ages to learn in a supportive, culturally aligned environment while also covering more topics within the partnership's limited budget. Survey data were analyzed to evaluate the video's impact on viewers' pre- and post-intervention understanding of prostate and testicular cancers, as well as respondents' satisfaction with the video, exposure to and use of early detection services, and sources of cancer information. RESULTS: From baseline to immediately post-intervention, participants' overall knowledge increased significantly, and this gain was maintained at the two-month follow-up. Men of diverse ages were successfully recruited, and this worked effectively as a support group. However, combining two complex cancer topics, in depth, in one video appeared to make it more difficult for participants to retain as many relevant details specific to each cancer. Participants related that there was so much information that they would need to watch the video more than once to understand each topic fully. When surveyed about their best sources of health information, participants ranked doctors first and showed a preference for active rather than passive methods of learning. CONCLUSION: After viewing this ASL video, participants showed significant increases in cancer understanding, and the effects remained significant at the two-month follow-up. However, to achieve maximum learning in a single training session, only one topic should be covered in future educational videos.

African-American women's perceptions of their most serious health problems.

African Americans experience a disproportionate burden of illness. According to the Centers for Disease Control and Prevention (CDC), heart disease, cancer, cerebrovascular disease and diabetes are the most common causes of mortality among African Americans. Data were gathered from 1,055 African-American women to gain their perspectives of the most serious health problems affecting African-American women and their related knowledge, attitudes and health promoting behaviors. Women listed CDC's top four causes of mortality as their top four most serious health threats. Cancer was reported as a serious health threat by 81% of the participants, whereas heart disease, the most common cause of mortality and a disease amenable to prevention and early intervention, was mentioned by only 31% of the women. Diabetes was reported by 59% of the women and cerebrovascular disease by 52%. As the Health Belief and other theoretical models would predict, awareness of the seriousness of these four disease groups among African-American women was associated with a greater likelihood of adherence for several of the recommended behaviors. Many opportunities exist for raising women's awareness of these four diseases and linking women's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.

Problem-solving and distress in prostate cancer patients and their spousal caregivers.

GOALS OF WORK: Prostate cancer, the most common life-threatening cancer among American men, increases risk of psychosocial distress and negatively impacts quality of life for both patients and their spouses. To date, most studies have examined the relationship between patient coping and distress; however, it is also likely that what the spouse does to cope, and ultimately how the spouse adjusts, will affect the patient's adjustment and quality of life. The present study examined the relationships of spouse problem-solving coping, distress levels and patient distress in the context of prostate cancer. The following mediational model was tested: Spouses' problem-solving coping will be significantly inversely related to patients' levels of distress, but this relationship will be mediated by spouses' distress levels. PATIENTS AND METHODS: One hundred seventy-one patients with prostate cancer and their spousal caregivers were assessed for mood; spouses were assessed for problem-solving coping skills. Structural equation modeling was used to test model fit. MAIN RESULTS: The model tested was a good fit to the data. Dysfunctional spousal problem-solving was a significant predictor of spouse distress level but constructive problem-solving was not. Spouse distress was significantly related to patient distress. Spouse dysfunctional problem-solving predicted patient distress, but this relationship was mediated by spouse distress. The same mediational relationship did not hold true for constructive problem-solving. CONCLUSIONS: Spouse distress mediates the relationship between spouse dysfunctional coping and patient distress. Problem-solving interventions and supportive care for spouses of men with prostate cancer may impact not only spouses but the patients as well.

Black cosmetologists promote diabetes awareness and screening among African American women.

PURPOSE: his study evaluated several factors that were thought to contribute to African American women's disproportionate incidence and sequelae of diabetes. METHODS: African American women (1055) living in San Diego County completed surveys about diabetes-related beliefs, screening behaviors, knowledge, and attitudes. Participants' ages ranged from 20 to 94 years, and 33.7% of the women reported completing college. RESULTS: Most of the women (59%) perceived diabetes to be a serious health threat to African American women. Thirty-two percent of the total sample and 37% of the high-risk group reported having been screened for diabetes within the past year. Nearly 37% reported never having been screened for diabetes, and 31% of those at above-average risk of developing diabetes could not recall ever having been screened. Women had a limited knowledge of the symptoms of diabetes, ways to decrease the risk factors and the sequelae of diabetes. Higher-risk women showed greater diabetes knowledge. CONCLUSIONS: Most participants reported that diabetes was a significant threat to their health but lacked sufficient knowledge to protect themselves from the disease. A focused, aggressive education campaign could yield better health outcomes.

Filipina American women's breast cancer knowledge, attitudes, and screening behaviors.

BACKGROUND: Filipino Americans are the fastest growing Asian minority group in the United States. There is limited knowledge about their breast cancer knowledge, screening practices and attitudes. METHODS: As part of the evaluation of the Asian Grocery Store-Based Cancer Education Program, 248 Filipino American women completed baseline and follow-up surveys, while an additional 58 took part in focus groups. RESULTS: Compliance with annual clinical breast exam guidelines among women 40 to 49 years old was 43%, and annual mammography use among women 50 and over was 56%. The Asian Grocery Store-Based Cancer Education Program and complementary focus group study identified multiple barriers that hindered women from attending education programs, with time as the most frequently reported barrier. CONCLUSION: The Asian Grocery Store-Based Cancer Education Program was reported to be a culturally acceptable and effective way of disseminating breast cancer information and one that addressed the women's most frequently reported barrier, lack of time.

Japanese American women: behaviors and attitudes toward breast cancer education and screening.

Moores University of California, San Diego, Cancer Center's Asian Grocery Store-Based Cancer Education Program trained bilingual, bicultural student health educators to provide breast cancer information to Japanese American women. A subset consented to help evaluate the program by completing baseline and follow-up surveys. Study participants reported high adherence to mammography screening guidelines, but lower than optimal adherence to clinical breast examination (CBE) and monthly breast self-examination (BSE) guidelines. While less than half of the women felt they had enough knowledge about breast cancer, nearly all indicated that they would be willing to share any knowledge they gained with loved ones and that their loved ones would be receptive to their information. A limitation of the study is its small sample.

The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer.

Dyadic adjustment and coping styles have been shown to predict levels of psychological distress following cancer diagnoses. This study examined the relationship between coping and distress in couples faced with prostate cancer, considering dyadic functioning as a third variable that potentially moderated or mediated the relationship. To investigate its influence on the success of patients' and spouses' coping efforts, both moderational and mediational models were tested using couples' composite dyadic adjustment scores. Only the moderational model was supported for patients: dyadic strength moderated the effects of avoidant coping and intrusive thinking on mood disturbance. Despite maladaptive coping, patients that were members of stronger dyads reported less distress than those in more dysfunctional relationships. Findings suggest that the relationship between coping and distress depends on the quality of dyadic functioning. Being part of a strong dyad may serve as a buffering factor, implying the need for psychosocial intervention for couples in maladjusted relationships.

Problem-solving skills and emotional distress in spouses of men with prostate cancer.

BACKGROUND: Prostate cancer, the most common cancer in American men, may increase the risk of emotional distress in patients and their spouses. Problem-solving skills may be related to the emotional distress of the spouses. METHOD: Thirty-two spouses of prostate cancer patients completed measures of problem-solving skills and emotional distress. RESULTS: Proactive problem-solving skills were related to less emotional distress in spouses. Subtypes of problem-solving skills were differentially related to emotional distress. CONCLUSIONS: Enhancement of problem-solving skills may contribute to improved health-related quality of life of spouses of prostate cancer patients.