Couples Coping with Cancer: Implementation and Recruitment Strategies

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Couples Coping with Cancer Implementation and
Recruitment Strategies

• Gretchen Zunkel, PhD, CNS, RN
• April 21, 2006

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Purpose The long-term goal for this program of
research is to develop intervention strategies
for the patient-partner dyad following diagnosis
and treatment of early stage breast cancer.
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Goals

• The short-term goals are to develop recruitment
  strategies and determine the feasibility of
  implementing Mindfulness-Based Stress Reduction
  (MBSR) as an intervention program with outcomes
  of enhanced stress related coping skills,
  decreased depression, anxiety, and improved sleep
  quality. A sub-goal is determine whether
  relationship quality is improved.

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Background for Research Project Couples Coping
with Cancer

• Dis-synchronous illness trajectories- couples may
  have different patterns of reaction and response
  over the course of the illness
• Holding different explanatory models
• Differing views of responsive and supportive
  behaviors
• Gender related communication issues

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Patient and family are partners in the health
care process

• Impact of cancer diagnosis affects all family
  members
• Stresses and uncertainties of illness can be
  overwhelming
• For some families quality of life deteriorates
• Other families become more resilient

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Partners experience stress

• Family members report stressors of their own
  during the illness experience
• Partners report mood disturbance, sleep
  disorders, and work disruption
• Partners have reported feeling helpless and
  isolated
• When their help is most needed, these life crises
  may overwhelm significant others

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Interpersonal interaction

• So much of what people do involves interaction
  with others interpersonal functioning has the
  potential to be of great importance in the
  stress-coping response.
• The tasks or issues are shaped by the partner
  relationship and by what each partner does as
  well as how the other responds.

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Communication issues

• Relationship talk-improved adjustment for women
• Some supportive attempts are delivered
  effectively and other fail to provide support
  even though delivered with good intentions
• Unhelpful responses characterized by lack of
  empathy or change of focus
• If perceived responsiveness is low, support group
  was an alternative
• (Pistrang Barker, 1995)

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Couple-Focused Intervention

• 6 sessions of a couple-focused group
  intervention
• Lower depressive symptoms in active group
• Women with unsupportive partners benefited most
• Women with more physical impairment benefited
• (Manne et al., 2005)

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Why Mindfulness-Based Stress Reduction?

• Individual intervention shown effective in both
  clinical
• and non-clinical populations
• Potential for positive outcomes in both patient
  and partner
• Empirical evidence for decreased depression,
  anxiety,
• improved sleep
• Process of engaging in intervention as a couple
  may
• improve marital satisfaction and closeness

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Implementation

• Discuss study with potential participant
• Send out information and measurement packet
• Retention and accrual
• Analyzing the data

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Recruitment Strategies

• Recruitment strategies
• Building base for collaboration
• Letters and flyers to clinicians
• Post-cards and letters to be mailed to patients
• Speaking at support groups
• Meet and greet oncologists who are in direct role
  to encourage enrollment

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Card Ad- mailing to potential participants

• Couples Coping with
• Breast Cancer
• Join an 8 week program for women with early stage
  breast cancer and their male partners. Help
  University of Minnesota School of Nursing
  researchers understand the ways that couples
  respond to and manage a diagnosis of breast
  cancer. Mindfulness-Based Stress Reduction is a
  program that will teach you skills designed to
  reduce stress in your life. The program consists
  of 8 2-1/2 hour sessions and a one day retreat
  during which you will learn to practice
  meditation with some light yoga. The group
  sessions will be held on Friday afternoons.
• For information, please contact Gretchen Zunkel,
  PhD, RN, CNS at 612-624-5435 or zunke004_at_umn.edu
• This program is sponsored by the University of
  Minnesota Center for Health Trajectory Research

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Brochure
Who is Eligible We are recruiting couples women
with a diagnosis of early stage breast cancer
(who are within 9 months of diagnosis) and their
male spouses/partners. Both members must be able
to complete the questionnaires in English. If
you are unable to participate in this study, you
can leave your name and we will contact you for
future studies. We need your permission to keep
your name and address on file.

• Couples Coping with Breast Cancer
• You are invited to participate in a research
  study to test a program that will teach you a
  technique called Mindfulness-Based Stress
  Reduction developed by Jon Kabat-Zinn. The skills
  in this program are designed to provide you with
  ways to reduce stress in your life. The program
  consists of 8 2-1/2 hour sessions and a one day
  retreat during which you will learn to practice
  meditation with some light yoga. Your
  participation will help researchers to understand
  the ways that couples respond to and manage a
  diagnosis of breast cancer.

What We Ask of You Contact us at the phone number
listed You will receive a phone call to
determine if you are eligible for the study. If
you are eligible, you and your partner will be
invited to participate in an 8 week
Mindfulness-Based Stress Reduction program Before
and after the 8 week program, and 3 months later,
you will each fill out a packet of questionnaires
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Challenges

• Obtaining consent from both members of the couple
• Schedule intervention so both people can
  participate
• Work around chemotherapy and radiation
• HIPPA is a barrier to communication with
  clinicians about prospective subjects