Karen Kayser

The relationship between dyadic coping and marital quality: a 2-year longitudinal study

Previous studies have revealed that the ways couples deal with stress in their lives are significantly associated with their marital quality and overall marital functioning. However, there has been little empirical evidence linking dyadic coping with marital quality over time. This study addresses the relationship between dyadic coping and marital quality among 90 couples over a period of 2 years. The results reveal that dyadic coping was significantly associated with marital quality over 2 years. For women, both their own dyadic coping and that of their partner were significant predictors, whereas for men only their own dyadic coping was predictive. The results are discussed with regard to prevention of marital distress.

WOMEN COPING WITH CANCER

Using a perspective based on relational theory, the influence of several relationship factors on womens adjustment to cancer was examined in 49 cancer patients, all mothers with young children. The results indicated that women who report higher mutuality, fewer self-silencing beliefs, and fewer coping strategies of protective buffering experience a more positive psychosocial adaptation to cancer.

A review of couple-based interventions for enhancing women's sexual adjustment and body image after cancer.

Despite the growing interest in couple-based interventions for women with cancer, only few of these interventions primarily focus on improving women’s sexual and body image. A review of studies that investigated the impact of an intervention on women’s sexual adjustment and/or body image was conducted. Twelve studies met inclusion criteria for this review: 8 randomized control trials, 2 pilot randomized control trials, and 2 quasi-experimental designs. Our analysis revealed that interventions that produce stronger effects tend to be couple-focused and include treatment components that (1) educate both partners about the woman’s diagnosis and treatments, (2) promote couples’ mutual coping and support processes, and (3) include specific sexual therapy techniques to address sexual and body image concerns. Future intervention research should incorporate randomized, controlled clinical trial designs conducted according to the revised CONSORT (Consolidated Standards of Reporting Trials); include measures of body image, sexual satisfaction, and sexual dysfunction; have adequate statistical power; and include more diverse samples, especially women who are younger or from minority or less-educated groups.

Do Couple-Based Interventions Make a Difference for Couples Affected by Cancer?: A Systematic Review

BackgroundWith the growing recognition that patients and partners react to a cancer diagnosis as an interdependent system and increasing evidence that psychosocial interventions can be beneficial to both patients and partners, there has been a recent increase in the attention given to interventions that target couples. The aim of this systematic review was to identify existing couple-based interventions for patients with cancer and their partners and explore the efficacy of these interventions (including whether there is added value to target the couple versus individuals), the content and delivery of couple-based interventions, and to identify the key elements of couple-based interventions that promote improvement in adjustment to cancer diagnosis.MethodA systematic review of the cancer literature was performed to identify experimental and quasi-experimental couple-based interventions published between 1990 and 2011. To be considered for this review, studies had to test the efficacy of a psychosocial intervention for couples affected by cancer. Studies were excluded if they were published in a language other than English or French, focused on pharmacological, exercise, or dietary components combined with psychosocial components, or did not assess the impact of the intervention on psychological distress (e.g., depression, anxiety) or quality of life. Data were extracted using a standardised data collection form, and were analysed independently by three reviewers.ResultsOf the 709 articles screened, 23 were included in this review. Couple-based interventions were most efficacious in improving couple communication, psychological distress, and relationship functioning. Interventions had a limited impact on physical distress and social adjustment. Most interventions focused on improving communication and increasing understanding of the cancer diagnosis within couples. Interventions were most often delivered by masters-level nurses or clinical psychologists. Although most were delivered in person, few were telephone-based. No difference in efficacy was noted based on mode of delivery. Factors associated with uptake and completion included symptom severity, available time and willingness to travel.ConclusionGiven effect sizes of couple-based interventions are similar to those reported in recent meta-analyses of patient-only and caregiver-only interventions (~d=.35-.45), it appears couple-based interventions for patients with cancer and their partners may be at least as efficacious as patient-only and caregiver-only interventions. Despite evidence that couple-based interventions enhance psycho-social adjustment for both patients and partners, these interventions have not yet been widely adopted. Although more work is needed to facilitate translation to routine practice, evidence reviewed is promising in reducing distress and improving coping and adjustment to a cancer diagnosis or to cancer symptoms.

Partner support and changes in relationships during life-threatening illness : Women's perspectives

Abstract This study examined the role of the primary partnered relationship as a factor in womens adjustment to cancer. Data from semistructured interviews with 40 women, in combination with their scores on a standardized measure of the mutuality of the relationship, allowed for an investigation of the following questions: How do women with cancer perceive the effect of their illness on their primary partnered relationship? What types of support do women receive from their partners during the illness experience? Is this support adequate? What is the relationship between the mutuality of the primary partnered relationship and the support provided by the partner? The results indicated that the type of support the partner provides as well as the mutuality of the relationship contribute positively to womens coping. Thus, the mutuality of womens primary partnered relationships should be assessed routinely, and psychosocial interventions should sensitize couples to the benefits of enhanced mutuality during the illness experience.

A pilot randomized controlled trial of the feasibility of a self-directed coping skills intervention for couples facing prostate cancer: Rationale and design

BackgroundAlthough it is known both patients’ and partners’ reactions to a prostate cancer diagnosis include fear, uncertainty, anxiety and depression, with patients’ and partners’ reactions mutually determining how they cope with and adjust to the illness, few psychosocial interventions target couples. Those that are available tend to be led by highly trained professionals, limiting their accessibility and long-term sustainability. In addition, it is recognised that patients who might benefit from conventional face-to-face psychosocial interventions do not access these, either by preference or because of geographical or mobility barriers. Self-directed interventions can overcome some of these limitations and have been shown to contribute to patient well-being. This study will examine the feasibility of a self-directed, coping skills intervention for couples affected by cancer, called Coping-Together, and begin to explore its potential impact on couples’ illness adjustment. The pilot version of Coping-Together includes a series of four booklets, a DVD, and a relaxation audio CD.Methods/designIn this double-blind, two-group, parallel, randomized controlled trial, 70 couples will be recruited within 4 months of a prostate cancer diagnosis through urology private practices and randomized to: 1) Coping-Together or 2) a minimal ethical care condition. Minimal ethical care condition couples will be mailed information booklets available at the Cancer Council New South Wales and a brochure for the Cancer Council Helpline. The primary outcome (anxiety) and additional secondary outcomes (distress, depression, dyadic adjustment, quality of life, illness or caregiving appraisal, self-efficacy, and dyadic and individual coping) will be assessed at baseline (before receiving study material) and 2 months post-baseline. Intention-to-treat and per protocol analysis will be conducted.DiscussionAs partners’ distress rates exceed not only population norms, but also those reported by patients themselves, it is imperative that coping skills interventions target the couple as a unit and enhance both partners’ ability to overcome cancer challenges. This pilot study will examine the feasibility and potential efficacy of Coping-Together in optimising couples’ illness adjustment. This is one of the first feasibility studies to test this innovative coping intervention, which in turn will contribute to the larger literature advocating for psychosocial care of couples affected by prostate cancer.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000438954

Disaster Relief Within a Collectivistic Context : Supporting Resilience After the Tsunami in South India

Abstract Until recently, most research on catastrophic events has focused on human outcomes with limited exploration of related adaptational processes. The little knowledge we have is based upon events occurring in the western world, despite the higher frequency of disasters in the nonwestern world. This study examines the cultural context of coping among survivors of the 2004 tsunami in Tamil Nadu, India. A non-probability, purposive sample of ten emergency responders, who represented a broad range of professions and were directly involved with relief efforts along the coast of South India, were interviewed individually one year after the tsunami. Data were collected using a semi-structured interview format with open-ended questions. Consistent with the collectivistic culture in India, content analysis was conducted using the Listening Guide methodology. Interpretive analysis revealed five common ways of coping: (1) returning to routine, (2) rebuilding family structures, (3) communal sharing of resources, (4) emotional expression of grief and loss to a supportive listener, and (5) finding benefits from the disaster experience. While these coping efforts may generally appear to be universal among people experiencing a natural disaster, findings reveal key aspects of the collectivistic cultural context of southern India. Discussion of the findings presents a compelling case for in-depth training of disaster responders in cross-cultural practice in order to effectively address the needs of survivors of mass level trauma.

The Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE): Meeting the Challenge of Interprofessional Education

UNLABELLED Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in todays health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. DESIGN An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. SETTING/SUBJECTS The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. MEASUREMENTS Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. RESULTS Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. CONCLUSION Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes.

“You need something like this to give you guidelines on what to do”: patients' and partners' use and perceptions of a self-directed coping skills training resource

PurposeThis study aims to report on the acceptability of a self-directed coping skills intervention, called Coping-Together, for patients affected by cancer and their partners, including the strengths and limitations of the intervention design.MethodsThis initial version of Coping-Together included a series of four booklets, which aimed to provide practical coping strategies for the day-to-day management of common physical and psychosocial challenges. Thirty semi-structured interviews were conducted with 27 patients and/or 14 partners. Interviews were audiorecorded, transcribed verbatim, and analyzed for content.ResultsParticipants endorsed the self-directed format, and the focus of Coping-Together on practical information was a feature that set it apart from other resources. The majority of participants interviewed felt that the proposed coping strategies were “doable”; however, only half of the participants reported learning new coping skills after reading the booklets. Additional benefits of reading the booklets were increasing awareness of challenges to prepare for, giving hope that something can help you “pull through”, providing a sense of normality, connecting patients and partners to people and services, and complementing support received from health professionals. Despite the general acceptability of the intervention, some aspects of its design were criticized, including the workbook-like exercises, expectations about using the resource together, level of guidance provided, and amount of information included. In general, most participants felt that too much negative information was included, whereas more experiential information was desired.ConclusionsPreliminary evaluation of Coping-Together supported its practical approach and highlighted improvements to enhance its contribution to patient and partner coping.

Bridging the Gaps: An Interdependent Model for Educating Accountable Practitioners

Abstract This article presents an Interdependent Model that integrates field instruction with the clinical and research curricula to educate students to become accountable practitioners. It describes the application of this model in teaching single-system evaluation to social work students with support from faculty, field advisers, and agency practitioners who provide field supervision. The merits of using this model as compared to other more common, less comprehensive approaches to social work education are examined. Issues relating to the implementation of the Interdependent Model are also discussed.