Sharon L. Manne

Intimacy‐Enhancing Psychological Intervention for Men Diagnosed with Prostate Cancer and Their Partners: A Pilot Study

INTRODUCTIONnFew couple-focused interventions have been developed to improve distress and relationship outcomes among men diagnosed with localized prostate cancer and their partners.nnnAIMSnWe examined the effects of a five-session Intimacy-Enhancing Therapy (IET) vs. Usual Care (UC) on the psychological and relationship functioning of men diagnosed with localized prostate cancer and their partners. Pre-intervention levels of psychological and relationship functioning were evaluated as moderators of intervention effects.nnnMETHODSnSeventy-one survivors and their partners completed a baseline survey and were subsequently randomly assigned to receive five sessions of IET or UC (no treatment). Eight weeks after the baseline assessment, a follow-up survey was administered to survivor and partner.nnnMAIN OUTCOME MEASURESnDistress, well-being, relationship satisfaction, relationship intimacy, and communication were investigated as the main outcomes.nnnRESULTSnIET effects were largely moderated by pre-intervention psychosocial and relationship factors. Those survivors who had higher levels of cancer concerns at pretreatment had significantly reduced concerns following IET. Similar moderating effects for pre-intervention levels were reported for the effects of IET on self-disclosure, perceived partner disclosure, and perceived partner responsiveness. Among partners beginning the intervention with higher cancer-specific distress, lower marital satisfaction, lower intimacy, and poorer communication, IET improved these outcomes.nnnCONCLUSIONSnIET had a marginally significant main effect upon survivor well-being but was effective among couples with fewer personal and relationship resources. Subsequent research is needed to replicate these findings with a larger sample and a longer follow-up.

The relationships among knowledge, self-efficacy, preparedness, decisional conflict, and decisions to participate in a cancer clinical trial

Cancer clinical trials (CCTs) are important tools in the development of improved cancer therapies; yet, participation is low. Key psychosocial barriers exist that appear to impact a patients decision to participate. Little is known about the relationship among knowledge, self‐efficacy, preparation, decisional conflict, and patient decisions to take part in CCTs.

Using the interdependence model to understand spousal influence on colorectal cancer screening intentions: a structural equation model.

BackgroundAlthough it is widely thought that the marital relationship plays a role in individuals’ decisions to have colorectal cancer screening, few studies have evaluated partner influences.PurposeWe evaluated the role of marital relationship factors such as a relational perspective on the frequency of spouse discussions about screening and screening intentions. Individual-level factors were also evaluated.MethodsOne hundred sixty-eight couples with both members non-adherent with screening completed measures of perceived risk, screening benefits and barriers, marital quality, relational perspective, discussion frequency, and screening intentions.ResultsCouples’ attitudes about screening were interdependent and one partner’s attitudes and behavior were associated with the other partner’s intention. There was also evidence of joint effects in that intentions were associated with both one’s partner’s attitudes and one’s own attitudes.ConclusionsColorectal screening intentions are associated with both partners’ attitudes as well as whether or not couples have discussed screening with one another.

Psychosocial Correlates of Sun Protection Behaviors among U.S. Hispanic Adults

The incidence of skin cancer among U.S. Hispanics increased 1.3xa0% annually from 1992 to 2008. However, little research has focused on skin cancer prevention among the rapidly growing Hispanic population. In this study, we examined theory-driven, psychosocial correlates of sun protection behaviors in a population-based sample of 787 Hispanic adults (49.6xa0% female, mean agexa0=xa041.0xa0years) residing in five southern or western U.S. states. Participants completed an English- or Spanish-language online survey in September 2011. The outcomes of focus were sunscreen use, shade seeking, and use of sun protective clothing. The correlates included suntan benefits, sun protection benefits and barriers, skin color preference, perceived natural skin protection, photo-aging concerns, perceived skin cancer risk, skin cancer worry, skin cancer fatalism, and sun protection descriptive norms. Results of multiple linear regression analyses revealed the following: sun protection barriers were negatively associated with each outcome; descriptive norms were positively associated with each outcome; perceived natural skin protection was inversely associated with sunscreen use; skin cancer worry was positively associated with shade seeking and use of sun protective clothing; skin cancer fatalism was negatively associated with shade seeking; and skin color preference was negatively associated with use of sun protective clothing. A number of additional statistically significant associations were identified in bivariate correlation analyses. This study informs the potential content of interventions to promote engagement in sun protection behaviors among U.S. Hispanics.

Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults

INTRODUCTIONnSkin cancer is the most common cancer, and its incidence is increasing. Young adults expose themselves to large amounts of ultraviolet radiation (UV) and engage in minimal skin protection, which increases their risk. Internet interventions are effective in modifying health behaviors and are highly disseminable. The current studys purpose was to test an Internet intervention to decrease UV exposure and increase skin protection behavior among young adults.nnnSTUDY DESIGNnRCT conducted in 2014, with data analyzed in 2015.nnnSETTING/PARTICIPANTSnA national sample of adults aged 18-25 years at moderate to high risk of developing skin cancer by a self-report measure was recruited online.nnnINTERVENTIONnParticipants were randomized to one of three intervention conditions: assessment only, the website of a skin cancer organization, or a tailored interactive multimedia Internet intervention program (UV4.me) based on the Integrative Model of Behavioral Prediction.nnnMAIN OUTCOME MEASURESnSelf-reported overall UV exposure and skin protection assessed at 3 and 12 weeks after baseline. Secondary outcomes were self-reported intentional and incidental UV exposure, sunburns, sunscreen use, and skin cancer screening.nnnRESULTSnFor the intervention arm, there were significant decreases in UV exposure and increases in skin protection at both follow-up time points compared with the assessment-only condition (p<0.001). The effect sizes (Cohens d) comparing the experimental and assessment-only arm for exposure behaviors were 0.41 at 3-week follow-up and 0.43 at 12-week follow-up. The effect sizes for protection behaviors were 0.41 at 3-week follow-up and 0.53 at 12-week follow-up. The control condition was not significantly different from the assessment only condition. All three conditions exhibited decreased exposure and increased protection at both follow-ups (p<0.01), but the effect was much stronger in the intervention group. Secondary outcomes were generally also significantly improved in the intervention condition compared with the other conditions.nnnCONCLUSIONSnThis is the first published report describing the results of an RCT of an Internet intervention to modify skin cancer risk behaviors among young adults. The UV4.me intervention significantly improved self-reported skin cancer prevention behaviors. Future research will investigate mechanisms of change and approaches for dissemination.nnnTRIAL REGISTRATIONnThis study is registered at www.clinicaltrials.gov NCT02147080.

Attitudinal barriers to participation in oncology clinical trials: factor analysis and correlates of barriers

Patient participation in cancer clinical trials is low. Little is known about attitudinal barriers to participation, particularly among patients who may be offered a trial during an imminent initial oncology consult. The aims of the present study were to confirm the presence of proposed subscales of a recently developed cancer clinical trial attitudinal barriers measure, describe the most common cancer clinical trials attitudinal barriers, and evaluate socio-demographic, medical and financial factors associated with attitudinal barriers. A total of 1256 patients completed a survey assessing demographic factors, perceived financial burden, prior trial participation and attitudinal barriers to clinical trials participation. Results of a factor analysis did not confirm the presence of the proposed four attitudinal barriers subscale/factors. Rather, a single factor represented the best fit to the data. The most highly-rated barriers were fear of side-effects, worry about health insurance and efficacy concerns. Results suggested that less educated patients, patients with non-metastatic disease, patients with no previous oncology clinical trial participation, and patients reporting greater perceived financial burden from cancer care were associated with higher barriers. These patients may need extra attention in terms of decisional support. Overall, patients with fewer personal resources (education, financial issues) report more attitudinal barriers and should be targeted for additional decisional support.

A qualitative analysis of couples’ communication regarding colorectal cancer screening using the Interdependence Model

OBJECTIVEnColorectal cancer screening (CRCS) uptake in the US remains low. The purpose of this study was to use qualitative methods to characterize partner support and influence regarding CRCS decisions among couples who were both either adherent or non-adherent with CRCS.nnnMETHODSnEighteen couples were interviewed regarding their discussions about CRCS and support and influence strategies used. Analyses were guided by the Interdependence Model.nnnRESULTSnDirect and indirect partner effects were found. Direct partner effects were evidenced when the impact of one spouse on the CRCS decision of the other was clearly defined and intended. Three direct partner effect themes were leadership, persuasion, and partnership. Indirect partner effects were evidenced by one spouse considering the information, experience, or actions of the other in ways that informed CRCS decision-making, even if that influence was not intentional or specifically directed at CRCS. Three indirect partner effect themes were companionship, support, and peer socialization.nnnCONCLUSIONnSpouse influence plays a role in CRCS decisions. Individuals view CRCS as being important to the health and quality of their relationship.nnnPRACTICE IMPLICATIONSnWith this increased understanding of the interpersonal context of CRCS, it may be possible to include close others in interventions to improve CRCS.

Sun protection and sunbathing practices among at-risk family members of patients with melanoma

BackgroundDespite the increased level of familial risk, research indicates that family members of patients with melanoma engage in relatively low levels of sun protection and high levels of sun exposure. The goal of this study was to evaluate a broad range of demographic, medical, psychological, knowledge, and social influence correlates of sun protection and sunbathing practices among first-degree relatives (FDRs) of melanoma patients and to determine if correlates of sun protection and sunbathing were unique.MethodsWe evaluated correlates of sun protection and sunbathing among FDRs of melanoma patients who were at increased disease risk due to low compliance with sun protection and skin surveillance behaviors. Participants (N = 545) completed a phone survey.ResultsFDRs who reported higher sun protection had a higher education level, lower benefits of sunbathing, greater sunscreen self-efficacy, greater concerns about photo-aging and greater sun protection norms. FDRs who reported higher sunbathing were younger, more likely to be female, endorsed fewer sunscreen barriers, perceived more benefits of sunbathing, had lower image norms for tanness, and endorsed higher sunbathing norms.ConclusionInterventions for family members at risk for melanoma might benefit from improving sun protection self-efficacy, reducing perceived sunbathing benefits, and targeting normative influences to sunbathe.

Erythema and ultraviolet indoor tanning: Findings from a diary study

ABSTRACTThe use of artificial ultraviolet (UV) indoor tanning (IT) beds increases the risk of skin cancer. The IT industry claims IT devices provide users with control over the amount of UV radiation exposure and thus reduces risks of sunburn (i.e., skin erythema) when tanning. This study aims to establish the prevalence and predictors of IT-related erythema using diary data. Six bimonthly diary surveys were administered to 198 female college IT users. Diaries assessed IT use and IT-related erythema. Among participants who used IT, 66xa0% experienced at least one episode of erythema and nearly one in five IT sessions resulted in skin erythema. Those who reported the most frequent IT use prior to the study were less likely to experience an IT-related erythema on a given IT session compared to the least experienced IT users. Perceived susceptibility to burns from IT use was positively associated with risk of erythema. Erythema was a frequently reported experience among IT users. Implications for policy makers and behavioral medicine practitioners are discussed.

Interpersonal influences on patients’ surgical decision making: the role of close others

Patients make medical decisions in consultation with their partner, family, and friends. However, little is known about the ways in which these close others influence their decisions, particularly with respect to discrete decisions such as those related to medical treatments. This cross-sectional study investigated their influence on the surgical decisions of inflammatory bowel disease patients referred for surgery to remove their colon (Nxa0=xa091). Guided by research on social control and classic research on power and influence in close relationships, we identified four types of close other decision influence: persuasion, assistance with understanding, indirect influence, and negative influence. Linear logistic and regression analyses showed that patients were more likely to have surgery when their close other used persuasion, and they reported lower decisional conflict when their close other helped them understand the decision. Patients were less likely to have surgery and reported greater decisional conflict when their close other used negative influence tactics. Findings demonstrate the importance of considering social context when investigating patient decision making.