Development and pilot test of a dyadic psychosocial intervention for couples coping with head and neck cancer.

Abstract

187 Background: Patients receiving radiotherapy for head and neck cancers (HNCs) experience significant persistent side effects such as abnormally reduced salivation, difficulty swallowing, and taste changes. To control these side effects and minimize discomfort, intensive self-care protocols are prescribed, but adherence is poor. Spouses/partners play a critical role in supporting adherence, but often lack knowledge, experience high rates of distress, and display poor communication that can interfere with patient self-management and self-care. Methods: We developed and pilot-tested a skills-training intervention comprised of tailored manuals and 6 counseling sessions delivered over the telephone to HNC patients and their partners. The goal is to reduce healthcare utilization and improve patient and partner quality of life (QOL). To guide the development and content of the intervention, qualitative interviews with 6 HNC patients (83% male) and 6 spouses were analyzed using a grounded theory approach. For the pilot test, couples completed surveys prior to initiating radiotherapy and were randomized to the intervention or usual medical care. Eight weeks later, they completed follow-up surveys. Results: Based on the qualitative findings, we developed the intervention to teach: 1) self-management skills; 2) communication skills; and 3) strategies to improve communal coping and confidence in the ability to work as a team. To date, 20 couples (Mean Age = 57 years; SD = 8) have participated. Solid recruitment (83%) and low attrition rates demonstrate feasibility. Strong program evaluations (Mean = 8.7 out of 10) and homework completion rates (85%) support acceptability. Conclusions: This is the first program in HNC that actively involves both members of the couple to address barriers in the home environment in which self-management occurs. By empowering couples with the skills to coordinate care and support, the program holds great promise for improving self-management behaviors, reducing costly hospitalizations and treatment interruptions, and improving patient and partner QOL.