Couples Coping with Cancer: Implementation and Recruitment Strategies

1. Couples Coping with Cancer: Implementation and Recruitment Strategies GretchenZunkel, PhD, CNS, RN April 21, 2006

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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.

8. 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)

9. 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)

10. 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

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

12. 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

13. 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@umn.edu • This program is sponsored by the University of Minnesota Center for Health Trajectory Research

14. 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. 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 • 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.

15. 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