Study protocol for the Exercising Together© trial: a randomized, controlled trial of partnered exercise for couples coping with cancer

Background Most cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental, and relational health in couples coping with breast, prostate, or colorectal cancer. Methods Survivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: (1) Exercising Together© where partners train as a team in a supervised group setting; (2) separate supervised group exercise classes for survivors or partners, respectively; (3) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL, and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow-up (12 months). Discussion Exercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship. Trial registration ClinicalTrials.govNCT03630354. Registered August 14, 2018

Study Protocol for the Exercising Together© Trial: A Randomized, Controlled Trial of Partnered Exercise for Couples Coping with Cancer

Background Most cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental and relational health in couples coping with breast, prostate or colorectal cancer. Methods Survivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: 1) Exercising Together© where partners train as a team in a supervised group setting, 2) separate supervised group exercise classes for survivors or partners, respectively, 2) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF-alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow up (12 months). Discussion Exercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship.

Financial distress and its associated burden in couples coping with an advanced cancer

Purpose As the economic burden and financial distress (FD) resulting from cancer care are increasingly recognized, FD remains inadequately understood from the perspective of patients and their spousal caregiver, the relational context where most financial and treatment decisions are navigated. Therefore, we assessed FD in both patients with advanced cancer and their spouses to identify symptom and QOL correlates. We additionally examined if illness communication moderated the association between FD and QOL. Methods Patients undergoing treatment for stage III/IV lung cancer or grade III/IV primary brain tumor and their spouses completed measures of their own FD, QOL, symptoms, perception of their spouse’s symptoms, and overall illness communication. Results Patients (62.7%) and spouses (64.7%) endorsed FD; however, spouses rated FD with greater relative severity. For both, FD was associated with greater anxiety, depression, and poorer physical QOL. For patients, FD was additionally associated with poorer mental QOL. Spousal caregivers accurately perceived patient FD, yet patients underreported spouse’s FD by a clinically meaningful difference. A 3-way interaction (FD X role X illness communication) revealed (b = .40, p = .041) that illness communication moderated the association between FD and physical QOL for spouses only. Conclusion In the advanced cancer setting, FD is prevalent in both patients and their caregivers and associated with psychological distress and poor physical QOL. Results suggest that optimal FD interventions should include patients and spouses. As illness communication appears to buffer the negative association of FD with physical QOL, studies targeting illness communication deficits in couples facing advanced disease are warranted.

742 Linkages between sleep quality and mental health among couples coping with type 1 diabetes across survey and daily diary methods

Introduction Sleep serves an important role in maintaining and promoting metabolic and mental health. The interdependent nature of couple relationships makes examining sleep quality from a dyadic perspective critical. This study examined the effect of sleep quality on mental health among couples coping with type 1 diabetes across survey and daily diary methods and investigated whether relationship satisfaction moderated these relations. Methods 199 persons with type 1 diabetes (Mage = 46.82) and their spouses (Mage = 46.41) completed one survey questionnaire reporting their own sleep quality (PSQI), depressive symptoms (CESD), and relationship satisfaction (CSI). They also completed 14-day diaries reporting on their own sleep quality and negative affect. The actor-partner interdependence model and multi-level model were used to examine the effect of sleep quality on mental health across the cross-sectional and daily diary surveys. Multi-level modeling examined effects of within-person and between-person effects of sleep quality on next-day daily negative affect (controlling for prior day affect). Results Cross-sectional survey data revealed an association between poorer global sleep quality and higher depressive symptoms for both partners (actor effects). Spouses’ poorer sleep quality was associated with higher depressive symptoms for persons with T1D (partner effects). Daily diary data demonstrated an association between within-person and between-person effects of own poor sleep quality and higher negative affect for both partners. Poorer daily sleep quality for persons with T1D was associated with higher negative affect for spouses (partner effects). When examining the moderating role of relationship satisfaction, spouses’ poorer overall sleep quality was associated with greater depressive symptoms and overall negative affect respectively for those with lower relationship satisfaction but not for those with higher relationship satisfaction across both methods. Conclusion Findings support the conceptualized link between sleep quality and mental health as both an intraindividual and dyadic process among couples coping with T1D across survey and daily diary methods. Additionally, better relationship satisfaction may buffer the effect of overall poor sleep quality on mental health for spouses. Support (if any) This work was supported by NIH NIDDK program project grant (DP3DK103999). Individual support was provided by T32 MH019986 (ELT).

Couples Coping With the Serious Illness of One of the Partners

Chronic kidney failure is a serious somatic disease. Addressing the issue of living with a chronic disease means fully considering the patients’ entourage, their families, and those close to them, especially their children and spouses.Objectives: The present paper focuses on the couple’s psychological experience when one of them suffers from a chronic disease, in this instance kidney disease. In particular, how is the spouse affected by the treatment provided? The aim is not only to see how care for sick people can be improved, but also, more specifically, how relatives and especially partners can receive attention.Methodology: A qualitative approach is not only adopted, being based on the psychotherapeutic follow-up of the partners of patients with chronic kidney disease, but also of the patients themselves, addressing the matter of their life as a couple. Three couples were considered, and two case studies are presented here. The issues that cut across these different situations are examined.Results and Discussion: Some couples show considerable resourcefulness. However, over the years, that capacity for adaptation and inventiveness can also be interrupted by the periods of greater suffering and even despair, especially when the somatic pathology becomes chronic. Many spouses talk about how living with a sick partner weighs down on them, causing severe fatigue. Some aspects of the illness can also become traumatic. The disease regularly disrupts the daily life of the couple and the family. This leads to a reworking of family relations. Each couple has its own history with the condition. As it emerges, it can disrupt the bonds of filiation, especially when the illness is hereditary. Making psychological care more accessible to the partners involved constitutes a major challenge for our hospital care systems.

The Experienced Benefits of the 17-Item Benefit Finding Scale in Chinese Colorectal Cancer Survivor and Spousal Caregiver Couples

The specific aims of the present study were twofold: (i) to examine the psychometric properties of a Chinese version of the 17-item Benefit Finding Scale (BFS-C), and (ii) to explore the experienced benefits in colorectal cancer (CRC) survivors and their spousal caregivers (SCs). A total of 286 CRC survivors and SCs participated in the investigation, which assessed participant variables of demographic characteristics and benefit finding (BF). Statistical methods applied were confirmatory factor analysis (CFA), Cronbach’s α, Pearson’s correlation, Kappa coefficient, paired t-tests, and one-way ANOVAs. CFA analysis supported a three-factor model for structure validity. All Cronbach’s α for BFS-C was greater than 0.870 in both CRC survivors and SCs. The test–retest correlations at the scale level ranged from good to excellent for CRC survivors (r = 0.752–0.922), and from moderate to good for SCs (r = 0.469–0.654). There were moderate to high correlations between CRC survivors and SCs in all of the paired BFs (all Ps < 0.001, r = 0.332–0.575). This report provided the satisfactory psychometric properties of the BFS-C in such aspects as construct validity, internal, and test–retest reliability among couples coping with CRC in China. Healthcare professionals need to treat couples as a unit and develop dyadic interventions to improve dyadic BF when supporting CRC survivors.