Lewis, F.M., Cochrane, B.B., Fletcher, K.A., Zahlis, E.H., Shands, M.E., Gralow, J.R., . . . Schmitz, K. (2008). Helping Her Heal: A pilot study of an educational counseling intervention for spouses of women with breast cancer. Psycho-Oncology, 17, 131–137.

To enhance spouses’ skills and confidence in communicating and interpersonally supporting their wives with breast cancer

To improve spouses’ self-care, depressed mood, anxiety, and marital adjustment

Baseline measures of the six study scales were obtained: depression, spouse skills, anxiety, self-efficacy of spouse, marital quality, and interpersonal sensitivity and mutuality. Five one-hour sessions were scheduled and delivered at two-week intervals. Details of the fully scripted educational counseling intervention session were described, and content was presented in a tabular format. Homework for each participant to complete with his wife was assigned to build skills and enhance efficacy. An exit interview with each participant and his wife was conducted. Post-test measures were taken.

• The sample (N = 40) was comprised of 20 wives with breast cancer and 20 male spouses. A total of 26 spouses consented and completed baseline inventories, after which 6 spouses dropped out of the study. A total of 20 spouses completed the intervention program and study post-test measures.
• Mean age of spouses was 53 years (SD = 9.5); mean age of wives was 48 years (SD = 8.6).
• Of the 20 wives, 19 were Caucasian and one was Black.
• Of the 20 spouses, 18 were Caucasian, one was Asian, and one declined to specify ethnicity.
• Wives were diagnosed with local or regional breast cancer (stages 0–III) within the past six months and had been diagnosed an average of 4.1 months at the beginning of the study (median time since diagnosis of 4.2 months).
• Ten wives (50%) were receiving chemotherapy, radiation therapy, or both at the time the spouses were participating in the study. Types of treatment received were breast-conserving surgery (55%) and surgical (45%), such as partial, radical, or prophylactic mastectomy.
• Of the sample, 80% of spouses and 85% of wives had college degrees or higher, and 85% of spouses and 70% of wives worked full- or part-time.
• The average length of marriage was 17.1 years (SD = 10.7), with a median of 14.8 years.
• Half (50%) of the couples had one child or more living at home.

• Multisite
• Outpatient setting
• Pacific Northwest: One-hour counseling intervention sessions were scheduled and delivered at two-week intervals in a private clinic room.

A pre/post-test pilot study design was used.

• Spouse Skills Checklist: This 11-item checklist was developed for the study and included two parts: a 5-item wife support subscale and a 6-item self-care stress management report.
• Center for Epidemiologic Studies–Depression (CES-D) Scale: This is a 20-item self-report of symptoms, with a score of 16 or higher indicating need of referral for clinical evaluation of depression. Significant (p = 0.001) reduction in depressive symptoms was reported.
• Spielberger State-Trait Anxiety (STAI-Y) Scale: Significant (p < 0.001) anxiety reduction was reported.
• Cancer Self-Efficacy Scale–Spouse (CASE-S): Total scale (19-item self-report) spouse skills significantly (p < 0.001) improved. Subscale improvements were also reported.
• Dyadic Adjustment Scale (DAS): Four subscales measured affectional expression, consensus, cohesion, and satisfaction. There was significant (p = 0.028) improvement on affectional expression, but was not significant on the remaining subscales.
• Mutuality and Interpersonal Sensitivity Scale (MIS): There were no significant changes in this 32-item measure of cancer-specific marital quality.

Depressed mood and anxiety were significantly (p = 0.001 and p < 0.001, respectively) diminished; self-efficacy was significantly improved; spousal skills were significantly (p < 0.001) improved; and marital quality was significantly (p = 0.028) improved but only on one of the affectional expression subscales. There was no significant improvement on the other subscales of marital quality. There were no significant changes in the cancer-specific measure of marital quality. Spouses verbalized that the educational counseling intervention was helpful, specifically for listening skills.

A brief, structured, skill-focused, efficacy-enhancing educational counseling intervention has the potential to positively affect spouses’ adjustment (mood and anxiety), skills, self-efficacy, and self-care during the diagnosis and treatment phase of their wife’s breast cancer. The program focuses the intervention on the spouse to reduce tension and improve interpersonal communication regarding the wife’s diagnosis, treatment, feelings, and associated emotions.

• The sample was small (< 30).
• The stated purpose and goals of the study and intervention did not specify the impact on the wives of participants, yet the wife of each participant was included in the exit interview. Wives’ opinions and responses were not included at the beginning of the study, so there was no baseline for comparison of their responses.
• The sample was primarily white people with relatively long marriages.
• Whether the exit interviews were conducted before or after the post-test measurements is not entirely clear.

The Helping Her Heal program offers promise to assist with building coping skills and support strategies for couples by educational counseling intervention among spouses of people with breast cancer and other chronic conditions.