Manne, S.L., Kissane, D.W., Nelson, C.J., Mulhall, J.P., Winkel, G., & Zaider, T. (2011). Intimacy-enhancing psychological intervention for men diagnosed with prostate cancer and their partners: A pilot study. Journal of Sexual Medicine, 8(4), 1197–1209.

To evaluate (a) the impact of an intimacy-enhancing therapy (IET) versus a usual care (UC) program on survivor and partner psychological outcomes, including distress, well-being, and relationship outcomes (relationship satisfaction and intimacy), (b) the impact of an IET on relationship communication, and (c) the role of preintervention levels of each outcome variable on post-IET intervention outcome variables  

Participants received assignment to either an IET or a UC group. The IET intervention consisted of  five 90-minute couple sessions delivered by a trained therapist. This person focused on improving couples’ ability to comfortably share their thoughts and feelings to promote mutual understanding and support for cancer concerns and to facilitate emotional intimacy. The IET program techniques evolved from cognitive-behavioral and behavioral marital therapy practice and other published communication skills interventions adapted for prostate cancer. Careful attention was made to ensuring treatment fidelity by videotaping sessions and using manuals to structure the intervention. UC group participants received standard clinic psychosocial care. The IET group received the same surveys following the fifth and final session of the IET (approximately two months post-baseline). The UC and IET participants who did not complete sessions received a second round of surveys eight weeks after baseline assessment.

• The sample (N = 71) included 34 participants in the UC group and 37 participants in the IET group.  
• Mean age of participants in both groups was 60 years (SD = 8.35).
• UC group males represented 34 (48%) survivors and no partners; IET group males represented 37 (52%) survivors and 2 (3%) partners.  
• UC group females represented no survivors and 34 (47%) partners; IET group females represented no survivors and 35 (49%) partners.
• Survivors had a diagnosis of stage 2 localized prostate cancer, an Eastern Cooperative Oncology Group score of 0, and mean time since diagnosis of eight months.
• The sample was white (86%), well educated (83% had completed high school or beyond), and married (95%), and had mean relationship length of 27 years. 

• Multisite
• Outpatient setting
• Memorial Sloan-Kettering Cancer Center and Fox Chase Cancer Center (northeastern United States)
   

• Transition phase after initial treatment
• Late effects and survivorship; localized prostate cancer

A pre/post-test pilot design was used.

• Mental Health Inventory: (a) Psychological Distress Scale assessed depressive and anxiety symptoms of patients and partners; coefficient alphas for patient survivors and partners exceeded 0.94 at baseline and second assessment, (b) Psychological Well-Being Scale assessed satisfaction with life, sense of future hopefulness, and feelings of calmness; coefficient alphas for patient survivors and partners exceeded 0.93 at both assessment times.    
• Impact of Events Scale: Measured severity of cancer-specific distress; coefficient alphas for both survivors and partners above 0.92 at both assessment times. 
• Cancer Concerns: Rated partner and survivor concerns about 10 cancer-related problems; the tool was developed for the study, and coefficient alphas exceeded 0.81 for both groups at both assessment times.
• Dyadic Adjustment Scale (DAS): Assessed relationship functioning, satisfaction, and distress; coefficient alphas exceeded 0.90 for both survivors and partners at both assessment times.
• Personal Assessment of Intimacy in Relationships: Assessed emotional closeness; coefficient alphas exceeded 0.82 for both groups at both assessment times.
• Self-Disclosure/Perceived Partner Disclosure: Assessed degree to which survivors and their partners disclosed thoughts, information, and feelings about cancer to each other and perceived partner responsiveness.
• Communications Pattern Questionnaire
   

Seventy-three percent of IET couples attended 80% or more of the sessions, but another 21.6% of the IET group did not attend any sessions following random assignment to the IET group. Treatment fidelity on 114 of 138 sessions averaged 87.4%. Intervention survivors and partners rated the sessions as “quite successful,” but only 72% of the intervention group reported completion of homework assignments as part of the IET program. With study attrition, an intent-to-treat statistical analysis approach was used.

There were no significant treatment effects for general distress, cancer-specific distress, and relationship intimacy for either survivors or partners. There were no significant treatment differences for relationship communication for either survivors or partners. IET effects were largely moderated by baseline couple relationship and psychosocial factors (individual distress). Survivors who had high levels of cancer concerns at baseline significantly reduced those concerns post-IET. Moderating effects of preintervention levels for self-disclosure and perceived partner disclosure and responsiveness resulted from the intervention. The IET program improved cancer-specific distress, low intimacy, martial satisfaction, and communication if a couple experienced problems in these areas before the intervention.  
 

The IET had a marginally significant (p = 0.08) main effect on survivor well-being and improved overall outcomes for couples with fewer personal and relationship resources. Couples with more resources (e.g., higher educational level, stronger marital ties) experienced no improvement from the IET program.

• The sample was small, with less than 100 participants.
• The sample was predominately Caucasian, heterosexual, and well educated.
• Drop-out rate was high following randomization to the treatment group.

Interventions such as the IET may prove valuable for couples challenged by treatment and outcomes of prostate cancer treatment. As members of the healthcare team, nurses have an obligation to assess prostate cancer survivors about their overall coping skills, learning, and relationship needs to offer patient- and couple-centered interventions to improve the quality of their relationships and adjustment to living with prostate cancer.