Porter, L.S., Keefe, F.J., Baucom, D.H., Hurwitz, H., Moser, B., Patterson, E., & Kim, H.J. (2012). Partner-assisted emotional disclosure for patients with GI cancer: 8-week follow-up and processes associated with change. Supportive Care in Cancer, 20, 1755–1762.

To (a) examine data collected eight weeks following participants’ completion of the intervention to determine whether treatment effects were maintained, and (b) process data to identify factors that might explain variability in response to the intervention 

After providing informed consent, participants were administered baseline measures and then randomly assigned to either a partner-assisted emotional disclosure intervention group or an education/support condition group. The partner-assisted emotional disclosure intervention protocol systematically trained couples in skills designed to help patients disclose their feelings and concerns related to the cancer experience.

Individual couples attended four in-person sessions with a master's-level therapist. Sessions included training in communication skills to help patients express their cancer-related thoughts and feelings and partners to encourage patients’ disclosure and communicate understanding and acceptance. The majority of sessions were devoted to couples’ conversations in which patients were given the opportunity to disclose their cancer-related thoughts and feelings to their partners.

Couples in the cancer education/support condition group attended four in-person sessions that centered on presenting information relevant to living with cancer. The therapists and scheduling sessions were the same as for the disclosure intervention. Couples in this condition group did not receive any training in communication skills, and patients were not encouraged to discuss their thoughts and feelings related to the cancer experience with their partners.

• The sample included 130 couples. 
• Mean age of patients was 59.4 years; mean age of partners was 59.3 years.
• The patient sample was 71% male and 29% female; the partner sample was 29% male and 71% female.
• Patient diagnoses were colorectal cancer (42%), pancreatic cancer (15%), esophageal cancer (11%), and other cancers (32%).
• The majority of patients were Caucasian, had stage IV disease, and had received chemotherapy; half were educated beyond high school.
• The majority of partners were Caucasian and were educated beyond high school (60%).

• Outpatient setting
• Duke University and University of North Carolina Hospitals

• End of life/multiple phases
• End of life; survivorship; sustained intervention effect

A randomized controlled trial design was used.

• Quality of Marriage Index (QMI): study Cronbach’s alpha average for both patients and partners = 0.90    
• Miller Social Intimacy Scale (MSIS): study Cronbach’s alpha average for patients and partners = 0.90
• Profile of Mood States (POMS): study Cronbach’s alpha average for patients and partners = 0.89
• Holding Back From Disclosure Measure: study Cronbach’s alpha for patients only = 0.88
• Positive and Negative Affect Scale (PANAS): noted to have reliability and validity
• Self-Feeling Awareness Scale (SFAS): inter-rater reliability previously established

The study experienced a 27.7% attrition rate due to patient death or declining health or conflicts between study completion and life issues. Analysis occurred according to an intent-to-treat model based on an initial randomized sample of 130 couples. For couples in which the patient initially reported high levels of holding back from discussing cancer-related concerns, the partner-assisted emotional disclosure intervention led to significant improvement in relationship quality (p = 0.002) and intimacy (p = 0.020) over an eight-week follow-up period compared to an education/support control condition. There was no treatment effect on mood. Overall, the benefits of disclosure intervention appeared largest for patients who were high in holding back.

In patients who were more expressive during disclosure sessions, patients and partners were significantly more likely to report increases in relationship quality and intimacy from baseline to post-treatment assessment. When patients reported more negative affect following the disclosure sessions, both patients and partners were significantly more likely to report decreases in psychological distress between baseline and post-treatment assessment.

The intervention showed a positive effect on couples’ relationships over the eight-week follow-up; however, there was no demonstrated effect on affect or mood disturbance for patients or their partners.

• Some couples were unable to complete the four sessions of the intervention due to the face-to-face structure of the intervention.
• The large amount of data collected by telephone contact at eight weeks postintervention may influence the accuracy of data.
• Whether partners were also caregivers for patients at the end of life is unclear. 
• Participants tended to be white, well-educated, heterosexual couples.
• The study's focus on patient emotional disclosure, with limited attention to caregiver disclosure, may affect relationship quality and intimacy issues.

Nurses have a role in assessing patient–partner coping during cancer treatment and referring couples to relevant resources to facilitate physical, spiritual, and psychosocial health of couples. Partner-assisted emotional disclosure in a structured supportive environment may benefit couples when patients have difficulty expressing cancer-related concerns.