Themes Addressed by Couples With Advanced Cancer During a Communication Skills Training Intervention

摘要

Context Couple-based communication interventions have beneficial effects for patients with cancer and their partners. However, few studies have targeted patients with advanced stages of disease, and little is known about how best to assist couples in discussing issues related to life-limiting illness. Objectives The purpose of the present study was to identify themes addressed by couples during a Couples Communication Skills Training intervention and the frequency with which they discussed issues related to end of life. Methods Content analyses were conducted on recordings of 72 sessions from 12 couples facing advanced gastrointestinal cancer. Coding was based on six themes identified a priori from the framework for understanding what patients and family value at end of life. The percent of couples addressing each theme was calculated to gauge level of importance and acceptability of these topics. Results The majority of couples addressed topics previously identified as salient at end of life, including clear decision making, affirmation of the whole person, pain and symptom management, contributing to others, and preparation for death. In addition, novel aspects to these themes emerged in the context of couples' conversations, illustrating the importance of the couple relationship in adjusting to life with a life-limiting illness and anticipating the transition to end of life. Conclusion Findings suggest that couples likely would be receptive to an intervention that combines training in communication skills with guidance in focusing on issues related to life completion to assist with transitions at end of life. Such interventions might enhance both individuals' abilities to cope with illness-related symptoms and demands, enjoy the time they have together, and derive meaning from the experience.