Couple-focused interventions for men with localized prostate cancer and their spouses: A randomized clinical trial

Abstract

Objectives: Few couple-focused interventions have improved psychological and relationship functioning among men diagnosed with localized prostate cancer and their spouses. This study compared the impact of intimacy-enhancing therapy (IET), a general health and wellness intervention (GHW), and usual care (UC) on the psychological and relationship functioning of localized prostate cancer patients and their partners. Relationship length, relationship satisfaction, and patient masculinity were evaluated as moderators.

Design: This study was a randomized clinical trial with three study arms and four assessment time points.

Methods: A total of 237 patients and partners were randomly assigned to receive IET, GHW, or UC. Participants completed measures of psychological functioning and relationship satisfaction at baseline, 5 weeks, 3 months, and 6 months post-baseline. Primary outcomes were psychological adjustment, depression, cancer-specific distress, cancer concerns, and relationship satisfaction.

Results: Spouses in IET showed greater increases in relationship satisfaction than spouses in GHW and UC between the baseline and 5-week follow-up. Among patients in longer relationships, significant increases in psychological adjustment were found in both treatments compared to UC. Among spouses in longer relationships, psychological adjustment increased in both IET and UC but declined in GHW.

Conclusions: Intimacy-enhancing therapy did not show an impact on general or cancer-specific distress, but did show an early impact on relationship satisfaction among spouses. IET was superior to UC for patients in longer relationships. It will be important for researchers to understand which couple-focused interventions benefits both patients and spouses and to identify characteristics of patients, partners, and couples who may not benefit from psychological treatments. Statement of contribution What is already known on this subject? Men diagnosed with localized prostate cancer report lower health-related quality of life and both patients and spouses report elevated distress. Relationship communication plays a role in couples' psychological adaptation to prostate cancer. Couple-focused interventions have illustrated an impact on relationship communication. There are no studies comparing different couple-focused interventions. What does this study add? Intimacy-enhancing therapy was not superior to no treatment or a comparison treatment for the broad range of psychological and relationship outcomes. Intimacy-enhancing therapy was superior to no treatment for patients in longer-term relationship. The general health and wellness intervention was not beneficial for men in shorter relationships and for men who did not endorse traditional masculine norms.

Keywords: couples’ therapy; general health and wellness intervention; intimacy-enhancing therapy; prostate cancer; psychological intervention.

Figure 1.

Study CONSORT.

Figure 2.

Patient and spouse relationship satisfaction over the four waves of data collection as a function of treatment condition. GHW = general health and wellness intervention; IET = intimacy-enhancing therapy; UC = usual care.

Figure 3.

Change in general psychological adjustment over time as a function of relationship length, role, and treatment condition. GHW = general health and wellness intervention; IET = intimacy-enhancing therapy; UC = usual care.

Figure 4.

Interaction between patient masculinity, treatment condition, and role predicting depression. GHW = general health and wellness intervention; IET = intimacy-enhancing therapy; UC = usual care.