Helping Couples Communicate When the Prognosis is Poor

Laura S. Porter, PhD

Laura S. Porter, PhD

Communication for any couple can be challenging, but especially when one partner has advanced cancer. In an effort to give patients and their partners the skills they need to facilitate end-of-life conversations, a group of researchers in North Carolina evaluated a couple’s communication skills training (CCST) intervention, and findings from their pilot study suggest the tool has benefits for both patients and their spouses.

The study findings follow on an earlier quantitative analyses pointing to the effectiveness of CCST in improving relationship satisfaction. The results, presented at the recent 2016 Palliative Care in Oncology Symposium, dig deeper into the content of the conversations, focusing on themes important to the couples and how CCST specifically assists them in addressing difficult topics.

A team from Duke University Medical Center and the VA Medical Center in Durham, North Carolina recruited 12 couples for this pilot study. The patients had a diagnosis of stage III or IV gastrointestinal cancer (45% had colorectal cancer and 26% pancreatic cancer) with a life expectancy of at least 6 months.

Ten of the 12 patients in the study were male. The mean age of participants was 54, and they had been married for an average of 19 years. Either the patient or the partner of each couple scored high on the measure of holding back from disclosing cancer-related thoughts or feelings.

The CCST intervention, delivered via Skype and facilitated by a skilled therapist, trained couples in communication skills for sharing their thoughts and feelings, as well as making decisions as a couple; couples were encouraged to use the CCST skills to discuss cancer-related issues between sessions.

Researchers then analyzed the audio recordings from 72 sessions to identify common and recurrent topics that patients and spouses raised in conversations. Based on frequency, they determined which topics were most important and accessible to the couples. These included themes previously described as being important to patients at the end of life, such as treatment (including side effects and logistics); roles (responsibilities at home, work, with family, social groups); family interactions, conflicts, and participation in treatment decisions; understanding prognosis and dealing with uncertainty about the future, and preparation (getting affairs in order, ending treatment).

New themes also emerged when the content of the CCST sessions were explored, including difficulties with communication, providing emotional support to each other, and a desire for greater emotional intimacy. Also identified were worries over “protective buffering,” putting one’s needs second to those of the spouse, and concerns over the surviving spouse’s living and financial situation and grief.

Study authors, led by Laura S. Porter, PhD, an associate professor at Duke University's Schools of Medicine and Nursing, said that these findings, “support the feasibility of an intervention that combines training in communication skills with guidance for using these skills to discuss topics most meaningful to couples facing advanced illness.”

The authors noted that the conversations were helped by training in communication techniques, as well as the involvement of a skilled therapist who created a safe environment for the discussions. In addition to improving conversations about life-limiting illnesses, providing couples with communication training could also improve general relationship satisfaction between partners, the authors concluded.

Reference

Porter LS, Fish L, Uronis HE, et al. The elephant in the room: Facilitating conversations about advanced cancer between patients and their spouses. J Clin Oncol. 2016;34(suppl 26S; abstr 233)