An Online Psychoeducational Intervention for Young Women with Breast Cancer and their Partners
Breast cancer is distressing for couples in general but even more so when the illness strikes at a relatively young age. In addition to common relationship challenges, younger couples have to contend with the loss or disruption of age-appropriate goals for themselves. Presently, there are virtually no resources designed specifically to assist young couples coping with breast cancer. The purpose of this study is to develop and evaluate an online educational program geared to the unique needs and demanding schedules of young couples. The purpose of the program is to improve couples’ relationships and mutual coping. Seventeen couples will take part in the 7-week program. They will complete questionnaires before and after participating to evaluate the program’s helpfulness. This study will allow for the creation of a user-friendly, cost-effective tool that could help to improve the lives of all young couples coping with breast cancer in the years to come.
Seven-Week Psychoeducational Online Intervention: A website will be designed expressly for the purposes of this project. It will contain:
- Information relevant to young couples with BC;
- Learning modules focusing on relationship principles that underlie optimal couple coping and adjustment to cancer.
The website will be moderated by a mental health professional with experience in psycho-oncology. All participants will be invited to attend a face-to-face orientation session prior to beginning the program.
- To develop and standardize an intervention aiming to:
- Educate couples about common relationship challenges associated with BC in general, and those specific to young couples in particular;
- Normalize couples’ experiences and combat feelings of isolation and difference that young couples often experience in relation to their existing peer group.
- To test the impact of the intervention on couple support and relationship functioning in the areas of:
- Intimacy and closeness;
- Capacity for mutual empathy and understanding;
- Communication skills;
- Dyadic coping ability.
The primary outcome variables will be relationship satisfaction and feelings of intimacy between partners. Relationship satisfaction will be measured using the Dyadic Adjustment Scale (DAS) which contains factors pertaining to dyadic consensus, dyadic cohesion, affectional expression, and relationship satisfaction. Relationship intimacy will be assessed with the Personal Assessment of Intimacy in Relationships scale (PAIR). The PAIR consists of five subscales representing different types of intimacy: emotional, social, sexual, intellectual, and recreational. Together, the DAS and the PAIR assess relationship variables that have been associated with positive adjustment to BC including partner affection, empathy, and understanding. Secondary outcome measures will provide information on couple mutuality and individual psychological adjustment. The Mutual Psychological Development Questionnaire (MPDQ) assesses feelings of mutuality by combining ratings on indices of empathy, engagement, authenticity, empowerment, zest, and diversity (openly expressing and working through differences). The Mental Health Inventory (MHI) will be used to assess psychological distress and well-being. It was selected for this study because, in addition to measuring anxiety and depression, its five factor formulation of psychological functioning includes loss of perceived control and feelings of connection with others, variables considered applicable to psychosocial adjustment to cancer. The MHI was also considered an appropriate instrument because it was designed to measure psychological functioning in non-clinical as well as clinically distressed samples. For the female patients, quality of life (including physical and sexual impairment) will be measured using the Cancer Rehabilitation and Evaluation System (CARES) for its potential as a mediating variable that may interact with treatment outcome. All of the aforementioned scales have proven validity and reliability.
The questionnaire package will be administered to both partners at baseline and then following completion of the program (approximately 7-weeks later). Demographic information and treatment expectancy will be obtained at baseline. In addition to the standardized instruments, the 7-week measurement point will include a treatment satisfaction questionnaire. Program-use variables will also be considered in the analysis such as the number of times partners logged on together versus independently, and degree and type of involvement on the discussion board (i.e., number of times logged on; observing versus actively participating).
Women diagnosed with breast cancer at or before the age of 40 experience greater distress and poorer quality of life than women diagnosed later in life. In addition to having to cope with the range of issues common to all women with breast cancer, young women face unique challenges such as loss of fertility, concerns for young children, and interruptions to early-stage careers. The presence of adequate social support is a mitigating factor for distress in young women, and spousal support in particular has been shown to play a crucial and distinctive role in determining how well a woman adjusts to breast cancer. Unfortunately, the evidence suggests well-spouses are significantly distressed themselves, and often fall short in their attempts to meet the needs of their ill partners despite generally good intentions. Consequently, researchers have recommended that psychosocial interventions be geared to couples. However, traditional counseling interventions may not appeal to younger couples with numerous responsibilities and time constraints.
The purpose of this study is to examine the feasibility, process, and outcomes of an innovative online intervention tailored to the unique needs of young women and their partners. The primary goal is to improve partners’ relationship functioning and capacity to work together as a team in relation to the illness. The secondary goal is to combat feelings of isolation by creating a community of similarly affected couples.
The intervention will be delivered via a professionally moderated, password-protected website and entail:
- Information relevant to young couples with breast cancer;
- Structured, interactive learning modules;
- Discussion board.
The online modality is particularly suited to the younger demographic targeted by this project because of its familiarity, comfort, convenience, and flexibility.
A non-randomized, repeated measures analysis of variance design will be used to test the intervention. Seventeen couples will be recruited within the Greater Toronto Area. Questionnaires assessing relationship functioning, psychological adjustment, and quality of life will be administered to participants at baseline and at completion of the 7-week program. Qualitative data from the website and treatment satisfaction questionnaire will be analyzed thematically in order to improve the intervention and its delivery.
The potential for this online intervention to fill a void in support options available to both young women with breast cancer and their partners is vast. Following completion of the project, not only will there be a demonstrable product in the website, but we will have the knowledge with which to further test the intervention in a RCT. The ultimate impact of the proposed project will be the creation of an accessible, cost-effective, empirically validated tool that could help to improve the quality of life of all young couples coping with breast cancer, regardless of geographic location, in the years to come.