Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma

Abstract

BACKGROUND The majority of prostate carcinoma survivors experience enduring sexual difficulties and associated distress in the years after definitive treatment. A counseling intervention aimed at improving levels of sexual satisfaction and increasing successful utilization of medical treatment for erectile dysfunction (ED) was developed and pilot‐tested for both the survivor of prostate carcinoma and his partner. METHODS All male participants were 3‐month to 5‐year survivors of localized prostate carcinoma who had been treated with radical prostatectomy or radiation therapy, and were married or in a committed relationship. Couples were randomized to attend four sessions of counseling together or to have the man attend alone. In both groups, partners completed behavioral homework. The sessions included education on prostate carcinoma and sexual function and options to treat ED as well as sexual communication and stimulation skills. Standardized questionnaires at baseline, posttreatment, and at 3‐month and 6‐month follow‐up assessed sexual function, marital adjustment, psychologic distress, and utilization of treatments for ED. RESULTS Fifty‐one of 84 couples randomized to treatment completed the intervention (61%). Attendance by the partner did not affect outcomes. Participants completing the intervention demonstrated improvment in male overall distress (P < 0.01), male global sexual function (P < 0.0001), and female global sexual function (P < 0.05) at 3‐month follow‐up, but regression toward baseline was noted at 6‐month follow‐up. However, utilization of ED treatments increased from 31% at the time of study entry to 49% at the 6‐month follow‐up (P = 0.003). CONCLUSIONS The results of this brief pilot counseling intervention demonstrated significant gains in sexual function and satisfaction and increased utilization of treatments for ED. However, modifications are needed in future randomized trials to reduce the rate of premature termination and to improve long‐term maintenance of gains. Cancer 2005. © 2005 American Cancer Society.

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review

“…This is an important omission as where patient outcomes may not be improved there may be still benefits for partners, which go unseen because they are not assessed. This review exemplifies this as some moderate to strong effects are seen in partners but not patients [38,66]. As discussed previously, the role of partners in patient adjustment can be substantial, which reinforces the need for more consistent assessment of outcomes in partners.…”

“…Six studies compared the couples intervention with a patient-only intervention [35,36,37,38,39,40], eight studies used a patient-only comparison group and a usual care control group [41,42,43,44,45,46,47,48], one study compared two types of couples interventions with a patient-alone comparison group [49], and the remaining twenty compared a couples intervention with usual care or waiting-list controls. Twenty-eight studies reported effect sizes, or provided information to calculate effect sizes.…”

“…Interventions were grouped into two categories according to their main therapeutic approach: 'Cognitive Behavioural Skills Training' (CBST) (n=25), which focuses on illness cognitions, education, goal setting, and coping strategies such as problem solving and symptom management; and 'Relationship Counselling' (RC) (n=10), which addresses relationship difficulties such as sexual intimacy, partner supportiveness, and communication [38,51,45,52,53,54,55,56,57,58]. There was no noticeable effect of mode of delivery (faceto-face, telephone, online) on illness type or outcomes.…”

“…When compared with a patient-only or control group, couples interventions based on CBST improved cognitive outcomes including self-efficacy [36,49,38,59] and illness appraisals [41,60,61,39,62].…”

“…Such interventions improved sexual self-schemas, sexual intimacy [43], and relationship quality [60]. RC also effectively targeted interpersonal/ intimacy outcomes in partners including relationship satisfaction [54], dyadic adjustment [58], sexual distress, sexual communication [58], and sexual function [38,58].…”