Effects of Advanced Practice Nursing on Patient and Spouse Depressive Symptoms, Sexual Function, and Marital Interaction After Radical Prostatectomy Ruth McCorkle Michael F. Dowd Mary Pickett Mary Lou Siefert Joanne P. Robinson he American Cancer A secondary analysis of a prospective randomized clinical trial with Society (2006) estimat- repeated measures was conducted to examine the effects of a stan- ed that approximately dardized nursing intervention on patient and spouse depressive 234,460 men were diag- symptoms, sexual function, and marital interaction. Another purpose Tnosed with prostate cancer in the of this study was to determine if, over time, differences existed in United States in 2006. Scientific men and their spouses’ levels of depressive symptoms, sexual func- advances achieved in screen- tion, and marital interaction following radical prostatectomy. ing/early detection and treatment Spouses reported significantly higher levels of depressive symptoms modalities for prostate cancer and significantly more marital interaction distress compared to resulted in greater numbers of men electing radical prostatecto- patients. Patients reported significantly more distress pertaining to my. Radical prostatectomy is the sexual function than their spouses. primary treatment chosen by men who meet eligibility criteria for this procedure because they Joseph & Burggraf, 2000; Singer Colling, 2003) and as a couple desire a “cure” and a way to “cut et al., 1991). (Maliski, Heilemann, & Mc- out the cancer” (Rollins, 2004). Prostate cancer survivors and Corkle, 2001). Psychological dis- When surgery is an option, there their spouses may experience a tress, urinary incontinence, im- is a decision-related tradeoff that variety of immediate and long- potence, marital communication involves choosing between an term negative consequences re- problems, and fatigue represent improved chance for survival lated to treatment effects that can the constellation of symptoms versus preservation of sexual and decrease their quality of life as that frequently accompany the urinary function (Pickett, Bruner, individuals (Butler, Downe- postoperative recovery period Wamboldt, Marsh, Bell, & Jarvi, following radical prostatectomy 2001; Perez, Skinner, & Meyer- (Bertero, 2001; Bisson et al., Ruth McCorkle, PhD, FAAN, is the witz, 2002; Rondorf-Klym & 2002; Lavery & Clarke, 1999). Florence S. Wald Professor of Nursing, and Director of the Center for Excellence in Chronic Illness Care at Joanne P. Robinson, PhD, APRN, BC, is an Associate Professor, Rutgers State Yale University, School of Nursing, University, College of Nursing, Newark, NJ. New Haven, CT. Mary Pickett, PhD, RN, is an Associate Professor at Villanova University, College Mary Lou Siefert, DNSc, APRN, of Nursing, Philadelphia, PA. AOCN, is a Research Associate at Yale University, School of Nursing, Acknowledgment: This research was supported by the American Cancer Society, New Haven, CT. Grant #TPRB-98-010PBP, 1998-2001. Michael F. Dowd, PhD, is a Author Discussion Forum Statistician at Yale University, School Visit the Urologic Nursing discussion board at www.suna.org/discussions of Nursing, New Haven, CT. to discuss this article with authors Ruth McCorkle and Joanne Robinson. UROLOGIC NURSING / February 2007 / Volume 27 Number 1 65 Introduction sure depression and two subscales of trial that examined nursing’s impact on quality of life follow- Men and their spouses may the Cancer Rehabilitation and experience a variety of immediate and Evaluation System tool were used to ing radical prostatectomy (Mc- long-term consequences related to measure sexual function and marital Corkle, Pickett, Malkowicz, & radical prostatectomy for treatment of interaction. Robinson, 1998) provided an prostate cancer. opportunity to contribute to the Results body of evidence related to dif- Objective Findings from 107 couples docu- ferences between men and their The purpose of this study was to ment the positive and negative impact spouses on depressive symp- determine the effects of a standard- of a diagnosis of prostate cancer and toms, sexual function, and mari- ized nursing intervention (SNIP) on surgical treatment on these out- tal interaction following radical men and their spouses’ levels of comes. Spouses reported significantly higher levels of depressive symptoms prostatectomy. In the parent depressive symptoms, sexual func- study, participants randomized tion, and marital interaction following compared to patients, but both radical prostatectomy over time and to patients and spouses reported fewer to the intervention group determine if differences existed depressive symptoms over time received post-hospital care from between the men and their spouses’ regardless of whether subjects were an advanced practice nurse levels over time. in the control or intervention (SNIP) (APN) according to a standard- group. Patients reported significantly ized nursing intervention proto- Method more distress pertaining to sexual col (SNIP). See Table 1 for a A secondary analysis of data function than their spouses, and the description of the protocol. The from an earlier prospective random- spouses reported significantly more SNIP was designed to alter the ized clinical trial that examined the marital interaction distress than the patients. physical symptoms, emotional SNIP on quality of life following radical distress, and existential crisis prostatectomy generated the data for that occur with a diagnosis of this study. Measurement of outcome Conclusions variables (depressive symptoms, sex- Nurses must assess and contin- cancer. Specific objectives of ual function, and marital interaction) ue to monitor levels of depressive SNIP nurses were to facilitate occurred at baseline, 1, 3, and 6 symptoms, sexual function distress, postoperative recovery of the months following radical prostatecto- and marital interaction distress for patient, assist the patient and my for men and their spouses. The men who have undergone radical spouse with problem solving Center for Epidemiologic Studies- prostatectomy and their spouses. after discharge from the hospital, Depression Scale was used to mea- and promote the couple’s transi- tion from the acute to the chron- ic phase of illness (Rolland, 1987). Data collection began in These symptoms can exert a neg- need to be systematically ad- 1998 and was completed in 2001. ative impact on patients’ physical dressed by health care providers and psychosocial function and following this primary cancer Purpose affect spouses’ lives by increasing treatment (Burt, Caelli, Moore, & The purpose of the present caregiving responsibilities (Gia- Anderson, 2005; Hughes, Hodg- study was to determine the relli, McCorkle, & Monturo, 2003) son, Muller, Robinson, & Mc- effects of SNIP on men and their and altering the marital relation- Corkle, 2000; Pickett, Cooley, spouses’ levels of depressive ship either temporarily or perma- Patterson, & McCorkle, 1996). symptoms, sexual function, and nently (Baider, Koch, Esacson, & Countless numbers of men and marital interaction following rad- Kaplan De-Nour, 1998; Cliff & their spouses experience uncer- ical prostatectomy over time and MacDonagh, 2000). Many cou- tainties associated with negative to determine if differences exist- ples find that maintaining close physical and psychosocial effects ed between the men and their interpersonal relationships is resulting from diagnosis and treat- spouses’ levels over time. challenging while dealing with ment (Germino et al., 1998). the distress associated with the Development of evidence-based Study Design and Methods diagnosis and treatment of a life- practice guidelines designed to A secondary analysis of a threatening illness (Harden et al., support couples through the prospective randomized clinical 2002; Harden, 2005). process of recovery and rehabilita- trial with repeated measures was Cost-containment efforts with- tion after radical prostatectomy used to examine the effects of in the health care environment fos- would provide clinicians with SNIP on patient and spouse ter decreased length of hospitaliza- valuable information (Cunning- depressive symptoms, sexual tions with brief postoperative ham, 2003). A well-defined inter- function, and marital interaction. recovery periods (Kirsh, Worwag, vention model is essential for Measurement on outcome vari- Sinner, & Chodak, 2000). Well-doc- improving the rehabilitation phase ables occurred at baseline, 1, 3, umented short and long-term qual- and quality of life for post-prosta- and 6 months following radical ity of life concerns experienced by tectomy patients and their spous- prostatectomy. The setting was many patients who have under- es (Resendes & McCorkle, 2006). the urology practice of two acad- gone a radical prostatectomy A randomized controlled emic medical centers in a 66 UROLOGIC NURSING / February 2007 / Volume 27 Number 1 UROLOGIC NURSING 27Number 1 /February 2007/Volume Table 1. Standardized Nursing Intervention Protocol (SNIP) Conceptual Week Contacts* Areas Patient Content Spouse Content Couple Content 1 1HV Providing • Assess physical, psychological, social, • Assess ability, willingness, and com- • Establish a relationship. I PC direct care and financial needs and functional fort to provide care. • Assess knowledge of prostate cancer (PDC) ability. • Discuss symptom assessment and and surgical procedure. • Evaluate symptoms, symptom man- management. • Review discharge instructions and Monitoring agement, and medications. • Address spouse’s concerns