Psychosocial needs and perception of inequity: combination of methods of action to help cancer patients' spouses - A pilot study

peer reviewedLe cancer est une maladie chronique ayant indéniablement un impact sur les patients qui en sont atteints mais aussi sur les membres de leur famille. Les conjoints, plus particulièrement, adopteront généralement le rôle de proche aidant principal et ressentiront de nombreux besoins psychosociaux, ainsi qu’une détresse émotionnelle. Notre recherche action a pour objectif de satisfaire les besoins psychosociaux des conjoints de patients atteints d’un cancer. Pour ce faire, elle compare l’efficacité de la combinaison de deux méthodes d’action « hiérarchisation des besoins psychosociaux et résolution de problème » à l’utilisation d’une seule méthode d’action, la « hiérarchisation des besoins psychosociaux ». Parallèlement, l’influence de la perception d’iniquité sur la mise en place des méthodes d’action est évaluée. Trente-sept conjoints, répartis aléatoirement dans deux groupes (expérimental versus témoin), ont répondu à divers questionnaires évaluant à trois reprises (T0, T1 et T2) les variables dépendantes suivantes : besoins psychosociaux et détresse émotionnelle. D’autres variables (les données socio-démographiques et la perception d’iniquité) n’étaient évaluées qu’au T0. Lors du T0, l’ensemble des participants réalisent la hiérarchisation. Entre le T0 et le T1, le groupe expérimental pratique la résolution de problème alors que le groupe témoin n’y a accès qu’ultérieurement, entre le T1 et le T2. Les résultats montrent une diminution significative du nombre de besoins insatisfaits quand les participants ont eu accès aux deux méthodes. Toutefois, aucune influence de la perception d’iniquité n’a été observée sur la mise en place des méthodes.Cancer is a chronic illness that impacts both patients and family members. Spouses will often take on a caregiver role, meeting psychosocial needs such as health professional needs and information needs. This caregiver role can also create emotional distress. Moreover, spouses might experience perceived inequity characterized by a combination of feelings of overinvestment and of underbenefit. This perception of inequity can also lead to emotional distress. Given the consequences of cancer on spouses, psychological interventions may be one means for helping them to cope. In this study, cognitive and behavioural methods are proposed to spouses in order to support them facing their partner’s cancer and their own issues. The overriding objective of this study is to satisfy the psychosocial needs of cancer patient spouses. In order to reach this objective, it compares the efficacy of two methods of action: 1/ hierarchical organization of psychosocial needs and problem-solving, and 2/ hierarchical organization of psychosocial needs alone. This research also aims to assess the influence of the perception of inequity that spouses might feel on the utilization of the two methods of action. The main hypothesis was that the combination of the two methods of action would have a greater and intensified impact on the assessed dependant variables than the utilization of the hierarchical organization of psychosocial needs alone. Thirty-seven spouses were randomly assigned into two groups: the experimental group (n= 19) and the control group (n= 18). The methodology provided identical protocols to the two groups with one difference in that the training period differed in order to measure the effect of training for problem-solving skills. The average age of participants in the experimental group was 58 (SD = 11) on average, and 57 (SD = 11) in the control group. They were asked to complete several questionnaires at three different time periods with a three-week time interval (T0, T1 and T2) assessing these dependent variables: psychosocial needs and emotional distress (anxiety and depression). Socio-demographic data and the perception of inequity were only evaluated at T0. At T0, all participants realized a hierarchy of psychosocial needs. Between T0 and T1, the experimental group trained in the problem-solving method while control group trained between T1 and T2 for this method. Repeated ANOVA measures were conducted to assess the evolution of the psychosocial needs. Student t-tests were computed to assess the influence of inequity perception on the utilization of the two methods of action. The results confirmed previous findings demonstrating the psychosocial needs in spouses of cancer patients. Indeed, it appears that these participants perceive more psychosocial needs than those of similar samples. This difference might be explained by the period of our intervention which occurred earlier than in experimental designs of similar studies. The overall emotional distress felt by our participants was characterized by anxiety. Therefore, being the caregiver of a cancer patient seems to foster anxiety more than depression. The results confirmed the main hypothesis showing a significant decrease of the number of unsatisfied psychosocial needs when participants have used the two methods of action. This decrease was observed whenever the combination was implemented. In other words, the combination of the two methods of action optimized meeting psychosocial needs. However, the perception of inequity did not seem to influence the utilization of these two methods. This research presents some limitations in the form of a small sample size and of a single assessment of inequity perception at T0. Nevertheless, the results of this preliminary study remain interesting and promising: further research could enhance the employed experimental design in a larger sample in order to obtain more robust results