The purpose of this investigation is basically threefold. The first objective is to evaluate the efficacy of a problem-solving skills approach to facilitate coping and adjustment of patients newly diagnosed with cancers that have a good prognosis. In addition, a second purpose involves assessing the increase in effectiveness of problem-solving training if a significant other is also trained simultaneously along with the cancer patient him or herself. A third goal is to determine whether such intervention programs can be implemented and found to be effective in both urban and rural communities (i.e., is such training generalizable across settings and patients?). To accomplish these objective, the major study involves an experimental, prospective outcome study utilizing randomized assignment to treatment condition that will be conducted over a period of four years. Three treatment conditions will be included in the investigation: (a) Standard Medical Care + Problem-Solving Skills Training; (b) Standard Medical Care + Problem-Solving Skills Training with a Significant Other; and (c) Standard Medical Care only (i.e., waiting-list control). The active intervention programs will involve 10 1.5 hour sessions. Major assessment points involving measures addressing quality of life, adherence to medical regimens, and the hypothesized moderators of adjustment (e.g., problem-solving ability) will include pretreatment, posttreatment, a 6-month follow-up, and 12-month follow-up. To provide for assessment of the effectiveness of these treatment approaches across settings and populations, this protocol will be conducted at two treatment sites, namely, Hahnemann University Hospital and Hershey Medical Center at Pennsylvania State University. Hahnemann University, located in Philadelphia, represents an urban population, whereas Hershey Medical Center, situated in Central Pennsylvania, is characterized by more rural and small city populations. Analyses will also focus on determining the types of patients characteristics associated with successful coping (e.g., pretreatment levels of distress, type of cancer, gender, ethnic background, etc.). A pivotal component of the problem-solving training is the incorporation of the Home Care Plans which are """"""""expert"""""""" guided problem-solving outlines concerning 21 problems commonly experienced by cancer patients and their families. These plans were developed as part of a state-wide cancer patient education initiative. Because this program involves training of nurses and other health care professionals across the State of pennsylvania, the opportunity exists to conduct a quasi-experimental evaluation of the effects of problem-solving training of cancer patients by nurses and other healthcare professionals in the community at large.
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