Objective: The purpose was to describe how wives of prostate cancer patients conceptualized their preparedness to care for the physical and emotional needs of their spouses immediately after, and 3 and 6 months after their husbands’ radical retropubic prostatectomy. Design: This was a secondary analysis of data collected from wives during a two group randomized clinical trial. Quantitative and qualitative data, generated by the PCGS were analyzed to describe how wives conceptualized their preparedness to care for spouses after prostatectomy. Data collection and analysis began in 1998 and was completed in 2001. Sample and Setting: Subjects were the wives of men undergoing radical retropubic prostatectomy for prostate cancer. In 1998 The American Cancer Society funded a randomized clinical trial to investigate "Nursing’s Impact on Quality of Life Post-prostatectomy". In this study wives were recruited along with their husbands who were patients at a Urology Clinic of a large east-coast medical center. The control group (n=53) and the intervention group (n=57) were comparable. The typical subject was Caucasian completed some college, was employed at least part-time, and had a combined family income over $50,000. Mean ages of the control group an intervention groups were 51.6 years 56.6 years, respectively. Variables: The main variable if interest was wives conceptualization of their preparedness to care for the physical and emotional needs of their spouse. Methods: As part of the randomized trial, the intervention group received an experimental treatment, called a standardized nursing intervention protocol, designed to facilitate problem-solving the dyads and patient recovery after discharge from the hospital. The PCCS was administered to all wives at 2 days, 3, and 6 months post-operatively. Internal consistency reliability is 0.72 (Chronbach’s Alpha). Background variables and items 1-5 of the PCGS were analyzed for measures of variability and central tendency and group differences over time treated by repeated measures of ANOVA. Item 6 of the Preparedness for Caregiving Scale asked wives; "What kinds of things did you feel unprepared for?" Transcribed responses were imported to NUD*ist software.The content of subjects’ responses to the open-ended question were coded and analyzed inductively to uncover feelings, expectations, and conceptual categories of preparedness. The raw data were reviewed by a senior cancer nursing investigator and the conceptual categories were reviewed by a research intervention nurse. Finding: Caregivers in the intervention group did not differ significantly from caregivers in the control group. Both groups reported greater improvement in preparedness in their role as caregivers over time. However, 32% of the control group and 38% of the intervention group continued to report unpreparedness regarding the physical and emotional needs of their spouses. Subjects in the control group felt less well prepared to care for emotional needs at three months than at baseline. Intervention group caregivers who were "not too well" prepared dropped from 21.2% to 1.8%. The intervention group reported greater preparedness than the control group to care for the emotional needs of their husbands at three months. The differences between the two groups approached significance at the p=.138 level. The content analysis of narrative responses to the open-ended question, generated three conceptual categories. At baseline the wives conceptualized preparedness as: (1) Prepared with Practical Information, (2) Prepared for Emotional Responses, and (3) Prepared with Resources for Problem-Solving. The three conceptual categories were valid for both groups and evident at baseline, three months and six months, but specific preparedness needs and subcategories varied by group across time. Conclusions Preparedness to care for a spouse after prostate surgery was characterized by an ability to identify, and use information and resources for problem-solving. Some family caregivers, despite advanced education, economic independence, and a strong support system needed assistance in role acquisition at the onset of the patient’s illness and repeatedly over at least 6 months. One third of caregivers recognized and reported a need for ongoing assistance from health professionals in order to adjust to the caregiving role. Preparedness for caregiving was conceived by wives as an ongoing process of skill attainment and refinement rather than an achieved state of readiness. Implication: Because preparedness needs continued to be active at three months and six months, the findings suggest that the content, process, and timing of a nursing intervention may be adjusted to meet the evolving needs of caregivers. A systematic, structured, and individualized intervention to assist spouses to prepare for the role of family caregiver, may have a positive effect on a spouse’s quality of life and thereafter on the quality of life for the couple.
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