Too close for comfort? COVID-19-related stress among older couples and the moderating role of closeness

Married and cohabiting couples have important influences on one another’s stress and well-being. Pandemic-related stress may influence the extent to which couples' stress levels are coregulated. This study examined the experience of nonspecific stress and pandemic-related stress and the moderating role of closeness among couples aged 50 and over in which at least one member had hypertension. A total of 30 couples reported their feelings of closeness to one another in a baseline interview and their feelings of nonspecific stress and pandemic-related stress every three hours for 5 days. There was no difference in closeness and nonspecific stress between husbands and wives. Wives reported greater pandemic-related stress than husbands. Actor-partner interdependence models revealed that wives’ nonspecific stress predicted husbands’ nonspecific stress (b = 0.17, SE = 0.04, p < .001) and that husbands’ nonspecific stress predicted wives’ nonspecific stress in each three hour period (b = 0.19, SE = 0.04, p < .001) and these associations were not moderated by closeness. Coregulation in pandemic-related stress among husbands and wives was moderated by wives’ feelings of closeness such that when wives’ feelings of closeness were lower, greater husband pandemic-related stress predicted lower pandemic-related stress for wives (b = -0.16, SE = 0.07, p < .05) whereas when wives’ feelings of closeness were higher, greater husband pandemic-related stress predicted greater pandemic-related stress for wives (b = 0.22, SE = 0.09, p < .05). These findings indicate that closeness may have detrimental effects especially when considering emotional coregulation in couples regarding the pandemic.

339. Implementing a Smoking Cessation Intervention Among People Living With HIV (PLWH)

Background PLWH who smoke have increased mortality and decreased quality of life. Our clinic is a large, urban academic center that cares for over 1,600 PLWH with a large proportion of smokers (recent estimates 61% current, 16% former). Our goal was to assess the outcomes of our new clinic-wide smoking cessation intervention. We hypothesize that our intervention will increase smoking cessation among our patients. Methods A multidisciplinary committee met to design a cessation pathway to increase smoking cessation in the clinic. The pathway began with an assessment of smoking during triage. The provider then discussed cessation during the visit and patients who were ready to quit were referred to a health educator. Upon referral, participants were enrolled in the smoking cessation trust (SCT) which is a free program for patients who have been smoking before 1988 (N = 33) and provides NRT. Participants who were born after 1980 (N = 10) received their NRT through the Ryan White formulary. The intervention consisted of a baseline interview and 5 modules. Participants received their NRT or pharmacologic agent prior to the intervention. Participants (N = 43) were PLWH from our clinic who smoke and were referred from May 1, 2018 through March 1, 2019. Results Participants were 79% black, 74% male and on average were 47 years old. Among participants, 21 participants met with a health educator for the initial interview and participated in the intervention, while 22 only met with the health educator for an introductory interview to determine which pharmacologic/NRT agent would work best for them. Of the 43 participants, 30 participants received pharmacologic/NRT agents. Among all participants, 23% of individuals quit smoking cigarettes within 2 months of completing the baseline interview and first module. Of those that quit, 50% used Chantix and 70% attended counseling sessions with the health educators. Of the participants who did not quit, 21 participants cut down on the amount they smoked with almost 81% of them cutting the number of cigarettes they smoked in half. Conclusion A multidisciplinary intervention consisting of assessment, counseling, and pharmacologic therapy and/or NRT can improve cessation in PLWH that smoke (23%). Future studies are needed to confirm these results among larger populations. Disclosures All authors: No reported disclosures.

Patient (pt) experiences with avelumab in treatment-naive metastatic Merkel cell carcinoma (mMCC): Qualitative interview findings from a registrational clinical trial.

90 Background: MCC is a rare, aggressive skin cancer with a poor prognosis. Avelumab is the only anti–PD-L1 monoclonal antibody approved for treatment of mMCC. This qualitative research embedded in a clinical trial aimed to explore pt experiences on treatment with avelumab. Methods: All treatment-naive pts with mMCC entering the registrational, open-label, multicenter trial to investigate the clinical activity and safety of avelumab were invited to participate in optional, semistructured, 30-min phone interviews at baseline (prior to study drug administration) and at weeks 13 and 25. Interviews were conducted by trained professionals, audio-recorded, transcribed, and analyzed using a qualitative software package, ATLAS.ti V7. Key concepts identified from the baseline interview for each pt were assessed during follow-up interviews. Results: A total of 29 pts (mean age, 71 y; 76% male) completed the baseline interview; 19 pts (6 in USA, 4 in France, 5 in Italy, 3 in Germany, 1 in Australia) had ≥1 follow-up interview. The baseline interviews revealed the negative psychological burden on pts living with a symptomless disease and the hope for avelumab to be a successful therapy. Over the course of the trial, most pts reported an increased or continued sense of hope and willingness to fight MCC. Pts who self-reported their disease to be improved (n=12) also reported being stable or experiencing improvements in their ability to do their daily activities and in their physical well-being and having more energy than before starting avelumab. They also reported worrying less and being optimistic. Six pts among the 7 who reported their condition as stable (n=4) or worsened (n=3) reported a worsening of their physical well-being. Nine pts reported fatigue/tiredness on the day of and the day after receiving the avelumab infusion. The reported baseline and longitudinal experiences were similar across pts from all countries. Conclusions: This qualitative study alongside a registrational trial showed that pts experienced perceptible benefits in their physical and psychological well-being following treatment success with avelumab in mMCC. Clinical trial information: NCT02155647 part B.

The impact of widowhood on depression: findings from a prospective survey

Background. We investigated the impact of widowhood on depression and how resources and contextual factors that define the meaning of loss modified this effect.Method. In a prospective, nationally representative sample of women in the US aged 54 or older we compared 64 women who were widowed in the 3 years between data collection waves with 431 women who were stably married over the time interval.Results. Those who became widowed reported more depression than controls for 2 years following the loss. However, this effect was confined to respondents whose husbands were not ill at baseline. Widowed women whose husbands were ill at baseline already had elevated depression in the baseline interview and did not become significantly more depressed after the death. Consistent with this result, women who were not depressed pre-bereavement were most vulnerable to depression following the loss of an ill spouse during the first year of widowhood.Conclusions. Results suggest that spouses' illness may forewarn wives of their impending loss and these women may begin to grieve before his death. Those forewarned women who are not depressed pre-bereavement may experience the most post-bereavement depression. Findings are discussed in light of previous, more methodologically limited studies.