Do Couple-Based Interventions Make a Difference for Couples Affected by Cancer?: A Systematic Review

Abstract

BackgroundWith the growing recognition that patients and partners react to a cancer diagnosis as an interdependent system and increasing evidence that psychosocial interventions can be beneficial to both patients and partners, there has been a recent increase in the attention given to interventions that target couples. The aim of this systematic review was to identify existing couple-based interventions for patients with cancer and their partners and explore the efficacy of these interventions (including whether there is added value to target the couple versus individuals), the content and delivery of couple-based interventions, and to identify the key elements of couple-based interventions that promote improvement in adjustment to cancer diagnosis.MethodA systematic review of the cancer literature was performed to identify experimental and quasi-experimental couple-based interventions published between 1990 and 2011. To be considered for this review, studies had to test the efficacy of a psychosocial intervention for couples affected by cancer. Studies were excluded if they were published in a language other than English or French, focused on pharmacological, exercise, or dietary components combined with psychosocial components, or did not assess the impact of the intervention on psychological distress (e.g., depression, anxiety) or quality of life. Data were extracted using a standardised data collection form, and were analysed independently by three reviewers.ResultsOf the 709 articles screened, 23 were included in this review. Couple-based interventions were most efficacious in improving couple communication, psychological distress, and relationship functioning. Interventions had a limited impact on physical distress and social adjustment. Most interventions focused on improving communication and increasing understanding of the cancer diagnosis within couples. Interventions were most often delivered by masters-level nurses or clinical psychologists. Although most were delivered in person, few were telephone-based. No difference in efficacy was noted based on mode of delivery. Factors associated with uptake and completion included symptom severity, available time and willingness to travel.ConclusionGiven effect sizes of couple-based interventions are similar to those reported in recent meta-analyses of patient-only and caregiver-only interventions (~d=.35-.45), it appears couple-based interventions for patients with cancer and their partners may be at least as efficacious as patient-only and caregiver-only interventions. Despite evidence that couple-based interventions enhance psycho-social adjustment for both patients and partners, these interventions have not yet been widely adopted. Although more work is needed to facilitate translation to routine practice, evidence reviewed is promising in reducing distress and improving coping and adjustment to a cancer diagnosis or to cancer symptoms.

Updated meta-review of evidence on support for carers

“…27 One review described overall quality as satisfactory; 31 another reported separately on the quality of primary studies for different outcomes (overall low to moderate). 24 In reviews targeting carers of people with cancer, one 33 suggested that studies were of moderate quality, 33 one 35 reported moderate to strong evidence 35 and one 36 reported fair to good-quality evidence. 36 Limitations and variable study quality were also reported in reviews of interventions for carers of people with stroke.…”

“…Multicomponent interventions were the focus in many reviews; those with psychosocial or psychoeducational content featured prominently, 28,[34][35][36][37][38]46 as did those containing education and/or communication skills training. 21,24,26,40,44,45 Other (more specific) interventions included stroke liaison workers, 39 volunteer mentoring, 32 meditation-based activity, 23 art-making classes 33 and home-based exercise.…”

“…Of the reviews, 14 [19][20][21][22][23][24][25][26][27][28][29][30][31][32] focused on interventions for carers of people with dementia, four [33][34][35][36] focused on carers of people with cancer, four [37][38][39][40][41] focused on carers of people with stroke, three [42][43][44] focused on carers of people with various conditions at the end of life and two 45,46 focused on carers of people with mental health problems. Not all reviews reported the geographic location of the included primary studies.…”

“…A quality assessment of primary studies was carried out in 25 [19][20][21][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43][44][45][46] of the 27 included reviews. In most cases, it was possible to determine at least the overall quality of the included studies.…”

Use and need for psychosocial support in cancer patients

“…Multivariable logistic regression analysis revealed that family-centered support use can be predicted by the [3][4][5][6][7][8][9][10][11][12][13][14]. f According to the SF-8 Health Survey (range, 0-100).…”