Couple-based interventions may help improve the psychological wellbeing of cancer patients and their partners, but more research is needed

Cancer diagnosis and treatment can have negative consequences for the psychological wellbeing of patients and their caregivers.

This blog will summarise a systematic review on whether couple-based interventions make a difference for couples affected by cancer (Regan, 2012).

The review tried to answer three questions:

What is the efficacy of couple-based interventions on depression, anxiety, distress, or quality of life?
How is the content of the couple-based interventions tailored and delivered?
What elements of these interventions seem to be most effective in reducing distress and improving outcomes for patients and partners?

Methods

The authors searched a range of databases that helped identify the interventions that targeted both the patient and their partners. They limited their review to papers in English and French. They also contacted researchers known to work in this area. After screening the titles and abstracts of 1,279 articles, they included a total of 23 studies in the systematic review.

The authors used PRISMA guidelines to maximise methodological quality of their review. In addition, they used Effective Public Health Practice Project (EPHPP) criteria to assess methodological quality and National Health and Medical Research Centre (NHMRC; Australian) guidelines for hierarchically assessing levels of evidence.

According the EPHPP criteria, eight studies had a global rating of ‘strong’ and the remainder were ‘moderate’. In terms of NHMRC criteria, six studies were appropriately designed randomised controlled trials (RCT), 12 were from pseudo-RCTs, and 5 were cohort studies.

Therapies in the review were delivered by psychologists, clinical psychology doctoral students, clinical social workers, psychiatric nurse counsellors, and health care professionals

Classification of interventions

Each intervention was classified as either:
- a dyadic intervention (patient and partner engage in intervention at the same time and with similar roles, n=17)
- a coaching intervention (partner takes on the role of ‘proxy’ therapist, n=3)
- an individual intervention (patient and partner receive the same or similar intervention separately, n=3)
Delivery methods included: face-to-face with couples (n=15); by telephone (n=4); face-to-face and telephone (n=3); face-to-face, over telephone and educational videos (n=1)
Those who delivered the intervention included psychologists, clinical psychology doctoral students, clinical social workers, psychiatric nurse counsellors, and health care professionals
Only 7 of the 23 interventions required specific training of intervention protocol (ranging from a 6-hour to a 4-day seminar)

Characteristics of participants and uptake/attrition

Most patients were Caucasian, highly educated, diagnosed with breast or prostate cancer and in their early 50s. Partners were defined as spousal partners
73.2% of the patients and 71.3% of the partners provided data at the final follow-up point
Common reasons for withdrawal were: distance to the intervention, illness burden, intervention not meeting needs, being too busy, and refusal of group assignment

Results

Global quality of life

Immediately following the intervention, one study showed weak to moderate improvements for patients and 2 studies for partners. Out of four studies, only 1 showed improvements at from 6-month to 12-month follow-up for patients and 2 for partners at 6- and 12-month follow-up.

Psychological distress

For patients: Nine reported greater improvements for intervention than control; 3 studies reported improvements compared to baseline immediately after the intervention.
For partners: Two studies reported significant improvements for intervention groups compared to control groups and 3 reported improvements compared to baseline. One study found within intervention group improvement at the final follow-up point compared to baseline (single arm intervention trial with 16 couples)

Target population and timing

The authors reported that interventions aimed at early-stage cancer patients and partners resulted in greater improvements than interventions for late-stage or advanced cancer patients
One study found that intervention effects were greater for patients with unsupportive partners, patients with higher levels of physical distress, couples in shorter relationships, and patients receiving chemotherapy compared to those not receiving it

Mode of delivery

There were no significant differences between face-to-face and telephone delivery although participants in the telephone-based interventions felt that some face-to-face interaction was still necessary

Conclusions

Most of the couple-based interventions included in this review demonstrated significant improvements for intervention couples

The reviewers concluded:

Most of the couple-based interventions included in this review demonstrated significant improvements for intervention couples compared to control couples, albeit with small to medium effect sizes (d ~ .35-.45), on a range of psychological outcomes.

The greatest impact of these interventions was found in outcomes such as couple communication, distress, and relationship functioning.

Limitations included inadequate description of attrition rates, randomisation and blinding procedures and limited use of intention-to-treat analyses. Also, the generalisability of the findings of the studies is limited as most participants were middle-aged Caucasian women in heterosexual relationships.

Summary

This review shows that couple-based interventions can have a beneficial impact on various psychological outcomes for patients and partners, however more studies are needed to determine longitudinal outcomes and what each gender needs and wants from an intervention. In addition, more couple-based interventions for different cancer types and among males and younger couples are needed.