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

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          Abstract

          Background

          With 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.

          Method

          A 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.

          Results

          Of 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.

          Conclusion

          Given 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.

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          Most cited references39

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          The prevalence of psychological distress by cancer site.

          The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined. The sample was extracted from a database that consists of 9000 patients who completed the Brief Symptom Inventory as a component of comprehensive cancer care. Relevant data points for each case included age, diagnosis, gender, insurance status, marital status, race and zip code. Simple frequencies, percentages, measures of central tendency and variability were calculated. In addition, a univariate and multiple regression analysis was used to examine the relationships of these relevant variables to psychological distress. The overall prevalence rate of distress for this sample was 35.1%. The rate varied form 43.4% for lung cancer to 29.6% for gynecological cancers. While some rates were significantly different, diagnoses with a poorer prognosis and greater patient burden produced similar rates of distress. Pancreatic cancer patients produced the highest mean scores for symptoms such as anxiety and depression, while Hodgkin's patients exhibited the highest mean scores for hostility. These results offer vital support for the need to identify high-risk patients through psychosocial screening in order to provide early intervention. To simply perceive cancer patients as a homogeneous group is an erroneous assumption. Failure to detect and treat elevated levels of distress jeopardizes the outcomes of cancer therapies, decreases patients' quality of life, and increases health care costs. Copyright 2001 John Wiley & Sons, Ltd.
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            Distress in couples coping with cancer: a meta-analysis and critical review of role and gender effects.

            Research concerning distress in couples coping with cancer was integrated using meta-analysis and narrative critical appraisal. Individual levels of distress were determined more by gender than by the role of being the person with cancer versus that person's partner. That is, women reported consistently more distress than men regardless of their role (standardized mean difference = 0.31). The association between patient and partner distress within couples was only moderate (r = .29) but is sufficient to warrant further consideration of the notion that these couples react as an emotional system rather than as individuals. It is noteworthy that this association is not moderated by gender. With a general lack of comparison groups, the question of how much distress can be ascribed to the cancer experience cannot be answered decisively; elevations in distress are probably modest. We critically discuss these results, identify important unanswered questions, and indicate directions for future research. Attention needs to be directed toward factors other than cancer as direct influences of distress in these couples and to mediators and moderators of the cancer experience. Copyright (c) 2008 APA.
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              Interventions with family caregivers of cancer patients: meta-analysis of randomized trials.

              Family caregivers of cancer patients receive little preparation, information, or support to perform their caregiving role. However, their psychosocial needs must be addressed so they can maintain their own health and provide the best possible care to the patient. The purpose of this article is to analyze the types of interventions offered to family caregivers of cancer patients, and to determine the effect of these interventions on various caregiver outcomes. Meta-analysis was used to analyze data obtained from 29 randomized clinical trials published from 1983 through March 2009. Three types of interventions were offered to caregivers: psychoeducational, skills training, and therapeutic counseling. Most interventions were delivered jointly to patients and caregivers, but they varied considerably with regard to dose and duration. The majority of caregivers were female (64%) and Caucasian (84%), and ranged in age from 18 to 92 years (mean age, 55 years). Meta-analysis indicated that although these interventions had small to medium effects, they significantly reduced caregiver burden, improved caregivers' ability to cope, increased their self-efficacy, and improved aspects of their quality of life. Various intervention characteristics were also examined as potential moderators. Clinicians need to deliver research-tested interventions to help caregivers and patients cope effectively and maintain their quality of life. Copyright 2010 American Cancer Society, Inc.
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                Author and article information

                Contributors
                Journal
                BMC Cancer
                BMC Cancer
                BMC Cancer
                BioMed Central
                1471-2407
                2012
                6 July 2012
                : 12
                : 279
                Affiliations
                [1 ]Centre for Translational Neuroscience and Mental Health, Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
                [2 ]Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
                [3 ]Kent School of Social Work, University of Louisville, Louisville, KY, USA
                [4 ]School of Medicine, University of Queensland, Brisbane, Queensland, Australia
                Article
                1471-2407-12-279
                10.1186/1471-2407-12-279
                3464780
                22769228
                09fc8f43-c63a-45a3-87d2-d6b0e5383fd3
                Copyright ©2012 Regan et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 September 2011
                : 21 June 2012
                Categories
                Research Article

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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