Hopkinson, J.B., Brown, J.C., Okamoto, I., & Addington-Hall, J.M. (2012). The effectiveness of patient–family carer (couple) intervention for the management of symptoms and other health-related problems in people affected by cancer: A systematic literature search and narrative review. Journal of Pain and Symptom Management, 43, 111–142.

To review patient–family psychosocial interventions in cancer care on physical, psychological, social, and quality-of-life effects

To evaluate associated theoretical models and measured effects

• Databases used in the search were MEDLINE, EMBASE, PsycINFO, and CINAHL.
• Keywords were cancer, systematic, review, couple, family, psychosocial intervention, symptom, and quality of life.
• Inclusion criteria: English-language adults with cancer (18 years or older) from resource-rich countries; family/couples/partners (all gender combinations); relationship of caregiving between patient and other(s); illness-related (not long-term relationship) problems; studies with experimental design (e.g., randomized controlled trial [RCT], case control, systematic review); nonpharmacologic interventions; illness-related disruption in relationships and/or illness-related conflict; and evaluation of an outcome (e.g., satisfaction, distress, quality of life, pain)
• Exclusion criteria: Teenagers and children; people in residential care and other institutions where primary carers are professionals; pharmacologic interventions; intervention that cannot be delivered in a community setting (i.e., patient’s home); non-Western culture; intervention that is targeted at long-standing family dysfunction; intervention that is delivered over a long period of time (more than 2.5 months); intervention where the effect is not expected for longer than 2.5 months; study of past cause of family dysfunction; study of future prevention of family dysfunction; nonillness-related family problems; care/support/intervention for carer independent of patient (e.g., management of carer problem); care/support/intervention for patient independent of carer (e.g., management of patient problem); patient–healthcare professional relationships; carer–healthcare professional relationships; education or support for healthcare professionals; and organization/delivery of a service

• A total of 80 references were retrieved.
• One author performed a title and abstract scan on each retrieved study. The second author reviewed 10% of studies for reliability.
• Disagreements were resolved through discussion.

• A final number of 27 studies were included in the review.
• Sample range across studies was 14–480.
• Of the 27 studies (published between 1999 and 2009), 22 interventions focused on patients and family caregiver (dyad focus; too few studies focused on a multi-member family unit were found to include).
• Sample studies included patients with early-stage breast, gynecologic, and prostate cancers; all stage central nervous system tumors; and cancer-related pain; as well as patients undergoing chemotherapy.

• Active antitumor treatment phase   
• Elder care; palliative care

Dyad-focused nonpharmacologic interventions may improve coping and emotional support. High attrition related to the practical burdens associated with trial participation and care of a seriously ill patient impact the design and conduct of RCTs to test these interventions, but adverse events are few. Interventions that promote interactions within the dyad are more likely to have a measurable effect on emotional health outcomes than those targeted to a single member of the pair. Few studies are theory-based.

Dyadic interventions that promote interaction appear to be beneficial to impact anxiety, depression, and distress in patients with cancer and the family members who care for them.

The review was limited to English language studies.

High attrition rates in studies imply that it is important to match the intensity/complexity of an intervention with the dyad’s ability/willingness to participate fully, or risk drop out. Further theory development and testing are needed to guide design and conduct of future studies in this area.