Li, Q., & Loke, A.Y. (2014). A systematic review of spousal couple-based intervention studies for couples coping with cancer: Direction for the development of interventions. Psycho-Oncology, 23, 731–739. 

STUDY PURPOSE: To explore the existing interventions for spousal couples coping with cancer in terms of type of intervention, contents, approach, and outcome measurements, and to identify directions for the development of interventions

DATABASES USED: Science Citation Index Expanded, PsycInfo, MEDLINE via OVIS SP, CINAHL

KEYWORDS: intervention; program; therapy; cope; coping; cancer; oncology; carcinoma; couple; partner; spouse

INCLUSION CRITERIA: Published in English or Chinese within the four databases searched; couple-based interventions; studies had to focus on couple-based interventions; outcome measures included the patients with cancer and their spousal caregivers

EXCLUSION CRITERIA: Commentaries, editorials, literature reviews, conference proceedings

• FINAL NUMBER STUDIES INCLUDED = 17
• SAMPLE RANGE ACROSS STUDIES: 9–263
• TOTAL PATIENTS INCLUDED IN REVIEW: 1,142 couples
• KEY SAMPLE CHARACTERISTICS: Patients were coping with prostate cancer, breast cancer, or gynecologic cancer; 70% focused on a gender-specific cancer; interventions involved an average of 6.2 sessions, with a range of 1–16 sessions; face-to-face sessions lasted an average of 79 minutes, with a range of 45–120 minutes; telephone contact time lasted an average of 32 minutes, with a range of 20–45 minutes; interventions lasted 8.3 weeks, with a range of 1–24 weeks from the first to last session; follow-up periods of the interventions were immediately post-intervention (n = 5 [29.4%]), eight weeks (n = 1 [5.9%]), 3 months (n = 4 [23.5%], 6 months (n + 1 [5.9%], and 12 months (n = 6 [35.3%]).

• APPLICATIONS: Palliative care

Of the 17 articles reviewed, interventions were focused mainly on patient caregiving and caregiver self-care, usually lasted for six weeks using a face-to-face group mode., and had follow-up around three months. The outcomes measures were grouped into three main dimensions: dyadic appraisal, dyadic coping, and dyadic adjustments. Positive outcomes were reported for these interventions, including improvements in communications, dyadic coping, quality of life of the patients and their partners, psychosocial distress, sexual functioning, marital satisfaction, and caregiver self efficacy. The majority of interventions were delivered to individual couples face-to-face. Attrition rate ranged from 6%–34%, with an average of 20%. Interventions were grouped as skills training (n = 11), counseling (n = 6), and psychoeducation (n = 2). Skills training and psychoeducation were most often provided together.

The findings highlighted the positive outcomes of couple-based interventions that focus on couples coping with cancer. Although all studies focused on the couple's communication and relationship, only 40% focused on the subject of the caregiver's self-care. All of  the intervention studies included in the review reported positive outcomes to some extent, including quality of life, psychosocial distress, sexual functioning, and marital satisfaction of the patients and their partners.

• Heterogeneity of studies included, such as varied types of cancer and differences in delivery of the intervention, is a limiting factor.  
• What phases of cancer care were involved in the studies included is not clear.  
• Cohort studies were included and not differentiated from RCTs.

Future couple-based intervention research should focus on patients with cancer whose spouse is an active caregiver and provide intervention and assessment of both partners as a unit (dyad). Findings from this review show that couple-based interventions had multiple benefits for patients and caregivers. The high attrition rates seen suggest that the most acceptable timing, duration, and method of delivery is not clear. Although benefit was shown, what factors would indicate those couples who would be most likely to benefit from couples interventions is not clear, and findings do not clarify which approaches are most beneficial.