Li, Q., Xu, Y., Zhou, H., & Loke, A.Y. (2015). A couple-based complex intervention for Chinese spousal caregivers and their partners with advanced cancer: An intervention study. Psycho-Oncology. Advance online publication. 

To evaluate the acceptability and feasibility of a couples-based coping intervention, Caring for Couples Coping with Cancer (4Cs), and to gather preliminary data on the efficacy of the intervention

A convenience sample of couples received the 4Cs intervention, a couples-based intervention delivered weekly for six weeks by a researcher or therapist to small groups of couples (three to eight). The couples received semistructured instruction using information via didactic instruction, group sharing and group interaction. Sessions were supplemented using the guidebook Live With Love: Hope for the Best, Prepare for the Worst. Assessments were made at baseline and upon completing the six-week intervention.

• N = 117 
• MEAN AGE = Caregivers; 56.8 years (range = 26–76 years), patients; 57.7 years (range = 26–79 years)
• MALES: Caregivers (33%); patients (76%), FEMALES: Caregivers (67%); patients (33%)
• KEY DISEASE CHARACTERISTICS: Gastrointestinal, lung, and urogenital cancers (55.6%, 29.9%, and 11.1%, respectively)
• OTHER KEY SAMPLE CHARACTERISTICS: Stage III and IV cancer; Chinese adult married couples

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: China

• PHASE OF CARE: Multiple phases of care

Nonrandomized, pre- and postintervention study

• Cancer Behavior Inventory (CBI-B)
• Dyadic Coping Inventory (DCI)
• Cancer-Related Communication Problems (CRCP-SF12)
• Hospital Anxiety and Depression Scale (HADS) 
• Benefit Finding Scale (BFS)
• Revised Dyadic Adjustment Scale (RDAS)

The 4Cs cancer program for couples was easy to recruit for, had relatively low drop-out rate, and was well-tolerated by the participants. The couples showed significant increases in self-efficacy (p < 0.01), the DCI (p < 0.05), the PCS of SF12 (p < 0.05), and positive emotions on benefit finding (p < 0.05). Participants also experienced a significant decrease in overall CRCP (p < 0.05) and anxiety (p < 0.01).

The 4Cs program was feasible to administer to couples facing cancer and appeared to have preliminary data supporting its benefit for the emotional health and coping of couples dealing with cancer.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no random assignment)

The 4Cs couples-based intervention shows promise for improving couple efficacy, coping, physical health, and positive emotions. Larger, multisite, randomized, controlled trials of this intervention are needed.