O'Toole, M.S., Zachariae, R., Renna, M.E., Mennin, D.S., & Applebaum, A. (2016). Cognitive behavioral therapies for informal caregivers of patients with cancer and cancer survivors: A systematic review and meta-analysis. Psycho-Oncology. Advance online publication. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the overall effect of interventions using cognitive behavioral therapy (CBT) components and to explore possible moderators of this effect, including trial design, outcomes evaluated, demographic variables, intervention duration and modality of delivery, illness-related variables among patients, and study quality

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PsycINFO, Cochrane, CINAHL, and Embase
 
INCLUSION CRITERIA: Peer-reviewed articles and articles that (a) investigated the effect of a CBT for informal caregivers (ICs) of patients with cancer or cancer survivors; (b) employed at least one quantitative measure of psychological, physical, or interpersonal functioning/well-being of the IC both pre- and postintervention; (c) enrolled adult samples aged 18 years or older; (d) reported results that could be converted into an effect size; and (e) were written in English. Articles about CBT if it included at least one of the following components: cognitive restructuring, imaginal or in vivo exposure, coping skills training, problem solving, behavior activation, behavioral experiments, structured homework, acceptance-based strategies, stress and anxiety management through relaxation, or mindfulness
 
EXCLUSION CRITERIA: Nonadult, non-English, after January 2014

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,131 retrieved, 163 eligible 
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 36
  • TOTAL PATIENTS INCLUDED IN REVIEW = 3,820 analyzed
  • KEY SAMPLE CHARACTERISTICS: Randomized, controlled trials (RCTs) (K = 27) comparing CBTs with a nonactive control condition (K = 21). Individual (as opposed to group) (K = 28) therapy for couples/dyads (K = 28), and delivered face-to-face (K = 22). Patients with mixed stages of cancer (K = 14). Twelve studies explicitly stated that the intervention adhered to a cognitive behavioral framework. The most commonly employed treatment components (see definition above) were coping skills training (K = 24), problem solving (K = 15), cognitive restructuring (K = 14), structured homework (K =11), and relaxation (K = 10).

Results

A small statistically significant effect of CBTs (Hedges' g = 0.08, p = 0.014) was revealed, which disappeared when RCTs were evaluated alone (Hedges' g = 0.04, p = 0.2). A number of variables were explored as moderators. Only the percentage of female participants was positively associated with the effect size. More specifically, females were more responsive to CBT interventions with an effect on physical health and mastery.

Conclusions

Based on the negligible effect of CBTs across outcomes, future studies should consider moving beyond traditional CBT methods, as these do not appear efficacious. Future interventions should orient toward advances in the basic affective sciences and derived therapies to better understand and treat the emotional struggles experienced by ICs.

Limitations

  • High heterogeneity
  • Low sample sizes
  • Variability in theoretical definition and use of CBT across studies

Nursing Implications

Translating CBT interventions to practice has been a challenge in the nursing discipline. These findings suggest that, although CBT techniques like problem solving could be meaningful, CBT may be one component of a mulitmodual intervention for the best effect for the family caregiver. Nurses should also recognize that gender may influence the possible benefit patients experience from a CBT intervention.

Legacy ID

6202