A literature review on the mutual impact of the spousal caregiver–cancer patients dyads: ‘Communication’, ‘reciprocal influence’, and ‘caregiver–patient congruence’

Acceptability of internet-delivered cognitive behavioural therapy and carer inclusion for breast cancer survivors: Thematic findings from interviews

Breast cancer survivors often lack post-treatment psychological care options. Internet-delivered cognitive behavioural therapy (iCBT) has proven effective for depression and anxiety among survivors. Involving carers in iCBT can further encourage survivors and enhance the benefits they receive. This study explored survivors' experiences with iCBT and their perspectives on carer involvement. Fifteen participants were interviewed. Data were analysed using thematic content analysis. Most survivors found iCBT helpful, mentioning evidence-based approach, reminders, readiness for change, recognising benefits, and contributing to research as engagement facilitators. Suggestions included widespread availability of the programme and additional guidance on some tools. Reluctance to involve carers resulted from survivors' unwillingness to discuss cancer, desire not to burden others, and the need for ownership over their recovery. Findings support iCBT's acceptability in addressing post-treatment depression and anxiety among survivors. Future research could explore alternative ways to involve carers, such as dedicated programmes, optional joint exercises, or brief interventions.

Communication and support of patients and caregivers in chronic cancer care: ESMO Clinical Practice Guideline

•ESMO Clinical Practice Guideline with key recommendations for communication and support of cancer patients and caregivers. •The guideline discusses training in communication of oncology clinicians and research on communication in cancer care. •Practical recommendations aim to support oncology clinicians in their communication with patients and caregivers. •Figures summarising the responsibilities of the clinician, the oncology team and the health care institution are provided.

Mutual communication intervention for colorectal cancer patient-spousal caregiver dyads: A randomized controlled trial

OBJECTIVE

Gender could impact the psychosocial outcomes and coping strategies of cancer patients and their spousal caregivers (SCs). This study aims to develop a gender-concerned program for colorectal cancer (CRC) couple-based mutual communication intervention (MCI) and to assess its effectiveness on the intra-couple relationship and the individual functions of the partners.

DESIGN

A randomized clinical trial with two study groups was utilized.

METHODS

A total of 144 CRC patients and their SCs were randomly assigned to either MCI or usual care (UC) groups, and all of them were required to complete the measurements at baseline and post-intervention. The primary outcome was for mutual communication, and the secondary outcomes included dyadic coping, relationship satisfaction, anxiety, depression, benefit finding and quality of life. The data were analysed by multi-level modelling.

RESULTS

The MCI program was feasible and acceptable for Chinese CRC couples and was effective for the improvement of the intra-couple relationship and the individual functions of each partner. CRC patients showed more improvement in mutual communication and dyadic coping than their SCs in the MCI group. Also, this intervention effectiveness was found to be independent of gender.

CONCLUSIONS

The MCI program is beneficial for Chinese CRC couple's adaptation outcomes. This suggests that clinical medical staff should consider the gender tendency during the implementation of interventions. More researches are needed to extend the application of the MCI program to different participants (e.g. patients with the diagnosis of other types of cancer and their SCs).

Cancer patient and caregiver communication about economic concerns and the effect on patient and caregiver partners' perceptions of family functioning

PURPOSE

Financial strain and stressful life events can constrain open communication within families. A cancer diagnosis can bring heightened emotional stress and financial strain for most cancer patients and their families. We evaluated how level of comfort and willingness to discuss important but sensitive economic topics affected longitudinal assessments of family relationships, exploring both within-person and between partner effects over 2 years after a cancer diagnosis.

METHODS

A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multi-level models were developed to examine the associations between comfort discussing economic aspects of cancer care and family functioning.

RESULTS

Broadly, caregivers and patients who were comfortable discussing economic topics reported higher family cohesion and lower family conflict. Dyads' assessments of family functioning were influenced both by their own and their partners level of communication comfort. Overtime, caregiver but not patients perceived a significant decrease in family cohesion.

CONCLUSIONS

Efforts to address financial toxicity in cancer care should include examination of how patients and families communicate as unaddressed difficulties can have detrimental effects on family functioning in the long term. Future studies should also examine whether the prominence of specific economic topics, such as employment status, varies depending on where the patient is in their cancer journey.

IMPLICATIONS FOR CANCER SURVIVORS

In this sample, cancer patients did not perceive the decline in family cohesion that was reported by their family caregiver. This is an important finding for future work that aims to identify the timing and nature to best intervene with caregiver supports to mitigate caregiver burden that may negatively impact long-term patient care and QoL.

Interventions strategies and their efficacy in illness perceptions in patients with cancer: A systematic review and meta-analysis

PURPOSES

To identify intervention strategies for improving illness perception (IP) of cancer patients and/or family caregivers; and to examine the effects of IP interventions by meta-analysis.

METHODS

A systematic search was performed to identify literature that focused on improving the IP of cancer patients and/or family caregivers from the establishment of eight databases to August 2023. Manual screening was also applied. The IP intervention strategies for cancer populations were synthesized basing the CSM. Meta-analysis was conducted to assess the effects of IP interventions on health outcomes. Multiple subgroup analyses of the same intervention conditions were conducted to explore the optimal IP-focused intervention.

RESULTS

18 studies were included. 11 studies were conducted in a meta-analysis. No studies on family caregivers' IP were identified. Compared to general care, subgroup analysis revealed that IP interventions had favorable effects on cancer patients' IP as well as quality of life and other outcomes. Six IP intervention strategies (information support, cognitive reframing, emotion adjustment, active coping, effective appraisal, and self-social identification) were generated. Meta-analysis showed that compared with theory-less studies (Z = 8.64, p < 0.01) and single delivery formats (Z = 3.66, p < 0.01), the theory-based interventions (Z = 10.86, p < 0.01) and mixed delivery formats (Z = 7.15, p < 0.01) had higher positive effects on IP outcomes.

CONCLUSIONS

The positive outcomes of IP intervention focusing on cancer patients were highlighted. IP traits and patients' and their caregivers' needs in coping with specific cancer types should be explored before the intervention design. More IP interventions targeting cancer dyads are warranted to develop in the future.

The Illness Perceptions and Coping Experiences of Patients with Colorectal Cancer and Their Spousal Caregivers: A Qualitative Study

(1) Background: Illness perception (IP) is an important psychological construct for couples dealing with cancer, which impacts health outcomes and the psychological adjustment to cancer. More research is needed to explore the traits of IP and the efforts of couples coping with cancer. Thus, this study was designed to explore the coping experiences and features of the IPs of couples dealing with cancer. (2) Methods: A total of 24 patients with colorectal cancer (CRC) and 20 spousal caregivers (SCs) participated in semi-structured interviews. All interviews were recorded digitally, transcribed, and analyzed by using an inductive thematic analysis. (3) Results: Two themes (individualized and predominant IP; IP sharing and restructuring) were developed. A preliminary framework was formulated to illustrate the relations among subthemes and the relations between themes with an adjustment of a positive IP to CRC. In this framework, based on multiple sources and factors, the natural disparities formed the IPs of the partners of couples and determined the incongruence of IPs. The effects of IP incongruence on lives under the disease guided the three directions of coping approaches (i.e., information and available support, appropriate disclosure and reflection, and leaving the CRC diagnosis behind) which were adopted by couples dealing with CRC to share and restructure the IP with their spouses for effective dyadic coping. (4) Conclusions: This study provides insights to healthcare providers into the experiences of couples dealing with CRC and the development of couple-based IP intervention programs: (a) it initially provides adequate factual knowledge for enhancing beliefs in the ability to control illness, (b) encourages illness-centered conversations and disclosure regarding thoughts and emotions for promoting positive congruence of IP between the partners of couples dealing with a hard dilemma, and (c) guides couples to perceive positive changes and explore the illness's meaning. Understanding each theme of personalized IP and adopting effective IP coping approaches can help guide couples dealing with CRC to efficiently promote constructive IP and better health outcomes.

A couple-based unmet supportive care needs intervention for colorectal cancer couples: A preliminary feasibility study

PURPOSE

To support colorectal cancer couples cope with cancer, we developed a couple-based unmet supportive care needs intervention program guided by the Supportive Care Needs Framework and examined the feasibility, acceptability, and initial effects of the unmet supportive care needs program.

METHODS

The design of a pre-and post-intervention study was conducted among Chinese colorectal cancer couples. The intervention was delivered in five sessions through in-person and telephone interventions combined. To measure program feasibility through recruitment and retention rates, and to test program acceptability through quantitative and qualitative post-intervention program assessments. The complete data (N = 20 pairs) were used to calculate effect sizes to assess the initial intervention effect.

RESULTS

There was evidence of the feasibility of the intervention program in terms of recruitment (66.7%) and retention (83.3%) rates. Participants' satisfaction with the program also attested to its acceptability. The intervention (Cohen's = 0.15-0.56) had a small-moderate effect size in improving unmet supportive care needs and most cancer-adapted outcomes for colorectal cancer couples, validating the initial effect of the program.

CONCLUSIONS

The unmet supportive care needs program is feasible, acceptable, and preliminarily effective in supporting Chinese colorectal cancer couples to improve unmet supportive care needs and cancer adaptability, as provided by this study.

Dyadic coping, resilience, and quality of life in young and middle-aged couples after gynecologic cancer: An actor-partner interdependence mediation model

PURPOSE

To examine the effects of dyadic coping on quality of life (QoL) and the mediating role of resilience in these effects among young and middle-aged couples after gynecologic cancer (GC).

METHODS

A cross-sectional study was conducted between July 2022 and June 2023 from one tertiary hospital in Wuhan, China. 240 pairs of young and middle-aged GC couples were recruited. The demographic and clinical characteristics questionnaire, the Dyadic Coping Inventory, the 10-item Connor-Davidson Resilience Scale, and the 12-item Short-Form Health Survey were used to collect data. The process of dyadic analysis was based on the actor-partner interdependence mediation model.

RESULTS

GC patients' dyadic coping had an actor effect on both their own physical and mental QoL, while spouses' dyadic coping only exerted an actor effect on their own mental QoL. The mediating effects of resilience on the relationship between dyadic coping and QoL were identified in dyads. Moreover, spouses' dyadic coping could indirectly influence patients' QoL through their own and patients' resilience.

CONCLUSION

The findings confirm the dyadic relationships between dyadic coping, resilience, and QoL among young and middle-aged couples facing GC. These results suggest that it is necessary to develop couple-based interventions to improve dyadic coping and resilience, thus enhancing the QoL of both members.

Health literacy, eHealth literacy and their association with burden, distress, and self-efficacy among cancer caregivers

Purpose

Health literacy skills are vital for cancer caregivers in helping cancer survivors to navigate their diagnosis, treatment, and recovery but little is known. This study explored health literacy and eHealth literacy among cancer caregivers and the relationship between health literacy/eHealth literacy and potential associated factors.

Methods

Informal caregivers who had cared for an individual with cancer completed a survey which collected demographic data and measured caregiver health literacy, eHealth literacy, self-efficacy, burden, and distress.

Results

Seven percent of caregivers had inadequate health literacy. Caregivers scored lowest on health literacy domains related to caregiver social support, information seeking and understanding care recipient preferences. eHealth literacy was associated with self-efficacy and burden while, different health literacy domains were associated with burden ('Understanding care recipient needs and preferences'), self-efficacy ('Cancer-related communication with the care recipient' and 'Understanding care recipients needs and preferences') and distress ('Proactivity and determination to seek information', 'Understanding care recipient needs and preferences', 'Understanding the healthcare system').

Conclusion

Findings highlight key areas of need regarding cancer caregiver health literacy which future research can target. Given the observed relationship between aspects of health literacy and burden, distress and self-efficacy future work could be carried out on how to alleviate high levels of burden and distress and how to enhance self-efficacy among cancer caregivers by addressing health literacy skills.

Implications for cancer survivors

Findings from this study will inform the development of health literacy interventions to support caregivers to build their health literacy skills and enable this group to better support cancer survivors as a result.

Health literacy interventions for informal caregivers: systematic review

AIM

The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.

METHODS

MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool.

RESULTS

Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL.

DISCUSSION

Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.

Using the Actor-Partner Interdependence Model to explore the psychological impact of COVID-19 on anxiety in dyads of patients with cancer and caregivers

BACKGROUND

Delineating the compound psychological effect of the pandemic on cancer care, and the interdependency across cancer patient-caregiver dyads have yet to be explored. This study examines the levels of psychological impact of COVID-19 on patient-caregiver dyads anxiety, and the interdependent associations between their COVID-19 and cancer concerns, and risk perceptions.

METHOD

There were 352 patients and caregivers (patient-caregiver dyads, N = 176) included in this study (43.2% spousal dyads). Generalized Anxiety Disorder-7 and questionnaires regarding risk perception, perceived confidence in healthcare system, COVID-19, and cancer-related concerns were administered. Actor-Partner Interdependence Model (APIM) analyses were used to determine the interdependent effects. Indirect effects were tested using mediation pathway analyses.

RESULTS

Patients reported significantly higher levels of risk perceptions and anxiety than their caregivers (p < 0.01). Anxiety rates (GAD-7 ≥ 10) were also significantly higher (26.7% vs 18.2%, p < 0.01). Dyads' anxiety, "general COVID-19 concerns," "cancer-related concerns," and risk perceptions were correlated (ps < 0.01). APIM showed only actor effects of general COVID-19 concerns, cancer-related COVID-19 concerns, and risk perceptions on anxiety (βs = 0.19-0.53, ps < 0.01). No partner effects were observed. Similar results were found in the composite APIM. Indirect effects of the patient/caregiver's variables on their partner's anxiety were observed in the mediation analyses.

CONCLUSION

Concerns about COVID-19 and cancer care could be indirectly associated in patient-caregiver dyads and need to be proactively addressed. As pandemic evolves into endemicity, engagement with patients and caregivers should strive to be sensitive to their differential needs and messages should be tailored to the informational needs of each.

Associations between dyadic communication and dyadic coping of patients with cervical cancer and their spouses: a study utilizing the actor-partner interdependence model

There is a growing focus on exploring dyadic interactions and outcomes between couples undergoing cervical cancer (CC). The purpose of this cross-sectional study was to figure out how dyadic communication influences both CC patients' and spouses' coping abilities. A sample of 286 CC dyads completed questionnaires assessing dyadic communication and dyadic coping. The actor-partner interdependence model was used to analyze the interaction effect between the dyads. Dyadic communication among cervical cancer (CC) patients has a predictive effect on their own negative dyadic coping (β =  - 0.141, P = 0.034) and on their spouses' delegated dyadic coping (β = 0.133, P = 0.044). In contrast, dyadic communication among CC spouses is negatively associated with their own supportive dyadic coping (β =  - 0.237, P < 0.001), delegated dyadic coping (β =  - 0.156, P = 0.018), common dyadic coping (β =  - 0.148, P = 0.026) and also with CC patients' supportive dyadic coping (β =  - 0.153, P = 0.022). Dyadic communication between CC patients and their spouses affect their own and each other's dyadic coping. Exploring interventions focused on the CC couples' communication strategies to enhance their positive dyadic coping should be considered.

Physical Activity Together for Multiple Sclerosis (PAT-MS): A randomized controlled feasibility trial of a dyadic behaviour change intervention

Background

Many people with advanced multiple sclerosis (MS) and their care-partners do not engage in sufficient physical activity (PA) for health benefits. We developed "Physical Activity Together for MS (PAT-MS)", a 12-week dyadic behavioural intervention, to promote PA among these dyads. Herein, we evaluated the feasibility of PAT-MS before a definitive trial.

Methods

A randomized controlled feasibility trial, with 1:1 allocation into the intervention or wait-list control condition. Predefined progression criteria included rates of recruitment, retention, safety, participant satisfaction and adherence. Changes in self-reported and accelerometer-measured PA were assessed at baseline and post-intervention using mixed-factor ANOVAs. Effects sizes were calculated as Cohen's d.

Results

The recruitment rate (i.e., 20 participants in 10 months) was not acceptable. However, retention (80%) was acceptable. No serious adverse events were reported. There were high levels of participant satisfaction with the intervention (content (median = 6 out of 7), facilitator (median = 7 out of 7), and delivery (median = 5 out of 7)) and adherence (92% of the group sessions, 83% of the individual support calls, and 80% of the practice activities were completed). There were statistically significant time-by-condition interactions on self-reported PA, steps/day, and %wear time and minutes in sedentary behaviour, and moderate-to-vigorous PA from baseline to post-intervention in people with MS and their family care-partners.

Conclusion

PAT-MS appears feasible, safe, and efficacious for PA promotion in MS dyads. We established effect size estimates to power a future definitive trial and identified necessary methodological changes to increase the efficiency of study procedures and improve the quality of the intervention.

Trial registration

ClinicalTrials.gov NCT04267185; Registered February 12, 2020, https://clinicaltrials.gov/ct2/show/NCT04267185.

Mutual communication processes within Chinese colorectal cancer patient-spousal caregiver dyads: A qualitative study of taking gender into account

PURPOSE

Mutual communication within cancer couples is a complex process. More research is needed to explore the complex process of mutual communication and its nuances presented by various factors in different culture contexts. Gender, a factor embedded in marital relationships, is an important consideration. We thus aim to explore the mutual communication process within Chinese colorectal cancer couples and take gender into account.

METHODS

A qualitative study was conducted by interviewing 20 colorectal cancer patients and 15 spousal caregivers. Inductive thematic analysis was used to analyze the transcripts.

RESULTS

Three themes (mutual communication and support interaction, communication quality, and foundation of mutual communication and collaboration) were developed. Gender was found to have specific impact on emotional disclosure and communication challenges. A preliminary framework of "smile" was constructed to demonstrate the relationship among the three themes and the relationships between the three themes and dyads' psychosocial adaptation to colorectal cancer.

CONCLUSIONS

Study findings demonstrate complex mutual communication processes within colorectal cancer couples and the impact of gender. The findings will contribute to developing more effective colorectal cancer couple-based mutual communication interventions. Health practitioners are suggested to improve mutual communication within colorectal cancer couples in three aspects: relational topics, emotional disclosure and communication skills. Guiding couples to deal with each theme and the relationship among the themes simultaneously is helpful for them to return and smile to their normal life.

Decision-making trade-offs: A classic grounded theory study of Chinese acute leukaemia patients and their family caregivers across the trajectory of illness

AIM AND OBJECTIVES

To identify the main concern of patients with acute leukaemia and their family caregivers in the process of coping with the disease and to determine how patients and their family caregivers address these concerns on an ongoing basis.

BACKGROUND

Acute leukaemia is a progressive disease that may lead to physical problems and mental stress in patients. It also affects the psychological well-being and quality of life of family caregivers. Nevertheless, few studies explore the behavioural pattern across the trajectories of illness in Chinese patients with acute leukaemia and their family caregivers.

DESIGN

Grounded theory.

METHODS

Theoretical sampling was performed to collect 14 sets of secondary data from Bilibili platform, literature, articles from WeChat official account, press releases and documentary. A total of 29 participants were selected to participate in semistructured interviews from the haematology department of a tertiary care hospital in Fuzhou, Fujian Province from January 2021 to November 2021. Data collection and analysis were conducted in a synchronous iterative manner until theoretical saturation was reached. Data analysis included open coding, selective coding and constant comparison, et al. The CCOREQ checklist was utilised.

RESULTS

This study discovered the main concern (i.e. seeking survival) and main behavioural pattern of how patients with acute leukaemia and their family caregivers addressed this issue. Three decision-making strategies, 'responding' 'accommodating' and 'resisting' also emerged.

CONCLUSIONS

This study explored the behavioural pattern of patients with acute leukaemia and their family caregivers in the process of coping with disease. The study found that the main concern of patients with acute leukaemia and their family caregivers, and provided a theoretical basis for disease management and nursing interventions for them in the future.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study contribute to nursing knowledge, practice in the field of patients' participation in decision-making.

PATIENT OR PUBLIC CONTRIBUTION

Due to the characteristics of grounded theory (no presupposition of research questions), the interviews in this study mainly focus on theory generation. Participants were not asked to assess the burden of the intervention and the time required to participate in the study, as interviews were conducted for theory generation. This study may assist patients and family caregivers in obtaining better understand and adapt to changes across the trajectory of illness, as well as to promote public destigmatisation of acute leukaemia and reforms in family-hospital-community diversified care.

Are couple-based psychological interventions beneficial for the mental health of prostate cancer patients and their spouses? A systematic review and meta-analysis

As the survival rates for prostate cancer (PCa) have improved, there has been an increasing focus on the mental health of couples affected by this condition. There have been several couple-based psychological interventions, and yet the impact of this treatment modality on the mental health of PCa patients and their spouses is unclear. Consequently, a systematic search was conducted in PubMed, Embase, Cochrane, LILACS, and Web of Science up to March 2023 for randomized controlled trials (RCTs) addressing the impacts of couple-based psychological interventions on both PCa patients and their spouses. Besides, the Cochrane Risk of Bias Assessment Tool was employed to evaluate the methodological quality and potential bias of the included studies. Moreover, statistical analysis and meta-analysis were performed utilizing Revman 5.4, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence. A total of nine RCTs were included, utilizing anxiety, depression, distress, communication, and self-efficacy as outcome indicators to assess mental health. Results demonstrated that couple-based psychological interventions increased spouses' self-efficacy (WMD, 0.21; 95% CI: -0.00 ~ 0.42; P = 0.05) and communication (SMD, 0.34; 95% CI: 0.09 ~ 0.59; P = 0.009), while reducing their distress (SMD, -0.21; 95% CI: -0.40 ~ -0.02; P = 0.03). Nonetheless, there is a need for additional research on the effect of couple-based psychological interventions on the mental health of PCa-affected couples given the limited evidence supporting this conclusion.

Effects of family-centered positive psychological intervention on psychological health and quality of life in patients with breast cancer and their caregivers

PURPOSE

Positive psychological intervention could improve individual's psychological health and quality of life. This study aimed to examine the effectiveness of family-centered positive psychological intervention on resilience, hope, perceived benefits, and quality of life in breast cancer patients and their caregivers.

METHODS

A two-group, randomized controlled study, including 98 dyads of breast cancer patients and caregivers, was conducted. Dyads were randomly assigned to intervention (n = 49) and control (n = 49) groups. Both the control and intervention groups received 4 weeks of health education, while the intervention group additionally received a 4-week family-centered positive psychological intervention. Outcome measures compared at baseline (T1), immediately after the intervention (T2), and at 1-month follow-up (T3), included validated measures of resilience (Connor-Davidson Resilience Scale), hope (Herth Hope Index), perceived benefits (Perceived Benefits of Diagnosis and Treatment of Breast Cancer, Positive Aspects of Caregiving), and quality of life (Functional Assessment of Cancer Therapy-Breast, Caregiver Quality of Life Scale).

RESULTS

Resilience, hope, perceived benefits, and quality of life of dyads were significantly higher in the intervention group than those in the control group at T2 and T3 (all p < 0.05). Linear mixed model analysis demonstrated a significant interaction effect of group × time × role (p = 0.007) on hope and a significant difference in the improvement of hope (p < 0.05) between patients and their caregivers.

CONCLUSIONS

Our family-centered positive psychological intervention was effective in improving psychological health and quality of life for breast cancer patients and caregivers. This study provides evidence for the effectiveness of positive clinical psychological interventions.

TRIAL REGISTRATION

ChiCTR2300072809.

Facilitators and Barriers to Older Adult Participation in Cancer Trials: A Qualitative Study Exploring Patient-Caregiver Dyad Congruence

PURPOSE

Family caregivers play an integral role in caring for older adults with cancer. Few studies have examined older adults with cancer and their family caregivers as a unit in a relationship or a dyad. Dyad congruence, or consistency in perspective, is relevant to numerous aspects of living with cancer, including the decision to enroll in a cancer clinical trial.

METHODS

Semistructured interviews of 32 older women (age ≥ 70 years) with breast cancer and their family caregivers (16 dyads) were conducted at both academic and community settings from December 2019 to March 2021 to explore perceived facilitators and barriers to cancer trials. Dyad congruence was defined as aligned (matching) perspectives, and incongruence was defined as misaligned (nonmatching) perspectives.

RESULTS

Five (31%) of 16 patients were age ≥80 years, 11 (69%) had nonmetastatic breast cancer, and 14 (88%) were treated in an academic setting. Six (38%) of 16 caregivers were in the 50-59 age group, 10 (63%) were female, and seven (44%) were daughters. Dyad congruence centered on the clinical benefit of trials and physician recommendation. However, compared with caregivers, patients were more motivated to contribute to science. Patients and caregivers also differed on the perceived extent to which the caregiver influenced enrollment.

CONCLUSION

Older patients with cancer and their caregivers generally agree about the facilitators and barriers to cancer trial enrollment, but some perceptions are misaligned. Further research is needed to understand whether misaligned perspectives between patients and caregivers influence clinical trial participation of older adults with cancer.

A prospective study of psychological distress among patients with advanced cancer and their caregivers

BACKGROUND

Cancer can impact the psychological well-being of both patients and their informal caregivers. We investigated the joint trajectories of psychological distress among Singaporean advanced cancer patients-caregiver dyads. We also examined predictors of trajectory group membership.

METHODS

This study utilised data from 299 patients with advanced solid cancer and their caregivers over 33 months (12 times points). Group-based trajectory modelling was used to examine the joint trajectories of patient anxiety, patient depression, caregiver anxiety and caregiver depression scores using the Hospital Anxiety and Depression Scale.

RESULTS

Four joint trajectory groups were found: (1) Patient-caregiver low distress (27%), (2) patient-caregiver increasing distress (28.5%), (3) patient low- caregiver borderline distress (25%), (4) patient-caregiver high distress (19.5%). Dyads where the patient is below 50 years of age were more likely to be in Group 4. Dyads where caregiver-patient emotional closeness was low were more likely to be in Groups 2 or 4 where dyads reported increasing/high distress. Dyads that reported financial inadequacy were more likely to be in Groups 2, 3 and 4, while dyads with caregivers who were employed were more likely to be in group 3.

CONCLUSIONS

A substantial proportion of patients and caregivers reported anxiety and/or depression that lasted or increased throughout the study duration. We found significant heterogeneity in how dyads experienced psychological distress, suggesting that efforts should consider dyadic differences when providing psychological support. Particular focus should be placed on identifying dyads that are at risk and who require additional support.

Spouse caregivers' identification of the patient as their primary support person is associated with better patient psychological well-being

Examine the impact of the primary-support person (PSP) role on advanced cancer patient and spouse caregiver psychological well-being, above and beyond the effects of relationship satisfaction.

Secondary analysis of cross-sectional questionnaire data.

88 advanced cancer patient/spouse-caregiver dyads.

Patients and caregivers independently completed measures assessing depression, anxiety, perceived stress, and relationship satisfaction, and identified their PSP. Patient and caregiver psychological well-being outcomes were regressed on patient and caregiver PSP variables in an actor-partner interdependence model.

Half of patients identified their caregiver as PSP; 9% of caregivers identified their patient as PSP. When caregivers identified their patient as PSP, the patient reported better outcomes. No associations were seen for patient identification of caregiver as PSP or caregiver well-being.

Clinicians can encourage patients to find ways to continue to focus on their relationship with the caregiver and help caregivers connect with other sources of support.

Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review

(1) Background: Effective communication among couples in which one has been diagnosed with cancer is critical to improve their psychosocial adaptation to cancer. The objective of this review was to explore the characteristics and measurement outcomes of existing couple-based communication interventions in the cancer context. (2) Methods: Eight electronic databases were searched from database initiation to August 2022 to identify eligible articles. Hand searching was also performed on the included articles' reference lists and authors. (3) Results: A total of 14 intervention studies were eligible to be included in this review. Cancer couples with distress or communication problems before intervention were more likely to benefit from the couple-based communication interventions. Positive outcomes were reported, including an improvement in relationship functioning (including mutual communication, intimacy, and relationship satisfaction) and individual functioning (including a decline of anxiety, depression and cancer-related concerns, and an increase in psychological adjustment and quality of life). (4) Conclusions: These findings supported the importance of improving mutual communication behaviors to promote cancer patient-spousal caregiver dyads' psychosocial adaptation to cancer. While most included studies were conducted in western countries and the sample size was relatively small, more research is warranted to develop more efficacious couple-based communication interventions.

A qualitative study about colorectal cancer patients and spousal caregivers' experience and needs during COVID-19: implications for self-efficacy intervention

Objective

This study aims to understand the experiences of colorectal cancer (CRC) patients and their spousal caregivers during the COVID-19 pandemic and to refine a self-efficacy (SE) intervention for these couples.

Methods

A descriptive phenomenological approach was used in this study. Data were collected from 11 CRC couples. All interviews were recorded, transcribed, and analyzed using the Colaizzi strategy.

Results

Three themes and eight subthemes emerged: (1) Get and contribute support, (2) Life's challenges, and (3) Journey of reconstruction. The CRC couples encountered escalating challenges in coping with cancer during COVID-19. At the same time, they have received considerable support and developed confidence in rebuilding themselves in the process. Healthcare providers are advised to focus on giving appropriate support to CRC couples, so they can go further.

Conclusions

This study gave insights into healthcare providers on the experiences of CRC couples and the development of SE intervention program to support these couples: (1) initially providing caregiving training for spousal caregivers and psychological support for patients, (2) encouraging self-care for CRC couples in the middle stage, (3) guiding them to view life positively in the later stage, and (4) assessing their situation in time to identify their needs and to provide support. Healthcare providers are recommended to increase flexibility in the SE intervention program delivery format to reduce the impact of COVID-19 on CRC couples.

A randomized controlled trial of emotion regulation therapy for cancer caregivers: A mechanism-targeted approach to addressing caregiver distress

BACKGROUND

Caregivers of patients with cancer play a crucial role in the health of the person they care for, and in the healthcare system at large. Family caregivers receive minimal support, despite being at greater risk for anxiety and depression than patients themselves. Cognitive behavioral therapy (CBT), an effective therapy for anxiety and depression, has shown mixed efficacy when delivered to cancer caregivers. Emotion Regulation Therapy (ERT), a contemporary CBT, may uniquely target processes underlying distress associated with caregiving. Therefore, we adapted both CBT and ERT to target the needs of caregivers (i.e., CBT-C and ERT-C) and are conducting a multi-site randomized trial to examine the comparative efficacy of these interventions.

METHODS

Family cancer caregivers (n = 200) reporting distress related to caregiving are recruited from two academic cancer centers and randomly assigned to either ERT-C or CBT-C. Caregivers in both interventions engage in eight weekly one-hour sessions by videoconference with a trained interventionist. Caregiver participants complete study assessments at baseline, post-treatment, 3-and 6-months follow-up. Patients of each caregiver can also enroll in the study and complete assessments at baseline and 3-months follow-up. Outcome measures include psychosocial constructs such as anxiety, depression, quality of life, as well as proposed mechanistic constructs and salivary markers of stress and inflammation.

CONCLUSIONS

The results of this study will advance the science of caregiving interventions in cancer by addressing a critical gap in our ability to mitigate anxiety and depression in caregivers, as well as further our understanding of how these changes may influence patients' outcomes.

Caregiver activation of relatives of patients with advanced cancer

OBJECTIVE

Relatives of patients with advanced cancer often have many caring responsibilities. Not everyone may have sufficient knowledge, skills, and confidence-also known as caregiver activation-to provide such care. We assessed caregiver activation in relatives and its association with their personal characteristics and their own well-being.

METHODS

A cross-sectional study among relatives of patients with advanced cancer. Measures included caregiver activation (C-PAM), resilience, personal self-care, caregiver burden, depressive symptoms, quality of life, and social well-being. The C-PAM distinguishes four levels of activation, ranging from poor (level 1) to adequate (level 4). Bivariate and multivariable regression analyses were performed.

RESULTS

Two hundred fifty-four relatives were included; 32% had level 1 activation, 30% level 2, 27% level 3 and 11% level 4. Higher levels of caregiver activation were found among partners, those who provided more hours of informal care, were more resilient, and scored higher on personal self-care. Higher caregiver activation was associated with lower caregiver burden, less depressive symptoms, and better social well-being.

CONCLUSION

In our study, the majority of relatives seem insufficiently prepared to provide care for their loved one. Supporting them in gaining knowledge, skills, and confidence to provide such care may improve their own well-being.

Merging Yoga and self-management Skills (MY-Skills) to influence self-efficacy among individuals with persistent pain: A pilot study

CONTEXT

Individuals with persistent pain-related disability have lower self-efficacy, which impacts daily function and health.

AIM

To explore self-efficacy among individuals with persistent pain who were part of a dyad (caregiver and care-recipient) who completed the Merging Yoga and self-management Skills intervention (MY-Skills).

METHODS

Participants completed MY-Skills, an 8-week group, dyadic-based self-management and yoga program. Self-efficacy outcomes were collected using the Chronic Pain Self-Efficacy Scale; PROMIS® Self-Efficacy for Managing Daily Activities; and PROMIS® Self-Efficacy for Managing Symptoms.

RESULTS

Eight participants completed the study (50.23 ± 14.77 years old, 77% female, (69%) with pain >10 years). Self-efficacy improved across all measures and domains, with significant improvement for physical function self-efficacy (38.97 ± 19.45 vs. 59.10 ± 18.60, p = .004).

CONCLUSIONS

MY-Skills improved self-efficacy to varying degrees, which may contribute to participants' confidence in performing activities. Further research is needed to examine dyadic outcomes among caregivers and care-recipients.

Caregiver role strain in caring for vulnerable persons living with HIV: correlates of caregiver and care recipient reports

Informal care of family and friends is important for the health and well-being of disadvantaged persons living with HIV (PLWH). Caregiver role strain may threaten the function and continuity of their main relationships and their health impacts. Data were from a disadvantaged, primarily African American, sample of PLWH care recipients. Caregiver role strain was operationalized as a latent factor measured by variables including PLWH's perceptions of their caregiver not wanting or complaining about helping them or wanting a break. We found that greater caregiver role strain was associated with higher levels of HIV-related stigma and depressive symptoms. Lower role strain was associated with more collaborative problem solving and shared medical treatment decision-making. Caregiver role strain was linked to disadvantaged PLWHs' worse stigma and mental health; collaborative engagement in care and coping assistance were protective of role strain. Caregiving relationship-focused research and interventions are needed for resourcing and sustaining disadvantaged African American communities' caregiving and health.

Dyadic psychosocial interventions for patients with cancer and their caregivers: an update

PURPOSE OF REVIEW

Cancer causes significant impacts on patients and their caregivers. Cancer is also associated with multiple physical and emotional challenges for the patient-caregiver dyad. This patient-caregiver dyad should be considered as a unit of care by healthcare providers and supported through dedicated psychological interventions.

RECENT FINDINGS

Twelve studies that tested dyadic interventions aiming to support patient-caregiver dyads were identified from the period April 2020 to December 2021. Studies were predominantly randomized controlled trials (RCTs) and single-arm pilot studies. Half of the interventions were online. Interventions were mostly focused on dyadic adjustment and appeared to be acceptable, feasible and globally effective. However, effects were evident predominantly on individual rather than dyadic outcomes. The interventions targeted either individual psychological outcomes, such as depression and anxiety, and are reported to be effective or various individual outcomes and also appeared to be effective. However, there was a large heterogeneity in quality and sample sizes across all intervention types.

SUMMARY

Dyadic psychological interventions may be an effective support for patient-caregiver dyads dealing with multiple physical and emotional challenges. Online interventions and the variability of intervention types may respond to dyads specific needs, but though need to be rigorously evaluated through powered RCTs.

Dyadic Experiences and Psychosocial Management of Couples Facing Advanced Cancer: A Systematic Review of the Literature

Background

Cancer diagnosis and treatment represent a real upheaval both for the patient and for his or her life partner. Adjustment to cancer has been widely studied at the individual level, however, there is little in the literature about the experiences of the couple as an entity. This is especially true with regard to a population facing advanced cancer. This systematic review aimed to make an inventory of 1) the current knowledge relating to the experience of the patient-partner dyad when confronted with advanced cancer, and 2) the psychosocial interventions specifically centered on this dyad.

Method

This review was conducted using the Cochrane methodology. The eligibility criteria for the literature review were: one of the members of the dyad being treated for advanced cancer, dyad composed of the patient and his/her life partner. Databases from PubMed, PsycArticle, PsycInfo, Psychology and Behavioral Sciences Collection and Scopus were investigated. A thematic content analysis on the basis of admitted articles made it possible to respond to each of our research objectives.

Results

Three hundred eighty-nine citations were found. Twenty were admitted to the systematic review of the literature. It highlighted the following experiences of the advanced cancer patient-life partner dyad: uncertainty about the future, disjointed time, intrusion into the couple's intimacy, attachment style and caregiving within the couple, couple's adjustment to cancer symptomatology, the couple's supportive care needs, role changes, nature of communication within the couple, anticipation of the coming death, and the meanings and beliefs around death. This review also describes the range of couple therapies used in the context of advanced cancer: emotionally focused-couple therapy, existential therapy, art therapy, support therapy and couple communication and intimacy promotion. These therapies seem to have individual beneficial effects for both the patient and his or her life partner as well as improving marital functioning.

Conclusions

These results clearly highlight that consideration of the couple and communication within the couple during care are fundamental to dyadic adjustment to advanced cancer. Further studies (qualitative and quantitative) are needed to better understand the couple's experience in order to adapt the management of the couple facing advanced cancer.

Factors influencing the burden on spousal caregivers of breast cancer survivors

Purpose

To examine the status of spouses’ burdens of caring for breast cancer survivors and explore the relationships between social support, family resilience, breast cancer survivors’ individual resilience, and caregiver burden.

Methods

A cross-sectional study on 315 young and middle-aged breast cancer survivors and their spousal caregivers was conducted at eight comprehensive Southwest China hospitals. The caregivers completed the Chinese Version of the Family Resilience Assessment Scale, the Perceived Social Support Scale, and the Zarit Caregiver Burden Interview, while breast cancer survivors completed the shortened Chinese version of the Connor-Davidson Resilience Scale. Structural equation modeling was used to evaluate the relationships among social support, family resilience, survivors’ individual resilience, and caregiver burden.

Results

Caregiver burden (45.76 ± 14.66) was found to be severe. Social support, family resilience, and individual resilience were significantly negatively associated with caregiver burden (β =  − 0.421, P < 0.001; β =  − 0.208, P < 0.001; and β =  − 0.444, P < 0.001, respectively). Individual resilience not only partially mediated the relationship between family resilience and caregiver burden (b =  − 0.052; 95% confidence interval, − 0.110, − 0.018), but also partially mediated the relationship between support and caregiver burden (b =  − 0.045; 95% confidence interval, − 0.102, − 0.011).

Conclusions

The findings suggest that higher social support, family resilience, and individual resilience tend to ease caregivers’ burden. Healthcare workers should have an in-depth understanding of the care needs of survivors, actively contact social security departments and social organizations to provide financial, technical, and emotional support, and provide family-based care-skills training and psychological counseling to reduce spousal caregivers’ burdens.

Beyond "being open about it": A systematic review on cancer related communication within couples

Extensive literature addresses the correlates of communication behaviors within couples in the specific stressful context of oncology. This literature focused mainly on the concepts of disclosure, concealment, holding back and protective buffering to gain more insight into the potential benefits of open communication on the psychological and relational wellbeing of the patient, the spouse and the dyad. The current systematic review aims to present this literature, summarize research findings and suggest empirical, theoretical and clinical implications. Methods: The search method applied in this review was in line with the PRISMA guidelines. Key words related to couples' communication and oncology were used to identify relevant studies according to title and abstract fields from 1.1.2000 until 31.1.22. Results: Out of 3277 papers, a total of 55 articles were identified as relevant for this review. These quantitative studies used cross-sectional and longitudinal designs. Overall, integrating findings from different studies showed that while avoiding communication is negatively associated with psychological and relational wellbeing, the benefits of disclosure seems to be dependent on different factors including the partner's responsiveness, contextual factors and personal characteristics. The existing literature is limited in providing data regarding the nature of adequate or helpful partner responses, the best timing, and the specific topics that are recommended to be disclosed such as specific fears. Most importantly, it is limited in heterogeneity of constructs of communication that were studied, scales that were used and diverse mediators and moderators that were examined. Accordingly, an effort to reach consensus of definition and assessment of communicative behavior is recommended for future studies, and addressing responsiveness to communicative initiations seems to be important for clinical practice.

Family carer needs in advanced disease: systematic review of reviews

BACKGROUND

Family carers are vital in the management and delivery of home-based palliative care. Decision-makers need to know what the most commonly expressed unmet needs of family carers are to target available support services.

AIM

To identify the most commonly expressed needs of family carers of people with an advanced disease, assess the quality of current evidence, and set an agenda for future research and clinical practice.

DESIGN

A systematic review of reviews, prospectively registered on PROSPERO. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research syntheses.

DATA SOURCES

MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Informit and Cochrane Library were searched for reviews about the needs of carers looking after patients with advanced disease from 2010 to 2020.

RESULTS

Findings from 21 reviews identified emotional support, disease-specific knowledge, carer role responsibilities, self-care and general practical support as the most commonly expressed needs expressed by family carers. Additionally, access to professional services, formal education opportunities and communication with health professionals were identified as caregivers' preferred ways of having these needs met. Extraction of carer-specific needs was challenging at times as results were often combined with patient results in reviews.

CONCLUSION

Practical difficulties exist in effectively resourcing services to meet the needs of family carers. Information regarding the most commonly expressed needs shared by caregivers and their preferred delivery source can provide an opportunity to focus available support services to achieve the highest possible impact for carers of patients with advanced disease.

PROSPERO REGISTRATION NUMBER

CRD42018088678.

Attentes du patient atteint de cancer vis-à-vis de son aidant principal au Burkina Faso

Cette étude a pour objectif d’analyser les attentes des patients atteints de cancer vis-à-vis de leurs aidants principaux dans un contexte de pays à ressources limitées, et de déterminer la concordance entre ces attentes et les rôles assumés par leurs aidants principaux. Au total 72 patients ainsi que l’aidant principal de chacun d’eux ont été inclus. Les attentes des patients variaient selon le lieu (hôpital, domicile ou commerces). La concordance entre ces attentes et les rôles assumés par leur aidant principal était mauvaise.

Will I or my loved one die? Concordant awareness between terminal cancer patients and their caregivers is associated with lower patient anxiety and caregiver burden

OBJECTIVE

The aims of this study were to investigate the association between patients' awareness of their terminal illness and the levels of anxiety and depression, whether the concordance between the patients' and caregivers' belief about the patient's terminal illness was associated with patient's anxiety and depression, and with the caregiver burden.

METHOD

The study recruited 31 terminally ill patients with cancer along with their caregivers from a Palliative Care Unit. All data about patients and caregivers' awareness of the illness, patients' depression and anxiety, and caregiver burden were collected.

RESULTS

Patients aware of their short-term prognosis of death showed lower levels of anxiety than the unaware ones, especially women. Aware patients with concordant caregivers showed lower levels of anxiety but not of depression. Caregivers concordant with the patients' awareness presented lower levels of strain and burden. Finally, terminal patients who had an adult child caregiver were less likely to be aware of their terminal condition.

CONCLUSIONS

It appears that illness awareness and the caregiver's concordance with the patient's belief on the terminal condition are associated with lower anxiety, especially in women, and a reduced burden for caregivers.

Dyadic support across contraceptive decision-making among young adult breast cancer survivors and their partners

OBJECTIVE

The purpose of this study is to explore the role of dyadic support across the contraceptive decision-making process between young adult breast cancer (YABC) survivors and their partners.

RESEARCH APPROACH

Semi-structured interviews with YABC survivors and their partners.

PARTICIPANTS

Twenty-five young adult breast cancer survivors and their partners (n = 50). Survivors reported an average age of 36.9 years (SD = 4.30) and the majority self-identified as white (86.2%).

METHODOLOGICAL APPROACH

Thematic analysis approach with dyads as the primary unit of analysis, guided by the dyadic decision-making framework and the Theory of Gender and Power.

RESULTS

Perceived lack of contraceptive options due to a history of hormone-sensitive cancer, perceived infertility, and contraception as a result of cancer treatment (e.g., hysterectomy) contributed to the contraceptive decision context for survivors and their partners. Contraceptive support varied across couples depending on the cancer-specific context, where communication, sharing responsibility, and respecting bodily autonomy revealed as supportive behaviors. Other social influences including survivors' desire to conceive biologically and family planning desires also related to partner supportive behaviors.

INTERPRETATIONS

YABC survivors face specific challenges to contraceptive decision-making where partners can offer supportive behaviors. Health care providers can also support couples by engaging in triadic communication about contraception and family planning.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY

Psychosocial providers can support couples by encouraging them to talk together about contraception and highlighting the importance of triadic communication with a healthcare provider to support shared decision-making and alignment of contraceptive decisions with family planning desires.

Prospective assessment of psychopathological symptoms and their relation to demographic factors in primary caregivers of cancer patients throughout chemotherapy

PURPOSE

The present study aims to investigate the course of psychological symptoms through chemotherapy in a sample of primary caregivers of patients with cancer and to examine all possible correlations between psychological distress and demographic characteristics.

METHODS

In this prospective study, 112 primary family caregivers of cancer patients were evaluated. Symptom checklist 90 revised (SCL-90-R) was administered to assess their pathological symptoms, the Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety. There was an evaluation at the beginning of chemotherapy and a second at the end of the patients' intravenous chemotherapy treatment (EOT).

RESULTS

A total of 112 primary caregivers were initially enrolled in the study, and 99 (88.4%) completed it. Caregivers' psychopathology was low to moderate at both points of time (baseline and EOT). However, a considerable decrease in the Global Severity Index (GSI) emerged over time.

CONCLUSIONS

At EOT, participants reported statistically significant decreases in five aspects of SCL 90, namely Depression, phobic anxiety, obsessive-compulsive symptoms, somatization, and psychoticism. A notable finding was that female caregivers were significantly more distressed, especially when providing care to a male recipient.

Dyadic Coping in Couples Facing Chronic Physical Illness: A Systematic Review

Objective: Chronic physical illness affects not only patients but also their partners. Dyadic coping (DC)-the ways couples cope in dealing with a stressor such as chronic illness-has received increased attention over the last three decades. The aim of the current study was to summarize the state of research on DC in couples with chronic physical illnesses. Methods: We conducted a systematic review of qualitative, quantitative, and mixed-methods studies published between 1990 and 2020, assessing DC in couples affected by severe physical illnesses. We used DC and related search terms for the literature search in Psycinfo, Psyndex, and Medline. Five thousand three hundred thirty studies were identified in three electronic databases and 49 of these were included in the review (5,440 individuals reported on 2,820 dyads). We excluded studies on cancer, cardiovascular disease, and multiple sclerosis because of existing reviews in the respective fields. Half of the studies included were on diabetes. Other studies were on arthritis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, human immunodeficiency virus (HIV), Huntington's disease, lupus erythematosus, Parkinson's disease, renal diseases, stroke, and endometriosis. Two raters extracted data using a predefined protocol, including study quality. Results were collated in a narrative synthesis organized by illness and DC operationalization. Results: Overall, DC was associated with beneficial outcomes in physical health, well-being, and relationship satisfaction. Differential effects became apparent for certain chronic conditions potentially depending on certain disease characteristics, such as early-onset, sudden-onset, or life-threatening conditions. Conclusion: Facing challenges together as a couple seemed indispensable for adapting to a diverse range of demands related to chronic illnesses with some specific demands of particular chronic diseases. There is a need for the development of truly dyadic interventions with an eye on the specific challenges of the various chronic conditions.

Open Communication and Physical Intimacy in Young and Midlife Couples Surviving Cancer Beyond the First Year of Diagnosis

OBJECTIVES

To assess the association between levels of dyadic coping (e.g., collaboration, communication) and sexual satisfaction in young and midlife couples surviving cancer beyond the first year of diagnosis.

SAMPLE & SETTING

This cross-sectional study included 49 young and midlife couples (aged 21-57 years) beyond the first year of diagnosis. Couples were from rural and urban areas.

METHODS & VARIABLES

A mailed survey was used to gather data from cancer survivors and their partners.

RESULTS

Controlling for cancer survivor sex and age, open communication was significantly associated with greater involvement in affectionate and sexual behaviors of the couple. Protective buffering behaviors (i.e., concealing worries and avoiding communication) were not significantly associated with engagement in physical intimacy. Perception of how much a partner openly communicates was more salient for engaging in physical intimacy than one's own open communication.

IMPLICATIONS FOR NURSING

Nurses should include partners in planned care, assess the concerns of the partner, and treat the couple as the unit of care.

Interventions to Improve Self-Efficacy in Colorectal Cancer Patients and/or Caregivers: A Systematic Review and Meta-Analysis

Objective

High levels of self-efficacy (SE) in colorectal cancer (CRC) patients and/or caregivers enable patients to cope with cancer, reduce caregiver burden, and promote quality of life (QOL) in patients and caregivers alike. This review aims to (a) identify the SE theory sources covered by SE interventions or interventions, including targeting improved SE for CRC patients and/or caregivers, to guide future development of SE interventions; and (b) explore intervention effects based on SE theory through meta-analysis.

Methods

Using five electronic databases—CINAHL, Cochrane Library, Embase, PsycINFO, and PubMed—a systematic search was performed in April 2021 to identify English or Chinese literature that studied improving SE interventions for CRC patients and/or caregivers. Manual screening of the articles' references list was also performed.

Results

A total of 18 studies were found to be suitable and included in this review. Of the 18 studies that were included, 10 randomized controlled trials (RCTs) studies with 917 participants were eligible for meta-analysis. Interventions provide support for SE drawing on different sources of information. Performance accomplishment (PA) is the key source, with vicarious experience (VE) and verbal persuasion (VP) assisting in improving PA. Reducing negative emotional arousal (NEA) and improving positive emotional arousal (PEA) are also indispensable factors in improving SE. The meta-analysis results show that interventions based on the SE theory can bring about positive effects for CRC patients and/or caregivers.

Conclusions

Different sources of information aimed at improving SE, covered by the interventions, including PA, VE, VP, NEA, and PEA, have been explored. Positive intervention outcomes that focused on improving SE for CRC patients and/or caregivers were identified and highlighted. For future SE interventions, we advocate choosing combination sources of SE information to design interventions. It is recommended that future SE improvement interventions should focus on improving PA, supplemented by increasing VE, while reducing NEA and providing useful VP.

At the Heart of It All: Emotions of Consequence for the Conceptualization of Caregiver-Reported Outcomes in the Context of Colorectal Cancer

Colorectal cancer (CRC) can be demanding for primary caregivers; yet, there is insufficient evidence describing the caregiver-reported outcomes (CROs) that matter most to caregivers. CROs refer to caregivers' assessments of their own health status as a result of supporting a patient. The study purpose was to describe the emotions that were most impactful to caregivers of patients with CRC, and how the importance caregivers attribute to these emotions changed from diagnosis throughout treatment. Guided by qualitative Interpretive Description, we analyzed 25 caregiver and 37 CRC patient interviews, either as individuals or as caregiver-patient dyads (six interviews), using inductive coding and constant comparative techniques. We found that the emotional aspect of caring for a patient with CRC was at the heart of caregiving. Caregiver experiences that engendered emotions of consequence included: (1) facing the patient's life-changing diagnosis and an uncertain future, (2) needing to be with the patient throughout the never-ending nightmare of treatment, (3) bearing witness to patient suffering, (4) being worn down by unrelenting caregiver responsibilities, (5) navigating their relationship, and (6) enduring unwanted change. The broad range of emotions important to caregivers contributes to comprehensive foundational evidence for future conceptualization and the use of CROs.

A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples

PURPOSE

Couples are usually affected by cancer as patient-partner dyads, and they may react as a unit rather than as individuals, i.e., dyadic coping. This paper aims to comprehensively summarise the relationship between dyadic coping and dyadic outcomes (relationship satisfaction, quality of life, and psychological adjustment) in cancer couples, and provide valuable evidence to guide future research.

METHOD

A systematic search of five online databases, e.g., Cochrane Library, Embase, Medline, PubMed, and PsycINFO, was conducted to identify cancer couple-based studies published in English or Chinese from January 1990 to March 2021. A manual search was also performed on the article reference lists.

RESULTS

Twenty-eight studies met the inclusion criteria. We found that communication, supportive dyadic coping, delegated dyadic coping and common dyadic coping might strengthen marital bonds, alleviate couples' stress, and facilitate mental health, but on the other hand, they possibly increase patients' and/or partners' physical or psychological burden. Negative dyadic coping and protective buffering were related to lower relationship satisfaction, worse quality of life, and more depressive symptoms. Patients reported more self-emotional disclosure, common dyadic coping, and negative dyadic coping than partners, while partners showed more holding back, supportive dyadic coping, delegated dyadic coping, and protective buffering. Moreover, patients were more susceptible to dyadic coping strategies.

CONCLUSIONS

This review provides a comprehensive overview of the relationship between dyadic coping and dyadic outcomes. Based on the available evidence, the development of personalised interventions for improving dyadic coping is required to help couples live better with cancer.

Patient activation and treatment decision-making in the context of cancer: examining the contribution of informal caregivers' involvement

PURPOSE

The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship.

METHODS

Survey data collected from 504 cancer survivors were utilized. Structural equation modeling (SEM) controlling for covariates was used to examine the relationship between patient activation measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM.

RESULTS

Patient activation was significantly associated with treatment planning being reflective of survivors' goals and values (p < 0.001); adherence to treatment (p = 0.011); and satisfaction (p < 0.001). Caregiver's involvement significantly moderated the association between activation and adherence to treatment.

CONCLUSIONS

Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver's involvement, patient activation was not associated with treatment adherence. Research is needed to test and deliver self-management interventions inclusive of informal caregivers.

IMPLICATIONS FOR CANCER SURVIVORS

Findings supported the need not only to monitor and sustain patient activation across the cancer continuum, but also to assume a dyadic perspective when designing self-management interventions in cancer survivorship.

The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers

It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.

Caregiver Characteristics Associated With Cognitive Complaints in Women With Breast Cancer

OBJECTIVES

To explore whether caregiver characteristics were associated with cognitive complaints reported by women with breast cancer undergoing chemotherapy.

SAMPLE & SETTING

61 dyads of women with breast cancer and their caregivers were recruited at Duke Women's Cancer Care Raleigh in North Carolina.

METHODS & VARIABLES

An exploratory, cross-sectional design was used. Data were obtained on patients and caregivers. Patient cognitive complaints were represented by cognitive impairment (CI) and cognitive ability (CA).

RESULTS

Two significant associations were found.

IMPLICATIONS FOR NURSING

Healthcare providers should consider caregivers when assessing and managing patients' cognitive symptoms. This study suggests the value of including caregivers when establishing interventions for patients who have cognitive complaints.

Communication between Advanced Cancer Patients and Their Family Caregivers: Relationship with Caregiver Burden and Preparedness for Caregiving

Cancer impacts spouse caregivers, especially when couples engage in dyadic coping around the cancer. Communication is a key factor in this process. Our goals were to describe cancer-related communication between advanced cancer patients and their spouse caregivers, and to describe how dyadic communication patterns are related to caregivers' reported burden and preparedness for caregiving. Caregivers completed measures of caregiver burden and preparedness for caregiving. Then, the patient and caregiver were asked to interact with each other in two structured discussions: a neutral discussion and a problem discussion focused on cancer. Discussions were coded using the Rapid Marital Interaction Coding System (RMICS2). Caregivers reported moderate levels of preparation and burden. Greater caregiver hostility communication predicted higher levels of caregiver burden, whereas greater caregiver dysphoric affect communication predicted lower levels of caregiver burden. Whereas positivity was more common than hostility in couples' communication, patient hostility was a significant predictor of caregiver preparedness. Patient neutral constructive problem discussion was also associated with increased caregiver preparedness. Caregiver outcomes are an understudied component to dyadic cancer research. Our paper describes observational data on cancer-related communication between caregivers and advanced cancer patients and communication's influence on caregiver outcomes. This work provides the foundation for future evidence-based communication interventions that may influence both patient and caregiver outcomes.

Family resilience, perceived social support, and individual resilience in cancer couples: Analysis using the actor-partner interdependence mediation model

PURPOSE

This study aimed to examine the impact of family resilience on the individual resilience of couples during cancer and explore the potential mediating role of perceived social support and the moderating role of sex in this association in cancer patient-spouse dyads.

METHOD

The participants were 272 cancer patients and their spouses (N = 544) who completed the Family Resilience Assessment Scale, the Perceived Social Support Scale and the Resilience Scale. We adopted the actor-partner interdependence mediation model to examine whether and how patients' and their spouses' family resilience was associated with their own and their partners' perceived social support and individual resilience.

RESULTS

The results indicated that the patients' and their spouses' level of family resilience was positively associated with their own individual resilience directly and indirectly by increasing their own perceived social support. The family resilience of the spouses was associated with an increase in the patients' individual resilience only indirectly by increasing the patients' perceived social support. The spouse-actor effects between family resilience and individual resilience differed significantly by sex.

CONCLUSION

Enhancing family resilience and perceived social support within the family can improve individual resilience. The findings regarding the sex differences serve as a rationale for gender-based approaches to improving individual resilience in the family context.

The role of symptom appraisal, concealment and social support in optimizing dyadic mental health in heart failure

Objectives: Heart failure patients and their family care partners experience poor mental health, yet the majority of the research focuses on patients and care partners separately. Guided by the Theory of Dyadic Illness Management, the purpose of the current study was to identify distinct patterns of dyadic mental health in heart failure and identify the individual, dyadic and familial factors associated with group membership.Method: Fifty nine heart failure community-dwelling patients and their spouse care partners were recruited from an outpatient heart failure clinic. Mental health was operationalized by depressive symptoms, measured with the Patient Health Questionnaire-9 (PHQ-9) measure of depression. Distinct groups of dyadic mental health were determined by categorizing depression scores within dyads.Results: Three groups of dyadic mental health were identified: an optimal dyadic mental health group (31%), a poor dyadic mental health group (32%) and an incongruent dyadic mental health group (37%). Patient age, patient fatigue, patient concealment, incongruent dyadic appraisal of pain interference and social/familial support were significantly associated with group membership.Conclusion: Findings underscore the salience of a dyadic approach to health and the clinical relevance of identifying patterns of dyadic mental health so we may determine those most in need of intervention.

The experiences and needs of couples affected by prostate cancer aged 65 and under: a qualitative study

PURPOSE

Prostate Cancer (PCa) is often considered to be an illness affecting older men, however the prevalence in younger men (<=65 years) is rising. Diagnosis and treatment for PCa can have a significant impact on the lives of both the man with PCa and his partner. This study explored the experiences and needs of younger men and their partners affected by PCa. The findings will be used to inform service provision and develop interventions appropriate to need.

METHODS

Participants were recruited from respondents to a national PROMS study (Life After Prostate Cancer Diagnosis (LAPCD), who indicated on completed questionnaires their willingness to be interviewed. Semi-structured telephone interviews were conducted with twenty-eight couples, separately (56 participants). Data were analysed using the Framework Method.

RESULTS

Following the diagnosis of PCa, couples' experienced changes in their intimate relationships, parental/familial roles, work and finances, and social connections and activities. Couples adopted a range of strategies and behaviours to help their adjustment to PCa, such as communicating with each other, distancing, distraction, and adopting a positive mindset towards PCa. This, in turn, influenced how their identity as a couple evolved.

CONCLUSIONS

Following a diagnosis of PCa, the identity of couples are continually evolving. It is important that these couples are provided with the appropriate information, support and resources to help them transition along the cancer pathway.

IMPLICATIONS FOR CANCER SURVIVORS

Key areas of support identified for younger couples include: 1) couple focused support programme to foster relationship strategies/behaviours that facilitate couple adjustment; 2) age-specific support, e.g. 'buddying systems' connecting younger couples affected by PCa and providing them with tailored information (written/online/app).

Brain cancer patient and support persons' experiences of psychosocial care: a mapping of research outputs

BACKGROUND

People with brain cancer and their support persons (SPs) are critical sources of information on the components of care that contribute to psychosocial outcomes.

AIMS

To determine the proportion of studies that examined (1) at least one of 14 nominated components of psychosocial cancer care and (2) more than one component of care.

METHODS

Medline, The Cochrane Library, PsycINFO and Embase were electronically searched for publications from January 1999 to December 2019. Publications that met the inclusion criteria were coded according to the number and type of psychosocial care components assessed from 14 listed components, and whether patient and/or SPs' views about care were elicited.

RESULTS

Of the 113 included publications, 61 publications included patient-reported data only (54%), 27 included both patient and SP-reported data (24%) and 25 included SP-reported data only (22%). Most assessed a single component of care (77% of patient-reported and 71% of SP-reported). No publications assessed all 14 components. The "Psychosocial" component was the most frequently assessed component of care for patient-reported (n = 80/88, 91%) and SP-reported publications (n = 46/52, 88%).

CONCLUSIONS

Publications reporting on psychosocial care in brain cancer present a relatively narrow view of patient and support person experiences. The inclusion of both patient and support person perspectives and the assessment of multiple components of care are required in future research to optimize psychosocial outcomes in brain cancer.

Effects of Dyadic Interventions on Quality of Life among Cancer Patients: An Integrative Review

Interventions delivered to cancer patients along with their caregiver as a unit of care indicates dyadic intervention. With the shift of care to home, dyadic interventions are being popular among cancer care. This review aims to identify the dyadic interventions targeting quality of life (QOL) of cancer patient. The current review examined different dyadic interventions for cancer patients from January 2009 to January 2020. PubMed, Psych-info, and CINAHL databases were searched, and 27 studies were included in the review. There were different dyadic interventions for cancer patients including skill based, psychosocial (psycho-educational, educational, counseling), yoga, mindfulness, coping, dance, writing, training along with education, and counseling. Interventions were different in mode of delivery, duration, and delivery personnel. Interventions had improved some aspects of QOL among cancer patients as well as caregivers. Although some aspects of QOL were improved, precise dose and use of different approaches together could be integrated to develop further interventions. Further intervention based on strong theoretical framework guided by the standard protocol is recommended.