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Li M, Zhang L, Li N, Luo X, Chen J, Zhang Y, Xiong C, Zhao M, Guo Z, Yan J. Effects of couple-based dyadic interventions on breast cancer patients and their intimate partners: A systematic review and meta-analysis. J Adv Nurs 2023; 79:3192-3213. [PMID: 36918983 DOI: 10.1111/jan.15639] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/17/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
AIMS To evaluate the effects of couple-based dyadic interventions on breast cancer patients and their intimate partners and compare the effects between interventions with different durations (<3 months; =3 months; >3 months). DESIGN A systematic review and meta-analysis. DATA SOURCES Six English databases, PubMed, Embase, Web of Science Core Collection, the Cochrane Library, Medline, PsycINFO, and three Chinese databases, China National Knowledge Infrastructure (CNKI), WanFang, and Weipu (VIP), from database inception to 19 February 2022. REVIEW METHODS The quality of the included RCTs was evaluated using the Cochrane risk-of-bias tool and the data analysis was performed by using RevMan 5.4 and Stata 15. The outcomes were categorized into five aspects: dyadic relationship, overall quality of life (QOL), physical health, psychological health and social adjustment. RESULTS Nineteen RCTs were included. For patients' overall effects, couple-based dyadic interventions can improve sexual frequency, psychological health (anxiety; depression; well-being; body image) and social adjustment (family function-cohesion; social function-total). In the subgroup analysis, it can adjust patients' relationship satisfaction (>3 months), sexual frequency (>3 months), depression (<3 months and >3 months), well-being (>3 months), and body image (3 months). For intimate partners, no statistically significant overall effects were found, and all results in the subgroup analyses showed no statistical significance. CONCLUSIONS The results revealed the different effects of couple-based dyadic interventions on dyads. It also suggested that tailored intervention duration should be a focus in future studies to obtain the potential actor-partner benefits. IMPACT This study revealed that the overall effects of the couple-based dyadic interventions include enhancing patients' sexual frequency, psychological health and social adjustment. Clinical practitioners should consider the intimate partners' outcomes and conduct couple-based dyadic interventions that contain more tailored elements to achieve better effects. NO PATIENT OR PUBLIC CONTRIBUTION Registration: The systematic review and meta-analysis of RCTs has been registered in PROSPERO (Number: CRD 42021286679).
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Affiliation(s)
- Mingfang Li
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Lijuan Zhang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Na Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xia Luo
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Jing Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Yue Zhang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Chenxia Xiong
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Meng Zhao
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Zijun Guo
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Jun Yan
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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Laflamme SZ, Bouchard K, Sztajerowska K, Lalande K, Greenman PS, Tulloch H. Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease. PLoS One 2022; 17:e0269366. [PMID: 36121800 PMCID: PMC9484654 DOI: 10.1371/journal.pone.0269366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, p<0.001; cvdepression = 1.09, p<0.001). Interventions for caregivers reporting attachment insecurity and burden should be explored to potentially lessen caregiver distress as they support their partners with heart disease.
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Affiliation(s)
- Simone Zofia Laflamme
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen Bouchard
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karolina Sztajerowska
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Lalande
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Paul S. Greenman
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Bei E, Mashevich K, Rotem-Mindali O, Galin-Soibelman S, Kalter-Leibovici O, Schifter T, Vilchinsky N. Extremely Distant and Incredibly Close: Physical Proximity, Emotional Attachment and Caregiver Burden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148722. [PMID: 35886574 PMCID: PMC9323703 DOI: 10.3390/ijerph19148722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/05/2022]
Abstract
Informal caregivers are at risk of caregiver burden, and physical proximity to the care recipient may add to this negative outcome. Yet, individual differences in emotional proximity to the care recipient such as attachment orientations may contribute to caregivers’ comfort towards different degrees of physical proximity, leading to varying levels of burden. The current study is the first to explore the role of physical proximity on caregiver burden as moderated by attachment orientations. A sample of 162 Israeli caregivers who are active users of the Camoni website completed our online survey. Sociodemographic characteristics, including a self-reported questionnaire on the physical proximity to the care recipient, were collected. Caregivers’ attachment orientations were assessed with the Experiences in Close Relationships–Relationship Structures questionnaire. Caregiver burden was assessed using the Caregiver Burden Inventory. Multiple regression and simple slope analyses were conducted. Attachment anxiety and avoidance were positively associated with burden, whereas physical proximity was not. Attachment avoidance, but not attachment anxiety, moderated the association between physical proximity and caregiver burden, with caregivers who live closer to their care recipient experiencing greater burden when high levels of avoidance were present. Our findings reveal the complex dynamics between attachment orientations and physical proximity in the context of informal care, highlighting the need for better integration of these two interlinked constructs in both care research and practice.
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Affiliation(s)
- Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
- Correspondence: ; Tel.: +30-69-8204-1162
| | - Karin Mashevich
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
| | - Orit Rotem-Mindali
- Department of Geography and Environment, Bar-Ilan University, Ramat Gan 5290002, Israel;
| | - Shira Galin-Soibelman
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
| | - Ofra Kalter-Leibovici
- The Gertner Institute, Sheba Medical Center, Ramat Gan 5290002, Israel; (O.K.-L.); (T.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv P.O. Box 39040, Israel
| | - Tami Schifter
- The Gertner Institute, Sheba Medical Center, Ramat Gan 5290002, Israel; (O.K.-L.); (T.S.)
| | - Noa Vilchinsky
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel; (K.M.); (S.G.-S.); (N.V.)
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Distinct dyadic coping profiles in Chinese couples with breast cancer. Support Care Cancer 2021; 29:6459-6468. [PMID: 33900457 DOI: 10.1007/s00520-021-06237-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Conceptualizing cancer as a dyadic stress provides new insight into how stress impacts couples with breast cancer. The present study aimed to identify subgroups with distinct dyadic coping profiles in a sample of Chinese couples with breast cancer and to determine how these subgroups differed in terms of demographic and clinical characteristics in addition to marital adjustment outcomes. METHODS Using convenience sampling, a cross-sectional survey was conducted. Couples with breast cancer completed the general information questionnaire, the Dyadic Coping Inventory, and the Locke-Wollance Marital Adjustment Test. The modeling was performed using a latent profile analysis to identify the dyadic coping subgroups. Parametric and nonparametric tests were applied to examine between-group differences across the identified classes. RESULTS The analytical results supported a three-class solution of dyadic coping groups: high (27.4%), medium (32.2%), and low (40.4%). Between-group differences were found in educational background, number of children, postoperative time, and type of surgery. CONCLUSION Most couples reported low levels of dyadic coping. The couples with an educational level of primary school or below, with one child or who were childless, and who had undergone breast preservation surgery within the past year were more likely to belong to the low dyadic coping group. When supporting couples with breast cancer, it is essential to assess several demographic and clinical risk factors in addition to the marital adjustment level to identify high-risk subgroups that warrant intervention.
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Thana K, Lehto R, Sikorskii A, Wyatt G. Informal caregiver burden for solid tumour cancer patients: a review and future directions. Psychol Health 2021; 36:1514-1535. [PMID: 33393827 DOI: 10.1080/08870446.2020.1867136] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Recent shifts in healthcare delivery and treatment for solid tumour cancer patients have modified the responsibilities of informal caregivers. The objective of this study was to: review informal caregiver burden factors and determine areas where future research is needed. METHODS The Arksey and O'Malley's framework and a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this review. Research literature was systematically searched using five-electronic databases, including PubMed, PsycINFO, Cochrane, CINAHL, and SCOPUS, and reference lists from included studies to identify publications since 2010. Inclusion criterion was caregivers providing home-based care to a cancer patient. RESULTS The search yielded 43 eligible papers of 2119 reviewed, including articles from over 17 countries. Caregiver physical and psychological health, financial strain, and social isolation, as well as limited family and social support continued to be important factors contributing to high levels of caregiver burden. Less recognised factors affecting higher burden included caregivers' self-esteem, male gender, and the dynamic nature of cancer treatment. CONCLUSIONS This review updates the state of the science on informal caregiver burden when caring for patients with solid tumour cancers and informs future interventions on how to reduce this burden.
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Affiliation(s)
- Kanjana Thana
- Faculty of Nursing, Chiangmai University, Chiangmai, Thailand
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, MI, USA
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Karantzas GC, Romano D, Lee J. Attachment and aged care: a systematic review of current research. Curr Opin Psychol 2018. [PMID: 29529481 DOI: 10.1016/j.copsyc.2018.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attachment theory is an important framework from which to examine familial aged care. Despite this, the role of attachment in later-life caregiving remains unclear. The current study presents a systematic review of papers within the last five years on attachment and various outcomes related to familial aged care. For the caregiver, attachment anxiety was associated with poorer mental health, and attachment insecurity with a more controlling manner of caregiving. The few studies conducted with care recipients found that attachment insecurity was associated with greater self-appraisals of dementia symptoms and a lower sense of security. Research continues to suffer from the use of inadequate assessments of individual differences into adult attachment.
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Affiliation(s)
- Gery C Karantzas
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Daniel Romano
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Juwon Lee
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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Liu Y, Li Y, Chen L, Li Y, Qi W, Yu L. Relationships between family resilience and posttraumatic growth in breast cancer survivors and caregiver burden. Psychooncology 2018; 27:1284-1290. [DOI: 10.1002/pon.4668] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/09/2018] [Accepted: 01/30/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ye Liu
- Qilu Hospital of Shandong University; Qingdao P.R. China
| | - Yuli Li
- School of Nursing; Shandong University of Traditional Chinese Medicine; Jinan P. R. China
- School of Nursing; Shandong University; Jinan P. R. China
| | - Lijun Chen
- School of Nursing; Shandong University of Traditional Chinese Medicine; Jinan P. R. China
| | - Yurong Li
- School of Public Health; Qingdao University; Qingdao P. R. China
| | - Weiye Qi
- School of Nursing; Shandong University of Traditional Chinese Medicine; Jinan P. R. China
| | - Li Yu
- School of Nursing; Shandong University of Traditional Chinese Medicine; Jinan P. R. China
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Brandão T, Pedro J, Nunes N, Martins MV, Costa ME, Matos PM. Marital adjustment in the context of female breast cancer: A systematic review. Psychooncology 2017; 26:2019-2029. [PMID: 28342270 DOI: 10.1002/pon.4432] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/15/2017] [Accepted: 03/22/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Breast cancer (BC) diagnosis and subsequent treatments present significant challenges and distress for both patients and their partners. This can lead to difficulties in marital relationships and, consequently, decreases in marital adjustment and psychosocial adaptation to BC for both partners. Our objective was to systematically review studies assessing marital adjustment in the context of female BC to understand which factors are associated with marital adjustment in both patients and partners and characterize the measures used to assess marital adjustment within these studies. METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English, peer-reviewed articles exploring factors associated with marital adjustment in the context of female BC were considered for inclusion. RESULTS Fourteen studies were included. Results evidenced that psychosocial variables play an important role on marital adjustment. Specifically, open and constructive communication, more social support, and supportive dyadic coping were found to be associated with higher levels of marital adjustment. Other variables such as self-efficacy, sexual functioning, and psychological adjustment were also positively associated with marital adjustment. CONCLUSIONS Most studies evidenced an association between psychosocial variables and marital adjustment for both women and their partners. Some important dimensions such as communication patterns, coping strategies, and social support dynamics were identified as potential targets for psychological interventions. Some variables, however, were explored only in a few studies, which limit our conclusions. Future studies should explore the role these variables and other relational and emotional variables play in promoting marital adjustment after BC.
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Affiliation(s)
- Tânia Brandão
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Juliana Pedro
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Nuno Nunes
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Mariana V Martins
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Maria Emília Costa
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Paula Mena Matos
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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