A comprehensive meta-analysis of couple-based interventions on dyadic adjustment in coping with cancer: effectiveness and moderating variables

Abstract

Background Cancer can be seem as “we disease” that impacts cancer patients and their spousal partners Dyadic coping may influence the distress between couples and the potential beneficial effects of couple-based intervention on their relationship functioning has been identified However the approach effectiveness and dose-response relationship of interventions were inconsistent Moreover whether the effects of couple-based interventions were different among role- and gender- specific participants were still unknown Objectives To evaluate the immediate effects of couple-based interventions on improving dyadic adjustment (CIIDA) compared to controlled status (usual care or alternative programmes) on dyadic adjustment and psychological adjustment outcomes in different roles among couples with cancer The role- and gender-specific effects of CIIDA were further identified The sustaining effects and moderators of CIIDA on dyadic adjustment were further examined Methods The searches were performed in six databases The reference lists of included studies and selected reviews and contacted authors of relevant studies were examined also All the trials for inclusion risk of bias and extracted data were assessed by two reviewers independently The study results which judged to be clinically homogeneous in different comparisons were pooled by reporting g-value with 95% confidence intervals (CIs) Outliers were further examined by removed and Winsorized The overall quality of the evidence for each comparison were assessed by using the GRADE approach Subgroup analysis were conducted to further examine the influence of the study method participant and intervention factors on effect sizes Results Only studies reporting all the couples were married or in a romantic relationship were included There were 28 studies with the effects of CIIDA with a range of 3 to 16 sessions 1 to 6 months duration were investigated Study participants (n = 4813) were primary middle aged (mean = 55 0 years old) CIIDA had small to moderate effects on dyadic adjustment with a decreasing trends among 12 months post-treatment period (g = 0 21 to 0 17) for patients but spousal partners For role- and gender-specific effects female patients were the most beneficial participants from CIIDA with 4 to 6 sessions immediate on both dyadic adjustment (g = 0 31) and depression (g = 0 32) Whereas no significant effects in male patients and any gender of spousal partners In terms of immediate effect on dyadic adjustment female-specific cancer emotional expression skill and psychologist provider were the moderators for patients; couple attend together homework assignment and longer than 8 weeks were the beneficial subgroups for spousal partners Whereas control condition risk of bias stage approach mode of delivery number of sessions length of each session and total dose had no significant moderating effects For psychological adjustment CIIDA had immediate effects on depression (g = 0 27) and psychological well-being (g = 0 28) for patients but depression effect (g = 0 29) for spousal partners only Conclusions This is the first RCTs meta-analysis to identify the effectiveness of CIIDA on dyadic adjustment with gender- and role-specific participants among couples with cancer Female patients may be the mostly beneficial participants of CIIDA with lesser length of relationship younger age than male patients and the patient-focused intervention To further improving the effectiveness of CIIDA for patients adopting emotional expression skill and leading by psychologists which may increase the positive dyadic communication will be suggested Moreover to successfully reach the needs of spousal partners among CIIDA participating by couple together with a homework assignment for over 8 weeks should be considered for future CIIDA design

Date of Award	2018 Feb 14
Original language	English
Supervisor	Mei-Feng Lin (Supervisor)