This paper presents findings on how breast cancer patients and their partners cope together with the cancer diagnosis and treatment. It expands on earlier frameworks of dyadic coping by presenting a model that views dyadic coping as a process that varies according to how couples appraise the illness-related stress, communicate about it, coordinate their coping efforts, and make meaning from the illness experience. Indepth analyses were conducted on interviews with 10 couples who were coping with breast cancer. A qualitative method that comprises a series of "listenings" to the couples' experiences was used to examine how couples talked about their stress and coping efforts. Two patterns of relational coping were identified: mutually responsiveness and disengaged avoidance. The relational qualities of relationship awareness, authenticity, and mutuality were identified as important ingredients for dyadic coping. Suggestions for future research that fur-thers our understanding of relational coping are offered.

Previous studies have revealed that the ways couples deal with stress in their lives are significantly associated with their marital quality and overall marital functioning. However, there has been little empirical evidence linking dyadic coping with marital quality over time. This study addresses the relationship between dyadic coping and marital quality among 90 couples over a period of 2 years. The results reveal that dyadic coping was significantly associated with marital quality over 2 years. For women, both their own dyadic coping and that of their partner were significant predictors, whereas for men only their own dyadic coping was predictive. The results are discussed with regard to prevention of marital distress.

BackgroundWith the growing recognition that patients and partners react to a cancer diagnosis as an interdependent system and increasing evidence that psychosocial interventions can be beneficial to both patients and partners, there has been a recent increase in the attention given to interventions that target couples. The aim of this systematic review was to identify existing couple-based interventions for patients with cancer and their partners and explore the efficacy of these interventions (including whether there is added value to target the couple versus individuals), the content and delivery of couple-based interventions, and to identify the key elements of couple-based interventions that promote improvement in adjustment to cancer diagnosis.MethodA systematic review of the cancer literature was performed to identify experimental and quasi-experimental couple-based interventions published between 1990 and 2011. To be considered for this review, studies had to test the efficacy of a psychosocial intervention for couples affected by cancer. Studies were excluded if they were published in a language other than English or French, focused on pharmacological, exercise, or dietary components combined with psychosocial components, or did not assess the impact of the intervention on psychological distress (e.g., depression, anxiety) or quality of life. Data were extracted using a standardised data collection form, and were analysed independently by three reviewers.ResultsOf the 709 articles screened, 23 were included in this review. Couple-based interventions were most efficacious in improving couple communication, psychological distress, and relationship functioning. Interventions had a limited impact on physical distress and social adjustment. Most interventions focused on improving communication and increasing understanding of the cancer diagnosis within couples. Interventions were most often delivered by masters-level nurses or clinical psychologists. Although most were delivered in person, few were telephone-based. No difference in efficacy was noted based on mode of delivery. Factors associated with uptake and completion included symptom severity, available time and willingness to travel.ConclusionGiven effect sizes of couple-based interventions are similar to those reported in recent meta-analyses of patient-only and caregiver-only interventions (~d=.35-.45), it appears couple-based interventions for patients with cancer and their partners may be at least as efficacious as patient-only and caregiver-only interventions. Despite evidence that couple-based interventions enhance psycho-social adjustment for both patients and partners, these interventions have not yet been widely adopted. Although more work is needed to facilitate translation to routine practice, evidence reviewed is promising in reducing distress and improving coping and adjustment to a cancer diagnosis or to cancer symptoms.

Dyadic coping has received increased attention during the last decade, both in theory and empirical studies. Two main models of dyadic coping are proposed in the current literature: (1) a comparative approach in which each partner’s individual coping is compared with the other’s individual coping with regard to congruence or discrepancy and (2) a systemic model where dyadic coping is conceptualized as an interactive and reciprocal process. In this study, the predictive power of these two different models of dyadic coping is examined regarding relationship quality and well-being. The study is conducted with 443 Swiss couples. Results reveal that both dyadic coping measures are related to relationship quality and psychological well-being. However the systemic dyadic coping measure is a stronger predictor than the discrepancy measure for relationship quality. Both measures show weaker associations with well-being. Findings are discussed with regard to theoretical issues and their implication for practical work.

Systematic tracking of distress screening protocols is needed to demonstrate compliance with new standards of care and to demonstrate how well institutions are responding to their clinical obligation to address cancer patients' emotional and psychosocial needs.