A couple‐based intervention for patients and caregivers facing end‐stage cancer: outcomes of a randomized controlled trial

Abstract

Background: We evaluated the effect of Emotionally Focused Therapy (EFT) [intervention (INT)], modified for the advanced cancer population versus standard care [control (CTL)], on marital functioning and psychosocial outcomes among distressed couples. EFT examines the ways couples process patterns of interaction, facilitating change.Methods: Forty-two patients with metastatic cancer and their caregivers were assigned randomly to receive eight sessions of EFT delivered by one EFT-trained psychologist or standard care provided by multidisciplinary clinicians. Partners completed measures of marital functioning, depression, hopelessness, empathic caregiving (patient), and caregiver burden (caregiver) before randomization at baseline (T0), post-intervention (T1), and 3-month post-intervention (T2). Data were analyzed using three-way analyses of covariance; main effects were treatment, patient status, and sex. Multilevel modeling was also employed.Results: At T1, INT group led to significant improvement in marital functioning (p ≤ 0.0001) and patients' experience of caregiver empathic care (p = 0.02) versus CTL group. Effect sizes for these differences were in the large range (d = 1.00). In both groups, patients showed a marginally higher mean score for marital functioning compared with caregivers [INT: M = 56.3, standard deviation (SD) = 4.6 vs M = 54.3, SD = 4.5; CTL group: M = 43.4, SD = 10.3 vs M = 42.4, SD = 6.8, respectively]. At T2, results were maintained.Conclusions: The effectiveness of and adherence to the EFT couple intervention for patients facing advanced cancer were demonstrated in this study. Larger randomized control trials are needed to confirm these findings. Qualitative studies may help to further understand the mechanism by which such an intervention may act.

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review

“…Interventions were grouped into two categories according to their main therapeutic approach: 'Cognitive Behavioural Skills Training' (CBST) (n=25), which focuses on illness cognitions, education, goal setting, and coping strategies such as problem solving and symptom management; and 'Relationship Counselling' (RC) (n=10), which addresses relationship difficulties such as sexual intimacy, partner supportiveness, and communication [38,51,45,52,53,54,55,56,57,58]. There was no noticeable effect of mode of delivery (faceto-face, telephone, online) on illness type or outcomes.…”

“…When compared with a patient-only or control group, interventions based on RC were most effective at addressing interpersonal issues including relationship satisfaction [52,54], perceived partner acceptance of self-image [54], communication quality [56], marital functioning [57], and dyadic adjustment [58]. Intimacy [53] and sexual communication and distress [58] were more effectively targeted by RC.…”

New frontiers in couple-based interventions in cancer care: refining the prescription for spousal communication

“…The disclosure of feelings and concerns is a topic that has received considerable research attention and is commonly advocated in couple-based interventions [30][31][32][33]. The idea that couples should talk about feelings is grounded in social cognitive models of stress and coping which posit that stressful events such as cancer are a threat because they challenge individuals' existing schemas about themselves and their relationships [33,34].…”

Taking Care of Her: A Pilot Feasibility Study of a Caregiver Intervention for Women with Advanced Stage Ovarian Cancer

“…Instead the emphasis in most caregiver research has been and continues to be on helping the caregiver interpret and manage the patient's medications and symptoms [14] [15]. Even when intervention studies have included couples impacted by other gynecologic cancers (breast, cervical), very few have significantly improved the quality of interpersonal support or communication between the patient and spouse caregiver about the cancer and none have measured the impact of the intervention on spouse caregivers' skills or confidence to manage the toll of the cancer on themselves, the patient or their relationship [16] [17].…”