Feasibility and preliminary effect of a couple-based posttraumatic growth intervention for colorectal cancer couples: A randomized controlled pilot study

Effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Spouses often assume the role of primary informal caregivers for ageing partners. Spousal caregivers are more likely than other family members to experience negative psychological outcomes due to their unique identities. However, little is known as to whether psychoeducation interventions can support them in the caregiving process.

OBJECTIVES

To systematically identify and synthesise evidence regarding the effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

Eight electronic databases, including Cochrane Library, PubMed, CINAHL, MEDLINE, Embase, PsycINFO, Chinese Journal Net and Wanfang were searched from inception to August 2024. Randomised controlled trials of psychoeducation interventions on psychological outcomes in spousal caregivers of older adults were included. The quality of the evidence was evaluated using The Cochrane Risk of Bias Tool v2. The certainty of the evidence was assessed by the GRADE approach. Data synthesis methods, including meta-analysis and narrative synthesis, were conducted based on data availability. Meta-analysis was performed using a random-effects model given the substantial heterogeneity in the intervention design and outcomes. Sensitivity analyses were used to assess the robustness of the findings.

RESULTS

Among the 18 reviewed studies, the overall risk of bias indicated that four had low risk, eight had some concerns, and six had high risk. The pooled analysis suggested that psychoeducation interventions had significant effects on improving marital satisfaction (SMD = 0.28, 95 % CI: 0.09 to 0.47; low certainty) and positive aspects of caregiving (SMD = 1.30, 95 % CI: 0.44 to 2.16; very low certainty). However, the effects on depressive symptoms, caregiving burden, anxiety, mental health, coping and self-efficacy were negligible. Narrative synthesis of evidence suggested potential beneficial effects on posttraumatic growth, family functioning, family relationship and life satisfaction.

CONCLUSIONS

Psychoeducation interventions have potential to improve marital satisfaction and positive aspects of caregiving among spousal caregivers of older adults. However, the evidence has a low level of certainty with considerable variability in intervention design and outcome measures, indicating the need for further rigorous investigation. The non-significant effects on enhancing caregiving competence or alleviating negative psychological outcomes highlight the importance of exploring the specific needs and expectations of spousal caregivers.

REGISTRATION

PROSPERO (CRD42024498599).

A feasibility study of a coping-focused, couple-based family resilience intervention (CCFRI) in supporting couples experiencing colorectal cancer

PURPOSE

Colorectal cancer patients and their spousal caregivers possess the potential to build family resilience and navigate the challenges of the cancer journey. However, few intervention studies have focused on enhancing family resilience among colorectal cancer couples. This study aimed to evaluate the feasibility, acceptability, and preliminary effects of a coping-focused, couple-based family resilience intervention guided by the Walsh Family Resilience Model.

METHODS

A one-group, six-week pre- and post-intervention study was conducted. Six intervention sessions were delivered either face-to-face or by telephone. Quantitative data were collected using self-report questionnaires assessing family resilience, hope, family sense of coherence, spiritual well-being, perceived social support, and couple communication quality. Qualitative data were gathered through semi-structured interviews with open-ended questions and note-taking.

RESULTS

A total of 24 colorectal cancer patient-spousal caregiver dyads were initially recruited for the intervention, but only 19 couples completed all six intervention sessions. Feasibility outcomes indicated a couple recruitment rate of 68.6% and a retention rate of 79.2%. Small to moderate improvements were identified in family resilience, hope, family sense of coherence, perceived social support, and couple communication quality, though spiritual well-being showed limited change. The majority of participants were satisfied with the intervention and provided valuable suggestions for future improvements.

CONCLUSIONS

This study showed that the coping-focused, couple-based family resilience intervention may effectively support colorectal cancer couples, improving adaptation and coping. Future research with larger samples is needed to confirm long-term effects and further refine intervention components.

Couple-based group intervention for social isolation in colorectal cancer couples: A pilot study

PURPOSE

Colorectal cancer (CRC) patients and their spousal caregivers frequently experience social isolation. Nevertheless, interventions targeting social isolation mitigation in CRC dyads remain limited. This pilot study aimed to evaluate the feasibility, acceptability, and preliminary effects of couple-based group intervention for alleviating social isolation in Chinese CRC couples.

METHODS

The study utilized a single-arm pre-post intervention design, comprising a structured six-session group program that blended face-to-face and online components. Feasibility was evaluated through recruitment and retention rates. Acceptability was assessed via a mixed-methods approach combining post-intervention surveys with open-ended interviews. Outcome measures included validated instruments: the General Alienation Scale, Lubben Social Network Scale-6, Medical Outcomes Study 12-item Short-Form version 2, Dyadic Coping Inventory, and Perceived Social Support Scale.

RESULTS

The program demonstrated feasibility with a 62.5 % recruitment rate and an 85 % retention rate. Quantitative and qualitative data supported its acceptability through CRC couples' overall satisfaction. Effectiveness was evidenced by medium effect sizes (Cohen's d = 0.54-0.59) on both subjective and objective measures of social isolation and most secondary outcomes in CRC patients and spousal caregivers. Notably, spousal caregivers showed borderline significant improvements in physical health (d = 0.50, P = 0.056) and social support (d = 0.49, P = 0.063).

CONCLUSION

The feasibility, acceptability, and preliminary effects of the couple-based group intervention for social isolation in CRC couples were confirmed. These findings warrant a large-scale randomized controlled trial to rigorously evaluate the intervention's long-term effectiveness and potential for clinical implementation.

Correlated factors of posttraumatic growth in patients with colorectal cancer: A systematic review and meta-analysis

Objectives

This systematic review and meta-analysis aimed to identify and synthesize the factors correlated with posttraumatic growth (PTG) in patients with colorectal cancer (CRC).

Methods

PubMed, Web of Science, Embase, PsycINFO, CINAHL, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database (VIP) and SinoMed were searched for studies that reported data on the correlated factors associated with PTG in patients with CRC from inception to September 3, 2024. The methodological quality of the included studies was assessed via the Agency for Healthcare Research and Quality (AHRQ) methodology checklist and the Newcastle-Ottawa Scale (NOS). Pearson correlation coefficient (r) was utilized to indicate effect size. Meta-analysis was conducted in R Studio.

Results

Thirty-one eligible studies encompassing 6,400 participants were included in this review. Correlated factors were identified to be significantly associated with PTG in patients with CRC including demographic factors: residential area (r = 0.13), marital status (r = 0.10), employment status (r = 0.18), education level (r = 0.19), income level (r = 0.16); disease-related factors: time since surgery (r = 0.17), stoma-related complications (r = 0.14), health-promoting behavior (r = 0.46), and sexual function (r = 0.17); psychosocial factors: confrontation coping (r = 0.68), avoidance coping (r = -0.65), deliberate rumination (r = 0.56), social support (r = 0.47), family function (r = 0.50), resilience (r = 0.53), self-efficacy (r = 0.91), self-compassion (r = -0.32), psychosocial adjustment (r = 0.39), gratitude (r = 0.45), stigma (r = -0.65), self-perceived burden (r = -0.31), fear of cancer recurrence (r = -0.45); and quality of life (r = 0.32).

Conclusions

This meta-analysis identified 23 factors associated with PTG in CRC patients. Medical workers can combine those relevant factors from the perspective of positive psychology, further explore the occurrence and development mechanism of PTG, and establish targeted interventions to promote PTG.

Longitudinal relationship between posttraumatic growth and distress in lung cancer patients during neoadjuvant immunotherapy

Purpose

Posttraumatic growth (PTG) has been recognized as beneficial for the emotional well-being of cancer patients. However, the longitudinal relationship between PTG and emotional distress remains unclear and has rarely been investigated among patients undergoing neoadjuvant therapy. We investigated the linear and quadratic longitudinal associations between distress (depression, anxiety, and negative affect) and PTG in lung cancer patients undergoing neoadjuvant immunotherapy. We also tested individual variations in the longitudinal associations.

Methods

Data were pooled from three clinical trials (n = 231) evaluating the efficacy of neoadjuvant immunotherapy in lung cancer patients. At the beginning of each treatment cycle, patients completed questionnaires assessing PTG and distress. Cross-lagged panel analysis was used to evaluate longitudinal associations, and multi-group structural equation modeling was conducted to examine individual variations in these relationships.

Results

A unidirectional linear relationship was observed, with lower levels of distress predicting greater PTG over time. The impact of anxiety on PTG was more pronounced in patients with higher education or lower financial burdens, while the effect of negative affect was more salient in older patients. No significant quadratic effects of distress on PTG were observed.

Conclusions

Lower emotional distress may facilitate the development of PTG over time. The longitudinal effect of distress on PTG varied on age, education, and financial burdens.

Implications

Psychosocial interventions to promote PTG may be more effective by incorporating stress management and emotion regulation strategies, and need to be tailored to patients' socioeconomic characteristics.

A couple-based dyadic coping intervention for colorectal cancer patient-spousal caregiver dyads: A randomized controlled study

PURPOSE

To evaluate the clinical effects of a couple-focused dyadic coping intervention in colorectal cancer (CRC) couples.

METHODS

The study was a single-blinded randomized controlled study which 226 CRC couples were recruited and randomized to either the intervention (N = 113) or the control (N = 113) group. All couples received usual care while the six-week dyadic coping intervention was provided to the intervened couples in psycho-education and skill training methods through face-to-face combined with telephone formats. Measurement data, including dyadic coping, marital satisfaction, quality of life and psychological well-being were collected at pre- and post-intervention periods. And multilevel model (MLM) was applied to analyze the effects of the intervention and the role tendency.

RESULTS

A total of 173 couples completed the program and post-intervention evaluation. The retention rate was 76.5%. Results from MLM showed that the dyadic coping intervention is effective in promoting levels of dyadic coping (P < 0.001), marital satisfaction (P = 0.042), mental health (P = 0.006), and positive psychological well-being (P < 0.001), and alleviating depression (P = 0.015) in CRC couples. For role tendency, the intervention found to be more effective in CRC spousal caregivers' positive psychological well-being compared to the patients (P = 0.037).

CONCLUSION

The couple-based dyadic coping intervention is effective in promoting dyadic coping and improving psychological adjustment in CRC couples. More studies were needed to further evaluate the program and its long-term efficacy in the future. In addition, given the positive effects of the intervention, clinical nursing stuffs may consider implementing such intervention in their routine work while caring for CRC couples.

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.

Constructing and Preliminary Testing a Narrative Therapy Programme for Posttraumatic Growth in Chinese Patients With Inflammatory Bowel Disease-A Pilot Study

BACKGROUND

The research on posttraumatic growth (PTG) promotion programmes, particularly narrative therapy (NT), for patients with inflammatory bowel disease (IBD) remains limited. This pilot study aims to develop an NT programme to promote PTG and evaluate its feasibility, preliminary effectiveness, participants' experiences and improvement suggestions.

METHODS

The NT programme was initially developed through literature review, interviews with IBD patients and expert panel discussions. A randomized controlled pilot trial was conducted to assess the feasibility and preliminary effectiveness of the programme. Participants in the NT group received five consecutive weekly sessions of the programme, while the control group received standard care. Outcomes including PTG, anxiety, depression and quality of life were measured. Qualitative interviews were conducted to explore participants' experiences and suggestions for programme modifications.

RESULTS

The NT programme was developed with scientific rigour. The recruitment rate and retention rate were 62.5% and 96.7%, respectively. A significant reduction in anxiety levels was observed, and manifestations of PTG were reported in the NT group. Suggestions for improvement of the NT programme were received from the participants.

CONCLUSION

The NT programme was constructed to promote PTG in IBD patients in this study, further offering preliminary evidence for its feasibility and potential positive psychological change. However, large-scale research is needed to validate its effectiveness for broader applications.