Effectiveness of couple psycho-oncological interventions in increasing patients and their partners’ adaptation to disease: A systematic review and a meta-analysis

Effectiveness of mHealth-based psychosocial interventions for breast cancer patients and their caregivers: A systematic review and meta-analysis

BACKGROUND

Breast cancer causes significant distress in patient-caregiver dyads. While psychosocial and/or mHealth-based interventions have shown efficacy in improving their psychosocial well-being, no reviews have synthesised the effectiveness of such interventions delivered specifically to the breast cancer patient-caregiver dyad.

OBJECTIVE

To synthesise available evidence examining the effectiveness of mHealth-based psychosocial interventions among breast cancer patient-caregiver dyads in improving their psychosocial well-being (primary outcomes: dyadic adjustment, depression and anxiety; secondary outcomes: stress, symptom distress, social well-being and relationship quality), compared to active or non-active controls.

DESIGN

A systematic review and meta-analysis.

METHODS

Randomised controlled trials and quasi-experimental studies were comprehensively searched from seven electronic databases (PubMed, CENTRAL, CINAHL, Embase, PsycINFO, Scopus, Web of Science), ongoing trial registries (ClinicalTrials.gov, WHO ICTRP) and grey literature (ProQuest Dissertations and Theses Global) from inception of databases till 23 December 2022. Studies involving breast cancer patient-caregiver dyads participating in mHealth-based psychosocial interventions, compared to active or non-active controls, were included. Exclusion criteria were terminally ill patients and/or participants with psychiatric disorders or cognitive impairment and interventions collecting symptomatic data, promoting breast cancer screening or involving only physical activities. Screening, data extraction and quality appraisal of studies were conducted independently by two reviewers. Cochrane Risk of Bias Tool version 1 and JBI Critical Appraisal Checklist were used to appraise the randomised controlled trials and quasi-experimental studies, respectively. Meta-analyses using Review Manager 5.4.1 synthesised the effects of outcomes of interest. Sensitivity and subgroup analyses were conducted. The GRADE approach appraised the overall evidence quality.

RESULTS

Twelve trials involving 1204 breast cancer patient-caregiver dyads were included. Meta-analyses found statistically significant increase in caregiver anxiety (standardised mean difference (SMD) = 0.43, 95% confidence interval (CI) [0.09, 0.77], Z = 2.47, p = 0.01), involving 479 caregivers in 5 studies, and stress (SMD = 0.25, 95% CI [0.05, 0.45], Z = 2.44, p = 0.01), involving 387 caregivers in 4 studies post-intervention, favouring control groups. The intervention effects on the remaining outcomes were statistically insignificant. Beneficial effects of such interventions remain uncertain. The overall quality of evidence was very low for all primary outcomes.

CONCLUSIONS

Results of the effectiveness of mHealth-based psychosocial interventions on the psychosocial well-being of breast cancer patient-caregiver dyads are inconclusive. The high heterogeneity shown in the meta-analyses and very-low overall quality of evidence imply the need for cautious interpretation of findings. Higher-quality studies are needed to assess the effects of psychosocial interventions on dyadic outcomes and determine optimal intervention regimes.

Perception of disease, dyadic coping, and the quality of life of oncology patients in the active treatment phase and their life partners: an approach based on the actor-partner interdependence model

Objective

The aim of this study based on the Systemic Transactional Model was to examine the relationship between dyadic coping and (1) disease perception and (2) quality of life of a sample of cancer patients and their life partners.

Method

This cross-sectional study included 138 oncological dyads. The following questionnaires were used: Stress Appraisal Measure, Dyadic Coping Inventory, and European Organisation for Research and Treatment of Cancer QLQ-C30. Data collected was analysed by applying the actor-partner interdependence model.

Results

The perception of the disease as a threat as well as its centrality significantly negatively influences the positive forms of dyadic coping whilst the perception of the disease as a challenge has a significant positive influence on them. Dyadic coping does not influence symptoms but has significant influences on global health/quality of life.

Conclusion

This study has highlighted new information regarding how couples cope with cancer. The results encourage the inclusion of the perception of the disease and dyadic coping in interventions that aim to improve the quality of life of cancer patients and their life partners.

Psychotherapeutic intervention on breast self-examination based on Health Belief Model

The aim of this research was to verify the effectiveness of a Health Belief Model-based intervention in increasing knowledge and changing beliefs about breast cancer and its early detection as well as in improving breast self-examination behaviors. This randomized controlled clinical trial involved 210 women. The program was implemented by email and involved sending daily messages to participants for 30 days. The women in the intervention group received messages aimed at increasing the practice of breast self-examination behavior. Participants in the control group received messages promoting general health. Before and after the intervention there were evaluated the application of breast self-examination, level of knowledge, beliefs associated with health (susceptibility to develop breast cancer, disease severity, benefits of self-examination, barriers to achieving this behavior, cues to action, self-efficacy in performing self-examination). At the end of the program, a significant improvement in the perception of disease severity and the benefits of breast self-examination was obtained, as well as a significant increase in the percentage of participants who achieved this behavior. The results obtained are arguments for it to be implemented by health care providers who want to promote self-examination as a method of early detection of breast cancer.

The Influence of Health Beliefs, of Resources, of Vaccination History, and of Health Anxiety on Intention to Accept COVID-19 Vaccination

The aim of this study is to investigate whether Health Belief Model constructs, personal resources, vaccination history and health anxiety exert an influence on vaccination intention. To achieve this end, we carried out a cross-sectional study of 432 people drawn from a convenience sample who answered an online questionnaire. Multiple logistical regressions showed that perception of the severity of the disease, of the benefits of being vaccinated, of barriers, and of cues to action, along with the freeness and accessibility of the vaccine and general vaccination history, are significant predictors regarding vaccination intention.

The Relationship of Dyadic Coping With Emotional Functioning and Quality of the Relationship in Couples Facing Cancer-A Meta-Analysis

Objective: This study is a meta-analysis that considers the association between dyadic coping and emotional functioning, and between dyadic coping and the quality of the relationship as perceived by cancer patients and their life partners. Methods: A systematic search was conducted in the electronic databases PsycINFO, PubMed, ScienceDirect and those peer-reviewed cross-sectional and longitudinal studies published up until April 2020 that investigated these relationships were selected. Results: A total of 1,168 studies were identified, of which 10 met the inclusion criteria (N = 1,727 couples). These evidenced statistically significant positive relationships between common dyadic coping and emotional functioning and between common dyadic coping and the quality of the relationship as perceived by patients and their partners. There was also a statistically significant positive association between stress communication (by oneself), supportive dyadic coping (by oneself and by partner), and the quality of the relationship. In addition, a statistically significant negative association was found between negative dyadic coping (by oneself and by partner) and the quality of the relationship as perceived by patients' partners and also between negative dyadic coping (by oneself) and the quality of the relationship as perceived by patients. Conclusions: The results suggest the existence of a significant association between dyadic coping and emotional functioning and between dyadic coping and the quality of the relationship as perceived by members of couples facing cancer. However, these results must be interpreted with caution due to the small number of studies included in the analysis. Clinically, an understanding of the existence of such relationships is helpful for the implementation, and study of the effectiveness of, interventions aimed at improving dyadic coping in order to improve both quality of life and quality of relationship in couples where there is an oncological diagnosis.

Talking but not always understanding: couple communication about infertility concerns after cancer

BACKGROUND

Cancer related infertility can have an impact on couple relationships, with evidence that couple communication facilitates coping. However, little is known about the ways in which couples communicate about cancer-related fertility concerns. The aim of this article is to examine couple communication about fertility concerns in the context of cancer, and the perceived quality of such communication from the perspective of cancer survivors and their partners.

METHODS

Eight-hundred and seventy-eight cancer survivors (693 women, 185 men) and 144 partners (82 women, 62 men), across a range of tumour types and age groups, completed a survey which examined cancer related fertility concerns. Seventy-eight survivors (61 women and 17 men), and 26 partners (13 women and 13 men), participated in semi-structured interviews, in order to examine the subjective experience of fertility concerns in-depth. Thematic analysis was used to analyse the interviews and open ended survey questions. Valid percentages for single items from the relationships subscale of the Fertility Preservation Inventory (FPI) related to qualitative themes, identified frequency of responses.

RESULTS

The major theme was 'talking but not always understanding". 89.6% of cancer survivors and partners (95.1%) reported working well together handling fertility questions (FPI), but agreed that communication could be improved (65.9% survivors; 65% partners). Open and honest couple communication was associated with feelings of support, understanding and relationship growth, including perception of partner comfort (79.2% survivors, 81.6% partners). However, 32% survivors and 31.1% partners concealed fertility concerns to avoid upsetting their partner, or reported that their partner doesn't understand their fertility concerns (survivors 25.5%, partners 14.6%), with 14.1% of cancer survivors and 19.4% partners reporting fear of relationship breakdown because of fertility issues. Fear of rejection when forming new relationships, and concerns about how to talk to future partners, was reported by non-partnered individuals.

CONCLUSION

Health-care professionals should include partners of cancer survivors in fertility discussions. Couple interventions developed in general psycho-oncology should be extended to the domain of fertility, in order to facilitate effective couple communication. Communication in future relationships needs to be addressed for single people and adolescents and young adults (AYAs) who have fertility concerns.