Review and Meta-analysis of Couple-Oriented Interventions for Chronic Illness

Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA.
Annals of Behavioral Medicine (Impact Factor: 4.2). 12/2010; 40(3):325-42. DOI: 10.1007/s12160-010-9216-2
Source: PubMed


Evidence continues to build for the impact of the marital relationship on health as well as the negative impact of illness on the partner. Targeting both patient and partner may enhance the efficacy of psychosocial or behavioral interventions for chronic illness.
The purpose of this report is to present a cross-disease review of the characteristics and findings of studies evaluating couple-oriented interventions for chronic physical illness.
We conducted a qualitative review of 33 studies and meta-analyses for a subset of 25 studies.
Identified studies focused on cancer, arthritis, cardiovascular disease, chronic pain, HIV, and Type 2 diabetes. Couple interventions had significant effects on patient depressive symptoms (d = 0.18, p < 0.01, k = 20), marital functioning (d = 0.17, p < 0.01, k = 18), and pain (d = 0.19, p < 0.01, k = 14) and were more efficacious than either patient psychosocial intervention or usual care.
Couple-oriented interventions have small effects that may be strengthened by targeting partners' influence on patient health behaviors and focusing on couples with high illness-related conflict, low partner support, or low overall marital quality. Directions for future research include assessment of outcomes for both patient and partner, comparison of couple interventions to evidence-based patient interventions, and evaluation of mechanisms of change.

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    • "Although research findings and system theories suggest that chronic illness has an impact on the family as a unit, the health care system is typically patient focused and family systems needs are notably unmet. Recently published reviews of family interventions [8] [9] [10] [11] [12] [13] [14] show that interventions provided by health care often are characterized as psychoeducational versus relationship focused. Additionally, interventions are mostly directed towards the individual family member or "
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    ABSTRACT: Research shows that living with illness can be a distressing experience for the family and may result in suffering and reduced health. To meet families' needs, family systems intervention models are developed and employed in clinical contexts. For successful refinement and implementation it is important to understand how these models work. The aim of this study was therefore to describe the dialogue process and possible working mechanisms of one systems nursing intervention model, the Family Health Conversation model. A descriptive evaluation design was applied and 15 transcribed conversations with five families were analyzed within a hermeneutic tradition. Two types of interrelated dialogue events were identified: narrating and exploring. There was a flow between these events, a movement that was generated by the interaction between the participants. Our theoretically grounded interpretation showed that narrating, listening, and reconsidering in interaction may be understood as supporting family health by offering the families the opportunity to constitute self-identity and identity within the family, increasing the families' understanding of multiple ways of being and acting, to see new possibilities and to develop meaning and hope. Results from this study may hopefully contribute to the successful implementation of family systems interventions in education and clinical praxis.
    04/2014; 2014(1):547160. DOI:10.1155/2014/547160
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    • "The search was restricted to studies published between January 1990 and September 2012 because the concept of dyadic coping has been evaluated in couples coping with cancer since the early 1990s. The reference lists of the retrieved studies and other key reviews (e.g., Badr & Krebs, 2012; Berg & Upchurch, 2007; Manne & Badr, 2008; Martire et al., 2010; Regan et al., 2012) were checked in order to capture other relevant publications, which were not found in the computerized database searches. "
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    ABSTRACT: Objectives Cancer not only affects the patient but also the partner. In fact, couples may react as a unit rather than as individuals while coping with cancer (i.e., dyadic coping). We assessed (1) the relationship between dyadic coping and relationship functioning in couples coping with cancer and (2) whether intervention studies aimed at improving dyadic coping were able to enhance the relationship functioning of these couples. Recommendations for future studies are provided.MethodA systematic search was conducted to identify all eligible papers between January 1990 and September 2012. The databases PubMed, PsycINFO, the Cochrane Library, and EMBASE were screened.ResultsMost studies (n = 33) used an appropriate study design, adequate measurements, adequate analytical techniques, and a sufficient number of included participants to answer addressed research questions. However, the definition and assessment of dyadic coping strategies differed, which hampered comparison. Coping styles characterized by open and constructive (cancer-related) communication, supportive behaviours, positive dyadic coping, and joint problem solving were related to higher relationship functioning, whereas dysfunctional communication patterns (e.g., protective buffering, demand–withdraw communication), unsupportive behaviours, and negative dyadic coping were related to lower relationship functioning. The results of the intervention studies were inconsistent: while some studies reported a beneficial effect on relationship functioning, other studies report no such effect, or only found a positive effect in couples with fewer personal relationship resources.Conclusions This review showed that adequate dyadic coping may improve relationship functioning, while dysfunctional dyadic coping may impede relationship functioning. In order to increase the comparability of the reported findings, a more uniformly conceptualized perspective on dyadic coping is needed. A better understanding of the dyadic challenges couples coping with cancer may face and more insight on how to expand the dyadic coping of these coupes might facilitate improvements in the quality of cancer care. Couple-based intervention studies may increase the couples’ relationship functioning. However, future research is needed to examine more specifically which couples may benefit from such interventions.Statement of contribution What is already known on this subject? Dyadic coping may influence the distress experienced by both members of the couple and their relationship functioning. Several reviews already reported on the potential of couple-based interventions to improve the dyadic coping of couples coping with cancer and on the beneficial effects of this coping on the psychosocial adjustment and relationship functioning of patients and partners (e.g., Badr & Krebs, ; Martire, Shulz, Helgeson, Small, & Saghafi, ; Regan et al., ). However, even though we now know that couple-based intervention might be useful, no systematic review has been conducted that focuses specifically on the mechanisms of dyadic coping itself. What does this study add? This review showed the importance of stress communication, supportive behaviours, and positive dyadic coping for the maintenance or enhancement of relationship functioning in couples coping with cancer. In addition, the dyadic intervention studies send an important message that encourages to further examine the potential benefit of such interventions in future. However, more consensus in the conceptualization and assessment of the dyadic coping styles is needed in order to increase the comparability of the reported findings.
    British Journal of Health Psychology 03/2014; 20(1). DOI:10.1111/bjhp.12094 · 2.70 Impact Factor
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    • "These authors concluded that family-oriented interventions are effective with a tendency towards greater effects for longer interventions (Hartmann et al., 2010). Martire, Schulz, Helgeson, Small, and Saghafi (2010) in a meta-analysis of 25 couple-oriented interventions, again for chronic illness including cancer, found small but significant positive effects on patient depression and marital functioning (Martire et al., 2010). A meta-analysis by Hofmann, Sawyer, Witt, and Oh (2010) "
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    ABSTRACT: Cancer is a leading cause of burden of disease in Australia. The diagnosis of cancer is a major life stress with heightened psychological distress common and unmet psychological supportive care needs highly prevalent. There is a clinical imperative to provide accessible evidence-based psychosocial therapies to patients and their families in order to reduce distress and optimise psychological outcomes. A range of theoretical approaches have been proposed to guide psychological interventions in the context of cancer, including theories of stress and coping and social cognitive theories of adjustment. In addition, there is a well-established body of evidence demonstrating that psychosocial interventions improve psychological outcomes after cancer, and clinical practice guidelines for intervention to reduce distress in people affected by cancer have been developed based on this evidence. However, despite relevant theoretical models, empirical evidence, and the availability of guidelines, evidence-based psychosocial care for cancer patients is the exception rather than the norm. The answer to this problem may lie in research translation. A model for research translation is overviewed in this article with barriers to research translation discussed and a case study presented. Finally, recommendations for how health psychology can contribute to psycho-oncology research and practice are proposed.
    Australian Psychologist 02/2014; 49(2). DOI:10.1111/ap.12044 · 0.61 Impact Factor
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