Dyadic coping in cancer and couple-based interventions

Research Doctorate - Doctor of Philosophy (PhD)This thesis by publication is composed of an introduction, seven papers, and a final chapter that includes discussion of the overall body of work undertaken and its implications for future research. The research described in this thesis was undertaken concurrently with the development and initial testing of a novel, self-directed, couple-based intervention for patients with prostate cancer and their partners called Coping-Together. All papers relate to couple-based interventions for patients with cancer and their partners, and the role dyadic coping (i.e., how couples cope with cancer together) plays in couples’ adjustment to cancer. At the time of submission, four of seven papers have been accepted for publication, which meets the requirements set out by the University of Newcastle for submitting a thesis by publication. The Introduction presents an overview of the psychological impact of cancer on couples and the role dyadic coping plays in their adjustment to the disease. It provides a discussion on the prevalence of psychological distress among patients and partners, a summary of how coping with cancer has evolved from an individual concept to a dyadic concept, and a rationale for why in some cases it may be beneficial to intervene with distressed patients and partners together, rather than separately. Paper One, “Couples coping with cancer: Exploration of theoretical frameworks from dyadic studies”, presents a review of the various theories of dyadic coping that have been used to explore how couples adjust following a diagnosis of cancer. This is an important first step in outlining the current state of dyadic coping in the context of cancer. This narrative review identified seven theoretical perspectives of coping and interpersonal relationships that have been applied in the cancer context, including the Systemic Transactional Model of dyadic coping (STM), and provides a summary of the findings, and compared and contrasted the specific characteristics of each theoretical perspective. This paper is currently under review with Psycho-Oncology. Paper Two, “Cross-sectional relationships between dyadic coping and anxiety, depression, and relationship satisfaction for patients with prostate cancer and their spouses”, explores empirical data collected baseline survey of pilot study of a couple-based intervention called Coping-Together. This paper adds to the growing empirical evidence that patients’’ and partners’ dyadic coping behaviour influence their own psychosocial outcomes and that of their spouse. The results suggested that positive forms of dyadic coping were associated with increased relationship satisfaction, whereas negative forms of dyadic coping were associated with decreased relationship satisfaction and increased anxiety and depression. The results also indicated that spouses’ use of dyadic coping influenced one another’s outcomes on anxiety, depression, and relationship satisfaction. This paper has been accepted for publication in Patient Education and Counseling. Paper Three, “Do Couple-Based Interventions Make a Difference for Couples Affected by Cancer?: A Systematic Review”, presents the results of a systematic review of couple-based interventions for patients with cancer anrequires further exploration. This paper has been accepted for publication in BMC Cancer. Paper Four, “Uptake and attrition in couple-based interventions for cancer: Perspectives from the literature”, presents a review of the uptake and attrition rates of patients and partners approached to participate in randomised controlled trials of couple-based interventions. Paper Three indicated that couple-based interventions were efficacious, however their applicability and feasibility needs to be explored in greater detail. This descriptive review explores the variation in uptake and attrition by cancer type and stage, and by intervention type, content, and delivery. The results suggested that uptake did differ between patients and partners, and was not affected by cancer type. In terms of attrition, partners of patients with late-stage cancer were more likely to drop out of a trial compared to patients. This paper has been accepted for publication in Psycho-Oncology. Paper Five, “A Qualitative Investigation of Health Care Professionals’, Patients’ and Partners’ Views on Psychosocial Issues and Related Interventions for Couples Coping with Cancer” is a qualitative paper that compares and contrasts the perspectives of health care professionals (HCPs) involved in cancer care and couples facing cancer on how best to provide psychosocial support for couples. This paper provides a more in-depth exploration of the factors that influence the dissemination of couple-focused care. A range of HCPs, including oncologists, nurses, and psychologists, and couples facing various cancer diagnoses (e.g., breast prostate, head and neck) were interviewed. Results showed that HCPs and couples have different views regarding couple-focused care in cancer. For example, whereas most HCPs discussed the importance of referring couples to specialist psychosocial care, most couples felt they were coping well enough without specialist couple-focused psychosocial care and thatd their partners. Given the growing evidence that suggests couples’ react to cancer as an interdependent system, interventions designed for couples are becoming increasingly popular in psycho-oncology. This paper summarises the current evidence regarding the efficacy, feasibility, and acceptability of couple-based interventions in the context of cancer. The review indicated that couple-based interventions have a moderate impact on quality of life, psychological and relationship outcomes for couples affected that is comparable to individual-based interventions for patients and partners. However the uptake of these interventions by couples, coupled with the rates of attrition from them, is an issue that their primary health care professionals could provide sufficient psychosocial support