Couples Coping With Hematological Cancer: Support Within and Outside the Couple - Findings From a Qualitative Analysis of Dyadic Interviews.

Objective: Cancer affects the patients as well as their partners. Couples use different strategies to cope with cancer and the associated burden: individual coping, dyadic coping, and support from the social network and from professional health care. The aim of this qualitative dyadic interviews is to gain a deeper and more differentiated understanding of the support system inside and outside of the couple. Methods: Ten heterosexual couples (patients: seven men and three women) with different ages (patients: range = 22-75; spouses: range = 22-74), different hematological cancer (e.g., acute myeloid leukemia, non-Hodgkin's lymphoma) and cancer stages (initial diagnosis or relapse) participated in the study. Semi-structured dyadic interviews were conducted. Data of the verbatim transcripts were systematically coded and analyzed following structuring content analysis. Results: Three main categories (individual coping, dyadic coping, and outside support) and ten subcategories about coping and support strategies in hematological cancer patients and their spouses could be identified. All couples described cohesion in relationship as an essential common dyadic coping strategy. Most strategies were focused on the patient's wellbeing. Furthermore, couples reported different common plans for the future: while some wanted to return to normality, others were reaching out for new goals. Conclusion: Couples used various coping and support strategies, that differed in type and frequency between patients and spouses. Most of the strategies were perceived as beneficial, but some also triggered pressure. Overall, spouses seem to need more psychological support to improve their own wellbeing.

A psycho-oncological online intervention supporting partners of patients with cancer (PartnerCARE): Results from a randomized controlled feasibility trial.

OBJECTIVE: Partners of cancer patients are the primary supporters and burdened at the same time. Support for partners is hitherto scarce and existing offers are rarely used. The PartnerCARE online intervention was specifically developed to address the caregiving partners' needs. This two-arm parallel randomized controlled trial (RCT) evaluates the feasibility, acceptability, and potential efficacy of PartnerCARE. METHODS: Sixty German-speaking partners of patients with various cancer entities were randomized into two conditions: intervention group (IG) with PartnerCARE (N = 30) or waitlist-control group (N = 30). Participants completed online questionnaires at baseline (T0), post-treatment (T1) and 4-months follow-up (T2). Feasibility and acceptability outcomes included dropout rates, use and acceptance of PartnerCARE, individual user/e-coach feedback as well as negative effects. Relevant efficacy outcomes were assessed to test for potential intervention effects. RESULTS: Recruitment success illustrates demand for and acceptability of PartnerCARE. Satisfaction with the intervention was high (Client Satisfaction Questionnaire adapted to Internet-based interventions, T1: M = 24.66, SD = 6.42) and 73.3% of participants completed the intervention. Study dropout rate was low (T1: 17%, T2: 29%). More positive than negative side effects of the intervention were identified, and negative ones were mainly related to "intrapersonal change". For efficacy outcomes we found effects over time, with strongest effects within the IG from T0 to T1 in psychological distress (d = 0.73, 95%-CI: [0.34; 1.12]) and anxiety (0.66, [0.26; 1.04]), but no group effects were significant at T1 and T2. CONCLUSIONS: PartnerCARE is feasible, acceptable and potentially efficacious. Based on received feedback, PartnerCARE is currently undergoing further development and subsequently efficacy will be investigated in a RCT. TRIAL REGISTRATION: German Clinical Trial Registration: DRKS00017019. Registered on 08 April 2019.

Dyadic coping and social support: Various types of support in hematooncological patients and their spouses-Associations with psychological distress.

OBJECTIVE: Patients and spouses use various support strategies to deal with cancer and its associated burden. Support can be perceived within the dyad [perceived dyadic coping (PDC)] or from others [perceived social support (PSS)]. The present study investigates the association of PDC and PSS with depression and anxiety symptoms experienced by hematooncological dyads. METHODS: A total of 330 hematooncological dyads participated in the study. Dyadic Coping Inventory (DCI) including perceived stress communication and four PDC strategies (supportive, negative, delegated, common), ENRICHED Social Support Instrument (ESSI) and Patient Health Questionnaire-4 (PHQ-4) are used for assessment. To take nonindependence of patient's and spouse's variables into account, data are analyzed with the Actor-partner-interdependence model (APIM). RESULTS: Hematological cancer patients and their spouses reported a similar level of depression and anxiety symptoms. Perceived negative dyadic coping (DC) was adversely related with both patient's and spouse's outcomes (all p < 0.01) and perceived positive DC was adversely related with depression symptoms in both and anxiety symptoms in spouses (all p < 0.05). More PSS was associated with less depression and anxiety symptoms in both (all p < 0.05), and spouse's PSS (b = -0.04, p < 0.05) was significantly associated with patient's depression symptoms. CONCLUSIONS: This study highlights the association between perceived negative DC, perceived positive DC and PSS with depression and anxiety symptoms. Focus should be on enhancement of PSS especially in spouses, as they experience a comparable amount of psychosocial distress and have considerable impact on the patient's wellbeing.

PartnerCARE-a psycho-oncological online intervention for partners of patients with cancer: study protocol for a randomised controlled feasibility trial.

INTRODUCTION: Cancer burdens not only the patient but also the partner to a comparable extent. Partners of patients with cancer are highly involved in the caring process and therefore often experience distress and report a low quality of life. Interventions for supporting partners are scarce. Existing ones are rarely used by partners because they are often time-consuming per se and offer only limited flexibility with regard to schedule and location. The online intervention PartnerCARE has been developed on the basis of caregiver needs and consists of six consecutive sessions and four optional sessions, which are all guided by an e-coach. The study aims to evaluate feasibility and acceptance of the online intervention PartnerCARE and the related trial process. In addition, first insights of the putative efficacy of PartnerCARE should be gained. METHODS AND ANALYSIS: A two-arm parallel-group randomised controlled trial will be conducted to compare the PartnerCARE online intervention with a waitlist control group. The study aims to recruit in total n=60 partners of patients with any type of cancer across different access paths (eg, university medical centres, support groups, social media). Congruent with feasibility study objectives, the primary outcome comprises recruitment process, study procedure, acceptance and satisfaction with the intervention (Client Satisfaction Questionnaire adapted to Internet-based interventions), possible negative effects (Inventory of Negative Effects in Psychotherapy) and dropout rates. Secondary outcomes include quality of life, distress, depression, anxiety, caregiver burden, fear of progression, social support, self-efficacy, coping and loneliness. Online measurements will be performed by self-assessment at three time points (baseline/pre-randomisation, 2 months and 4 months after randomisation). Data analyses will be based on intention-to-treat principle. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Ethics Committee of the University of Ulm (No 390/18). Results from this study will be disseminated to relevant healthcare communities, in peer-reviewed journals and at scientific and clinical conferences. TRIAL REGISTRATION NUMBER: DRKS00017019.

INPART - a psycho-oncological intervention for partners of patients with haemato-oncological disease - study protocol.

BACKGROUND: Suffering from cancer confronts both the patient and their partner with a number of psychosocial challenges in various aspects of their life. These challenges may differentially impact on quality of life, coping ability and compliance to treatment. This especially holds true for haemato-oncological diseases. To date, psychological interventions have predominantly been developed for oncological patients however specific interventions for partners of haemato-oncological patients are rare. In this study we aim to conduct a psycho-oncological group-intervention for partners of patients with haemato-oncological diseases. The aim of the intervention is to significantly reduce symptoms of depression and anxiety in the partners and the patient, as well as enhancing dyadic coping. METHODS: The design of the INPART-study is an unblinded, randomised controlled trial with 2 treatment conditions (experimental and control) and assessments at baseline, 3 and 6 months. It will be conducted at three study centres: the university medical centre's in Leipzig, Hannover and Ulm. The outcome criteria will be a reduction in depressive and anxiety symptoms as well as an improvement of dyadic coping. DISCUSSION: This trial shall provide information regarding the efficiency of a psycho-oncological intervention for partners of patients with haemato-oncological diseases and give references to the possible outcome in terms of dyadic coping and the reduction of mental strain. The study was supported by a grant from the German José Carreras Leukaemia Foundation. TRIAL REGISTRATION: ISRCTN16085028 ; 20/03/2019.