Coping together: Couple-based communication interventions in cancer care

Life-threatening cancer significantly impacts patients' physical and psychological well-being. In marital relationships, individuals facing cancer, along with their spousal caregivers, often perceive the disease as a shared challenge, addressing cancer-induced challenges as an emotional system rather than as individuals. Communication within these couples plays a crucial role in the entire process of their joint coping. Effective communication, such as mutual constructive communication, enhances information exchange, decision-making, emotional support, and intimacy. Conversely, negative communication, like avoidance and criticism, hinders their joint coping and may even contribute to distress. Despite good intentions, engaging in protective buffering appears to increase the burden for both cancer patients and their caregivers. Therefore, educating couples on effective communication when confronting cancer becomes imperative. The earliest cancer couple-based communication intervention study dates back to 1983.1Christensen D.N. Postmastectomy couple counseling: an outcome study of a structured treatment protocol.J Sex Marital Ther. Winter. 1983; 9: 266-275https://doi.org/10.1080/00926238308410913Crossref PubMed Scopus (112) Google Scholar In this study, Christensen guided breast cancer couples to discuss relationship-related topics (e.g., relationship history and negative changes currently or potentially affecting their relationship) and to practice relationship-enhancing strategies using traditional communication skills, problem-solving techniques, and couples values, attitudes, symbols and abilities. This intervention significantly reduced participants' emotional discomfort and increased their sexual satisfaction. Over the following forty years, cancer couple-based communication interventions have shown promising development. Since researchers recognized the significance of communication within cancer couples, substantial efforts have been devoted to developing and refining relevant communication intervention programs. This progress can be outlined in three key aspects: research scope, intervention contents, and delivery formats. In terms of research scope, communication interventions extend beyond breast cancer, targeting couples diagnosed with gastrointestinal cancer, prostate cancer, and head and neck cancer.2Zhou J. Chen X. Wang Z. Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review.Healthcare (Basel). Jan 12 2023; 11https://doi.org/10.3390/healthcare11020236Crossref Scopus (3) Google Scholar This expansion addresses specific communication topics associated with different cancer types, such as intestinal dysfunction in gastrointestinal cancer, masculinity in prostate cancer, and self-image concerns in head and neck cancer, broadening the research scope. Regarding intervention contents, studies have enhanced relationship-related topics, including highlighting strengths, strengthening the sense of "we-ness," and addressing sexual problems. Additional contents encompass emotional disclosure, affective listening, and responses involving empathy and validation.2Zhou J. Chen X. Wang Z. Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review.Healthcare (Basel). Jan 12 2023; 11https://doi.org/10.3390/healthcare11020236Crossref Scopus (3) Google Scholar Furthermore, cancer couple-based communication interventions categorize spousal caregivers into two roles.2Zhou J. Chen X. Wang Z. Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review.Healthcare (Basel). Jan 12 2023; 11https://doi.org/10.3390/healthcare11020236Crossref Scopus (3) Google Scholar As supporters, caregivers assist cancer patients in expressing their feelings and understanding them to alleviate stress. As collaborators, caregivers and patients engage in mutual disclosure, response, and support. Delivery formats vary and include in-person sessions, offline group meetings, telephone consultations, video conferences, web-based instruction, or combinations of these methods. These diverse formats cater to the preferences and needs of cancer couples.2Zhou J. Chen X. Wang Z. Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review.Healthcare (Basel). Jan 12 2023; 11https://doi.org/10.3390/healthcare11020236Crossref Scopus (3) Google Scholar With the evolution of cancer couple-based communication interventions, numerous high-quality programs have been implemented globally. Notably, the Help Her Heal program, an educational counseling intervention for spousal caregivers supporting wives with breast cancer, originated in the United States3Lewis F.M. Cochrane B.B. Fletcher K.A. et al.Helping Her Heal: a pilot study of an educational counseling intervention for spouses of women with breast cancer.Psychooncology. Feb 2008; 17: 131-137https://doi.org/10.1002/pon.1203Crossref PubMed Scopus (54) Google Scholar and extended its reach to Canada and China.4Jones J.M. Lewis F.M. Griffith K. et al.Helping Her Heal-Group: a pilot study to evaluate a group delivered educational intervention for male spouses of women with breast cancer.Psychooncology. Sep 2013; 22: 2102-2109https://doi.org/10.1002/pon.3263Crossref PubMed Scopus (14) Google Scholar,5Nie Zhihong Liu June Su Yali Zhao Yue Yang Shenshen Qiu H. Couples communication intervention for spouses of breast cancer patients: a randomized trial.Chinese Nursing Management. 2019; 19: 682-687https://doi.org/10.3969/j.issn.1672-1756.2019.05.009Crossref Google Scholar Similarly, the CanCOPE program, focusing on couples coping with cancer, originated in Australia,6Scott J.L. Halford W.K. Ward B.G. United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer.J Consult Clin Psychol. Dec 2004; 72: 1122-1135https://doi.org/10.1037/0022-006x.72.6.1122Crossref PubMed Scopus (0) Google Scholar later expanding to Germany and China.7Heinrichs N. Zimmermann T. Huber B. Herschbach P. Russell D.W. Baucom D.H. Cancer distress reduction with a couple-based skills training: a randomized controlled trial.Ann Behav Med. Apr 2012; 43: 239-252https://doi.org/10.1007/s12160-011-9314-9Crossref PubMed Scopus (88) Google Scholar,8Cheng Y. Xiong M. Li Y. et al.Couples' skills training intervention in young breast cancer patients with fear of cancer recurrence: A randomized controlled trial.Eur J Oncol Nurs. Dec 2023; 67102459https://doi.org/10.1016/j.ejon.2023.102459Abstract Full Text Full Text PDF Scopus (0) Google Scholar The process of cross-cultural adaptation varied among researchers, involving self-designed methods or omitting this aspect altogether.5Nie Zhihong Liu June Su Yali Zhao Yue Yang Shenshen Qiu H. Couples communication intervention for spouses of breast cancer patients: a randomized trial.Chinese Nursing Management. 2019; 19: 682-687https://doi.org/10.3969/j.issn.1672-1756.2019.05.009Crossref Google Scholar However, adopting systematic and repeatable cross-cultural adaptation methods is imperative for maximizing research value and successful international promotion. Valuable insights can be gained from Blasco et al.'s approach in transforming meaning-centered psychotherapy and couple communication skills training for Latino families.9Torres Blasco N. Costas Muñiz R. Zamore C. et al.Cultural adaptation of meaning-centered psychotherapy for latino families: a protocol.BMJ Open. Apr 4 2022; 12e045487https://doi.org/10.1136/bmjopen-2020-045487Crossref PubMed Scopus (4) Google Scholar Following the ORBIT model, they employed a four-phase approach, including defining and refining, proof-of-concept and pilot, efficacy trial, and effectiveness research. Detailed content for each phase, such as addressing dimensions of cultural and linguistic adaptation according to the ecological validity model, demonstrates the effectiveness of a rigorous and comprehensive cross-cultural adaptation approach. While cancer couple-based communication interventions have shown promising development, there are still potential recommendations to propel future research. Currently, the majority of studies utilize standard questionnaires to measure communication,2Zhou J. Chen X. Wang Z. Li Q. Couple-Based Communication Interventions for Cancer Patient-Spousal Caregiver Dyads' Psychosocial Adaptation to Cancer: A Systematic Review.Healthcare (Basel). Jan 12 2023; 11https://doi.org/10.3390/healthcare11020236Crossref Scopus (3) Google Scholar presenting at least two drawbacks. Firstly, self-reported communication outcomes may be subjectively filtered, deviating from factual information. Secondly, questionnaire-based measurements are single-time retrospective, unable to capture dynamic changes in relationship and communication processes. To address these limitations, objective observation of interactions between cancer couples is crucial. Ecological momentary assessment (EMA) is a popular objective measurement, recording long-term interactions through audio recordings in the natural environment.10Langer S.L. Romano J.M. Keefe F. et al.Couple Communication in Cancer: Protocol for a Multi-Method Examination.Front Psychol. 2021; 12769407https://doi.org/10.3389/fpsyg.2021.769407Crossref Scopus (8) Google Scholar Additionally, utilizing vocal features, such as fundamental frequency (f0), holds promise for objectively estimating emotional arousal in communication processes.10Langer S.L. Romano J.M. Keefe F. et al.Couple Communication in Cancer: Protocol for a Multi-Method Examination.Front Psychol. 2021; 12769407https://doi.org/10.3389/fpsyg.2021.769407Crossref Scopus (8) Google Scholar Despite f0 indicating general emotional arousal rather than specific emotions, it presents significant potential for exploration. Challenges persist regarding when and how to initiate or cease communication within cancer couples, necessitating exploration of reasons behind their communication choices, preferences, and pre-existing patterns. Interviews with implementers of cancer couple-based psychological interventions may offer valuable insights. Conducting couple-based communication interventions is believed to benefit cancer couples by reducing distress and improving adjustment outcomes. However, such interventions are not routinely implemented in clinical practice settings. Therefore, it is imperative to assess the requirements, costs, and existing clinical foundations of relevant communication interventions to facilitate successful promotion. Junrui Zhou: Conceptualization, Validation, Investigation, Writing - Original Draft, Project administration. Xuan Chen: Validation, Investigation, Writing-Review & Editing. Zhiming Wang: Validation, Investigation, Writing-Review & Editing. Qiuping Li: Validation, Writing-Review & Editing, Supervision. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. This study received no external funding.

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