title: A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study.
abstract: OBJECTIVE
  The primary objective of this study was to evaluate the effectiveness of a couples intervention in improving marital functioning in advanced cancer patients and their spouse caregivers. A secondary objective was to determine its impact on other symptoms of psychosocial distress and its feasibility and acceptability as a clinical intervention.
  
  
  METHODS
  Using a one-arm pre- and post-intervention prospective design, 16 couples were provided 8 weekly sessions of Emotionally Focused Couple Therapy, modified and manualized for the cancer population. Subjects' marital functioning (Revised Dyadic Adjustment Scale [RDAS]), symptoms of depression (Beck Depression Inventory-II [BDI-II]), and hopelessness (Beck Hopelessness Scale) were assessed through self-report at T0 (baseline), T1 (after four sessions), T2 (after eight sessions), and T3 (3 months post-intervention follow-up).
  
  
  RESULTS
  RDAS scores improved from T0 to T2, with 87.5% of the couples showing some improvement (0.5-5 points) or significant improvement (>5 points) in marital functioning and 68.8% scoring in the non-distressed range (>or=48 RDAS). At T3, 60% of the couples (n=15) continued to score in the non-distressed range on the RDAS. BDI-II scores were significantly higher for patients than for caregivers. There was a significant reduction in the mean BDI-II score from T0 to T3 in all subjects (n=30). This reduction was more significant for the patients (n=15).
  
  
  CONCLUSIONS
  Providing support to couples at this challenging time may result in improved marital functioning and an opportunity for relational growth during end-stage cancer. This study serves as the first step in the development of an empirically validated intervention for couples.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. linda.mclean@uhn.on.ca
authors.forename: Linda M
authors.initials: LM
authors.lastname: McLean
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Jones
authors.forename: Anne C
authors.initials: AC
authors.lastname: Rydall
authors.forename: Andrew
authors.initials: A
authors.lastname: Walsh
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Esplen
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.forename: Gary M
authors.initials: GM
authors.lastname: Rodin
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008388:Marital Therapy; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D010555:Personality Inventory; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology; D018454:Spouses / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology; D016896:Treatment Outcome