title: Uptake and attrition in couple-based interventions for cancer: perspectives from the literature.
abstract: OBJECTIVE
  Recognition that patients and partners are both affected by a cancer diagnosis has led to increased interest in couple-based interventions. Although these interventions show promise for enhancing both patients' and partners' illness adjustment, couples' acceptance of these interventions is not well documented. This review explores these issues as reflected in uptake and attrition rates in published trials.
  
  
  METHODS
  A literature search identified 17 manuscripts reporting the uptake and attrition rates of couple-based interventions for couples facing cancer. The uptake (percentage of eligible couples randomised into a trial) and the attrition (percentage of couples who dropped out of a trial) rates were extracted by cancer type, cancer stage, intervention type, intervention focus and intervention delivery method.
  
  
  RESULTS
  Uptake and attrition rates ranged from 13.6% to 94.2% and 0% to 49.4%, respectively. Low uptake rates were noted for communication-focused interventions and those requiring both the patient and the partner to participate in the intervention simultaneously. Attrition was also high in the latter group. Uptake rates appeared slightly lower than individual-based interventions (58%-76%), as were attrition rates, although only for late stage cancer (~30% couple-based vs. ~69% individual-based). Common barriers to uptake included accessibility, competing priorities and illness severity.
  
  
  CONCLUSIONS
  The couple-based interventions had slightly lower uptake rates than what has been previously reported for individual-based interventions; however, lower attrition suggests patients and partners may be more inclined to complete an intervention when they participate together. The findings support the need to develop strategies to improve the delivery and acceptability of couple-based interventions in clinical practice.
authors.affiliation: Centre for Translational Neuroscience and Mental Health, Faculty of Health, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Regan
authors.forename: Sylvie D
authors.initials: SD
authors.lastname: Lambert
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
mesh_terms: D000223:Adaptation, Psychological; D001943:Breast Neoplasms / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts; D011471:Prostatic Neoplasms / Q000523:psychology; D012720:Severity of Illness Index; D018454:Spouses / Q000523:psychology*
keywords: cancer; couples; intervention; oncology; uptake