title: The development of a complex intervention in China: the 'Caring for Couples Coping with Cancer "4Cs" Programme' to support couples coping with cancer.
abstract: BACKGROUND
  As the primary informal caregiver for cancer patients, spousal caregivers are a population at a high risk of hidden morbidity. The factors impacting couples coping with cancer are complex, and within spousal caregiver-patient dyads the impact is mutual. The aim of this study is to explain the process that led to the development of an acceptable, feasible, and potentially effective 'Caring for Couples Coping with Cancer "4Cs" Programme' to support couples coping with cancer as the unit of intervention in China.
  
  
  METHODS
  The Medical Research Council's (MRC) framework for developing and evaluating complex interventions was adopted to develop an intervention for couples coping with cancer. Three steps were taken in the process of developing the 4Cs programme, namely: (1) identifying the evidence base by conducting a series of extensive reviews of the relevant literature and conducting a focus group study; (2) identifying/developing a theory by proposing a preliminary Live with Love Conceptual Framework 'P-LLCF' for cancer couple dyads; and (3) modelling the process and outcomes of the 4Cs programme.
  
  
  RESULTS
  The programme that was developed is comprised of six individual sessions to be delivered by the researcher/therapists over 6 weeks. The main contents of the sessions of the 4Cs programme are: primary stressors (section 1); secondary stressors (section 2); dyadic mediator (section 3); dyadic appraisal (section 4); dyadic coping (section 5); and a programme overview (section 6). The emphasis of the programme is on supporting couples coping with cancer. A booklet was developed to provide the participants with easy access to written information about their common concerns in caring for loved ones with cancer.
  
  
  CONCLUSIONS
  Guided by the MRC guidelines, a potentially effective, feasible, and acceptable 4Cs programme aimed at supporting couples coping with cancer as a dyad was developed. Future research is needed to pilot and evaluate the feasibility, modelling, and outcomes of this 4Cs programme.
authors.affiliation: Wuxi Medical School, Jiangnan University, Wuxi, Jiangsu Province, China. liqp@163.com.
authors.forename: Qiuping
authors.initials: Q
authors.lastname: Li
authors.affiliation: Wuxi People's Hospital, Wuxi, Jiangsu Province, China. 540923082@qq.com.
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Wuxi People's Hospital, Wuxi, Jiangsu Province, China. ryland200@sina.com.
authors.forename: Huiya
authors.initials: H
authors.lastname: Zhou
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China. alice.yuen.loke@polyu.edu.hk.
authors.forename: Alice Yuen
authors.initials: AY
authors.lastname: Loke
mesh_terms: D000223:Adaptation, Psychological; D002681:China; D005191:Family Characteristics; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D011788:Quality of Life; D018454:Spouses