|Title:||The feasibility and effects of a 'Caring for Couples Coping with Cancer (4Cs)' programme to support couples coping with cancer as a unit|
|Advisors:||Loke Yuen, Alice (SN)|
Mak, Yim-wah (SN)
Shae, Wan-chaw (FHSS)
|Subject:||Cancer -- Patients -- Care.|
Marriage -- Psychological aspects.
Hong Kong Polytechnic University -- Dissertations
|Department:||School of Nursing|
|Pages:||xxii, 463 pages : illustrations|
|Abstract:||Title: The feasibility and effects of a 'Caring for Couples Coping with Cancer (4Cs)' programme to support couples coping with cancer as a unit. Background: As the primary informal caregiver for cancer patients, spousal caregivers are the 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. Taking into account the hidden morbidities and relational dynamics of cancer couples, it is concluded that the factors that have an impact on couples coping with cancer are complex and multi-faceted, and that there is a need for a complex intervention to support cancer dyads. Aim: To examine the feasibility and effects of a '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 in developing and evaluating complex interventions was adopted in developing and piloting this 'Caring for Couples Coping with Cancer "4Cs" Programme'. Of the four phases in the process of developing-evaluating-implementing a complex intervention, this study conducted the first two phases: development and determination of feasibility/piloting. In phase I of the development of the 4Cs programme, three steps were conducted: (1) identifying evidence: evidence identified from extensive reviews of the literature and a focus group interview study; (2) identifying or developing a theory: a preliminary Live with Love Conceptual Framework (P-LLCF) was proposed, and the P-LLCF was tested using mixed methods design; and (3) modelling the process and outcomes: the 4Cs programme was developed based on the P-LLCF. In phase II of determination of feasibility/piloting: the 4Cs programme was piloted by a pre-intervention and post-intervention study design. A pre-intervention and post-intervention study design was conducted among cancer patients and their spousal caregivers. Among the 135 couples approached, a total of 117 dyads were successfully recruited at baseline, with 92 dyads successfully followed-up at 6 weeks. An information booklet and six face-to-face group sessions of the 4Cs program were offered to couples as dyads. Outcome measures, including dyadic mediators (self-efficacy), dyadic appraisal (Cancer Related Communication Problem, CRCP), dyadic coping (Dyadic Coping Inventory, DCI), and dyadic outcomes (physical and mental health, negative and positive emotions, and marital satisfaction), were assessed at T0 (pre-intervention) and T1 (post-intervention). Repeated measures analysis of variance and structural equation modeling (SEM) were applied in testing the outcomes of the 4Cs program.|
Results: The recruitment and retention rates were 86.7% and 78.6%, respectively. Significant improvements were seen in the couples' scores on overall (total) self-efficacy (CBI-B) (P<0.01), CRCP (P<0.05), DCI (P<0.05), the physical component summary (PCS) of SF-12 (P<0.05), anxiety (P<0.01), and benefit findings (P<0.05) from baseline to 6 weeks post-intervention. Patients had a significantly higher level of increase in the mean CBI-B (MD= +5.1, d=0.41) than spousal caregivers (MD= +1.4, d=0.19) (P<0.05). Spousal caregivers had a significantly higher level of increase in physical component summary score (P<0.01), and much greater level of decrease in anxiety (P<0.05) than the patients. No significant effects on time and role of marital satisfaction were identified. The overall effect sizes calculated in this study ranged from medium to small. The SEM of all six models resulted in convergence and showed goodness of fit to the data and variables, supportive of the constructs in the P-LLCF. Conclusion: This study provides evidence suggesting that the 4Cs program is acceptable, feasible, and effective in supporting cancer couples coping with the illness as dyads. Although a generally positive effect was identified in the pre- and post-intervention outcome measures, further evaluation of this 4Cs program in a large, multisite RCT is needed to provide substantial evidence.
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