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, such as 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 1983.¹ 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 40 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.² 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.² Furthermore, cancer couple–based communication interventions categorize spousal caregivers into two roles.² 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.²

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 States³ and extended its reach to Canada and China.^4,5 Similarly, the CanCOPE program, focusing on couples coping with cancer, originated in Australia,⁶ later expanding to Germany and China.^7,8 The process of cross-cultural adaptation varied among researchers, involving self-designed methods or omitting this aspect altogether.⁵ 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.⁹ Following the ORBIT model, they used 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,² 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 retrospectives, 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 is a popular objective measurement, recording long-term interactions through audio recordings in the natural environment.¹⁰ Additionally, utilizing vocal features, such as fundamental frequency (f₀), holds promise for objectively estimating emotional arousal in communication processes.¹⁰ 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 communicativon interventions to facilitate successful promotion.

CRediT author statement

Junrui Zhou: Conceptualization, Validation, Investigation, Writing – Original Draft, Project administration. Xuan Chen: Validation, Investigation, Writing – Review and Editing. Zhiming Wang: Validation, Investigation, Writing – Review and Editing. Qiuping Li: Validation, Writing – Review and 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.

Declaration of competing interest

The authors declare no conflicts of interest. Professor Qiuping Li, the corresponding author, serves as an editorial board member of the Asia–Pacific Journal of Oncology Nursing. The article underwent the journal's standard procedures and was handled independently, with no involvement from Professor Li or their research groups.

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 82172844). The funders had no role in considering the study design, data collection and analysis, decision to publish, or manuscript preparation.

Declaration of Generative AI in scientific writing

No AI tools/services were used during the preparation of this work.