Table 1.

Systematic Review of Dyadic Studies that Utilized IHCTs (N = 8 studies)

	Study Target and Demographics	Refusal rate, Follow-up, and Attrition	Theoretical Model and Study Design	Intervention and Control/Comparison Group Descriptions*	Main Findings*
Carmack, 2013	Target: breast, prostate, and colorectal cancer survivors (post-treatment) and their spouses N: 22 patient-spouse dyads Mean age: 63.1 (10.4) for survivors and 63.6 (7.1) for spouses	Refusal rate: N/A Follow-up: 14 weeks, 6 month Attrition:4.5% for survivors and 9.1% for spouse	Theory: Social Cognitive Theory Study Design: Therapy: CBT, education Delivery: Video-counseling sessions delivered by a Master’s prepared interventionist Dosage: Patients and spouses each received a tailored workbook, 9 web-based video counseling sessions (together as a couple), 3 tailored newsletters, and supporting materials including a portion plate, therabands, & pedometer.	Couples-Based (CB) Intervention: Survivors and spouses each received a workbook tailored to their current health behavior practices and individual goals. In addition to intrapersonal (individual) cognitive-behavioral strategies oriented towards one’s own behavior change (e.g., problem-solving, relapse prevention, goal-setting, cognitive restructuring, and time management), participants learned interpersonal cognitive-behavioral skills including communal coping, joint problem-solving, and adaptive communication strategies during 9 counseling sessions delivered via web-camera over 6 months Survivor Only (SO) Comparison Group: Survivors participate in the counseling sessions alone and no intervention materials are provided to spouses. Same intrapersonal skills are taught as the CB arm. No interpersonal skills were taught.	Survivors in both study conditions experienced changes in health behaviors and weight loss. Spouses in the CB group evidenced changes in health behaviors and weight loss; whereas, those in the SO condition had no significant changes in any outcomes.
Diefenbach, 2004	Target: Prostate cancer survivors and their spouses N: 5 focus groups (FGs) with 18 prostate cancer survivors (3 FGs) and 15 spouses (2 FGs) Mean age: patients = 67 years; spouses = 60 years	Refusal rate: NS Follow-up: N/A Attrition: N/A	Theory: Self-regulation theory Study Design: Focus groups evaluated a CD-ROM-based multimedia Prostate Interactive Educational System (PIES) to enhance treatment decision making. PIES virtually mirrors a health center to provide information about prostate cancer and its treatment through an intuitive interface, using videos, animations, graphics, and texts.	N/A	Patients and spouses were very interested in PIES and rated it as very useful; 83% stated a clear preference for the PIES software over printed materials. Patients and spouses rated the virtual library highly and patients showed greatest interest in watching video clips of other prostate cancer patients sharing their experience. Spouses wanted information specific to their own needs. Topics of interest to spouses were: nutrition, emotional support, caregiving after treatment, & communication and coping with sexual issues.
Gustafson, 2013	Target: The informal caregivers of patients with non-small cell lung cancer N: 285 patient-caregiver dyads Mean age: 52	Refusal rate: 32% Follow-up: Patients and caregivers completed bi-monthly assessments during the study Attrition: 41%	Theory: Self-Determination Theory Study Design: Therapy: CBT and Cognitive-Behavioral Marital Therapy Delivery: Password protected website Dosage: Caregiver-patient dyads in both arms received computers and internet access if needed and were reimbursed for the cost of Internet service during the study. Dyads in the CHESS arm received the intervention for 25 months or 13 months after patient death, whichever was less.	Intervention: CHESS-LC integrates 14 services to provide tailored cancer information (e.g., Ask an Expert feature, recent news, resource guide), support (e.g., limited access, facilitated bulletin boards, written and video accounts of how other lung cancer patients and families coped), and interactive tools (e.g., decision making support, action planning, skills building for easing distress and healthy relating, and journaling). Clinicians also receive a report that summarizes caregiver and patient ratings of the patient’s health status and lists their questions for the next clinic visit. Control: Patients and caregivers received training on using the Internet and a list of Internet sites about lung cancer.	Caregivers in the intervention arm consistently reported lower patient physical symptom distress than caregivers in the control arm. Significant differences were observed at 4 months and at 6 months
Milne, 2012	Target: cancer patients undergoing chemotherapy, their caregivers, and healthcare providers N: 9 patients with 4 different types of cancer and receiving chemotherapy Mean age: 56	Refusal rate: N/A – patients self-selected to take part in the study Follow-up: structured online surveys were completed 6–8 weeks after commencing use of the CanCare website and again at the end of study (5 months). Semi-structured interviews were also conducted at the end of study. Attrition: NS	Theory: Self-regulation theory Therapy: Education, Self-management Delivery: Password protected website Dosage: Patients had access to the website for approximately 5 months	Intervention: Patients could use the website to invite family, friends, and healthcare providers to help them develop and implement a shared care-plan for managing symptoms. They could also record symptoms, keep an appointment calendar, and create medication lists.	Patients saw the potential of the website but found it too complex to use and were frustrated by the lack of integration with existing hospital systems. The cancer-specific information tab rated highly and used extensively. Due to the lack of caregiver and provider engagement, it was not possible to test whether the CanCare intervention enhanced communication.
Reis, 2003	Target: Prostate cancer patients undergoing active treatment and their family members N: N/A	Refusal rate: NS Follow-up: N/A Attrition: N/A	Theory: Social-cognitive theory Study Design: Description is provided of a multimedia caregiving training program for prostate cancer patients and family members that provides assistance in prioritizing caregiving needs and expanding self-efficacy with caregiving tasks. Delivery: The program was designed for hybrid delivery utilizing both web-based resources (e.g., hyperlinks to internal and external resources) and a CD-ROM that stores and recalls media such as digital audio, video, high resolution graphics, and animations.	Intervention: The caregiving program separately assesses patient and family member perceived caretaking needs and caregiving skills related to treatment outcomes. The program then provides targeted instruction in caregiving techniques and skills based on patient and caregiver need and areas of disagreement.	Outcome measures will include pre–post changes in self-efficacy for specific caregiving functions, and pre–post changes in expectations of outcomes in performing these caregiving functions.
Schover, 2012	Target: patients treated for localized prostate cancer with surgery or radiotherapy and their partners N: 186 patient-partner dyads Mean age: 61	Refusal rate: NS Follow-up: post-treatment, and 6 and 12 month follow-ups Attrition:34%	Theory: No explicit theory Study Design: Therapy: Education, CBT Dosage: The 3 arms were a 3-month wait list control group, an immediate intervention group that received 3 face-to-face sessions over 12 weeks (90 minutes for session 1 and 50–60 minutes for sessions 2 and 3), and an immediate intervention group that used an internet format of the intervention though e-mail contact with their therapist. Booster telephone calls were made to the web and face to face groups at 1 and 3 months to discuss progress with end-of-treatment goals and ways to overcome remaining barriers. Delivery: Password protected, encrypted website. Each partner had a unique user name and password and could not access the other’s responses.	Web Intervention: Education, training to improve sexual communication and expression of feelings, cognitive-behavioral techniques to address negative beliefs about cancer and sexuality. Homework exercises had standardized report forms completed online and were submitted by each partner. Therapists e-mailed feedback to the couple. Face to Face Intervention: included the same content and cognitive-behavioral homework as the web intervention. Therapists discussed homework with couples in the session. Control: 3 month wait-list control	Women made significantly fewer visits to and completed significantly less of the website than men. In the web group, International Index of Erectile Functioning (IIEF) scores improved significantly more in men who completed >75% of the program. Sexual function/satisfaction did not improve significantly for women within any treatment group. Neither marital happiness nor overall distress changed significantly across time for men in any subgroup or in the total sample.
Silveira, 2011	Target: The informal caregivers of patients with solid tumors undergoing chemotherapy N: 300 patient-caregiver dyads are expected to be enrolled Mean age: N/A	Refusal rate: N/A – trial is ongoing Follow-up: post-intervention and 1 month Attrition: N/A – trial is ongoing	Theory: Stress and coping theory Study Design: The article provides a description of an ongoing trial. Therapy: Education and problem solving skills training Delivery/dosage: 10 weeks of automated telephone assessment for patients and web-based notification of symptom severity and problem-solving advice for caregivers	Intervention: Patients receive a Symptom Management Toolkit and weekly automated telephone assessment calls. Their caregiver receives weekly emails prompting them to log into the Cancer CarePartners website when their patient reports any core symptom severity of four or higher. The website informs caregivers of their patients’ symptom assessment scores and provides them with advice for how to help. Control: Patients receive a Symptom Management Toolkit followed by weekly automated telephone assessment calls. Caregivers receive an email with a PDF copy of “What you need to know about cancer” from the National Cancer Institute	The goal is to determine if, when compared to a comparison group receiving automated telephone assessment alone, patients who receive automated telephone assessment and whose caregivers receive access to the Cancer CarePartners website will report significantly less total symptom severity. Secondary outcomes for patients include: physical functioning, adherence to chemotherapy, and more appropriate utilization of health services. The study also will determine whether caregivers provide more social support and report less caregiver burden and distress.
Zulman, 2012	Target: prostate cancer patients post-treatment and their caregivers N: 4 FGs with 2–3 patient-caregiver pairs per group (N=22 total participants) and 2 iterations of usability testing with 4 patient-caregiver pairs per session (N = 16 total participants) Mean age: 52.6 years	Refusal rate: NS Follow-up: N/A Attrition: N/A	Framework: No explicit theory Study Design: Therapy: Supportive education, BMT, dyadic coping skills training Delivery: The web-based program utilizes a dyadic interface that directs questions to patients, caregivers, and the pair, and then provides tailored feedback based on the users’ responses. Couples complete the program together. Dosage: NS	Intervention: The article describes the process of developing a web-based version of the family involvement module of an in-person intervention for prostate cancer couples called FOCUS (Family involvement, Optimistic attitude, Coping effectiveness, Uncertainty reduction, and Symptom management). The family involvement module provides relational content that addresses communication, support, and teamwork.	In general, participants were comfortable completing the program on the web and working together as a dyad. Response to the program’s structure, design, and content was favorable, even among users who were older or had limited computer and Internet experience. The program received high ratings for ease of use and overall usability.

Note. FGs = focus groups; NS = Not specified; N/A = Not applicable; CBT = Cognitive-behavioral therapy; CBMT = Cognitive Behavioral Marital Therapy; BMT = Behavioral Marital Therapy.

^*If applicable.