Table 1.

Studies of Family-Based Psychosocial Interventions in Advanced Cancer.

	Sample Demographics	Refusal Rate, Follow-up, and Attrition	Theoretical Model, Therapy Type, and Intervention Delivery/Dosage	Intervention and Control Group Content	Main Findings for Patients and Caregivers
Donnelly et al, 200049	n: 14 Women with advanced breast cancer and 10 of their partners Mean age: 46 years	Refusal rate: 13% Follow-up: postintervention Attrition: 21%	Theory: no explicit theory Therapy: IPTDelivery/dosage: 40-minute weekly telephone sessions delivered to patients and partners separately by a clinical psychology postdoctoral fellow; the mean number of sessions completed by patients was 16, and the mean number of sessions completed by partners was 11	Intervention: treatment focused on relieving depressive symptoms and improving relationship functioning through a focus on current interpersonal problems such as role transitions, interpersonal conflict, grief, or interpersonal deficits Control: none. This was a single-arm pilot study	Because this was a pilot study, outcomes were not formally evaluated; however, participants rated their satisfaction with the program as “good” to “excellent,” and preliminary results through case review indicated that the implementation of IPT by telephone was both feasible and acceptable to patients and their partners
Gustafson et al, 201347	n: 285 Patient-caregiver dyads Mean age: 52 years	Refusal rate: 32% Follow-up: patients and caregivers completed bimonthly assessments for up to 25 monthsAttrition: 41%	Theory: Self-Determination Theory Therapy: CBT and cognitive-behavioral marital therapy Delivery: password protected Web site 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-LC arm received the intervention for 25 months or 13 months after patient’s death, whichever was less	Intervention: CHESS-LC integrated 14 services to provide tailored cancer information (eg, Ask an Expert feature, recent news, resource guide), support (eg, limited access, facilitated bulletin boards, written and video accounts of how other lung cancer patients and families coped), and interactive tools (eg, decision-making support, action planning, skills building for easing distress and healthy relating, and journaling). Clinicians also received a report that summarized caregiver and patient ratings of the patient’s health status and listed 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 6 months
Keefe et al, 200550	n: 78 mixed cancer patients and partners (76% spouses) Mean age: 59 years	Refusal rate: 53% Follow-up: Postintervention Attrition: 28%	Theory: no explicit theory Therapy: CBT Delivery/Dosage: 3 in-person sessions in patient’s home delivered over 1-2 weeks by nurses	Intervention: education about cancer pain and management, pain coping strategies training, and how to help the patient acquire and maintain coping skills Control: usual medical care	The intervention arm did not have a significant impact on patients’ QOL. Partners enrolled in the intervention reported modest improvements in their levels of caregiver strain compared with partners in the control arm
Kissane et al, 200638	n: 81 Patients who were dying from cancer and their families who were at risk for poor psychological outcome Mean age: 57 years	Refusal rate: 56% Follow-up: 6 and 13 months postbaseline Attrition: 25%	Theory: no explicit theory Therapy: family-focused grief therapy Delivery/dosage: 4 to 8 in-person sessions of 90 minutes each, conducted flexibly over the course of 9 to 18 months in either the hospital or home to accommodate ill patients Sessions were conducted by social workers. The frequency and number of sessions in each phase were modified to meet the needs of each family	Intervention: the intervention aimed to enhance family functioning through an exploration of family cohesion, communication of thoughts and feelings, and handling of conflict. Therapy proceeded in 3 phases: (1) identifying issues and concerns relevant to the specific family and devising a plan to deal with them, (2) intervention focusing on the agreed concerns, and (3) termination, which involves consolidating gains and the end of therapy Control: standard palliative care services	Although the patient was included in therapy sessions, only family members’ distress and grief reactions were outcomes because the patient was not alive at follow-up. Results indicated a significant decline in distress only among those family members in the intervention group who began treatment with high levels of psychological distress when compared with control group family members
Kuijer et al, 200451	n: 59 Mixed cancer patients and partners Mean age: 50 years	Refusal rate: 3% Follow-up: postintervention, 3 months Attrition: 34%	Theory: equity theory Therapy: CBT Delivery/dosage: 5 biweekly in-person sessions of 90 minutes each delivered by psychologists	Intervention: improving the exchange of social support and restoring equity Wait-list control: usual medical care	Patients and partners in the intervention arm reported better relationship quality postintervention relative to controls; they also reported lower levels of psychological distress relative to controls but partners did not. The significant intervention effects found for relationship quality and distress were not maintained at the 3-month follow-up
McLean et al, 201148	n: 42 Patients with metastatic cancer and their partners Mean age: 50 years	Refusal rate: 7% Follow-up: postintervention, 3 months Attrition: 14%	Theory: attachment theory Therapy: emotion-focused therapy Delivery/dosage: 8 weekly in-person sessions of 60 minutes each delivered by psychologists	Intervention: treatment focused on changing habitual and distressing patterns of interaction, increasing mutual understanding and emotional engagement, and strengthening the marital bond. Session topics included the impact of terminal diagnosis, effective communication, control of physical symptoms and communication with the medical team, fears, and the couple’s perceptions of time and how to spend it in a meaningful way. Control: usual medical care	The intervention resulted in statistically and clinically significant improvements in patients’ and partners’ marital functioning and in patients’ perceived experience of being empathically understood by their partners, compared with usual medical care. Results were maintained at 3-month follow-up. None of the couples assigned to the intervention group declined in marital functioning, whereas one-third of the couples in the control group deteriorated in marital functioning
Mohr et al, 200352	n: 9 Couples in which 1 partner was diagnosed with advanced cancer and had less than 18 months to live Mean age: 50 years	Refusal rate: not reported Follow-up: postintervention Attrition: 34%	Theory: no explicit theory Therapy: the treatment model shared many of the goals common to most forms of couples therapy, including reduction of distress in the couple, improving communication, and increasing intimacy Delivery/dosage: 8 weekly, 1-hour, in-home therapy sessions delivered by PhD-level clinical psychologists and social workers	Intervention: the treatment focused on helping couples find meaning and adjusting to changes in expectations and life goals, foster mutual emotional support, and facilitate conversations about death and dying and children Control: none. This was a single-arm pilot study	Because of the small sample size, results were reported in terms of effect sizes. Large effect sizes were reported for reductions in patient distress about dying and perceived partner negative responses as well as partners’ worry about dying. However, there was no change in the amount that patients thought about or worried about dying. Also noted were marginally significant reductions in caregiver distress and burden. Finally, both partners reported improvements in the quality of their relationship
Northouse et al, 200546	n: 134 Women with recurrent breast cancer and their family caregivers Mean age: 53	Refusal rate: 28% Follow-up: postintervention (3 months) and 6 months Attrition: 26%	Theory: Individual Stress and Coping Theory Therapy: CBT Delivery/dosage: 5 in-person sessions delivered by nurses. The intervention was delivered in 2 phases. In the initial phase, nurses conducted 3 home visits with the patient and caregiver that were spaced 1 month apart (90 minutes). In the booster phase, nurses conducted 2 follow-up phone calls to both the patient and caregiver (30 minutes)	Intervention: emphasis on family involvement, optimistic attitude, coping effectiveness, uncertainty reduction and symptom management Control: usual medical care	Patients who received the FOCUS program reported significantly less hopelessness, and patients and caregivers reported a less-negative appraisal of illness/caregiving than did those in the control group. Results were not maintained at follow-up. QOL remained the same for patients and caregivers in both the intervention and control groups
Northouse et al, 201245	n: 484 Advanced cancer patients (lung, colorectal, breast, and prostate) and their caregivers Mean age: 59 years	Refusal rate: 31% Follow-up: postintervention (3 months) and 6 months Attrition: 38%	Theory: Individual Stress and Coping Theory Therapy: CBT Delivery/dosage: Brief program: two 90-minute home visits and one 30-minute home session Extensive program: four 90-minute home visits and two 30-minute home sessions Both programs were delivered over the course of 10 weeks by nurses	Brief intervention: emphasis on family involvement, optimistic attitude, coping effectiveness, uncertainty reduction and symptom management Extensive intervention: same as above, but the program allowed more time for discussion and review of content Control: usual medical care	Both the brief and extensive programs were effective in decreasing avoidant coping and improved dyad’s social QOL. The extensive program improved dyads’ self-efficacy in their ability to manage the illness and caregiving. The brief program improved patients’ and caregivers’ use of healthy behaviors. Few effects were sustained over time
Porter et al, 200953	n: 130 Gastrointestinal cancer patients (65% stage 4) and their partners Mean age: 59 years	Refusal rate: 75% Follow-up: postintervention Attrition: 21%	Theory: no explicit theory Therapy: CBT, BMT Delivery/dosage: 4 in-person sessions ranging from 45-75 minutes delivered by social workers and psychologists	Intervention: strategies to facilitate patient disclosures about their cancer-related concerns Attention control: education, suggestions for communicating with providers, resources for health information, and suggestions for maintaining QOL	Patients who had higher pretreatment levels of holding back cancer-related concerns and who were in the intervention arm evidenced posttreatment improvements in relationship quality and intimacy relative to those in the control arm

Abbreviations: CBT, cognitive-behavioral therapy; QOL, quality of life; BMT, behavioral marital therapy ; IPT, interpersonal therapy; FOCUS, family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management; CHESS-LC, comprehensive health enhancement support system - lung cancer.