Dyadic interventions for cancer patient-caregiver dyads: A systematic review and network meta-analysis.

Abstract

Background: Cancer imposes significant psychological distress on both patients and caregivers. Dyadic interventions are designed to concurrently address the health problems of both, yet there remains limited evidence as to which specific dyadic interventions yield the most effective outcomes for both partners.

Objectives: To systematically synthesize and evaluate the comparative efficacy of various dyadic interventions on a wide range of outcomes within cancer patient-caregiver dyads.

Methods: Searches of eight electronic databases from inception to July 2, 2023, were performed. Data extraction and quality assessment were independently conducted by two reviewers utilizing the Cochrane risk of bias tool and the Jadad score. Stata 17.0 was used for network meta-analysis, with the Surface Under the Cumulative Ranking (SUCRA) curve employed to rank interventions based on efficacy for each outcome. Effect sizes were reported using standardized mean difference (SMD) with a 95 % confidence interval (CI), and publication bias was assessed via Egger's test. The study protocol was registered in PROSPERO under CRD42023467172.

Result: A total of 37 studies, spanning 8 countries, were included. According to SUCRA rankings, WeChat couple-based psychosocial support and the eHealth symptom and complication management program were identified as the most effective interventions for improving quality of life in both patients and caregivers (SUCRA = 82.1 %, SMD = 7.30, 95 % CI: 1.02, 13.58; SUCRA = 86.6 %, SMD =1.17, 95 % CI: 0.04, 2.31, respectively). Emotionally focused therapy was ranked as the most effective intervention for enhancing dyadic adjustment (SUCRA = 100 %, SMD = 1.63, 95 % CI: 0.91, 2.36; SUCRA = 99.9 %, SMD = 2.04, 95 % CI: 1.26, 2.82, respectively). Couple-based intimacy enhancement and telephone-based dyadic psychosocial interventions were deemed most effective interventions in alleviating anxiety (SUCRA = 88.2 %, SMD = -0.83, 95 % CI: -1.65, -0.00; SUCRA = 95.6 %, SMD = -1.08, 95 % CI: -1.76, -0.41, respectively), while telephone-based dyadic psychosocial intervention and coping skills training were the most efficacious interventions for reducing depression in both partners (SUCRA = 95.2 %, SMD = -0.89, 95 % CI: -1.55, -0.23; SUCRA = 99.8 %, SMD = -2.31, 95 % CI: -3.27, -1.35, respectively). Additionally, caregiver educational program was ranked highest for reducing caregivers burden (SUCRA = 95.6 %, SMD = -1.20, 95 % CI: -1.55, -0.23).

Conclusion: The highest-ranked dyadic interventions identified in this analysis offer valuable insights for clinical practice, providing strategies to enhance the quality of life, strengthen dyadic relationships, and alleviate anxiety, depression, and caregiver burden. Nevertheless, further robust randomized controlled trials are necessary to confirm these findings.