Dyadic coping and relationship satisfaction: A meta-analysis

Objectives
Cancer not only affects the patient but also the partner. In fact, couples may react as a unit rather than as individuals while coping with cancer (i.e., dyadic coping). We assessed (1) the relationship between dyadic coping and relationship functioning in couples coping with cancer and (2) whether intervention studies aimed at improving dyadic coping were able to enhance the relationship functioning of these couples. Recommendations for future studies are provided.

Method
A systematic search was conducted to identify all eligible papers between January 1990 and September 2012. The databases PubMed, PsycINFO, the Cochrane Library, and EMBASE were screened.

Results
Most studies (n = 33) used an appropriate study design, adequate measurements, adequate analytical techniques, and a sufficient number of included participants to answer addressed research questions. However, the definition and assessment of dyadic coping strategies differed, which hampered comparison. Coping styles characterized by open and constructive (cancer-related) communication, supportive behaviours, positive dyadic coping, and joint problem solving were related to higher relationship functioning, whereas dysfunctional communication patterns (e.g., protective buffering, demand–withdraw communication), unsupportive behaviours, and negative dyadic coping were related to lower relationship functioning. The results of the intervention studies were inconsistent: while some studies reported a beneficial effect on relationship functioning, other studies report no such effect, or only found a positive effect in couples with fewer personal relationship resources.

Conclusions
This review showed that adequate dyadic coping may improve relationship functioning, while dysfunctional dyadic coping may impede relationship functioning. In order to increase the comparability of the reported findings, a more uniformly conceptualized perspective on dyadic coping is needed. A better understanding of the dyadic challenges couples coping with cancer may face and more insight on how to expand the dyadic coping of these coupes might facilitate improvements in the quality of cancer care. Couple-based intervention studies may increase the couples’ relationship functioning. However, future research is needed to examine more specifically which couples may benefit from such interventions.


Statement of contribution
What is already known on this subject? 

Dyadic coping may influence the distress experienced by both members of the couple and their relationship functioning. Several reviews already reported on the potential of couple-based interventions to improve the dyadic coping of couples coping with cancer and on the beneficial effects of this coping on the psychosocial adjustment and relationship functioning of patients and partners (e.g., Badr & Krebs, 2012; Martire, Shulz, Helgeson, Small, & Saghafi, 2010; Regan et al., 2012). However, even though we now know that couple-based intervention might be useful, no systematic review has been conducted that focuses specifically on the mechanisms of dyadic coping itself.

What does this study add? 

This review showed the importance of stress communication, supportive behaviours, and positive dyadic coping for the maintenance or enhancement of relationship functioning in couples coping with cancer. In addition, the dyadic intervention studies send an important message that encourages to further examine the potential benefit of such interventions in future. However, more consensus in the conceptualization and assessment of the dyadic coping styles is needed in order to increase the comparability of the reported findings.

Dyadic coping and relationship functioning in couples coping with cancer: a systematic review.

Background
The spouse is generally the primary informal caregiver for cancer patients. Many studies have explored the experience of caregiving for cancer patients, but it is unclear whether there are gender differences in the spousal caring experience for cancer patients.

Aim
This review describes the recent published research on the stress process of spousal caregiving experience for cancer patients, and aims to identify any gender differences in the caregiving experience.

Methods
Electronic, manual and author's searches were conducted. Articles included were published in English and Chinese, from January 2000 to March 2012. Study population is couples coping with cancer. Focus is on caregiving experience for spouse with cancer, and findings include both male and female spousal caregivers in quantitative studies. The databases searched included MEDLINE, CINAHL, Science Citation Index Expanded, Scopus, PsycINFO and the China Academic Journal Full-text Database. The key search terms used were ‘cancer’ or ‘oncology’ or ‘carcinoma’ AND ‘caregiver’ or ‘caregiving’ or ‘carer’ AND ‘gender differences’ or ‘gender’ AND ‘spouse’ or ‘couple’ or ‘partner’. Spousal caregiving experiences of cancer patients were explored by adopting the ‘stress process’ of the Cancer Family Caregiving Experience Model from the gender perspective.

Results
Twenty-five articles were identified and included in this review. It was revealed that female spousal caregivers perceived higher level negative experience in caregiving, such as lower mental health, lower physical health, poorer health-related quality of life, lower life satisfaction and decreased marital satisfaction than male spousal caregivers. However, female spousal caregivers are more likely to experience personal growth than male spousal caregivers.

Conclusion
This review identified that female spousal caregivers for cancer patients had higher levels of negative experience in caregiving. A better understanding of the spousal caregiving experience will provide healthcare professionals with the information needed to develop interventions to support and prepare spousal caregivers to care for their loved ones with cancer.

Spouses' experience of caregiving for cancer patients: a literature review

Individual coping strategies and dyadic coping independently predict partner well-being and relationship functioning; however, it is unclear whether the coping processes are inter-related and whether they uniquely contribute to romantic relationship functioning. One hundred heterosexual dating couples rated the individual coping strategy of negative mood regulation as well as positive and negative dyadic coping. Relationship functioning was assessed via partners' reports of relationship satisfaction and observers' ratings of negative interaction in conflict. Actor-Partner Interdependence Models (APIMs; Cook & Kenny, 2005; Kashy & Kenny, 2000) revealed associations between individual coping and dyadic coping in the predicted directions. APIMs also indicated the unique contributions of positive and negative dyadic coping to relationship functioning, above and beyond contributions of individual coping strategies. Implications of dyadic coping as a target of efforts to prevent or treat partner and/or relational distress are discussed.

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Romantic partners' individual coping strategies and dyadic coping: Implications for relationship functioning.

One feature that distinguishes professional counseling from other mental health and illness disciplines is its developmental, strength-based, contextually-focused, and wellness perspective. Given the multicultural paradigm that the counseling field emphasizes, it is increasingly important to identify models like relational-cultural theory (RCT) that support these principles. This article includes an overview of the basic tenets of RCT and applications to mental health counseling

Lisa E. Watson

Papers

Cancer as a "we-disease": Examining the process of coping from a relational perspective.