Identifying the unmet needs of post-treatment colorectal cancer survivors: A critical literature review.

PURPOSE: Following treatment completion, colorectal cancer (CRC) survivors experience various unmet needs. This review aims to synthesize the unmet needs of CRC survivors after treatment and to identify demographic, disease or treatment-related, healthcare-related, and psychosocial factors correlated with unmet needs. METHOD: English or Chinese articles that focused on CRC survivors' post-treatment unmet needs were systematically searched from the five electronic databases, which included CINAHL, PubMed, Embase, PsycINFO, and the China Academic Journal Full-text Database, from the launch of databases to July 2023. The reference lists of the subsequent articles were further screened. RESULTS: 136 individual needs extracted from 50 manuscripts were classified into nine domains based on the Supportive Care Framework. The top four unmet needs identified by CRC survivors were assistance with fears of cancer recurrence, information about managing illness and side effects at home, emotional or psychological support and reassurance, and help with sexuality problems. Following surgery, CRC survivors showed strong demand in the physical, psychological, and information domains. Survivors completed treatment within 1-year had more diverse needs than those who completed 1-3 years. Unmet needs may be greater among CRC survivors who were young, female, more educated, and unmarried. Furthermore, greater unmet needs were associated with distress, anxiety, depression, and worse quality of life. CONCLUSIONS: Despite diverse needs experienced by post-treatment CRC survivors, a predominant focus on fears of cancer recurrence, information, psychological support, and sexuality needs is noted. Future studies should further explore the needs of CRC survivors after specific treatment and in different post-treatment periods.

A literature review of the relationship between dyadic coping and dyadic outcomes in cancer couples.

PURPOSE: Couples are usually affected by cancer as patient-partner dyads, and they may react as a unit rather than as individuals, i.e., dyadic coping. This paper aims to comprehensively summarise the relationship between dyadic coping and dyadic outcomes (relationship satisfaction, quality of life, and psychological adjustment) in cancer couples, and provide valuable evidence to guide future research. METHOD: A systematic search of five online databases, e.g., Cochrane Library, Embase, Medline, PubMed, and PsycINFO, was conducted to identify cancer couple-based studies published in English or Chinese from January 1990 to March 2021. A manual search was also performed on the article reference lists. RESULTS: Twenty-eight studies met the inclusion criteria. We found that communication, supportive dyadic coping, delegated dyadic coping and common dyadic coping might strengthen marital bonds, alleviate couples' stress, and facilitate mental health, but on the other hand, they possibly increase patients' and/or partners' physical or psychological burden. Negative dyadic coping and protective buffering were related to lower relationship satisfaction, worse quality of life, and more depressive symptoms. Patients reported more self-emotional disclosure, common dyadic coping, and negative dyadic coping than partners, while partners showed more holding back, supportive dyadic coping, delegated dyadic coping, and protective buffering. Moreover, patients were more susceptible to dyadic coping strategies. CONCLUSIONS: This review provides a comprehensive overview of the relationship between dyadic coping and dyadic outcomes. Based on the available evidence, the development of personalised interventions for improving dyadic coping is required to help couples live better with cancer.

The Experienced Benefits of the 17-Item Benefit Finding Scale in Chinese Colorectal Cancer Survivor and Spousal Caregiver Couples.

The specific aims of the present study were twofold: (i) to examine the psychometric properties of a Chinese version of the 17-item Benefit Finding Scale (BFS-C), and (ii) to explore the experienced benefits in colorectal cancer (CRC) survivors and their spousal caregivers (SCs). A total of 286 CRC survivors and SCs participated in the investigation, which assessed participant variables of demographic characteristics and benefit finding (BF). Statistical methods applied were confirmatory factor analysis (CFA), Cronbach's α, Pearson's correlation, Kappa coefficient, paired t-tests, and one-way ANOVAs. CFA analysis supported a three-factor model for structure validity. All Cronbach's α for BFS-C was greater than 0.870 in both CRC survivors and SCs. The test-retest correlations at the scale level ranged from good to excellent for CRC survivors (r = 0.752-0.922), and from moderate to good for SCs (r = 0.469-0.654). There were moderate to high correlations between CRC survivors and SCs in all of the paired BFs (all Ps < 0.001, r = 0.332-0.575). This report provided the satisfactory psychometric properties of the BFS-C in such aspects as construct validity, internal, and test-retest reliability among couples coping with CRC in China. Healthcare professionals need to treat couples as a unit and develop dyadic interventions to improve dyadic BF when supporting CRC survivors.

A literature review of post-treatment survivorship interventions for colorectal cancer survivors and/or their caregivers.

OBJECTIVE: Colorectal cancer (CRC) survivors have reported a number of concerns and unmet needs after treatment completion. This paper aims to explore existing survivorship interventions after CRC treatment according to the American Cancer Society CRC Survivorship Care Guidelines, to identify study gaps, and provide valuable evidence directing future research. METHODS: Five electronic databases, including CINAHL, PsycINFO, Embase, PubMed, and Cochrane Library databases from 2005 to October 2020, were systematically searched to identify English or Chinese literature on CRC post-treatment survivorship interventions. Manual searching through the articles' references lists was also conducted. RESULTS: Thirty studies met the criteria, and focused on addressing issues in four CRC Survivorship Care Guidelines domains. Several issues for CRC surveillance programmes remain to be explored. Regarding the long-term physical and psychosocial effects of CRC treatment, we found mounting evidence for various interventions to solve ostomy issues and improve distress/depression/anxiety, strong evidence for exercise to improve fatigue, and limited evidence in addressing CRC patient sexual concerns. For health promotion, high-quality evidence was found for exercises to improve cardiopulmonary fitness, metabolism, tumour-related biomarkers, and short-term improvement in physical fitness and QOL. Emerging evidence was found for a survivorship care plan to improve patient perceptions of care coordination. CONCLUSIONS: Further refinements based on the existing evidence, and the development of comprehensive CRC survivorship care comprising multiple essential survivorship components, are required. Furthermore, considering both survivor and caregiver cancer survivorship needs, future research may optimise the care delivered, and help survivors and their families live better with cancer.

A feasibility study of an integrated couples-based supportive programme for Chinese couples living with colorectal cancer.

AIM: To test the feasibility, acceptability and preliminary efficacy of using an integrated approach combined online and in-person delivery to support colorectal cancer (CRC) patients and their spousal caregivers coping positively with cancer together. DESIGN: A single-arm pre-post-feasibility design was used. METHODS: Chinese CRC patient-partner dyads (N = 24) accessed the blended intervention combined online platform and face-to-face sessions for six weeks between October 2019 to January 2020. Feasibility was measured through recruitment and retention and acceptability was examined by intervention engagement and post-treatment programme evaluation. Effect sizes were calculated using the complete data (N = 20 couple dyads) to evaluate preliminary treatment effect. RESULTS: Recruitment (70.6%) and retention rates (83.3%) supported programme feasibility. Participants' positive intervention engagements and evaluations indicated acceptability. The overall small-to-medium improvements in most outcome measures verified preliminary efficacy of the integrated couples-based supportive programme. The findings support its feasible and acceptable for couples coping with CRC and show potential efficacy.

An Implementation Process Evaluation Based on an Integrated Psychosocial Support Program of Colorectal Cancer Couples in China: A Pilot Study.

Studies have shown that the qualitative process assessment of cancer couple-based psychosocial interventions is often ignored. This article aims to evaluate the implementation process of an integrated psychosocial program developed for colorectal cancer couples. Semi-structured qualitative interviews were conducted with eight colorectal cancer couple participants and two intervention facilitators. Normalization Process Theory was used to guide the data collection and analysis. Data analysis was conducted using a directed content analysis approach within a framework approach. Participants had a good understanding of the program significance. For most participants, the intervention duration was appropriate, and was well integrated into daily life. A lack of understanding of psychological nursing, and a lack of confidence in the use of online platforms and other personal factors, inhibited participants' experience of participating in the intervention. The facilitator's challenge in the implementation process was being flexible in dealing with situations occurring outside of the framework plan. Face-to-face and online psychological interventions require more flexibility, and participant cognition of psychosocial care was the key to the successful implementation of the intervention. Future research should consider raising participants' awareness of psychological care to better integrate this type of intervention into participants' daily lives and routine care.

The dyadic relationship of benefit finding and its impact on quality of life in colorectal cancer survivor and spousal caregiver couples.

OBJECTIVES: To explore the benefit finding (BF) relationship between colorectal cancer (CRC) survivors and their spousal caregivers, and to discover the dyadic impact of BF on quality of life (QOL) in CRC survivor and spousal caregiver couples. METHODS: Conducted from May 2018 to December 2018, the study included 286 couples consisting of CRC survivors and their spousal caregivers. The study survey evaluated participants' BF, anxiety, depression, and QOL. Data analysis methods included Pearson's correlation, paired t test, and the actor-partner interdependence mediation model (APIMeM). RESULTS: CRC survivors and spousal caregivers reported comparable moderate to high BF experience (ranging from 68.9 to 80.8%). Moderate to high correlations were found between CRC survivors and their spousal caregivers in all of the paired BFs (including the overall BF scale and three factors) (all Ps < 0.001, r = 0.461-0.612). We found significant positive correlations of the same measures between dyads of CRC survivors and spousal caregivers (r = 0.331-0.612), including BFS-C (overall BF scale and three subscales), HADS-C (anxiety and depression), PCS, and MCS. To a certain degree, BF exerts an impact on couples' QOL through the mediating effect of psychological distress (anxiety and depression). CONCLUSIONS: The present study further confirms the dyadic interdependence between BF, anxiety, depression, and QOL in couples coping with CRC. In addition, the APIMeM findings may support the proposed mechanism, in that buffering against negative emotions (psychological distress) is an approach in which BF plays an important role, e.g., improves QOL, in the context of a stressful process.

Communication Needs of Cancer Patients and/or Caregivers: A Critical Literature Review.

OBJECTIVE: Effective communication for cancer patients and/or caregivers can meet information needs, reduce caregiver burden, improve physical and mental health, and promote intimacy. The aim of this review was to identify the communication needs of cancer patients and/or caregivers and to explore their specific communication needs to guide the development of future communication interventions. METHODS: Chinese and English databases were systematically searched from January 2010 to October 2019, including MEDLINE, CINAHL, PubMed, and the China Academic Journal Full-text Database. The key search terms used were "cancer" or "carcinoma" or "oncology" AND "patient" or "caregiver" or "carer" AND "communication" or "discussion" or "talk" AND "need" or "needs" or "desire.". RESULTS: A total of 26 articles was identified and included in this review. The findings revealed the needs of cancer patients and/or caregivers in terms of communication target, content, style, timing, and preferences. Communication targets included health professionals, peers, caregivers, and patients. Communication content included illness-related, emotional support, daily life, sexuality, death, and a way to communicate with health professionals. Communication style needed to be expressed through such things as language and communication atmosphere. Communication timing mainly referred to before treatment and approaching death. Communication preferences were related to factors such as demographics and ethnic origin. CONCLUSIONS: Cancer patients and/or caregivers have different communication needs in terms of target, content, style, and communication timing. A better understanding of the unique communication needs of patients and/or caregivers will offer health professionals detailed information on designing appropriate interventions to support cancer patients and caregivers.

A critical literature review of dyadic web-based interventions to support cancer patients and their caregivers, and directions for future research.

OBJECTIVE: With the rapid development of the Internet, e-health interventions are becoming popular and are showing positive impacts. Cancer affects not only patients but also their caregivers, leading to a recognition that cancer patient-caregiver dyads cope with cancer as a unit rather than as individuals. The objectives of this paper are to explore web-based interventions for cancer patient-caregiver dyads coping with cancer from the aspects of intervention content, delivery format, outcome measurements, and outcomes and to provide recommendations on developing patient-caregiver dyadic web-based interventions for future research. METHODS: Literature focused on cancer patient-caregiver dyadic web-based interventions, published in English or Chinese from the launch of five databases (CINAHL, PsycINFO, EMBase, Medline, Science Citation Index Expanded) to April 2019, was systematically searched. Manual searching through the references of full-text articles was also conducted. RESULTS: Of a total of 812 articles, 17 articles met the inclusion criteria. The content of these web-based dyadic interventions mainly included information support, communication and support, skills-building, and psycho-education. These web-based interventions reported a small to large positive impact on patients with cancer and their caregivers in terms of physical health (d = 0.17-0.75), psychological health (d = 0.04-0.80), overall quality of life (d = 0.20-0.68), and dyadic relationship (d = 0.30-0.95). CONCLUSIONS: Web-based dyadic interventions can be designed for tailored content, which benefits both patients and their caregivers. Future research on cancer patient-caregiver web-based interventions should be conducted in diverse cultures.