Brief Report A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study Linda M. McLean 1,2,4 *, Jennifer M. Jones 1,3,4 , Anne C. Rydall 1,3 , Andrew Walsh 1,3 , Mary Jane Esplen 2,3,4,5 , Camilla Zimmermann 1,2,4 and Gary M. Rodin 1,2,3,4 1 Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ont., Canada 2 Psychosocial Oncology and Palliative Care Research Division, Ontario Cancer Institute, University Health Network, Toronto, Ont., Canada 3 Behavioral Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Ont., Canada 4 Faculty of Medicine, University of Toronto, Toronto, Ont., Canada 5 Program of Psychosocial and Psychotherapy Research in Cancer Genetics Research Division, Toronto General Research Institute, University Health Network, Toronto, Ont., Canada * Correspondence to: Psychosocial Oncology and Palliative Care 16-755, Princess Margaret Hospital, 610 University Avenue, Toronto, Ont., Canada M5G 2M9. E-mail: linda.mclean@uhn.on.ca Abstract Objective: The primary objective of this study was to evaluate the effectiveness of a couples intervention in improving marital functioning in advanced cancer patients and their spouse caregivers. A secondary objective was to determine its impact on other symptoms of psychosocial distress and its feasibility and acceptability as a clinical intervention. Methods: Using a one-arm pre- and post-intervention prospective design, 16 couples were provided 8 weekly sessions of Emotionally Focused Couple Therapy, modified and manualized for the cancer population. Subjects’ marital functioning (Revised Dyadic Adjustment Scale [RDAS]), symptoms of depression (Beck Depression Inventory-II [BDI-II]), and hopelessness (Beck Hopelessness Scale) were assessed through self-report at T0 (baseline), T1 (after four sessions), T2 (after eight sessions), and T3 (3 months post-intervention follow-up). Results: RDAS scores improved from T0 to T2, with 87.5% of the couples showing some improvement (0.5–5 points) or significant improvement (45 points) in marital functioning and 68.8% scoring in the non-distressed range (548 RDAS). At T3, 60% of the couples (n ¼ 15) continued to score in the non-distressed range on the RDAS. BDI-II scores were significantly higher for patients than for caregivers. There was a significant reduction in the mean BDI-II score from T0 to T3 in all subjects (n ¼ 30). This reduction was more significant for the patients (n ¼ 15). Conclusions: Providing support to couples at this challenging time may result in improved marital functioning and an opportunity for relational growth during end-stage cancer. This study serves as the first step in the development of an empirically validated intervention for couples. Copyright # 2008 John Wiley & Sons, Ltd. Keywords: metastatic cancer; advanced cancer; marital distress; end of life; psychosocial distress; couples intervention Introduction The emotional adjustment of cancer patients and their spouse caregivers may be profoundly affected by the presence of the disease [1]. Couples where one is facing advanced disease may commonly have adjustment difficulties resulting in the experience of less intimacy, mutual support and cohesion, and greater marital conflict, especially as the end of life approaches [2]. There is now an emerging research literature that highlights the need to identify and support couples most at risk for psychological distress during end-stage cancer [3–6]. Providing support to couples at this challenging time can result in a reduction of psychological pain and psychosocial distress in both partners, and an opportunity to enhance the appreciation and significance of loved ones and to form deeper emotional connections [5,7–8]. A couples approach may also prepare the spouse caregiver for bereave- ment therapy, reducing the potential of future complicated grief and mental health difficulties [9]. However, despite advocacy for the development of couples interventions focused on the specific needs of the cancer patients and their spouses [4,6,10,11], there remain only five couple-based published reports for those facing advanced cancer (see McLean and Jones [6]). The primary objective of this pilot study was to determine the effect of a couples intervention on Received: 9 July 2007 Revised: 5 November 2007 Accepted: 15 November 2007 Copyright # 2008 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology (2008) Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1319