Adopting a Dyadic Approach to Treating Chronic Cancer-Related Fatigue: A Mixed Methods Study to Assess Patients' and Partners' Needs, Benefits, Barriers and Preferences

Introduction: Chronic cancer-related fatigue (CCRF) is a common symptom among patients. Current therapies target the patient alone, while evidence suggests that targeting the dyad might be more beneficial.Method: Using a mixed methods design, we conducted two studies that together aimed to provide more insight into the needs, benefits, barriers and preferences regarding a couples therapy for CCRF. In a qualitative study, we conducted focus groups and semi-structured interviews with a purposive sample of 10 patients and 10 partners with experience of CCRF care, followed by thematic analysis. In a subsequent quantitative study, a convenience sample of patients (n = 172) and partners (n = 55) completed an online survey developed based on the qualitative findings.Results: In the qualitative study, both patients and partners expressed that a couples therapy could help them. Perceived benefits included empowerment of partners to support patients and improved couples communication. In the online survey, the need for a dyadic approach to CCRF therapy was confirmed by both patients (39%) and partners (91%). The benefits reported by most patients and partners were that partners could get attention for their own problems related to the patients' cancer and fatigue (patients: 72%, partners: 86%) and receive advice on coping with fatigue (66% and 90%, respectively). Participants in both studies identified barriers, such as a fear of burdening partners with a couples therapy (50%). Partner involvement was considered desirable for most therapy elements (e.g., psychoeducation, contact with the therapist, exercises and relapse prevention). Yet, individual preferences varied widely.Conclusion: Results of both studies support the potential acceptability of a couples therapy for CCRF among patients and partners. Based on divergent preferences, we determined that a couples therapy must provide flexibility regarding the degree, intensity and type of partner involvement. Dyadic psychoeducation can be used as a solid starting point to manage expectations and get relief from perceived barriers.