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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Palliative Care 1/2015

The development of a complex intervention in China: the ‘Caring for Couples Coping with Cancer “4Cs” Programme’ to support couples coping with cancer

BMC Palliative Care > Ausgabe 1/2015
Qiuping Li, Yinghua Xu, Huiya Zhou, Alice Yuen Loke
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12904-015-0062-7) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no conflicts of interests.

Authors’ contributions

All of the authors contributed substantially to this manuscript. The first author (QL) participated in the design of the study, carried out the literature search/analysis, and drafted the manuscript. The second and third authors (YX and HZ) also made substantial contributions to the literature search/analysis and writing of the paper. The last author (AL) supervised the study, participated in its design and coordination, and made critical revisions for important intellectual content. All of the authors read and approved the final manuscript.



As the primary informal caregiver for cancer patients, spousal caregivers are a population at a high risk of hidden morbidity. The factors impacting couples coping with cancer are complex, and within spousal caregiver-patient dyads the impact is mutual. The aim of this study is to explain the process that led to the development of an acceptable, feasible, and potentially effective ‘Caring for Couples Coping with Cancer “4Cs” Programme’ to support couples coping with cancer as the unit of intervention in China.


The Medical Research Council’s (MRC) framework for developing and evaluating complex interventions was adopted to develop an intervention for couples coping with cancer. Three steps were taken in the process of developing the 4Cs programme, namely: (1) identifying the evidence base by conducting a series of extensive reviews of the relevant literature and conducting a focus group study; (2) identifying/developing a theory by proposing a preliminary Live with Love Conceptual Framework ‘P-LLCF’ for cancer couple dyads; and (3) modelling the process and outcomes of the 4Cs programme.


The programme that was developed is comprised of six individual sessions to be delivered by the researcher/therapists over 6 weeks. The main contents of the sessions of the 4Cs programme are: primary stressors (section 1); secondary stressors (section 2); dyadic mediator (section 3); dyadic appraisal (section 4); dyadic coping (section 5); and a programme overview (section 6). The emphasis of the programme is on supporting couples coping with cancer. A booklet was developed to provide the participants with easy access to written information about their common concerns in caring for loved ones with cancer.


Guided by the MRC guidelines, a potentially effective, feasible, and acceptable 4Cs programme aimed at supporting couples coping with cancer as a dyad was developed. Future research is needed to pilot and evaluate the feasibility, modelling, and outcomes of this 4Cs programme.
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