Sequential patient-spouse dyadic psychological intervention for perioperative emotional distress and dyadic coping in...

To evaluate the effects of a sequential patient-spouse dyadic psychological intervention on perioperative emotional distress, dyadic coping, and spouse caregiving burden in patients undergoing surgery for spinal metastases.

Patients with spinal metastases undergoing surgical treatment and their spouses were recruited in this single-center, prospective randomized controlled trial. A total of 88 patient-spouse dyads were randomly assigned to the intervention group or the control group at a 1:1 ratio. Patient emotional distress measured using the Distress Thermometer (DT) was the primary outcome. Spouse DT, patient and spouse Dyadic Coping Inventory (DCI) scores, and spouse Zarit Burden Interview (ZBI) scores were secondary outcomes. T0 was treated as the baseline covariate, and postbaseline outcomes were analyzed using baseline-adjusted linear mixed-effects models. A supplementary dyad-aware mixed model jointly modeled patient and spouse outcomes to account for within-dyad dependence.

A total of 88 dyads (44 per group) were included in the analysis. For the primary outcome, patient DT scores were lower in the intervention group across the postoperative assessment period (adjusted average difference, -0.46; 95% CI, -0.79 to -0.12; Wald χ² = 7.05; p = 0.008), although the patient-specific group-by-time interaction was not significant (p = 0.125). At 2 weeks after discharge, the adjusted patient DT difference was -0.71 (95% CI, -1.17 to -0.24; Holm-adjusted p = 0.009; Hedges' g = -0.67, 95% CI, -1.10 to -0.24). Spouse DT scores were also lower overall (adjusted average difference, -0.62; 95% CI, -0.92 to -0.32; p < 0.001), with a standardized difference at 2 weeks of g = -0.79 (95% CI, -1.23 to -0.36). In the joint dyad-aware DT model, the group-by-time interaction was significant (Wald χ² = 7.49, df = 2, p = 0.024), whereas the group-by-role-by-time interaction was not (p = 0.988). Patient and spouse DCI scores were higher overall in the intervention group (adjusted average differences, 5.50 and 3.33 points, respectively), but their role-specific group-by-time interactions were not significant. Spouse ZBI scores were lower overall in the intervention group (adjusted average difference, -3.24; 95% CI, -5.28 to -1.20; p = 0.002), without a significant group-by-time interaction.

The sequential patient-spouse dyadic psychological intervention was associated with modestly lower emotional distress and higher dyadic coping during the later perioperative period. The findings were strongest for distress at the post-discharge assessment, but mean DT scores remained above the clinical screening threshold in both groups. These results support further evaluation of structured dyadic psychosocial care with longer follow-up and dyad-focused analyses rather than immediate broad implementation.