The effectiveness of couple-based interventions on the marital outcomes of women with genital and breast cancer and their partners: a systematic review and meta-analysis

Table 5 Certainty of the evidence using the GRADE approach by outcomes

No of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Couple-based intervention	Routine care	Pooled effect Relative (95% CI)	Final judgment
Marital adjustment (Patients)
7	RCT^* Semi-experimental	Serious	Very Serious	No serious	No serious	No serious	268	251	SMD 1.6 Upper (0.6 upper to 2.7 upper)	⊕◯◯◯ Very low
Marital satisfaction (Patients)
7	RCT^*	Serious	Very Serious	No serious	No serious	No serious	170	171	SMD 0.6 upper (0.1 upper to 1.1 upper)	⊕◯◯◯ Very low
Marital Intimacy (Patients)
2	RCT^* Semi-experimental	Serious	No serious	No serious	Very serious	No serious	40	31	SMD 0.06 upper (0.5 lower to 0.6 upper)	⊕◯◯◯ Very low
Marital adjustment (Partners)
7	RCT^* Semi-experimental	Serious	Very Serious	No serious	No serious	No serious	262	247	SMD 1.6 upper (0.6 upper to 2.7 upper)	⊕◯◯◯ Very low
Marital satisfaction (Partners)
6	RCT^*	Serious	Serious	No serious	Serious	No serious	150	149	SMD 1.1 upper (0.1 Lower to 2.3 upper)	⊕◯◯◯ Very low
Marital Intimacy (Partners)
2	RCT^* Semi-experimental	Serious	Serious	No serious	Very serious	No serious	40	31	SMD 0.2 lower (0.8 Lower to 0.3 upper)	⊕◯◯◯ Very low

CI: confidence interval; RCT: randomized controlled trial; SMD: standardized mean difference
GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

ISSN: 1471-2407